WHO’s allocation framework for COVAX: is it fair?

Abstract

The COVID-19 Vaccines Global Access Facility (COVAX) represents an unprecedented global collaboration facilitating the development and distribution of vaccines for COVID-19. COVAX pools and channels funds from state and non-state actors to promising vaccine candidates, and has started to distribute successful candidates to participating states. The WHO, one of the leaders of COVAX, recognised vaccine doses would initially be scarce, and therefore, prepared a two-staged allocation mechanism they considered fair. In the first stage, vaccine doses are distributed equally among participating countries, while in the second stage vaccine doses will be allocated according to a country’s need. Ethicists have questioned whether this is the fairest distribution—they argue a country’s need should be taken into account from the start and correspondingly, have proposed a framework that treats individuals with equal moral concern, aims to minimise harm and gives priority to the worst-off. In this paper, we seek to explore these concerns by comparing COVAX’s allocation mechanism to a targeted allocation based on need. We consider which distribution would more likely maximise well-being and align with principles of equity. We conclude that although in theory, a targeted distribution in proportion to a country’s need would be more morally justifiable, when political realities are taken into account, an equal distribution seems more likely to avert a greater number of deaths and reduce disparities.

Vaccine nationalism: contested relationships between COVID-19 and globalization

“…Co-led by the WHO, GAVI, and the Coalition for Epidemic Preparedness Innovations (CEPI), the COVAX facility was launched in June 2020, the same month the US officially withdrew from the WHO. Aiming to ensure the worldwide vaccination of the most vulnerable populations and healthcare workers with approximately two billion doses by the end of 2021, this new multilateral procurement mechanism reflects an attempt at a global level to mitigate the effects of vaccine nationalism and grant access to countries who do not have the fiscal or political means to secure bilateral agreements with vaccine manufacturers (Eccleston-Turner & Upton, 2021; Gemünden & Thiel, 2021; Sharma et al, 2021). COVAX is the vaccine pillar of the Access to COVID-19 Tools Accelerator (ACT-A), 'a global and time-limited collaboration' launched by the WHO and partners in early 2020 to accelerate the development and production of, and equitable global access to, new COVID-19 essential health technologies (WHO, 2020a; Italic added).…”

“…After phase 1 is completed, in phase 2 the proportional approach will be replaced by a targeted distribution based on a country's needs (e.g. vulnerabilities, disease burden, and health system capacity) (Emanuel et al, 2021;Sharma et al, 2021). Once self-financing countries receive doses of vaccine to cover 20% of their population, they will be free to distribute domestically according to their own priorities.…”

“…197-198, 2021b. Although the proportional allocation may help incentivize wealthy countries to participate in COVAX (given their importance for its financing), it is morally problematic not to take a country's need into account from the start and not to prioritize the most vulnerable or worst off (Emanuel et al, 2021;Sharma et al, 2021). Furthermore, the COVAX's vaccine allocation schemes seem to be based on the responses of nation-states instead of the interests of global citizenry, though in ethics the unit of concern for justice is individuals, not countries (Emanuel et al, 2021).…”

Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries

“…As WHO reported, richer countries had received more than 87%, and low-income countries just 0.2% from all vaccine doses that have been administered globally [ 3 ]. Any priority-setting rule for allocating vaccines among LMICs would invite ethical debate, and this has been the case for COVAX’s, which tracks population size over other indicators of acute need [ 4 , 5 ]. But the importance of this ethical choice for LMICs is overshadowed by the serious shortfall of vaccines available to COVAX for distribution.…”

Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries

“…However, the situation was not so gracious as anticipated. Any priority-setting rule for allocating vaccines among LMICs would invite ethical debate, and this has been the case for COVAX's, which tracks population size over other indicators of acute need [4,5]. But the importance of this ethical choice for LMICs is overshadowed by the serious shortfall of vaccines available to COVAX for distribution.…”