Trade Hot Topics A Special Focus on COVID-19 and the Commonwealth | ISSUE 172

The Great Race: Ensuring Equitable Access to COVID-19 Vaccines Brendan Vickers, Salamat Ali, Neil Balchin, Collin Zhuawu, Hilary Enos-Edu and Kimonique Powell1

1. Introduction hugely inflated prices. For the billions of people living in developing countries, where there are little On 3 February 2021, the world marked an historic or no manufacturing capacity for vaccines and only milestone when the total number of COVID-19 fragile healthcare systems in place to cope with vaccinations administered globally surpassed the repeated waves of infection, a gruelling journey still total number of confirmed cases.2 The development lies ahead before full vaccination and general in record time of several vaccines and accelerating immunity are achieved. Indeed, some developing vaccination rates—especially in Bahrain, Israel, the countries could be left waiting until 2024 to (UAE), the (US) inoculate their citizens, even though the COVID-19 and the (UK)—suggest that the Vaccine Global Access (COVAX) Facility aims to end of the pandemic might be in sight for some secure equitable access to these lifesaving tools countries.3 The global picture, however, is one of (Duke Global Health Institute, 2020). This situation stark inequality in vaccine access and distribution, is of grave concern, especially given the with 75 per cent of all COVID-19 vaccines Commonwealth leaders’ commitment in July 2020 administered in just ten countries, while more than to ensuring equitable access to safe, effective, 130 countries have not received a single dose (UN, quality and affordable medicines and vaccines for 2021). Many developing countries—especially low- all—particularly the most vulnerable and high-risk income economies4—fear they will be left behind. populations.5 High-income countries have pre-purchased more Although an unprecedented challenge, vaccinating than half of the 12.4 billion vaccine doses being the entire global population is a health, moral and manufactured this year, leaving the rest to be economic imperative. A sustainable recovery from shared by the developing world—in some cases, at

1 Brendan Vickers is head of section of the International Trade Policy Section at the Commonwealth Secretariat. Salamat Ali, Neil Balchin and Collin Zhuawu are all economic advisers; Hilary Enos-Edu and Kimonique Powell are assistant research officers. Kim Kampel and Tanvi Sinha of the Commonwealth Small States Office in Geneva provided valuable inputs. Any views expressed are those of the authors and do not necessarily represent those of the Commonwealth Secretariat. 2 The total number of vaccine doses administered climbed to 105 million, while the number of confirmed cases was 103.5 million (Cookson and Smith, 2021). 3 The Economist Intelligence Unit (EIU) forecasts that vaccine coverage might not be widespread until 2023 or even 2024 (EIU, 2021). 4 Thirty-one of the world’s 46 least-developed countries (LDCs) in 2021 are in Africa; 9 of the 13 Commonwealth LDCs are African countries. 5 See the Commonwealth Statement on the COVID-19 Pandemic, available at https://thecommonwealth.org/sites/default/files/inline/ Commonwealth%20Statement%20on%20COVID-19%20FINAL%20VERSION_0.pdf Issue 172 | 2021 Issue 172 | 2021 | Page 2 Table 1. Sources: EIU(2021),press reports, company websites Note: Doses delivered and/or promised for2021. there are more than240 vaccines in development, 2021, February 6 of As months. recent over swiftly The COVID-19 vaccine landscape has evolved 2.1 2. among countries insub-Saharan Africa(SSA). to vaccines small states, least-developed countries (LDCs) and countries—especially access developing Commonwealth affordable the and of some highlights challenges andopportunities for ensuring equitable It landscape. vaccine of recent developments in the evolving COVID-19 This issueof solutions to contain andeliminateit. trade 2020). hasnot causedthispandemicbutcanprovide (ICC, countries developing economies, giventheirextensivetrade linkages with share ofthislosswould fall ontheadvanced significant A . and of (GDP) product is greater thanthecombined gross domestic more than US$9 trillion in lost output this year. This economyworld the costqueue—could the of back egregiously placesdevelopingcountries at the which nationalism, vaccine distribution—including unco-ordinated approach globally to vaccine an that estimated is It all. for medicines essential programme supportedbyequitableaccessto all of which requires a globally inclusive vaccination restrictions on the movement of goods and people, economies, endinglockdowns, andloosening the pandemic hinges on successfully opening up CureVac Bharat Biotech-ICMR Moderna Sinovac Biotech Johnson & Sputnik-V Sinopharm Pfizer-BioNTech Novavax Oxford/AstraZeneca Primary developers 7 6 The COVID-19 vaccine landscape within thebloc. year. The pharmaceutical companies withwhichtheEUhassigned contracts will produce 8.4billion doses and2.7billionofthosewillbeused The losseswould besignificantly lower ifdeveloping countries were able to vaccinate atleasthalfoftheirpopulations bytheendof Vaccine production, demandandsupply Leading COVID-19 vaccines across theworld, February2021 Trade Hot Topics Multinational USA Sweden, UK origin Country of Germany USA USA China provides an overview 6 International International dose (US$) Price per 1.50–4 32–37 12.3 19.5 <10 <77 14 10 16 1 ped f h vrs Te ol hs sufficient has world The manufacturing capacity virus. to produce 16billiondoses the of spread billion doses mustbeadministered worldwide to haltthe 11 and 10 between that estimated is It 1). are already inusemore than60countries (Table of which55are inclinicaltesting,and10vaccines million dosesofCOVID-19 vaccineamonthby The volume. by company isscheduledto reach production of100 manufacturer vaccine largest the SerumInstitute ofIndiabeing theworld’s out, stands India vaccines. own manufacture,their countries withthecapacity to develop,oreven There are only afew Commonwealth developing temperatures (Beck,2020). they if world—especially require cold storage refrigeration at ultra-low the across vaccines and specialisedlogistics networks inshipping underscore theimportanceofinternationaltrade hubs manufacturing few These Korea). South and large developingcountries (includingChina,India economies (theEU, theUKandUS)insome facilities are concentrated and inafew advanced skill- production highly most Consequently, capital-intensive. are they Moreover, complex. Vaccine production supply chainsare quite countries—at leastfor several monthsof2021. demand may outstripsupply to developing coverage up to 300 per cent of the population), with multiplemanufacturers (insomecases, for orders placedbyseveral developedeconomies (EU). Union European the producedin be year,will this which of billion 3.3 Doses 300m 720m 770m 900m 1.0bn 1.0bn 1.3bn 1.4bn 2.1bn 3.0bn India , EU, Israel, USA China , Belarus, Russia Bahrain, China,Egypt, UAE tries EU, UK,USA and21other coun India, UKand3other countries Approved in 7 However, becauseofpre- - of upgraded vaccines could delay thedeployment different administering vaccines for second or booster doses. The field trials vaccines, and Pfizer the AstraZeneca mixing trial a initiated has UK The versions ofvaccinesto defeat themutations. the and AstraZeneca University ofOxford, are lookingto engineer new with along CureVac, and GlaxoSmithKline products. their modify to closely working are companies Pharmaceutical variants. found to far. be completely effective against these new so developed Unfortunately, vaccines to date,nosinglevaccinehasbeen the to responsive of thesevariantsspread swiftly andare less Somecountries,SouthAfrica. and UK the including 4,000 new variantshavebeenfound inseveral than more Its virus. stable a not is COVID-19 Yet that thedrugcanreduce mortality by75percent. Mali—show togetherwith Uganda, and Africa South India, Kenya, countries—including Commonwealth inhibit effectively to COVID-19: proven trialsconducted inseveral been has drug The vaccines, the US has approved the use of Ivermectin. specific these Besides (WHO). Organization Health obtained emergency useapproval from theWorld have vaccines Oxford/AstraZeneca and BioNTech However,champions. national far,so only Pfizer-the approved theuseofvaccinesproduced bytheir Most advanced and some developing countries have variants 2.2 (Dorfman andKirstein, 2021). the bulk-imported Johnson&vaccine packaging and filling for six responsible globally of sites one be for to expected is vaccines Africa . on producing childhood immunisationprogrammes insouthern focused is firms the South Africangovernmentandlocalhealthcare tuberculosis. A public–private partnership between vaccines for diseasessuchasyellow fever and vaccines. Senegal and South Africa already produce the lacks scale andsophisticationnecessary for COVID-19 significantly continent the but Africa, There issomevaccinemanufacturing capacity in significant the Network. a Network has pharmaceutical industry, isoneofonly two LDCs in which Manufacturing Bangladesh, (DVMN). Vaccine countries Countries Commonwealth participate inthe16-memberDeveloping Five COVAXIN. also developeditsown COVID-19 vaccine: has Kirstein,India and 2021). March(Dorfman 2021 Approvals, authorisationandupgradingfor new income country. Among Commonwealth countries, in just 10 countries, only oneofwhichisalow- 95 per cent ofvaccinations have beenadministered far,So economies. developing some and advanced The rollout ofvaccineshasstartedinmost 2.3 are vaccine (Edward-Ekpu, 2020). there However, currently nofundsavailablefor humantrialsofthe countries. African other lineages ofSARS-CoV-2 circulating inNigeriaand vaccine candidatebuiltonthegenomesequenceof (ACEGID) inNigeriahasreportedly developeda Excellence for Genomics ofInfectious Diseases of Centre African The conditions. local to vaccines It isalsoimperative to testvaccinesinand adapt that is apossibility periodically, asare vaccinesfor influenza. There coronavirus vaccinesmighthaveto beupdated variants. new off also beenconsidered aspotential meansofstaving a third dose of an existing but different vaccine, have administering simply as such Alternatives, process. n Ida hv dvlpd hi on vaccines. own their Given thatthe two countries havepopulations in developed have India, and Globally, thetwo mostpopulous countries, China COVAX the interim distributionlist(Table A1). on also million)—are (0.25 Zealand New and million) economies—namely,(1.9 Canada advanced plan. Two the from benefit million)—will (12.8 Bangladesh and million) (16 (17.2 Nigeria million), Pakistan million), (97.2 population)—India Commonwealth countries (intermsof inoculate healthcare workers. Four large developing to population—enough country’s each of cent per population size. A first tranche will reach around 3.3 countries 145 nations, will receive doses in proportion to their The mid-2021. participating, including developed and developing by countries distribution of337millionvaccinesto low-income The COVAX Facility hassetoutaplanfor global before 2024. obtain sufficient doses to achieve general immunity Intelligence Unit predicts that the African region will struggle to Economist The vaccines. for queue the of back the at are countries African one. least vaccine dosesand47percenthavereceived at two received have cent per 23 around Israel, In 1). proportion oftheirpopulationsvaccinated(Figure are ahead oftherest oftheworld intermsofthe US the and UAE the Israel, A1). Bahrain, (TableGlobally, people million 12 around immunised the UK is leading the vaccination drive and has Progress on vaccination delivery

Issue 172 | 2021 | Page 3 Issue 172 | 2021 | Page 4 BioNTech and Moderna using advanced mRNA mRNA advanced using Moderna Pfizer- by and made BioNTech those including vaccines, Some multiple dosesinonevial. consequently, some firms are considering including equipment are facing extreme demand; Even so, manufacturers of this basic medical 8 India. around year,by followeda containers vaccine manufacturebillion to capacity with goods, these of producer biggest the is China vials. glass also hingesonadequatesuppliesofsyringes and The successful massinoculationoftheentire world 2.4 2022 andeveninto 2023. ownmass immunisation programmes, potentially through to their delays significant experience vaccines importedfrom ChinaandIndiamay the billions, other countries that depend on Figure 1. Source: https://ourworldindata.org/covid-vaccinations Supply of vials andsyringes Share ofpopulationwhohavereceived atleastonedoseofCOVID-19 vaccine (asof23February2021) the marketplace for COVID-19 vaccines. Thereforvaccines. marketplaceCOVID-19are the Developing countries are beingdisadvantaged in Affordability 3.1 producing nations. include trade-restricting measures among These includepricingandlogistics, andmay also effective vaccines. of deployment to and distribution challenges access, several face countries Commonwealth smallstates, LDCs andSSA countries 3. that they can withstandthermalshock. stringent quality teststo ensure theirdurability and the vialsinwhichthesevaccinesare stored mustpass temperatures. The raw materials used to manufacture technology, need to be stored at ultra-low Deployment challenges indeveloping andpricing end of2021(Schnirring, 2020). vulnerable 20 percentoftheirpopulations bythe developing countries to vaccinateatleastthemost US$6.8 raising of billion to purchase vaccines, withtheaimofallowing target its meet is to Facility Thestruggling done. be to needs more COVAX, developing countries to purchase vaccinesthrough While some high-income countries have aided research anddevelopmentofthevaccines. income countries because they invested in the explanation thatpricesare discounted for high- countries iscausefor concern; likewise the The 2021). exorbitant pricesbeingcharged to developing (Dyer, secretary budget Belgian the dose negotiated intheEU, the asrevealed inatweet by a $2.15 of of price the than higher times dose—two doses million a US$5.25 AstraZenecacostof reporteda 1.5 vaccine, purchased having Africa, South countries. developed and developing demonstrating marked pricedisparitiesbetween recently disclosedtheirvaccineprices, Belgium and Africa South However, information. sign, many countries donot divulgeprice disclosure agreement thatbuyers are required to pharmaceutical industryand,owing to thenon- Pricing to market isnot uncommon countries. inthe developing all among standard be will been publicly listed, there is no guarantee that they It isimportantto note thatwhilethesepriceshave (Curtis, 2020). up to $37adose,ifpurchased insmallerquantities price—reportedly that double almost is vaccine Moderna the while dose, per $19.50 as much as option, becauseitcould cost developingcountries less tenable a be may vaccine Pfizer’s countries. expected to bethefrontrunner amongdeveloping for lower andmiddle-income countries, is dose a US$3 at priced vaccine, AstraZeneca The Table1). (see challenges major also are of vaccines the some from profiting and pricing Variable these lifesaving tools. legitimate concerns aboutinequitableaccessto developing countries, many ofwhichare raising threat to significant a 2020)—poses al., et (Vickers and other medicalsuppliesrelated to COVID-19 personal protective equipment(PPE),ventilators with witnessed vaccines—previously superfluous of stockpiling and hoarding The over. times many of vaccinesto inoculatetheirentire populations vaccine manufacturers thatcould seethedelivery negotiated bilateral procurement agreements with reports thatsomehigh-income countries have children ortargeted groups ofadults, suchas those inAfrica,are primarily setupto immunise Commonwealth developingcountries, including infrastructure andlogisticalsystems inmany Existing nationalvaccinationdistribution road transport infrastructure. states (SIDS),andLDCs withunderdeveloped airand geographically isolated small island developing members withlimitedinternationaltransit routes, and isolatedrural populations, as well as in landlocked in Commonwealth countries withlarge, fragmented Many of the distributional challenges are exacerbated considerablepressure onlocalsupply chains. exert will This recipients. intended and/or road, andthenadministered to their a reach vaccines country, they needto bestored, Once transported byair doses. the distributing in face challenges may they vaccine, effective an of volumes procuretosufficient manage countries Even ifCommonwealth smallstates, LDCs andSSA Distribution andlogistical challenges 3.2 Some ofthevaccines widely approved by challenging. particularly are vaccines COVID-19 The complex storage conditions required for of Mozambique (Mancini, 2020). as parts such conflict- regions in vulnerable affected mobile—especially to reach highly often are difficult very populations orinternally displacedpersons, who be can it Similarly,logistics. and infrastructure transport by inaccessible to healthcare servicesandunderserved difficulties. additional Target populations may live in remote areas create issues Structural airports andflightshortages. movement, whichmay includetheclosure of waves oflockdowns andother restrictions on exacerbated bysecond and,insomecases, third vaccines For transported byair, thesechallengeswillbe networks. road underdeveloped with limitedairtransport infrastructure countries and Commonwealth in exist hurdles Major numbers ofadultsandvulnerable people. vaccines required to inoculate unprecedented distribute, manageandtrack thelarge volumesof This 2020). means significant upgrading al., of logistics systems to et Nkengasong 2020; (Cushing, populations onthescalerequired for COVID-19 they are generally unprepared for vaccinatingadult infected with diseases such as Ebola. Consequently, families, neighbours orco-workers ofthose

Issue 172 | 2021 | Page 5 Issue 172 | 2021 | Page 6 (UNICEF) concluded that most countries on the Nations InternationalChildren’s Emergency Fund for even before COVID-19, the WHOandtheUnited problematic is the requisite infrastructure. In Africa, for example, This Commonwealth developing countries that lack 2020). (Mancini, of distribution or the vaccine becomes unusable must remain intactthroughout thevariousstages chain storage cold The transportation. of stages refrigerators are neededto store dosesatall chain, meaninghigh-capacity freezers and/or currently availablevaccinesinvolveacold supply temperatures (-70°C and -20°C, respectively). low very at stored and be to need vaccines, Pfizer-BioNTech Moderna the including regulators, individuals—a potential cost oflives. terms ofmissedopportunities to vaccinate developing countries, not only financially but also in Significant wastage may come atahighcost to Commonwealth 2020). Institute, Health Global (Duke the timevaccinesneedto beadministered such assyringes, andensure they are availableat countries needto importrelated medicalsupplies, misused. additional layer ofcomplexity isintroduced if or temperatures high to exposed inadequate storage andtransportation conditions, high riskofwastage ifdosesare subjectto lives ofsometheavailablevaccinespresent a The complex storage requirements and short shelf instances inwhichsuitablefacilities are available. potential to compromise thecold chainevenin Unreliable 2014). members are furthercausefor concern, withthe al., electricity supplies etinsomeCommonwealth (Lydon equipment (23 percent)orbroken (14percent)cold chain members—many sites hadpoor-performing (41percent),outdated Commonwealth 18 Across including countries— facilities. 57 in points and immunisation 134,000 equipment chain cold Vaccines andImmunisationto beill-equippedwith eligible to participateintheGlobalAlliancefor Commonwealth regions found many countries pre-pandemic study withcoverage across Another 2015). al., et (Lydon effectively vaccines necessary to store, distribute,handleandmanage continent donot meettheminimumstandards 9 8

that wastage accounts for around 8percent ofthetotal cost ofvaccination programmes inlow- andmiddle-income countries. Institute, 2020). limited becauseanumberofhigh-income countries havealready negotiated large pre-purchasing agreements (Duke GlobalHealth temperatures for several monthsandisadministered inasingledose,but itssupply to developingCommonwealth countries may be six months(Curtis, 2020).Another vaccine candidate developedbyJohnson&canbestored atnormalrefrigeration countries. The Oxford/AstraZeneca vaccine, for example,canbe stored inanormal fridge(atbetween 2°Cand-8°C)for upto There is pre-pandemic evidence ofhighlevelsvaccine wastage indevelopingcountries. Karp et al(2015),for instance, estimated Certain vaccines withlessonerous storage requirements offer hope for widerand faster distributionin Commonwealth developing 9 An 8 All 3.3 vaccination effort. risks to pose health and exacerbate distrust of the genuine could This vaccines. falsified or market for substandard, unregulated, unapproved likelySupplyaretoalso 2020). limitations create a them major targets for theft or diversion (Cushing, doses, coupled withhighlevelsofdemand,make Finally, thelimitedsuppliesofCOVID-19 vaccine efficacy (Reuters, Bengaluru,2021). widespread scepticismabouttheirsafety and be slowed furtherincaseswhichthere is process ofadministeringCOVID-19 vaccinesmay The safely. doses the administer to able are they training andrequire additional supervision before healthcare workers may needto undergo further some effort, immunisation the of scale the Given will mean a longer timeline for vaccine deployment. underfunded andresources are already stretched developing countries where health systems are shortages of healthcare workers insome challenges, distribution immediate these Beyond vaccines through vaccinesharing. supporting equitableglobalaccessto COVID-19 some way toward addressing thisissueby go will initiative COVAX The countries. developed of rollout a vaccines generally skewed infavour of the world’s to contributing is This populations. countries prioritisingaccessfor theirown vaccines hasprompted vaccine nationalism, with Similarly, therace to secure supplies of COVID-19 in BelgiumandtheNetherlands. shortfalls resulting from production delays atplants delivery up make to vaccine Oxford/AstraZeneca the EUimposedrestrictions onexportsofthe recently, More supplies. medical essential and PPE of countries imposingrestrictions to curbexports of the pandemic,there havebeennumerous examples secure doses in sufficient quantity. Since the startof ability ofCommonwealth developingcountries to the for implications major have could This citizens. ensure they retain adequatesuppliesfor theirown may imposeexportrestrictions orstockpile to supply chains, there isariskthatsomecountries Given limitedproduction ofvaccinesandcomplex Trade restrictions admc ie ‘ni te aoiy f h world’s the of majority the ‘until (i.e. pandemic information (trade secrets) for the duration of the industrial designs, patents andundisclosed suspension ofrightsrelated to copyrights, a proposed submission The 2020). Council, TRIPS and other technologiesrelated to COVID-19 (WTO several waiver to TRIPSfor drugs, vaccines, diagnostics vaccines, Africa haverequested attheWTO for ageneral affordable Commonwealth countries ledbyIndiaandSouth ensure To distorting theconsequently inefficientmarket. contribute to highprices, theexclusiverightitself development ofnew medicines;they canalso Intellectual replicas. property rights(IPRs) promote innovationandthe produce to competitors invest inproduct developmentonly for their it unsustainablefor pharmaceuticalcompanies to develop Generally, mostmedicinesare expensiveto restrictions andstockpiling, asdiscussedearlier. co- international operation enhancedisevenstarker againstabackdrop oftrade for need The 2020). since fivefold 2005, shortagesofvaccinesoccurregularly (WTO, increased having medicine human for vaccines in trade Despite world. the in toevery person available are vaccines affordable ensure distribution ofCOVID-19 vaccinesisalsocriticalto International co-operation inthedevelopmentand the UnitedNations’Technology Bankfor LDCs. (TRIPS), andtheTechnology AccessPartnership of related AspectsofIntellectual Property Rights Organization (WTO) anditsAgreement onTrade- COVID-19 Tools (ACT) Accelerator, theWorld Trade including theWHOCOVAX Facility andAccessto agreements could beleveraged to thisend, Various existingmultilateral arrangements and countries. developing in groups vulnerable most the all—especially for vaccines to access ensuring key to successfully tacklingthepandemic,including Enhancing globalco-ordination andco-operation is Globalco-ordination 4.1 to ensure universal globalvaccination. at actions concerted multilateral, regional andnationallevelsare of required series A everywhere. that COVID-19 anywhere meansCOVID-19 The internationalcommunity needsto appreciate 4. 11 10 The way forward pandemic. These canincludelengthy negotiations withtheholder(s)ofIPRs, includingoveradequate remuneration. actions involvedin obtainingacompulsory licence are cumbersome and time-consuming atatime-criticalpointinthe effort to haltthe Some developing countries havecountered thatimplementing flexibilitiesunderthe Doha Declaration ischallenging becausethe Some epidemicinfectious diseasevaccine candidates cost inexcess ofUS$100million(Gouglasetal.,2018). 10 butrelatively cheapto produce, making Ngozi Okonjo-Iweala (Okonjo-Iweala, 2021). immediate priority ofthenew WTO Director-General Engaging members to find a solution is likely to be an considerations. health public and rights holders’ to strike therightbalancebetween safeguarding IP flexibilities sufficient provides already Health Public arguing thattheDohaDeclaration onTRIPSand However, somecountries challengedtherequest, meet nationalandglobaldemand. produce, developandexportgenericvaccines the waiver would enablecapableWTO members to granted, If immunity’). developed has population countries to access COVID-19 tools (, 2020). 2020). (G20, tools COVID-19 access to countries encouraged multilateral co-operation to helpmore extensive immunisationasa globalpublicgood’and November 2020, G20 leaders recognised the ‘role of Elsewhere, in a declaration issued at on 21–22 right ofmembers to grant compulsory licences Agreement to protect publichealth,includingthe WTO members to use the flexibilities in the TRIPS of right the confirms It health. public protecting Agreement for practical policyreasons aimedat TRIPS the in flexibilities specific clarified Health The 2001 Doha Declaration on TRIPS and Public Public Health Box 1. patent offices, government ministries and ministries regulatory authorities(WTO government etal.,2020). offices, patent capacity, and alackofco-ordination between licences inpractice, inadequateinstitutional countries, the complexity of implementing the economic pressure from someindustrialised and political include constraints The as compulsory licensing. such flexibilities of advantage face constraints andare unableto take full However, most developing countries continue to manufacture thoseproducts themselves. to servetheneedsofthosecountries thatcannot exported underacompulsory licenceexclusively other supportingdevices, to beproduced and active ingredients), vaccines, diagnostictestsand generic medicines, aswell asdrugs(andtheir 2017, provides amechanismto allow low-cost Article 2001). 31bis ofTRIPS, whichcameinto force inJanuary (WTO, granted be may licences and to determine the grounds upon which such Doha Declaration onTRIPSand 11

Issue 172 | 2021 | Page 7 Issue 172 | 2021 | Page 8 globally (WHO, 2020a,2020b). for COVID-19 are accessible to everyperson ensure thatvaccines, diagnostics andtherapeutics COVID-19 tests, treatments andvaccines, andto approval, delivery and equitable allocation of latter, to expeditethedevelopment,regulatory a globalCOVID-19 vaccine procurement pool;the initiatives were established:theformer, to provide To this end, the COVAX Facility and ACT Accelerator supply ofvaccinesto ensure theiraffordability. international co-operation intheproduction and The effect of 2020a). such declarations is to increase (WHO, the need for good common universal a be The WHOhasalsodeclared aCOVID-19 vaccineto experience overtheyears intacklinginfectious capacities, ithasalso gained considerable essential health care andlimited productive related to poverty andinequality, low accessto 2020). al., While thecontinent faces existingchallenges et (Nkengasong vaccines COVID‑19 the development, purchase and rollout of approach amongitsmemberstatesto prepare for co-ordinated‘whole-of-Africa’ a require will target billion people in the next three years. Achieving this 1.3 continent’s the of cent per 60 approximately The (AU) aimsto vaccinate and trade. economies andreviving ofcross-border movement immunisation plans, andthesafe reopening of and the procurement to delivery ofvaccines, theimplementationofnational step first imperative Strengthened regional co-operation isan Regional co-operation 4.2 confidence inmultilateralism. issues, suchastheclimatecrisis, andto restore help to strengthen collaboration onother global In 2020). WTO, 2020; coordinateda addition, effortvaccine global could al., et (WTO vulnerable most the affordableto vaccines of availability and an important role in improving the accessibility and bestpractices trade inpublicprocurement canplay efficient promote that level international government procurement rulesatthe WTO’s Trade Facilitation Agreement. tracking someoftherelevant provisions of the governments shouldconsider enforcing andfast- material inputs, andspeedy deliveryofvaccines, In pursuit ofuninterruptedsupply chainsandraw 12 border agenciesandother stakeholders. customs clearance. NationalTrade Facilitation Committees could play animportant role in facilitating greater cooperation between The Agreement’s provisions pertainingto pre-arrival processing, electronic payments andfreedom oftransit could enablespeedy 12 Furthermore, In addition,to ensure longer-term sustainability, 2021; Soy, 2021). Task Team) between thisyear and2022(Adepoju, million through theAfricanVaccineAcquisition 1.27 receive billion doses(600millionfrom COVAX and670 to forecast are success. countries efforts, African to continental and barriers international the Through of some dismantle support for vaccinemanufacture, may helpto and supplies medical of purchases allow to Bank framework putinplacebytheAfricaExport Import vaccine-financing a and Platform, Supply Medical Africa CDC’s Africa including efforts, distribution and procurement co-ordinate to efforts Regional health institutions. initiatives and strengthen the capacity of African was establishedin2017to supportpublichealth for DiseaseControl andPrevention (AfricaCDC) systems; atthecontinental level,theAfricaCentres countries havesetupaccessibleimmunisation measles and many others. At the local level, African diseases suchasEbola,HIV/AIDS, tuberculosis, COVAX allocation,includingto Cuba,China, India consequently started lookingelsewhere have to supplement the countries Caribbean Many Advocate, 2021). Barbados (The Caribbean the including , to 630 millionpeoplelivinginthearea offrom Argentina phase first the inCOVAX—enough to inoculate only 5 per cent of vaccines the of doses million 35.3 only receiveto expected is part, forms region However, theAmericas, ofwhich theCaribbean 2020). (CARICOM, allocations COVAX the of share made an initial payment of US$2 million to access a through thePan-American HealthOrganization, the EU, theCaribbean PublicHealthAgency, from funding With 2021). (CARICOM, vaccines of concerns aboutequitableaccessanddistribution ACT Accelerator FacilitationCouncil to address call for aglobalsummitinthecontext oftheWHO ordination to dealwiththepandemic,includinga advocating for greater collaboration andco- also areCommunityleaders(CARICOM) Caribbean requires and scalingup(Nkengasong etal.,2020). this financing project transfer, technology However, significant vaccines. COVID-19 aspire to retool operations andmanufacture in several Africancountries thatmightreasonably organisations eight identified has CDC Africa providing communities withinformation, by endeavours these in role influential an play can campaigns education Public vaccines. COVID-19 vaccine hesitancyanddevelop publictrustin providers face a significant challenge to overcome Commonwealth governmentsand healthcare 4.3 travel bubbles(Kampel, 2020). example byincludinglow riskcountries inplanned also can enable travel andrevive intra-regional tourism, for PICs The implement appropriate riskmitigationmeasures to 2020). (ICAO, COVID-19 possible thattheaviationsector remains free of by implementingmeasures to ensure asfar as well to consider establishingpublichealthcorridors do will PICs the As and Zealand PICs. New , to such, delivery vaccine for critical is which measures are likely to furtherlimitairtransport, addition, quarantining andsocialdistancing In flights. cargo and passenger both in reduction the PICs—especiallyconsidering most to vaccines movement are likely to interruptthedeliveryof elsewhere. from imported However, worldwide bansoninternational vaccines on rely to its abandoned having vaccine manufacturing project, theregion willhave Australia With rebound. these countries, to allow their economies to vaccination, willprovide doubleprotection for region’s remote geography, together with The 2020). (IMF, years previous of cyclones worst This impactcould cutdeeperthansomeofthe economies. their on effect considerable had has (PICs) remaining free ofCOVID-19, thepandemic countries Island Pacific the of two-thirds Despite is effort vaccinating itspopulation. collaborative of expected to continue astheregion embarkson sort This 2021b). Caribbean islands(CaribbeanNationalWeekly, similar share of medical personnel across other medical, 110 nursing andlabtechnicians, anditprovided a than more Barbados to deployed it For example, pandemic. the fight to countries CARICOM with partnering been has Cuba 2021). (Medley, CARICOM to produces its vaccines the India has committed to donating 500,000 doses of later this year (Caribbean National Weekly, 2021a). has secured, whichtheUnionwillmake available region ashare of the270millionvaccinedosesit the promised also has AU The 2021). Wilkinson, Caribbean accessitsvaccine(Suarez, 2020; a US$1billionloanto helpLatinAmericaand the and Africa (Campbell, 2021). China has designated National preparedness against black market or illegal sales and distribution of substandard andunsafe vaccines, development andto guard the and falsification prevent to strong oversight mechanisms for quality assurance tandem withhealthcare providers, shoulddevelop In distribution. turn, Commonwealth governments, working in equitable ensuring on emphasis sequencing vaccine rollout programmes, with identifying vulnerable populations and in Trust canalsobebuiltthrough transparency in are safe. other celebrities, to reassure peoplethatvaccines government leaders, sportspeople,musiciansand informationtoand senior of influence the harness 2020). with socialmediaplatforms to disseminate al., et Commonwealth governments can also work (Nkengasong itself COVID-19 WHO is using to dispel misinformation about vein to the WhatsApp messaging system the support to used information dissemination,for be exampleinsimilar al., could et tools Digital (Nkengasong 2020). support and counselling example, mobile phonetechnology could beused For programmes. vaccination COVID-19 national Technology canbeleveraged to manage aspectsof 2015; Songane, 2018). al., while et (Lydon flexibility, resources public-sector up improve freeing and costs, inventory Outsourcing sector canalso helpto reduce deliveryand companies. beverage components ofsupply chainlogistics to theprivate and food partners possessing cold chain facilities, such as This might involve collaboration with commercial vaccines. existing transporting and storing meet thecomplex cold chainrequirements for industry co-operation withincountries canhelpto private-sector capacity andpromoting inter- the scale required to combat COVID-19. Leveraging implementing nationalvaccinationprogrammes at distributional challengesassociatedwith from the private sector to overcome the significant Commonwealth countries canharnesssupport immunisation progress. monitor and health facilities tospecific distribution adequate stock levels, determine quantities for purchasing systems, forecast needs, maintain chain management to develop integrated plans needto besupportedbyexpertiseinsupply Such countries. Commonwealth all in vaccines of and distributionplanscanhelpto guidetherollout The developmentofnationalallocationframeworks (Cushing, 2020).

Issue 172 | 2021 | Page 9 Issue 172 | 2021 | Page 10 instance, theuseofcertificatesimmunity or effortsto revive economicdomestic activity. For These measures canbecomplemented bywider al., 2016). Nigeria to store vaccinesinremote areas (Shittu et solar-powered refrigerators havebeenusedin example, For chain. distribution the of areas other also scope to deploy innovativetechnologiesin is There 2018). Songane, 2016; (GSK,Mozambique successful in managinginfant vaccinations in approaches usingasmartphoneapphaveproven histories and report on vaccine stock levels. Similar vaccination appointments, record vaccination to register healthcare workers, schedule etd y OI-9 acn delivery’. vaccine COVID-19 by tested be to chains supply fabled ‘Asia’s (2020) S. Beck, vaccination-plans-in-first-distribution-list aljazeera.com/news/2021/2/3/covax-sets-out- www. February. 3 vaccines’. 337m of distribution Al Jazeera 5247(21)00013-6.pdf com/pdfs/journals/lanmic/PIIS2666- vaccines’. COVID-19 for prepares ‘Africa (2021) A. Adepoju, References receipt ofvaccinations. polymerase chainreaction (PCR)testsand through health declarations, confirmation of to documenttheirCOVID-19 status, including is currently indevelopmentto enableindividuals Similarly, phones. CommonPass, a globally interoperable platform, mobile their on vaccinated will beableto carryconfirmation they havebeen individuals example, for Denmark, In developed. passports are already availableorbeing Technology enabling digital versions ofvaccine citizens are suitably protected and/or vaccinated. on internationalarrivals, provided thattheir heavily rely SIDS—that countries—particularly role inreviving tourism sectors inCommonwealth a of part as broader riskmitigationstrategy, approach, could play akey of type This country. been vaccinatedagainstCOVID-19 to enterthe already allowing internationaltourists whohave travelinternationally.TheSeychellesand iswork confidence to enableindividualsto gobackto vaccine passportsmay eventually provide some 13 generational divide,witholder individualsenjoying more freedoms thanyounger peoplenot yet vaccinated. could exacerbate theseissues.Moreover, thepolicyofprioritising vaccination ofolderpeopleinmostcountries may create a their ability to obtainsecure employment (The Economist, 2021).Existingdigital divideswithinandbetween Commonwealth countries access COVID-19 vaccines andhence withoutvaccine passportsmay face additionalconditions orrestrictions ontheirmovementor There are, however, someconcerns thatvaccine passportsmay bepolitically divisive anddiscriminatory. Those unwilling orunableto (2021) ‘COVAX sets out plan for global for plan out sets ‘COVAX (2021) Lancet News , February. www.thelancet. February. , 13

Asian ensure CaribbeanStates’ equitableaccessto CARICOM (2020). ‘CARPHA Partners with, PAHO to 19-response-needed/ mottley-says-coordinated-approach-to-covid- com/caribbean-breaking-news-featured/mia- needed’. 5 February. www.caribbeannationalweekly. says coordinated approach to COVID-19 response Caribbean NationalWeekly could-source-covid-19-vaccines-through-africa/ www.caribbeannationalweekly.com/ caribbean-breaking-news-featured/caricom- 15 Africa’. January. through vaccines COVID-19 source Caribbean NationalWeekly china-more-covid-vaccines stories/20210113/jamaica-looks-cuba-india- http://jamaica-gleaner.com/article/lead- January. vaccines’. COVID more for China India, Cuba, to ‘Jamaica looks (2021) E. Campbell, be-tested-covid-19-vaccine-delivery blogs.adb.org/blog/asia-s-fabled-supply-chains- Development Bank challenges-distribution-and-corruption-98437 opinion-the-unspoken-covid-19-vaccine- COVID-19 Devex corruption’. and unspoken distribution ‘The challenges: vaccine (2020) J. Cushing, access-to-vaccines-in-developing-countries/ commonslibrary.parliament.uk/coronavirus- Commons Insight countries’. developing Curtis, J. (2020) ‘Coronavirus: access to vaccines in 458deffcd896 ft.com/content/e29efb8b-46ec-4815-98aa- ‘Vaccine (2021) confirmed cases’. A. Smith, milestone asglobalCovid jabspassnumberof and C., Cookson, caricom-on-covid-19-vaccine-availability/ https://caricom.org/ January. statement-by-the-caribbean-community- 13 vaccine COVID-19 availability’. on (CARICOM) Caribbean Community the by ‘Statement (2021). CARICOM vaccine/ caribbean-states-equitable-access-to-covid-19- org/carpha-partners-with-paho-to-ensure- https://caricom.October. 16 vaccines’. COVID-19 1 Nvme. www.devex.com/news/ November. 10 , Financial Times bo] 1 Dcme. https:// December. 14 [blog], 2 Nvme. https:// November. 25 , UK Parliament House of (2021a) ‘CARICOM could 22b ‘i Mottley ‘Mia (2021b) , 3 February. www. The Gleaner , 13 22) Ipeetn a ulc elh ordr to corridor health public a ‘Implementing (2020) International Civil AviationOrganisation (ICAO) global-vaccinations/ iccwbo.org/publication/the-economic-case-for- The Economic Case forGlobalVaccinations International ChamberofCommerce (ICC)(2020) partnerships: watch?v=TIDTx7tYJVw of power YouTube Mozambique’. in coverage ‘The vaccine transforming (2016) GSK www.thelancet.com/journals/langlo/ article/PIIS2214-109X(18)30346-2/fulltext October. diseases: a cost minimisation study’. of vaccine developmentagainstepidemicinfectious cost the ‘Estimating (2018) al. et D., Gouglas, www.g20riyadhsummit.org/ declaration/ November. pressroom/g20-riyadh-summit-leaders- 22 G20 (2020) human-trials/ scientists-develop-covid-19-vaccine-need- https://qz.com/africa/1911951/nigerian- trials’. human for funding developed aCovid-19 vaccinecandidatebutneed have scientists ‘Nigerian (2020) Y. Edward-Ekpu, promise-and-perils-of-vaccine-passports com/science-and-technology/2021/01/26/the- www.economist. January. 26 passports’. vaccine Economist, The access-to-coronavirus-vaccines/ January. www.eiu.com/n/85-poor-countries-will-not-have- 27 2023’. before vaccines coronavirus poor countries will not havewidespread access to 85 than ‘More (2021) Unit Intelligence Economist bmj.n281 vaccines’. Journal for paid others what learning are countries ‘Covid-19: (2021) O. Dyer, left-behind-when-covid-19-vaccines-arrive duke.edu/news/will-low-income-countries-be- vaccines arrive?’ 9 low- November. https://globalhealth. ‘Will (2020) income countries beleftbehindwhenCOVID-19 Institute Health Global Duke its-infancy-can-be-developed-153204 production-in-south-africa-how-an-industry-in- https://theconversation.com/vaccine- January. developed’. be ‘Vaccine can infancy (2021) F. Kirstein, production inSouth Africa:how anindustryinits and J., Dorfman, 2 Jnay www.bmj.com/content/372/ January. 29 , 2 Arl www.youtube.com/ April. 26 , G20 RiyadhSummit Leaders Declaration 22) Te rms ad eis of perils and promise ‘The (2021) Quartz Africa Quartz The Conversation British Medical The Lancet , 1 October. 1 , . https:// . , 20 , 17 . .M (04 ‘elh ytm ot f delivering of cost routine vaccinationinlow- andlower-middle system ‘Health (2014) J.-M. Lydon, P., Gandhi, G., Vandelaer, J., and Okwo-Bele, income countries’. value to increase vaccineimpactinlow andmiddle- the ‘Evaluating (2015) proposition for improving al. vaccinethermostability et C.L., Karp, trade/covid-19-and-tourism_d284a4dd-en thecommonwealth-ilibrary.org/commonwealth/ Trade Hot Topics States’. Small forRecovery Resilient Sustainable, a Kampel, K. (2020) ‘COVID-19 and Tourism: Charting islands-threatened-by-covid-19 Articles/2020/05/27/na-05272020-pacific- Focus Islands Threatened byCOVID-19’, ‘Pacific (2020) (IMF) Fund Monetary International #EB uploads/2020/05/ICAO-Update-05112020.pdf https://tiaca.org/wp-content/ Bulletin May. 11 Electronic 2020/30, operations)’. (Cargo pandemic crew the COVID-19 protectflight during pandemics thinkglobalhealth.org/article/trade-time- of time the pandemics’. in ‘Trade (2021) N. Okonjo-Iweala, com/articles/d41586-020-02774-8 access’. has Africa ensure to how vaccines: ‘COVID-19 (2020) T. Raji, and Tshangela, A., N., Ndembi, J.N., Nkengasong, 500000-covid diplomacy-caricom-asian-nation-donates- http://jamaica-gleaner.com/article/ business/20210127/india-extends-vaccine- January. 500,000 region’. the donates to doses COVID-19 nation Asian CARIOCOM: to diplomacy vaccine extends Medley,‘India (2021) H. 14f3-4226-a3e8-df1ee83e5692 Times campaign’. vaccine for chain” “cold out map to grapple ‘Logisticians (2020) D.P. Mancini, Africa’. learned from theWestern CapeProvince inSouth the privatesector: theevidenceandlessons Zaffran, (2015) logistics ‘Outsourcing M. vaccine to Raubenheimer,Lydon,Arnot-Krüger,P., and T., M., 92: 382–384. decade?’ income countries: whatisneededoverthenext My 7 https://www.imf.org/en/News/ 27. May , , 8 October. www.ft.com/content/c71d254c- Vaccine Bulletin oftheWorld HealthOrganization Think GlobalHealth , 33(29):3429–3434. Nature Vaccine Ise 13 https://www. #163. Issue , , 6 October.www.nature.6 , , 33(30):3471–3479. , 28 January. www. 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Issue 172 | 2021 | Page 11 Issue 172 | 2021 | Page 12 htu E, any M, htkr S, n Mle, R. Miller, ‘Reorganizingsupplychain (2016) vaccine Nigeria’s and S., Whitaker, M., Harnly, E., Shittu, countries agreements-renew-vaccine-hopes-developing- umn.edu/news-perspective/2020/12/new-covax- countries’. News CIDRAP developing for hopes agreements vaccine COVAX renew ‘New (2020) L. Schnirring, vaccine-faces-widespread-criticism India-s-abrupt-approval-of-local-coronavirus- english.alarabiya.net/coronavirus/2021/01/06/ criticism’. of localcoronavirus vaccinefaces widespread Reuters, Bengaluru (2021) ‘India’s “abrupt” approval version-9sept.pdf covid19-vaccine-allocation-final-working- who.int/docs/default-source/coronaviruse/who- COVID-19 HealthProducts Concept forFair Access andEquitable Allocationof World HealthOrganization (WHO)(2020b) transcript-who-actlaunch-24apr2020.pdf docs/default-source/coronaviruse/transcripts/ ACT Accelerator Launch World HealthOrganization (WHO) (2020a) COVID-19 caricom-countries-shopping-around-vaccines/ http://amsterdamnews.com/news/2021/feb/04/ aroundfor vaccines’. shopping countries‘CARICOM (2021) B. Wilkinson, TradeHotTopics_THT_Covid_No1_B_Vickers.pdf org/sites/default/files/inline/D17111_V5_TRD_ Hot Topics countries’. Commonwealth for challenges COVID-19-related medicalgoods:issuesand ‘Tradein (2020) C. Zhuawu, and S., Ali, B., Vickers, https://www.un.org/press/en/2021/ sc14438.doc.htm February. Doses’. of Availability Equitable Community, asSecurity Council Considers Global Testfor Moral ‘Secretary-General Biggest Equity Vaccine Calls (2021) (UN) Nations United news/world-africa-55751714 vaccine’. Covid-19 the for wait long ‘Africa’s (2021) A. Soy, 197–219. Journal ofHealthEconomics andManagement nationwide countries’. African forin delivery vaccine ‘Challenges (2018) M. Songane, 300. more storage is required’. reduces needfor additionalstorage facilities, but BBC News , Issue #159. https://thecommonwealth. Alarabaya News 1 Dcme. https://www.cidrap. December. 18 , 2 Jnay www.bbc.co.uk/ January. 22 , Amsterdam News 2 Arl www.who.int/ April. 24 , Health Affairs 6 aur. https:// January. 6 , 9 etme www. September 9 . Press Release , 4 February. 4 , International , 35(2): 293– , 18(2): Trade WHO , 17 docs.wto.org/dol2fe/Pages/SS/directdoc. and South Africa Treatment of COVID-19: Communication from India Agreement for the Prevention, Containment and (2020) World Trade Organization (WTO) TRIPS Council vaccine_report_e.pdf www.wto.org/english/tratop_e/covid19_e/ An InformationNote aboutIssueswithTrade Impact and World Trade Organization (WTO) (2020) Developing trips_e.htm www.wto.org/ November. english/thewto_e/minist_e/min01_e/mindecl_ 20 MIN(01)/DEC/2, on theTRIPS Agreement andPublic Health World Trade Organization (WTO) (2001) distribution-forecast forecast’. item/03-02-2021-covax-publishes-first-interim- distribution interim Statement first publishes ‘COVAX (2021) (WHO) Organization Health World who-wipo-wto_2020_e.pdf and Trade between Public Health,Intellectual Property Rights Medical Technologies and Innovations: Intersections Organization (WHO)(2020) Property Organization (WIPO)andWorld Health World Trade Organization (WTO), World Intellectual aspx?filename=q:/IP/C/W669.pdf&Open=True Delivering COVID-19 Vaccines around theWorld: Waiver from Certain Provisions oftheTRIPS . www.wto.org/english/res_e/booksp_e/ . 3 eray www.who.int/news/ February. 3 , . IP/C/W/669, 2 October. https:// October. 2 IP/C/W/669, . Promoting Access to Declaration WT/ . . Table A1. COVID-19 infections, vaccine deployment and COVAX vaccine allocations to Commonwealth member countries

COVID-19 Statistics (as of 23.02.21) Interim COVAX vaccine allocation Vaccination progress Health Expenditure (% of GDP)

Total cases Total deaths Total tests AZ/SII (indicative AZ/SKBio Pfizer-BioNTech Total allocation Total vaccinations % of population distribution) (indicative (exceptional vaccinated distribution) allocation)

World 111,285,971 2,485,417 225,792,000 93,072,000 1,200,420 320,064,420 214,552,448 1.33 9.8

Commonwealth 19,960,583 384,762 349,501,078 165,288,000 8,779,200 225,810 174,293,010 30,267,615

by region

Africa

Botswana 27,721 300 - 117,600 - 117,600 - 5.8

Cameroon 33,749 523 2,052,000 - - 2,052,000 - 3.5

Eswatini 16,839 647 108,000 - - 108,000 - 6.5

The Gambia 4,612 146 180,000 - - 180,000 - 3.1

Ghana 80,759 582 702,316 2,412,000 - - 2,412,000 - 3.5

Kenya 104,500 1,837 571,950 4,176,000 - - 4,176,000 - 5.2

Lesotho 10,467 291 156,000 - - 156,000 - 9.3

Malawi 31,106 1,024 57,004 1,476,000 - - 1,476,000 - 9.3

Mauritius 610 10 - 100,800 - 100,800 - 5.8

Mozambique 56,595 606 388,898 2,424,000 - 2,424,000 - 8.2

Namibia 37,896 411 278,027 - 127,200 - 127,200 - 8.0

Nigeria 153,187 1,874 702,055 16,008,000 - - 16,008,000 - 3.9

Rwanda 18,325 253 772,539 996,000 - 102,960 1,098,960 - 7.5

Seychelles 2,514 11 36,571 37.19 5.1

Sierra Leone 3,862 79 612,000 - - 612,000 - 16.1

South Africa 1,505,586 49,413 8,763,719 - 2,976,000 117,000 3,093,000 30,055 0.05 8.3

Tanzania 509 21 - 3.6

Uganda 40,243 333 536,511 3,552,000 - - 3,552,000 - 6.5

Zambia 75582 1040 1005232 1,428,000 - - 1,428,000 - 4.9

Asia

Bangladesh 544,116 8,374 3,944,744 12,792,000 - - 12,792,000 1,453,547 0.88 2.3

Brunei Darussalam 185 3 - 100,800 - 100,800 - 2.4

India 11,030,176 156,567 204,644,073 97,164,000 - - 97,164,000 11,443,075 0.83 3.5

Malaysia 288,229 1,076 5,667,000 - 1,624,800 - 1,624,800 - 3.8

Maldives 19,038 60 462,908 108,000 - 5,850 113,850 84,230 15.58 9.4

Issue 172 | 2021 | Page 13 Issue 172 | 2021 | Page 14

Pakistan 574,580 12,708 8,309,695 17,160,000 - - 17,160,000 - 3.2

Singapore 59,883 29 - 288,000 - 288,000 2,800 0.05 4.5

Sri Lanka 81,009 453 2,028,870 1,692,000 - - 1,692,000 366,907 1.71 3.8

Caribbean and Americas

Antigua and Barbuda 636 14 - 40,800 - 40,800 - 5.2

The Bahamas 8,477 179 - 100,800 - 100,800 - 6.2

Barbados 2,852 31 - 100,800 - 100,800 14,599 5.08 6.6

Belize 12,264 314 - 100,800 - 100,800 - 5.7

Canada 857,403 21,761 17,386,997 1,903,200 - 1,903,200 897,225 2.38 10.8

Dominica 141 28,800 - 28,800 - 6.6

Grenada 148 1 45,600 - 45,600 - 4.5

Guyana 8,452 190 100,800 - 100,800 - 5.9

Jamaica 21,826 405 130,117 146,400 - 146,400 - 6.1

St. Kitts and Nevis 41 - 21,600 - 21,600 - 5.3

Saint Lucia 3,142 32 - 74,400 - 74,400 - 4.4

St. Vincent and the Grenadines1,511 6 - 45,600 - 45,600 - 4.5

Trinidad and Tobago 7,686 139 89,994 - 100,800 - 100,800 - 6.9

Europe

Cyprus 33,567 230 2,047,291 - 6.8

Malta 21,306 306 577,153 54,629 12.37 9.0

United Kingdom 4,146,760 121,536 79,822,182 15,880,998 23.39 10.0

Pacific

Australia 28,939 909 9,149,803 2,879 0.01 9.3

Fiji 56 2 23,914 100,800 - 100,800 - 3.4

Kiribati 48,000 - 48,000

Nauru - 7,200 - 7,200

New Zealand 2,365 26 1,438,086 - 249,600 - 249,600 100 0.00 9.2

Papua New Guinea 1,111 10 684,000 - - 684,000 - 2.4

Samoa 3 - 79,200 - 79,200 - 5.2

Solomon Islands 18 108,000 - - 108,000 - 4.5

Tonga - 43,200 - 43,200

Tuvalu - 4,800 - 4,800

Vanuatu 1 - 100,800 - 100,800 - 3.4 Note: This interim COVAX distribution is only for the first and second quarters of 2021. Note: Tanzania and the Seychelles are excluded. Tanzania has opted out of this initiative. The Seychelles has expressed interest in the COVAX Facility and is yet to be included. Source: WHO (2021). ebr. h IP prah s o cn h tae n dvlpet adcp fr ra wee orthodox where areas for landscape development and trade the scan to is approach ITP The members. development issuesandproviding informed inputsinto therelated discourses involvingCommonwealth ITP isentrustedwiththeresponsibilities ofundertakingpolicy-oriented research andadvocacyontrade and and governments member among co-operation and countries in the common interest consultation of their peoples and in the promotion of international consensus-building. facilitating – economies island and association of54independentcountries, comprising large andsmall,developeddeveloping,landlocked an – Commonwealth the of agency intergovernmental main the is which Secretariat, Commonwealth the This Trade Hot Topic isbrought outbythe InternationalTrade Policy(ITP)SectionoftheTrade Divisionof Commonwealth Secretariat International Trade PolicySectionatthe developed countries (LDCs), smallstatesandsub-Saharan Africa. least – constituencies Commonwealth vulnerable highly on particularly impact that environment trading international the in issues emerging to response quick enable to flexible is plan work Its those. address to approaches are ineffective or where there are public policy failures or gaps, and to seek heterodox approaches Commonwealth members. consensus-building onissuesofinterest to of ideas, disseminatinginformed inputs, and workshops/dialogues for facilitating exchange related development issues, and supporting on arange of trade policy, emerging trade- arrangements, undertakinganalytical research Trade Organization and various regional trading member statesintheirnegotiations intheWorld ITP’s mostrecent activitiesfocus onassisting ITP Recent Activities • • • areas: ITP undertakes activities principally inthree broad Scope ofITPWork t otiue t te rcse involving processes the to contributes It and consultations research, policy conducts It members developing Commonwealth supports It Saharan Africa. particularly, smallstatesandLDCs andsub- of Commonwealth developingcountry participation members, beneficial more advance that the multilateral andbilateral trade regimes of policyoptionsfor successfuladaptation. changing international trading environment and advocacy to increase understanding ofthe through expandedtrade. friendly outcomes, notably theireconomic growth trade agreements thatpromote development in theirnegotiation ofmultilateral andregional

Supported byITP Selected Recent Meetings/Workshops Geneva, . Governance for 21stCentury Challenges,’ heldin Publication ‘WTO Reform: Reshaping GlobalTrade 26 June2019:LaunchoftheCommonwealth Studies ofSri Lanka Lanka incollaboration withThe Institute ofPolicy Fourth IndustrialRevolution heldinColombo, Sri Summit XII:ShapingSouth Asia’sFuture inthe 26–27 September2019:12thSouth AsiaEconomic Kingdom. Meeting heldatMarlborough House,London, United 10 October 2019:Commonwealth Trade Ministers and theUNWTO. Geneva, Switzerland incollaboration withtheWTO InclusiveApproach (WTO PublicForum) heldin of SmallEconomies: ATransformative and 11 October 2019:Tapping theTourism Potential London, UnitedKingdom. Integrated Framework) heldatMarlborough House, LDC Graduation (inpartnership with theEnhanced Shocks intheCommonwealth: Natural Disasters and 28 January2020:Roundtable DiscussiononTrade House, London, UnitedKingdom. Policy Dialogue,Bangladesh)heldatMarlborough the OECDDevelopmentCentre andtheCentre for Reflection by the LDV IV Monitor (in partnership with 29 January2020:Looking to LDC V:ACritical Development Centre, UN-OHRLLSandFERDI. Countries (LDC5)incollaboration withtheOECD the FifthUNConference onLeastDeveloped LDC IVMonitor andheldvirtually ontheroad to Resources, organised intheframework ofthe Tackling Vulnerabilities andLeveraging Scarce 21–23 October 2020:Recovery from COVID-19 –

Issue 172 | 2021 | Page 15 Issue 172 | 2021 | Page 16 please [email protected] For furtherinformation orto contribute to theSeries, Directorate oftheCommonwealth Secretariat Produced byTrade, Oceans andNatural Resources Series editor: Brendan Vickers Commonwealth Secretariat andinternationalexperts. analyses ontrade andrelated issues, prepared both by publication whichprovides concise andinformative Commonwealth Trade Hot Topics isapeer-reviewed ISSN: 2071-8527(print)ISSN: 2071-9914(online) Topics Trade Hot Issue 166: Issue 167: 168: Issue Issue 169: Issue 170: Issue 171: Topics Series Commonwealth Trade Hot Previous Ten Issuesofthe Issue 162: Issue 163: Issue164: Issue 165:

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