The World Health Organization (WHO) founded the COVID-19 Vaccines Global Access (COVAX) initiative to ensure the equitable distribution and access of COVID-19 vaccines across the world. Gavi, the Vaccine Alliance, the independent NGO Coalition for Epidemic Preparedness Innovations (CEPI), the European Commission, and the French government are all partners in the founding and leadership of COVAX with the WHO. Operating since the early months of the pandemic in 2020, the COVAX facility mission, to coordinate international resources that enable low-to-middle income countries in the developing world equitable access to COVID0-19 tests, therapies, and vaccine doses, became what appeared an impressive global collaborative. By the summer of 2020, over 170 countries representing over 60% of the human population had joined the COVAX facility with equity in mind. The conditions should have been in place to back significant equity principles during the pandemic—a critically important mission given that a majority of the world’s population lives in low-to middle-income countries (LMICs). While supposed free-market dynamics are to blame for many, in all actuality, an insidious form of crony capitalism could just as likely be the culprit.

A free market failure?

As of this article’s drafting, the World Health Organization Director-general, Dr. Tedros Adhanom Ghebreyesus has once again called for the wealthiest countries to hold off on distributing COVID-19 vaccine booster doses until the end of 2021.

During a press conferenceTedros expressed his alarm that most vaccine doses administered have been done so in populations in highly developed, that is, wealthy, countries.

“Globally, 5.5 billion vaccine doses have now been administered, but 80% have been administered in high- and upper-middle-income countries,” Tedros said. “Almost 90% of high-income countries have now reached the 10% target, and more than 70% have reached the 40% target. Not a single low-income country has reached either target.”

Indeed, it isn’t their fault. Even with the miracle of a developed and effective class of novel coronavirus vaccines, the pharmaceutical companies and to some extent at least powerful elements within rich nations have been motivated — as in the past — by financial gains and exploiting market dynamics, such as subsidies on the one hand to externalize costs—associated with what TrialSite has referred to as crony capitalism—while on the other maximize returns via capitalizing on demand dynamics.

The COVAX facility was set up with certain models of altruism and free-market dynamics in mind.  However, according to at least some vantages, the free market has failed to deliver due to a global issue of profit-driven diplomatic bureaucracy. And let’s not forget that the World Health Organization and its leadership are responsible for a part of the inequity. But we’ll address that more later.

Tedros, the WHO director-general, anticipated some defensive positions by the rich and powerful, telling that they have “heard excuses from manufacturers and some high-income countries about how low-income countries can’t absorb vaccines.”


“Almost every low-income country is already rolling out the vaccines they have, and they have extensive experience in large-scale vaccination campaigns for polio, measles, meningitis, yellow fever, and more,” he added.

“But because manufacturers have prioritized or been legally obliged to fulfill bilateral deals with rich countries willing to pay top dollar, low-income countries have been deprived of the tools to protect their people.  There has been a lot of talk about vaccine equity, but too little action.”

The proof of failure is in the numbers

TrialSite News reached out to the WHO regarding the latest numbers from the COVAX facility. According to the spokesperson from WHO, COVAX has shipped more than 232.1 million doses to 139 participants as of September 3, 2021. About 41 member states have started their vaccine rollout campaigns thanks to COVAX. There are still three awaiting countries, ones that have not yet started the rollout of any COVID-19 vaccines. These three countries include Burundi, Eritrea, and the Democratic People’s Republic of (North) Korea.

Put another way, 73% of all vaccine doses have been administered in only ten countries — including several European countries. 19.7% of vaccines have only been administered in low- and middle-income countries. But these countries account for over half of the world’s population — 51.2%.

The spokesperson does contend that vaccine inequity is decreasing, but the high-income countries have administered 61 times more doses per inhabitant than those in low-income countries. Several vaccines — including the AstraZeneca/Oxford, the Janssen, Moderna, Pfizer/BioNTech, the Sinopharm/BBIP, and the Sinovac COVID-19 doses — have received a EUL (emergency use listing) under the regulatory and compliance framework of the WHO.

The COVAX outlook notes that it is on course to fall nearly 30% short of its previously stated goal of about 2 billion shots this year. At least, this is according to Gavi, the WHO, and CEPI. Seth Berkley, the chief executive officer of Gavi, told news reporters during a press conference that the decision for COVAX to cut its targets hinges on a variety of factors while placing much of the blame on the wealthy countries in the world on the inequity of vaccine distribution. “This is of course, bad for the whole world as we’ve seen the dreadful consequences that take hold when the virus is left to roam unchecked,” said Berkley. “We cannot afford further delays. If we had unlimited supplies of vaccines, we often use vaccines off label, we can use them in experimental fashions, but I think right now we need to stick to where they’re needed.”

Gavi and other COVAX partners report to the general public that, via the latest version of the COVAX Global Supply Forecast, that they expect to see a “dramatic increase in deliveries” during the fourth quarter.

However, as reported already, the “latest forecast reflects a reduction in the number of doses that COVAX expected to receive in 2021.”

Note, COVAX has seen progress in favor of the goal of containing COVID-19. The initiative has more than $10 billion at its disposal, with legal-binding commitments that secure about 4.5 billion vaccine doses. However, even with this commitment and a clear framework to ensure equitable distribution and delivery of the vaccines, the global picture of access to vaccine doses remains wholly unacceptable and uncertain (to say the least).

International institutions can do better

The extreme disparity of vaccination rates in countries in Europe, the United States, Japan, Israel (etc.) to the rates in countries like Sierra Leone, Sudan, Malawi, Myanmar, Syria, Iraq, Afghanistan (etc.) is a failure by the WHO, COVAX partners, and wealthy nations.

This error is problematic on many levels. Tedros, in previous reports by TrialSite News and other media outlets, declared vaccine inequity the dawning of vaccine apartheid if nothing is done. Dr. Tedros‘ homeland still lacks vaccine doses to distribute to its over 3 million people. Although Tedros leads the WHO, the central element to our concern is that this is a pang of shared guilt held by all.

One suggested challenge to vaccine inequity — or at least a proportional response — is that national governments hold off on the distribution of COVID-19 booster doses until a noticeable increase in the vaccines delivered to populations that are in dire need of their first vaccine dose is increased. The COVID-19 vaccines, overall, remain effective against alarming virus variants like Delta and others, although anxiety in the rich nations grows due to a combination of waning effectiveness of the leading vaccine, Pfizer-BioNTech, virulent variants and growing breakthrough infections, and even breakthrough hospitalizations.

Who is Priming the Pump of Booster Demand?

But many argue the risk of breakthrough infection cases is still rare. Elderly people with underlying conditions are more likely to experience a breakthrough infection of COVID-19. These are also facts backed by the effectiveness of the COVID-19 vaccines and how the mass distribution and administration of vaccines could improve the outcomes of the pandemic. Select boosters could be administered to address high-risk populations in wealthy countries, such as the elderly do giving hundreds of millions of vaccinations to healthy people make sense given what’s unfolding?

But, again, fully vaccinated individuals are statistically more likely to die from falling or an opioid overdose than contracting the novel coronavirus. That number is 1 in 5,000, or just 0.02%, per day. The New York Times quotes experts claiming that the risk could be 1 in 10,000.

Due to the inherent limitations of Pfizer’s vaccine (wanes in effectivity with variants such as Delta within a matter of four to five months), breakthrough cases have occurred in recent weeks at a higher rate. These cases are concentrated in highly contagious settings among higher-risk populations.  

Health Inequity at Home & Abroad

TrialSite has reported that much like inequity exists in the world as it does in rich nations. Thus, in the United States, one who is poor, Black, and with co-morbidities may be five to six times at risk for death associated with Delta. TrialSite has chronicled a very similar economic class and race polarization dynamic in Brazil—another one of the major COVID-19 pandemic hubs. The reality is that market dynamics, including distortions such as crony capitalism, ensured during the pandemic that the rich countries were over-vaccinated while poor countries were, like usual, left high and dry.

Back to the beginning of this piece, the WHO director-general calls for a hold on rich nation vaccinations. The underlying argument for this position: that the move to implement boosters in countries like the United States could be a step in the wrong direction for reaching global immunization targets. The need to support the developing world is essential.

But what about the neo-colonial concentration of power that puts promising developing economies and nations at risk. Are NGOs like WHO really in a position to effectuate such deep, intertwined dynamics? Well as noted below TrialSite has accumulated data points that they are putting pressure on any country that declares the acceptable use of ivermectin as a means of dealing with the crisis to address at least the majority of mild-to-moderate cases. For example, in at least three countries, such pressure was applied.

Is the ‘Market’ the Right Target to Blame?

Now another point of view is that there is nothing inherently wrong with markets generally and that rather government-related special interests (crony capitalism) distort outcomes for all. For example, public health bureaucrats, political operatives, and their press partners generate fear which primes the pump of demand for boosters in rich countries like America. Meaning the media takes the sound bite messages given to it by the current POTUS administration leading to generalized fear rather than a true depiction of actual risk, followed by rational and incremental proportional responses.

90%+ of SARS-CoV-2 infections are mild-to-moderate, and that as many critical care physicians have lamented, many more lives could have been saved with early treatment regimens. Interestingly India or at least some regions in the world’s second-most populous country may have inherently figured that out. While the vaccine program was ramping up there last April and May, with Delta raging, that wasn’t the case. TrialSite carefully chronicled out despite the lack of access to vaccines at the time the public health authorities in the nation’s most populated state, Uttar Pradesh, used proactive testing and home outreach—including WHO-touted home medicine kits for early and aggressive treatment—that undoubtedly contributed to a striking turnaround of cases. While WHO didn’t do much to organize or assist this proactive, progressive approach, they most certainly tried to get in on some credit. WHO was even sued by a niche association of lawyers.

Thus, on the one hand, WHO’s COVAX, which must be subsidized by the rich countries and their pharmaceutical companies, has all but failed on its mission to protect poor, vulnerable populations in any sustained and meaningful way. Yet, on the other hand, TrialSite has collected information from interviews in various small, poor countries involved with WHO that those very same countries are scrutinized by the NGO should they take means into their own hands offering up early care COVID-19 treatment programs. Looked at from this point of view, the buck stops with the WHO director-general.

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