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* COVAX assigned early Pfizer shots to vaccination leaders
UK, UAE
* Dose-sharing methodology doesn't check states' vaccine
coverage
* Vaccine alliance Gavi is proposing changes - internal
document
* UK was among few countries that had Pfizer freezers, Gavi
says
* Gavi began to spend $25 million on cold-chain freezers in
August
By Francesco Guarascio
BRUSSELS, Sept 27 (Reuters) - In March, as wealthy Britain
led the world in vaccination rates and almost half its people
had received a shot, the organisation meant to ensure fair
global access to COVID-19 vaccines allotted the country over
half a million doses from its supplies.
By contrast Botswana, which hadn't even started its
vaccination drive, was assigned 20,000 doses from the same batch
of millions of Pfizer mRNA vaccines, according to publicly
available documents detailing COVAX's allocations.
Other poorer nations, with fledgling vaccination drives at
best, also received fewer shots than Britain. Rwanda and Togo
were each allotted about 100,000 doses, and Libya nearly 55,000.
The distribution was driven by the methodology used by
COVAX, a programme co-led by the World Health Organization, the
Coalition for Epidemic Preparedness Innovations (CEPI) and the
Global Alliance for Vaccines and Immunization (Gavi). Since
January, it has largely allocated doses proportionally among its
members according to population size, but regardless of their
vaccination coverage.
This made some rich nations, which already had many vaccines
through separate deals with pharmaceutical firms, eligible for
COVAX doses alongside countries with no vaccines at all.
Six months later, COVAX is planning to overhaul the
allocation methodology to ensure it takes into account the
proportion of a country's population that has been vaccinated,
including with shots bought directly from drugmakers, according
to an internal Gavi document reviewed by Reuters.
The proposal will be discussed at the Gavi board meeting on
Tuesday, and the change could be enacted in the fourth quarter
of this year, the document said.
The COVID-19 pandemic has presented an almost unprecedented
challenge, and large, hallowed institutions like the WHO and
U.S. Centers for Disease Control have at times struggled to keep
pace and shift course as new data has come in.
Asked why total vaccine coverage was not used earlier as a
measure, Bruce Aylward, a senior WHO and COVAX official, told
Reuters that the allocation terms could not be changed without
the consent of COVAX's more than 140 member countries, though he
did not elaborate on the process of reaching consensus.
He added that hard data on vaccines' efficacy, which
strengthened the case for a change, was now available.
"What's becoming interesting now, only in the last couple of
months, is the divergence between cases and deaths as a result
of vaccination coverage," he said.
"We are learning that the single best indicator of mortality
risk is the level of whole coverage, not just COVAX coverage."
SHORTAGE OF SHOTS
Britain will overall be a net donor in money and vaccines.
It has invested 71 million pounds ($97 million) in COVAX, which
in theory allows it to buy up to 27 million doses, plus this
summer began donating up to nine million shots, some via COVAX.
Yet there has been a wealth-driven inequality since before
vaccines became available, with governments in London,
Washington, Ottawa, Brussels and beyond, many of them COVAX
members, separately securing large supplies outside the scheme.
In June, COVAX scaled back its initial ambitions of acting
as a vaccine clearing house for the world to focus only on
countries deemed most in need. Yet within that group it was
still assigning vaccines according to the population sizes,
rather than their total vaccination coverage.
Since its inception 15 months ago, COVAX has been plagued by
vaccine shortages, caused initially by richer nations' hoarding
of limited doses.
Subsequently supplies were hit by drugmakers' problems in
ramping up production and export restrictions in manufacturing
hub India, which has held up delivery of many of the 240 million
doses of the AstraZeneca vaccine that COVAX allocated in late
February.
These issues have reduced its capacity to deliver to poorer
nations. It has so far shipped about 300 million doses to over
140 countries, far off of its initial target of 2 billion doses
by the end of the year, which has now been cut to 1.4 billion.
TOP OF GLOBAL RANKINGS
The March 15 allocation of the Pfizer shots, among about 50
countries, showed up the weakness in the COVAX methodology.
The batch of 14.1 million doses was the programme's first
significant allocation of the U.S. drugmaker's vaccines, after
a small initial batch of 1.2 million shots was divided among 18
countries in late January, WHO documents show.
At that time, many countries had not yet started their
vaccination campaign, mostly because of lack of vaccines. Even
European Union states were grappling with limited supplies.
Britain's vaccination drive was proving successful though,
and it had given at least one dose to 40% of its population.
Along with the United Arab Emirates and Israel, it led the
global rankings for administered doses proportional to
population, figures and estimates from One World in Data show.
The country was nonetheless among the leading beneficiaries
of the allocation, with 539,000 shots, which Gavi said were
delivered at the end of June. Only seven nations were assigned
more, including the more populous Brazil, Mexico, and the
Philippines. The UAE was assigned about 200,000 shots.
The British government confirmed it had received about half
a million doses from COVAX which it used in the country, but
declined to specify the date of delivery.
Other developed nations invested in COVAX but some refrained
from taking their share of shots because they could rely on
millions of doses from bilateral deals with drugmakers.
The UAE passed on its March allocation, Gavi said. The UAE
did not reply to requests for comment.
NO FREEZERS, NO VACCINE
The allocation also highlighted another driver of unequal
access, this one specific for vaccines like Pfizer's based on
new mRNA technology: a country's capability to handle the shots,
which needed to be transported and stored at temperatures of
around minus 70 degrees Celsius.
Indeed only about 50 countries - from Britain and Brazil to
Angola and Bolivia - could be included in the allocation of the
Pfizer doses because only they were deemed by COVAX to have the
level of "ultra-cold chain" equipment required.
That ruled out many countries in the developing world.
"A small number of countries were deemed ready to receive
Pfizer doses," a spokesman for Gavi said, when asked to explain
why Britain and UAE were among the first designated recipients.
Gavi initially did not consider it a priority to invest in
the ultra-cold chain equipment needed for mRNA shots, Gavi's
public board documents from December show, because it favoured
cheaper and easier-to-administer vaccines like AstraZeneca's,
which does not have such extreme temperature requirements.
Gavi and WHO officials have said that this was in line with
requests from poorer nations.
Indeed the 240 million AstraZeneca doses were allocated to a
far wider group of more than 140 countries in February - though
the export curbs in India, where the vaccine is made, meant only
about 80 million had been delivered as of late August.
"Preparing an ultra-cold supply chain is a risky
undertaking," said Heather Ignatius, managing director of
Advocacy at Path, a nonprofit global health organization, noting
that without certainty of deliveries it would make no sense to
invest in expensive freezers.
However Gavi changed course on ultra-cold chain investment
in June, when the United States pledged to donate hundreds of
millions of Pfizer vaccines to COVAX.
Later that month, Gavi decided to spend up to $25 million on
freezers needed to store the vaccine, a Gavi spokesperson told
Reuters.
The money began to be spent in August, according to an
official familiar with the matter. Gavi now aims to supply
freezers to about 50 poorer nations via UNICEF, which is in
charge of COVAX logistics, the Gavi spokesperson said.
($1 = 0.7289 pounds)
(Reporting by Francesco Guarascio @fraguarascio; Additional
reporting by Aziz El Yaakoubi in Dubai; Editing by Josephine
Mason and Pravin Char)
