COVAX Estimates Having 25% Fewer COVID Vaccines for 2021 Global Distribution

Last week, COVAX, the UN-backed worldwide initiative for equitable distribution of COVID-19 vaccines, reported an almost 25% reduction in their vaccine supply forecast for the end of the year.

They initially projected they'd have 1.9 billion doses to distribute globally for the remainder of this year. That number has now dropped to 1.425 billion doses, which puts more pressure on wealthy nations to act and help prevent further delays to global vaccine distribution.

The COVID-19 Vaccines Global Access, COVAX for short, is led by Gavi, the Vaccine Alliance (GAVI), the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO) alongside the United Nations Children's Fund (UNICEF).

Factors Affecting Reduced Vaccine Supply

In just six months, COVAX has already delivered about 240 million vaccine doses to 139 countries. However, there remains a stark gap between vaccination rates across nations.

Only 20% of people from low- and middle-income countries (LMICs) have received a first vaccine dose, in contrast with 80% of people from higher-income countries.

“COVAX relies on the manufactures for the timeline and the amount of the vaccines that COVAX can deliver,” Inci Yildirim, MD, PhD, a vaccinologist at Yale Medicine and an associate professor of medicine and global health at the Yale School of Medicine, tells Verywell. “Any delay or shortage in the supply from the manufacturers impacts COVAX's ability to protect the vulnerable populations worldwide.”

Several factors led to this reduced supply, Yildirim says, including:

• Key producers may be unable to scale up production of the vaccines
• There may be existing deals with high-income counties who can afford to pay for the available vaccines
• Delays in export processes and agreements with participating governments

Delays in the regulatory review and approvals of vaccine candidates, as well as vaccine stockpiling by wealthy nations, likely contributed as well.

“The continued vaccine nationalism—countries prioritizing their vaccine access and supply over the global vaccine need—is continuing to put pressure on vaccine production and the ability of COVAX to procure WHO-recommended vaccines,” Richard Reithinger, PhD, vice president of global health at the RTI International, tells Verywell.

COVAX seeks the support and cooperation of participating governments, donors, and manufacturers to help them in their goal of distributing vaccines more equitably.

“Last week’s announcement is one more sobering data point in the collective global failure to respond to a once-in-a-generation societal challenge,” Reithinger says. “The longer this status quo prevails, the longer the pandemic will continue, causing more cases and deaths, pushing countries’ health systems and its socio-economic fabric to collapse, and increasing the probability of a more pathogenic and virulent strain to emerge.”

Delaying Boosters May Increase Vaccine Supply

Last August, the WHO called for a delay in administering boosters until at least the end of September to prioritize vaccines for lower-income countries. In light of COVAX's recent news, they are extending this recommendation until at least the end of the year. They hope this will help countries vaccinate about 40% of their population, before boosters rollout.

“I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers,” Tedros Adhanom Ghebreyesus, PhD, director-general of the WHO, said at a press conference.

Many experts have criticized the U.S. booster rollout plan because of limited data demonstrating waning immunity after six to eight months.

“Given global vaccine coverage, and vaccine coverage in LMICs specifically, calling for a booster moratorium, [or delay], until the end of the year—and I would say even beyond the end of the year—is the right step,” Reithinger says. “A moratorium would ease pressure on vaccine manufacturers having to deliver vaccines to high-income countries, and allow vaccines to be re-routed to LMICs for procurement and distribution, including through COVAX.”

Vaccine manufacturers have promised to prioritize COVAX and LMICs, but many choose to prioritize —or are legally obligated to fulfill—deals with wealthy nations, causing other countries to be left behind. Rolling out booster shots in high-income countries that have already vaccinated a significant portion of their population may further exacerbate global vaccine inequity.

“Depending on what the U.S. government’s booster shot rollout would look like, the eligible population could range anywhere between 10 to over 200 million,” Reithinger says. “Delaying the booster rollout would thus ‘free’ a significant amount of doses for LMICs to access. Additionally, a moratorium on a booster rollout would also buy manufacturers time to substantially ramp up production capacity to meet the continued existing global demand for COVID-19 vaccines.”

How the U.S. Government Can Help

The U.S. can help establish equitable access to COVID-19 vaccines in a myriad of ways at both national and global levels, experts say.

“The U.S. could commit to forego vaccine allocations that it may have agreed to with vaccine manufacturers to the benefit of COVAX—allowing COVAX to ‘jump the queue’ so to speak—as well as donating vaccine doses to COVAX and LMICs,” Reithinger says.

According to the WHO, the world’s leading economies can swap near-term vaccine deliveries with COVAX, fulfill their vaccine pledges on schedule, and share vaccine manufacturing technology and know-how to help achieve global vaccination targets. Higher-income countries have promised to donate more than a billion doses, but less than 15% of that amount has been fulfilled so far.

“The U.S. has donated the largest amount COVID-19 vaccines compared to any other nation so far with about 110 million doses delivered, and 500 million doses planned to be donated,” Yildirim says. “However, we should put these numbers in context with the reality of 11 billion doses that are needed to vaccinate 70% of the world population. There is still a huge need.”

Aside from the previous and ongoing vaccine donations, the U.S. government will also allocate $2.7 billion to expand domestic vaccine manufacturing capacity. The financial aid will go to companies making supplies that are necessary for vaccine production.

The Biden Administration reportedly has more plans to help the rest of the world combat the pandemic, which they will announce later this month.

“The U.S. has to keep accelerating its efforts to increase global vaccine supply and access, as there is no way we will end this pandemic in our backyard without controlling it globally,” Yildirim says.

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