SAGE Extraordinary Meeting Update on Recent Developments Including COVAX

SAGE Extraordinary Meeting Update on recent developments including COVAX

May 27 2021

Dr. Kate O’ Brien Director, Department of Immunization, Vaccines and Biologicals

1 DATA AS OF 27 MAY 10:00AM CET 1,742M doses of COVID-19 vaccine have been administered 1 in 210 countries, areas, territories & economies 2

COVAX has shipped 72.0M doses to 125 participants 4 1,742M vaccine doses 1 have been administered globally Campaigns have not yet started in 10 countries, economies & territories 2

Note: The designations employed and the presentation of these materials do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 1. Source of data: Bloomberg; 2. Total of 220 countries, areas, territories & economies: 218 economies listed by World Bank + WHO Member states Cook Islands + Niue 3. WHO COVID-19 Dashboard at https://covid19.who.int/ ; 4. Including donations of doses through COVAX 2 PRELIMINARY – THIS LIST MAY NOT BE EXHAUSTIVE DATA AS OF 25 MAY 10:00AM CET Of the 15 COVID-19 vaccines now in use, AstraZeneca & Pfizer products remain the most prevalent

SII - Covishield only AstraZeneca - Vaxzevria only Unspecified or both

Vaccine Number of countries & economies using the vaccine

AstraZeneca - Vaxzevria / SII - Covishield 87 57 28 172

Pfizer BioNTech - Comirnaty 113

Beijing CNBG - BBIBP-CorV (Sinopharm) 66

Moderna - mRNA-1273 61

Gamaleya - Gam-Covid-Vac (Sputnik V) 55

Janssen - Ad26.COV 2-S 46

Sinovac - CoronaVac 35

Bharat - Covaxin 10

Novavax - Covavax 5

Wuhan CNBG - Inactivated 5

CanSino - Convidecia 4

SRCVB - EpiVacCorona 2

Anhui ZL - Recombinant 1

32 economies are using 1 vaccine; 177 are using 2 or more vaccines

1. World Bank classification (2021) of 218 economies. Note: The term country, used interchangeably with economy, does not imply political independence but refers to any territory for which authorities report separate social or economic statistics.

Source: Our World in data, WHO, Government websites; Press research 3 DATA AS OF 25 MAY 10:00AM CET Inequity is decreasing, but HICs have administered 69x more doses per inhabitant than LICs

HIC UMIC LMIC LIC Worldwide COVID-19 doses administered per 100 population Average per income group

60 53.5 50

40 Switch to WHO data

30 source 20.2 20 19.1

10 8.3 0 0.8 Dec Jan Feb Mar Apr May

Ratio of 10,000x 200x 84x 69x HIC to LIC 0 doses in LICs

SOURCE: Our World in Data (Dec-Mar 7); WHO Dashboard (Mar 12 onwards); source for income groups: World Bank. Using the latest available values for each week. 4 DATA AS OF 25 MAY 10:00AM CET Mongolia and Bhutan are the only LMIC/LIC that have achieved theoretical coverage of >20% 1

HIC UMIC LMIC LIC Median Cumulative COVID-19 doses administered per 100 population

240 40 doses / 100 120 population corresponds to at least 20% 100 Maldives theoretical coverage, assuming most vaccine 80 American Samoa Mongolia types require two doses 60 Serbia Dominica Bhutan 40 40

20 (>20%) 0 HIC UMIC LMIC LIC

Income group HIC UMIC LMIC LIC

Population , millions 1,238 2,872 2,954 686

Population in economies 887 8 4 0 above 40 d/100, millions and % 73.6% 0.3% 0.1% 0.0%

Economies above 40 d/100, # 51 5 2 0 and % of total 61.4% 8.9% 4.0% 0.0%

1. As defined by 40 doses administered per 100 population (at least 20% theoretical coverage, assuming most vaccine types require two doses)

SOURCE: WHO COVID-19 Dashboard using the list of economies by the World Bank 5 DATA AS OF 20 MAY 6:00PM CET While more than 20% of global deals, shipped COVAX doses represent only 4.9% of doses administered globally

COVAX deals vs global Ratio of COVAX doses delivered to total doses administered worldwide, deals 1 expressed as %

18,692 Ratio COVAX/ total 1 st COVAX delivery to India (17 Jan 2021)

24.6% Strong increase of doses 25 administered globally HIC 1 st COVAX international (esp. driven by China) shipment while COVAX supply is 20 (24 Feb 2021) stagnating due to India crisis and SII shortfall (20 May 2021) UMIC 15 LMIC 10 6.4% LIC 4.9% 4.7% AU 5 20.7% COVAX 0% 0 Deals Dec Jan Feb Mar Apr May

6 Source: Our world in Data (until 7 March), WHO COVID-19 Dashboard (12 Mar and following), COVAX (for deliveries) Overview of WHO EULs ands SAGE recommendations

Past date Earliest expected date

Sept/Oct 2020 Dec 2020 Jan 2021 Feb Mar April May

WHO EUL Pfizer/BioNTech SII/AZ Janssen Moderna Sinopharm SinoVac Dec 31 Oxford/AZ 1 Mar 12 Apr 30 May 7 Others Feb 15 TBD

Sept/Oct 2020 Jan 2021 Feb Mar April May

Values Guidance on Interim recs Interim recs Interim recs Interim recs Interim recs Pfizer SinoVac Moderna framework prioritization of Pfizer/BioNTech Moderna Oxford/ Janssen Sinopharm Others target AstraZeneca J&J update Sep 14 Jan 5 Jan 25 Mar 17 May 7 TBD SAGE populations Feb 8 meetings & Nov 13 Update 21 April policy recommendations

1. MFDS Korea EUL finalized Feb 15. EMA SK-Catalent followed Apr 16 and Wuxi (DS) Apr 30 https://www.who.int/publications/i/item/who-sage-values-framework-for-the-allocation-and-prioritization-of-covid-19-vaccination https://www.who.int/publications/m/item/who-sage-roadmap-for-prioritizing-uses-of-covid-19- vaccines-in-the-context-of-limited-supply https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-BNT162b2-2021.1 https://www.who.int/publications/i/item/interim-recommendations-for-use-of-the-moderna-mrna-1273-vaccine-against-covid-19 7 Misaligned supply expectations, low Vx rollout and low Vx confidence as particularly high risks to fast delivery

Supply/shipment risks Programmatic/operational risks

A Misaligned supply expectations Very high E Countries not ready to implement High

B Highly fragmented supply and delivery High F Low vaccine uptake/roll out Very high

C Changes in product preferences High G Negative impact on health services High

High H D Lack of ‘shipment readiness’ Insufficient operational funding High

I Multiple products in one country High

J Reduced/low vaccine confidence Very high

K High/negative wastage rate High

L Target populations missed High

M Serious adverse events not detected High

Source: WHO 8