The global Covax scheme launched with a lofty goal: Deliver two billion doses of Covid-19 vaccines, largely to the developing world, by the end of 2021.
A WHO employee supervising the arrival of the first batch of vaccines at Khartoum airport in the Sudanese capital on 3 March 2021. Photo: AFP
Even accounting for that ambitious target, actual progress has been lacklustre. With less than two months until the end of the year, only about a quarter of those two billion doses have actually been shipped.
At the same time, countries in the developed world have moved beyond their initial vaccine rollouts to administering booster doses at home.
The poorest nations have not just been left in the dust, they've been lapped: More booster shots have now been administered in high income countries than the total number of doses given to low income countries since the pandemic began.
And the World Health Organisation has been very critical of the way boosters are being offered.
"The WHO had called for a moratorium on boosters until the end of the year, so we could move those vaccine doses to those countries and to those populations that are still below 4-5 percent coverage," Chief Scientist Dr Soumya Swaminathan said last month.
"Even the frontline workers have not been fully covered."
Delta delays
Covax deliveries were sluggish for a very long time, and only really sped up in the second half of the year.
More than a quarter of the doses delivered to date were sent out just in the month of October.
That slow beginning was largely caused by the Indian Delta variant outbreak that led the Indian government to prevent exports from manufacturers, which Covax was relying on for much of its supply.
"The vaccines that they've been producing have all gone to Indians and we don't resent that necessarily, but it has meant that we are well behind in other parts of the world, most notably in Africa," said Covax co-chair and chair of the Coalition for Epidemic Preparedness Innovations Jane Halton.
"There's a whole swathe of countries where we've made little difference yet in terms of vaccinating those people."
World Health Organisation director General Tedros Adhanom Ghebreyesus. The organisation has been very critical of the way that booster shots have been offered. Photo: AFP / World Health Organisation / Christopher Black
Unequal negotiating power
Another problem was that Covax struggled against the first world in negotiating contracts.
One of the countries that has been waiting a very long time is the east African nation of Burundi, which only received its first Covid-19 vaccine doses last month.
"We have been waiting for this ceremony for a long time," the WHO's representative in Burundi, Xavier Crespin, said when the vials arrived. "We thank the donors."
But that donation did not come through Covax. The 500,000 Sinopharm vaccines gladly welcomed by Burundi came direct from the Chinese government.
Australia generous on pledges, but slow to deliver
Outside of Covax, China has been sending its vaccines across the developing world, distributing hundreds of millions in donations and selling hundreds of millions more.
According to the Lowy Institute, it is an approach that Australia has also adopted.
"Australia has been quite generous in terms of the promises that we've made," said Roland Rajah, the institute's international economics programme director.
"Australia is committed to providing roughly two doses for every Australian. That places us second in the world on a per capita basis, only second to the United States, which is promising to provide three doses per American."
"We couldn't get the funding we needed fast enough to actually be in the queue early enough, as opposed to some of these high income countries," Halton said.
"If we can fix that, then we can have a purchasing mechanism for low to middle income countries - they can compete on an even footing with the big wealthy countries and that will actually give those countries much more equitable access to vaccines."
But none of those doses are being administered by Covax, with the Australian government instead making direct donations largely to countries in the region.
"The Australian government is pretty aware of the national interest case in helping our own region," Rajah said.
"The Pacific Islands are a very vulnerable part of the world ... and of course, looming in the background of all of this is the desire to compete for influence ... with China, which is engaged in its own kinds of vaccine diplomacy throughout the region.
"The only other major donor that looks similar to us in terms of that profile, operating outside of Covax so much, is China."
That's not necessarily the "best way" of going about things from a "global equity perspective", Rajah added: "And also, it's not necessarily the most efficient way to bring an end to a global pandemic."
Australian and Fijian government officials at the Nadi International Airport after the arrival of 100,000 doses of the AstraZeneca vaccine. Photo: Supplied/Australian High Commission, Suva
Australia, like China, has opted to donate directly to countries rather than through Covax
Australia has been slow to deliver on its pledges compared to other nations, Rajah said, with just 8 percent of its promised doses dispatched to date.
"It's a bit hard to explain why we should be that low when you consider that we've had all this AstraZeneca basically sitting within the national health system going unused."
Australia's local manufacturing of coronavirus vaccines is also set to end when the current 50 million dose contract with CSL is completed.
"I would actually hope that Australia would continue to manufacture and produce vaccine for this global effort," Halton said.
"It may be that we can get enough vaccine from the very large global manufacturers ... but I do think we need to assess this going forward: if we're not hitting the targets we need to hit into the new year, I think we should give that some more thought."
Can we vaccinate the world?
Now that India is allowing vaccine exports again, and Covax has diversified its vaccine suppliers, things are ramping up quickly. Halton said she hopes that by the end of the year, Covax will have delivered more than 800m doses, which would increase "rapidly" in the first three months of 2022.
Several countries have upped their pledges to the scheme recently, including the United States and Canada, which promised an extra 200m doses to Covax at last month's G20 summit.
Meanwhile, the World Health Organisation has set a new target to achieve global vaccine coverage of 70 percent by mid-2022.
About 51 percent of the world population has received at least one dose of a vaccine, according to figures collated by Our World In Data.
"Between now and the end of this year, we're going to make another three billion doses of vaccine," Dr Bruce Aylward, a senior advisor with the World Health Organisation, said in late October.
"Can we take 550 million doses of that ... and make sure it goes into Covax and the other mechanisms that can get the equitable distribution that by the end of this year will see more lives saved, more livelihoods on track?"
Another challenge is that many people in the developed world are now just keen to put the pandemic behind them.
"There is a risk that the world basically moves on," Rajah said. "The rich world vaccinates itself, a lot of the upper middle income countries also get vaccinated and everyone forgets right until another problem ... explodes onto the world stage.
"I think we will probably eventually get there. The question is whether or not we get there fast enough and have that sense of urgency."
Rich countries acting like the pandemic is over may have the effect of prolonging the pain for everyone.
- ABC