Canada's COVAX program use draws criticism for unequal vaccine distribution

Canada is expected to receive over one million COVID-19 vaccines by the end next month through an international vaccine sharing initiative. The announcement has left some wondering if this will have an impact on the rollout of the vaccine in other countries, particularly those that are low or middle income.

COVAX is a global pool procurement mechanism for COVID-19 vaccines. It’s run in joint partnership between CEPI, the Coalition for Epidemic Preparedness Innovations, Gavi, The Vaccine Alliance, and the World Health Organization.

The program has two components to allow countries to access vaccines. There’s the advanced market commitment, a pool of funds donors contribute in order to purchase vaccines and distribute them to low-income countries. Currently, 92 countries are participating.

There’s also an option for higher income countries to purchase vaccines through what’s known as a self-financing mechanism.

Canada bought into both roles: it’s signed up as a self-financing country to obtain vaccines through COVAX, as well as donating to the advance market commitment to finance the pool purchasing for low-income countries.

For Canada to seek to correct some of its missteps by taking vaccines that should be going to countries with no bilateral deals is downright immoral. Anne-Emanuelle Birn, University of Toronto professor

Dr. Jason Nickerson, a humanitarian affairs advisor with Doctors Without Borders, admits it's a complex situation.

COVAX was established with the intent to equitably distribute vaccines to countries around the world, in order to vaccinate high-risk people, regardless of where they lived. If all countries participated in COVAX and used this as their primary mechanism of procuring and accessing vaccines, then we may have seen a more equitable distribution of vaccines around the world for frontline healthcare workers and other vulnerable populations. But that’s not how it’s playing out.

“Many wealthy countries went out and struck their own bilateral agreements with pharmaceutical companies, much in the way Canada did,” Nickerson tells Yahoo Canada. “Effectively they’ve hedged their bets to access larger quantities, or quantities more quickly.”

The fallout has resulted in an inequitable rollout of the vaccine, Nickerson explains. For the last two months, healthcare workers and other vulnerable people in high-income countries are receiving the vaccine, while those same demographics of people in low-income countries are not.

“There’s a public health prioritization that should put (healthcare workers and the vulnerable population) as a priority (in Canada),” he says. “But we can’t escape the reality that there’s a growing second wave of COVID in places like Malawi, or Mozambique or Eswatini today that’s overwhelming health systems and people there don’t have access to the vaccine.”

Anne-Emanuelle Birn, a professor of critical development studies and global health at the University of Toronto, agrees that Canada has fumbled its COVID-19 vaccine response, “from not preparing an existing plant for domestic production a year ago to making so many side deals with vaccine manufacturers for advance purchasing but not delivery, that the population could eventually be vaccinated five times over, the highest hoarding Ievel in the world.”

“For Canada to seek to correct some of its missteps by taking vaccines that should be going to countries with no bilateral deals is downright immoral,” she says.

When there’s only so much vaccine to go around at any given time and Canada is accessing through bilateral agreements as well as COVAX, the concern is that the country will find itself in the position where Canada has access to more vaccines than other countries.

“By jumping the line, Canada will be in the position to vaccinate low-risk people long before low and middle-income countries have the opportunity to vaccinate high-risk people,” says Nickerson. “That would be a situation that’s frankly indefensible. Particularly if the vaccines being used to vaccinate low-risk people in Canada are being drawn from COVAX, a mechanism that ensures countries that don’t have the same purchasing power as Canada have timely, equitable access to vaccines.”