By Philip Loft

22 September 2021 Covax and global access to Covid-19 vaccines

Summary 1 The pandemic 2 Covax 3 How is Covax performing? 4 International support for Covax

commonslibrary.parliament.uk Number 9240 Covax and global access to Covid-19 vaccines

Disclaimer The Commons Library does not intend the information in our research publications and briefings to address the specific circumstances of any particular individual. We have published it to support the work of MPs. You should not rely upon it as legal or professional advice, or as a substitute for it. We do not accept any liability whatsoever for any errors, omissions or misstatements contained herein. You should consult a suitably qualified professional if you require specific advice or information. Read our briefing ‘Legal help: where to go and how to pay’ for further information about sources of legal advice and help. This information is provided subject to the conditions of the Open Parliament Licence.

Feedback Every effort is made to ensure that the information contained in these publicly available briefings is correct at the time of publication. Readers should be aware however that briefings are not necessarily updated to reflect subsequent changes.

If you have any comments on our briefings please email [email protected]. Please note that authors are not always able to engage in discussions with members of the public who express opinions about the content of our research, although we will carefully consider and correct any factual errors.

You can read our feedback and complaints policy and our editorial policy at commonslibrary.parliament.uk. If you have general questions about the work of the House of Commons email [email protected].

2 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Contents

Summary 5

1 The pandemic 8

1.1 Impact 8

1.2 Vaccination and recovery 8

2 Covax 10

2.1 A global solution? 10

2.2 Participants 10

2.3 Scheme for low and lower-middle income economies 12

2.4 The future of Covax 14

3 How is Covax performing? 15

3.1 Procurement and deliveries 15

3.2 Vaccines to low-income countries 16

3.3 How will demand to be met? 19

4 International support for Covax 23

4.1 How many vaccines has the UK provided to individual countries? 23

4.2 Funding 23

4.3 Pledges to share vaccines 26

3 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

4 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Summary

The development of Covid-19 vaccines offers a potential pathway towards global recovery.

However, the purchasing and administration of vaccines has been dominated by richer economies. As of 17 September 2021, only 2% of people in low income countries (having a GNI per capita below US $1,045) have had at least one vaccine dose, compared to 67% in high income states (GNI per capita above US$ 12,696).

The UK, and the US are amongst the countries who have also secured agreements for vaccine doses several times their population need.

The Covax initiative was established in April 2020 by the World Health Organization (WHO), Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations. It aims to ensure fair access to Covid-19 vaccines, and to accelerate their production. For 92 low-income economies, Covax intends to donate sufficient doses to vaccinate around 30% of their populations in 2021-2022.

Funding for Covax is the primary support the UK gives to vaccination campaigns overseas, although the Prime Minister announced in June that the UK will donate 100 million Covid-19 vaccines by June 2022.

This briefing sets out how the Covax scheme works, and the challenges faced in administrating vaccine campaigns in Africa, , and the . Section 4 details the contributions of the UK and other high and upper-middle income economies to Covax and the distribution of vaccines.

How does Covax work? The Covax scheme uses funding from donors and self-financing members to support the research, manufacture, and distribution of Covid-19 vaccines. It currently has agreements to offer eight types of vaccine and to potentially purchase up to 4.3 billion doses. Around 740 million vaccines have also been donated to Covax.

While its paying members, such as Canada, and are required to pay for the vaccines procured via Covax, eligible low and lower- middle income economies can receive doses for free. This includes , , , , and . To ensure fairness, all states will first receive doses in proportion to their population until 20% of the population are vaccinated.

5 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Vaccine procurement and the pandemic in In March 2021, the rollout of Covax vaccines began. Despite the goal to distribute 170 million doses by 31 May, only 76 million were delivered. In July, Gavi estimated that Covax would deliver 2.2 billion doses by January 2022, but this estimate was reduced in September to 1.4 billion by the end of 2021.

Delays are due to increased domestic demand and the Indian Government halting the export of vaccines as the pandemic worsened in that country. The Serum Institute of India is one the largest global manufacturers of vaccines and was due to provide 1.1 billion doses to Covax. The Indian Government now intends for exports to resume in the final quarter of 2021.

Calls to share vaccines The WHO set a goal to vaccinate 10% of the population of every country by September, and 40% by December 2021. However, in July the WHO’s Director General, Tedros Adhanom Ghebreyesus, said the world “remains way off” achieving this target.

The WHO has previously called for higher-income countries to delay child vaccines and share doses with Covax. It has also opposed booster programmes, which some countries, such as the UK, are intending to carry out. In September, its Director General said no further booster shots should be administered during 2021 and the doses instead be made available to poorer countries.

In September, the APPG on Coronavirus said the UK Government should share doses to vaccinate low-income countries before giving booster jabs to healthy over-50s in the UK. The Health Secretary, Sajid Javid, has said the Government is implementing the advice of the Joint Committee on Vaccination and Immunisation in administering the booster jabs.

G7 and other pledges to donate vaccines Several countries, including the US and UK, have pledged to share doses, primarily via Covax. In June 2021, G7 members pledged to share one billion doses by June 2022, half of which will come from the US. This includes 870 million via Covax, of which half will be delivered by the end of 2021.

Within this pledge, the UK committed to donate 100 million doses by June 2022; 80% will be distributed via Covax. Since April 2020, the UK has committed £548 million to the Covax scheme (this does not include the value of the donated doses).

In September, the US, , and announced they would increase their donations. The Biden Administration has now pledged to share an additional 500 million doses, bringing the US total pledge to 1.1 billion.

To September, the UK donated 10.3 million doses: 6.2 million via Covax and 4.1 million directly with other countries. The UK has come to agreements to

6 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

share doses with countries in Africa, Asia and the Americas. These include , , , and Thailand.

While the WHO has welcomed the G7’s pledge, its Director has said the doses are needed “now” rather than next year. In July, the UN warned that almost 75% of countries requiring humanitarian aid had recorded more cases or deaths from Covid-19 than in all of 2020.

7 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

1 The pandemic

1.1 Impact

Since January 2020, globally there have been over 226.8 million confirmed Unless otherwise cases of Covid-19 and 4.7 million deaths. 1 In May, World Health Organization stated, all data (WHO) experts estimated total deaths could be as high as 6 to 8 million, if covers the period to those due to indirect factors such as reduced hospital capacity are 2 20 September 2021 included. The World Bank (WB) estimated the pandemic pushed 97 million people into poverty in 2020. 3 In April 2021, 90% of countries reported disruption to their health systems and in 2021 two-thirds of the world’s student population has already experienced school closures. 4

1.2 Vaccination and recovery

International bodies have said the rollout of vaccination programmes is necessary to save lives, reduce the likelihood of new variants of concern, and enable economic recovery. 5 It is uncertain what proportion of the population needs to be vaccinated to safely achieve global immunity, but it is likely to be above 60%. 6

In 2021, the WB estimates that global growth will be 5.6%, but there will be substantial variation between countries. Low-income economies are likely to expand by 2.8%, partly due to their slow pace of vaccination. 7 In July, the UN

1 WHO, Covid-19 dashboard, update 20 September 2021 2 Al Jazeera, Covid-19 death tolls likely a “significant undercount,” 21 May 2021 3 WB, Updated estimates of the impact of Covid-19 on global poverty, 24 June 2021 4 WHO, Covid-19 continues to disrupt essential health services in 90 percent of countries, 23 April 2021; UNESCO, One year into Covid-19 education disruption: Where do we stand?, 19 March 2021 5 Organisation for Economic Co-operation and Development (OECD), Access to Covid-19 vaccines: Global approaches in a global crisis, 18 March 2021; WB, Financing for Covid-19 vaccine rollout reaches $2 billion, 20 April 2021; UN, Secretary-General calls vaccine equity biggest moral test for global community […], 17 February 2021; UN, Inequity of Covid-19 vaccines grows “more grotesque every day”—WHO chief, 22 March 2021 6 WHO, Covid-19: Herd immunity, lockdowns and Covid-19, 31 December 2020; New York Times, How much herd immunity is enough?, 2 April 2021 7 WB, Global recovery strong but even as many developing countries struggle […], 9 June 2021

8 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

reported almost 75% of countries requiring humanitarian aid had recorded 8 more cases or deaths from coronavirus in 2021 than in all of 2020.

8 The Independent, UN: Covid hitting poor and conflict nations worse this year, 27 July 2021

9 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

2 Covax

2.1 A global solution?

Access to Covid-19 vaccines has been unequal. 9 As of 17 September 2021, 2% Covax is an of people in low-income countries had received one dose, compared to 67% abbreviation of in high income states. 10 Covid-19 Vaccines Global Access In April 2020, Covax was established as a global initiative to ensure equitable access to Covid-19 vaccines between countries, regardless of their income level. It functions by pooling global funding to invest in the research, manufacture, purchase, and distribution of vaccines.

Vaccines are either distributed at a cost for participating higher-income states or as donations to eligible low- and middle- income countries. Covax seeks to allocate vaccines fairly, distributing them according to population size and need. 11

It is jointly directed by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the vaccine alliance, and the WHO. UNICEF is a is a key delivery partner.

Funding for Covax is the primary support the UK provides to vaccination campaigns overseas, including in Commonwealth countries.

2.2 Participants

Countries participate in one of two schemes.

Advance Market Commitment (AMC) for low- and middle- income countries The 92 low- and middle- income countries and economies include , Yemen, , and the West Bank and Gaza. They have a

9 International Rescue Committee, Excess Covid-19 vaccines secured by US, UK and EU […], 10 March 2021 10 Our World in Data, Share of people who received at least one dose of Covid-19 vaccine, accessed 20 September 2021 11 Gavi, Covax explained, 3 September 2020

10 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

total population of 3.9 billion. 12 They are eligible to request sufficient doses from Covax to cover 20% of their population in the first instance. 13

The AMC list includes all economies with a Gross National Income per capita of less than $4,045 and economies eligible for certain WB support. While India is included as one of the 92 AMC economies, accounting for 35% of their total population, Covax intends to provide around 7-9% population coverage in India in the near term, rather than 20%. 14 Gavi-COVAX AMC-eligible countries & economies At July 2020 Low-income Afghanistan Ethiopia Gambia Syrian Arab Republic The Burundi Guinea-Bissau Nepal Tanzania Central African Rep. Korea, Dem. People's Rep Congo Yemen, Rep Eritrea Madagascar Lower-middle income Sudan Timor-Leste India Cabo Verde Indonesia Kenya Pakistan West Bank and Gaza Kyrgyz Republic São Tomé and Congo, Rep Lao PDR Principe Côte d'Ivoire , Arab Rep. Micronesia World Bank International Development Association eligible economies St. Vincent and the Grenadines St. Lucia

Source: Gavi, 92 low- and middle-income economies eligible to access Covid-19 vaccines through Gavi Covax AMC, July 2020

12 WHO, Costs of delivering Covid-19 vaccine in 92 AMC countries, February 2021, table 2 13 International Development Association, Borrowing countries, accessed 24 May 2021; Gavi, 92 low- and middle- income economies eligible to get access [..], 31 July 2020 14 R. Agarwal and G. Gopinath, Annex 1: Existing pandemic financing options for LMICS in the IMF’s A proposal to end the pandemic, 19 May 2021

11 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Self-financing programme for high and upper-middle income countries The 76 participants of the self-financing programme include the UK, EU, , Canada, and China. 15 Although they are eligible to request doses for up to 50% of their populations, they will not receive doses via Covax for more than 20% until all 92 Advance Market Commitment countries have. 16 While Canada and have drawn upon Covax for their vaccines, the UK has not. 17

2.3 Scheme for low and lower-middle income economies

Funding and purchase Funding for the AMC is separate to the self-financing stream. It is funded through Official Development Assistance and private philanthropy—section 4.2 of this paper sets out commitments. 18

Once vaccines are licensed by the WHO, Covax purchases them on behalf of AMC economies. These economies may also cost-share further purchases with Covax in addition to their donor-funded allocation. 19

Vaccine rollout In 2021, Covax intends to use 1.3 billion doses to vaccinate up to 20% of the Gavi estimates 1.8 populations of 92 eligible economies. 20 This 20% will include priority groups billion doses will such as health workers, people aged over 65 and those under 65 with save between underlying health conditions. 21 Doses are received in proportion to state’s population size. 200,000 and 800,000 lives in In June, Gavi secured additional funding to deliver 1.8 billion doses for lower- participating AMC income economies in 2021 and early 2022, sufficient to cover 30% of the 22 economies population in AMC-eligible economies. In May 2021, Gavi said it intends to vaccinate half their adult populations by 2022. 23

15 HC Deb, 14 October 2020, c22WS; Covax, Self-financing countries, 12 May 2021 16 Gavi, Covax explained, 3 September 2020 17 BBC News, Covax: Canada defends taking vaccines from sharing scheme, 4 February 2021; The Guardian, Australia’s purchase from vaccine-sharing Covax stockpile under fire, 17 August 2021 18 Gavi, Covax explained, September 2020 19 Gavi, The Covax AMC explained, undated 20 WHO, Covax announces additional deals to access promising Covid-19 vaccine candidates,18 December 2020 21 WHO, Fair allocation mechanism for Covid-19 vaccines through the Covax facility, 9 September 2020, p25 22 Gavi, World leaders unite to commit to global equitable access to Covid-19 vaccines, 2 June 2021 23 Gavi, Japan to host Gavi’s Covax AMC summit, 12 May 2021

12 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Once countries have been allocated sufficient doses for 20% of their population, further doses will be made available based on vaccine availability, country need, vulnerability, and Covid-19 threat. 24

On average, AMC economies are seeking to cover 50% of their populations through Covax. 25

Distribution Participants must first develop a Covid-19 national delivery and vaccination plan, which is reviewed by the WHO, UNICEF, and others to ensure readiness criteria are met. This includes providing national regulatory approval for vaccines, setting budgets, and determining priority populations. 26 The UK supports governments to apply to the Covax AMC and to design their rollout plans. 27

Humanitarian buffer The Covax scheme plans to reserve 5% of Gavi Covax AMC funding for a “humanitarian buffer.” The planned 100 million vaccine doses for 2021 may be used in areas of state failure and conflict, and in regions controlled by non- state armed groups inaccessible to governments. It will also provide a contingency in cases of severe outbreaks where regular vaccine allocation timelines are insufficient. 28 Covax said in July the buffer was now operational and had nearly 15 million doses stockpiled. 29

Delivery of other support through Covax By the end of 2021, low- and middle- income countries are also intended to receive 900 million diagnostic tests. 30 By mid-2021, the WHO also aims to provide 245 million courses of treatment. 31 To June, the WHO’s ACT- accelerator had procured 22 million diagnostic tests and $177 million for diagnostics. 32 A review of the mechanism is expected in September/October 2021. 33

24 WHO, Access and allocation: How will there be a fair and equitable allocation of limited supplies?, 12 January 2021 25 Gavi, One world protected: The Gavi AMC investment opportunity, 2021, p8 26 WHO, Country readiness for Covid-19 vaccines, 19 February 2021 27 PQ 179634 [Coronavirus: Vaccination], 20 April 2021 28 Gavi, Gavi Board approves Covax for high-risk groups in humanitarian settings, 23 March 2021; Gavi, The Covax humanitarian buffer explained, 31 March 2021 29 Covax, The Humanitarian buffer, 27 July 2021 30 WHO, Act now, ACT together 2020-2021 impact report, April 2021, p9 31 WHO, ACT-accelerator update, 26 June 2020 32 WHO, ACT-accelerator update, 4 August 2021 33 WHO, ACT-accelerator: Strategic Review, accessed 22 September 2021

13 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

2.4 The future of Covax

Covax has drawn criticism from participants and commentors for being slow to procure and ship doses compared to bilateral donors. 34 In July 2021, Gavi stressed that while it has missed targets in 2021, it was on track to deliver 2.2 billion doses by January 2022. 35 However, Covax’s latest forecast, published in September 2021, said it is likely to have access to only 1.4 billion doses in 2021, with around 1.2 billion for low-income countries. It expects 2.6 billion doses will be available to it by the end of March 2022. 36

In June 2021, reported that Covax is expected to be reformed by Gavi to reduce its financial risks and concentrate on low- and middle- income participants. Many higher-income states are expected to withdraw from Covax, reducing membership from 190 to around 120-130 by 2022. 37

In July, Covax launched “Covax Marketplace,” which is designed to address bottlenecks in production. CEPI expect it will allow suppliers to reallocate unused materials to speed up production. 38

34 New York Times, Where a vast global vaccination program went wrong, 2 August 2021; Reuters, to give Covax ultimatum to ship vaccines, 5 July 2021; Politico, Amid fresh virus surge, Africa sets out to save itself on vaccines procurement, 7 July 2021 35 Seth Berkley in The Lancet, Covax: More than a beautiful idea, 14 July 2021 36 Devex, Covax reduces end-of-year forecast figures, 8 September 2021; WHO, Joint Covax statement on

supply forecast for 2021 and early 2022, 8 September 2021 37 Reuters, Let down by rich and failing the poor, global vaccine scheme to be shaken up, 23 June 2021 38 CEPI, CEPI launces Covax marketplace to match buyers and sellers {…], 15 July 2021

14 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

3 How is Covax performing?

3.1 Procurement and deliveries

Covax has procured around 5.3 billion doses of Covid-19 vaccines for its self- funding and AMC-eligible participants, including 740 million donated doses. It aims to offer 10-12 different vaccines, and currently has agreements for eight, including AstraZeneca/Oxford and Pfizer. 39 It estimates for AMC countries, the cost to Covax will be around US$ 3.70 per person vaccinated with two doses. 40

Covax has procured the largest highest Covax has shipped around 296 million doses number of doses globally Includes potential vaccine deals and donations To 20 September 2021

5.3bn 4.4bn 451.0m 296.0m 2.5bn 2.3bn

0.7bn 0.7bn 0.6bn 0.5bn

Covax EU USA India Brazil Canada Japan UK Doses allocated Delivered

Note: Data covers publicised advanced market commitment by country, including potential doses purchased, those secured by donation, and doses purchased. Totals for countries do not include any allocations from Covax. Potential doses purchased may include those still subject to technical success and regulatory approval.

Sources: Duke Global Innovation Centre, Vaccine purchases, accessed 20 September 2021; UNICEF, Covid-19 market dashboard, accessed 20 September 2021 The first international Covax shipment took place in February 2021. 41 By 20 September 2021, Covax delivered nearly 296 million doses. 42

39 Gavi, Gavi signs agreement with Johnson and Johnson […], 21 May 2021 40 WHO, Costs of delivering Covid-19 vaccine in 92 AMC countries, February 2021, section 5.5 41 WHO, Covid-19 vaccine doses shipped by the Covax facility head to Ghana, 24 February 2021 42 WHO, Director General’s opening remarks at the World Health Assembly, 24 May 2021

15 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

The pandemic in India Due to the extent of the pandemic in India and the Indian Government placing export restrictions on vaccines in March, it was estimated that by June 2021, Covax would be around 190 million doses behind schedule. 43

The Serum Institute of India is the largest single supplier to the Covax scheme and was due to supply a total of 1.1 billion doses. 44 India is now expected to resume vaccine exports in the final quarter of 2021. 45 In August, Reuters reported the Institute is now producing 150 million doses a day, up from 65 million a day in April. 46

The loss of donations and exports from India raised concerns that AMC countries will not receive enough vaccines to administer second doses. The WHO has recommended countries prioritise first doses and requested manufacturers bring forward deliveries pledged for later in the year. 47

Following the loss of vaccines from India, Covax secured further vaccine agreements. However, these did not result in deliveries until the second half of 2021. 48 As stated above in section 2.4, Covax has had to reduce its forecasted projections on the number of vaccines it can deliver.

3.2 Vaccines to low- Projected Covax AMC vaccine income countries supply in 2021 South Asia 626m Sub-Saharan Africa 595m In April 2021, Covax planned to East Asia & Pacific 328m provide nearly 1.8 billion doses to Middle East & 135m AMC countries in 2021. Asia and & Central Asia 55m Africa would receive the largest Latin America & 27m totals. Total 1,766m Note: Includes requested doses only. Source: Gavi, Covax AMC investment opportunity, Africa April 2021, figure 5 The WHO aims for African states to receive 600 million vaccines in 2021, including from sources other than Covax. 49 The initial aim had been to supply 720 million doses in 2021, for a

43 Devex, India crisis puts Covax 150 million doses behind schedule, 10 May 2021 44 UNICEF, Executive Director […] remarks at briefing on Covax, 3 February 2021 45 Reuters, India unlikely to resume sizable COVID-19 vaccine exports until October, 18 May 2021; Al- Jazeera, India to resume Covid vaccine exports to Covax, neighbours, 20 September 2021 46 Reuters, India’s Covid vaccine supply jumps, raising export hopes, 30 August 2021 47 WHO, Risks and challenges in Africa’s Covid-19 vaccine rollout, 14 April 2021; WHO, Covid-19 virtual press conference-transcript, 17 May 2021 48 Gavi, Gavi signs agreement with Novavax to secure doses […], 6 May 2021. 49 WHO Africa, Covid-19 vaccines, accessed 9 July 2021

16 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

population of 1.3 billion. 50 The WHO hopes that through Covax and other partners, such as the African Union, 30% of the African population will be vaccinated by February 2022, down from an initial target of 60% by the end of 2021. 51

The rollout of Covax-delivered doses began in March 2021. 52 Around 90 million Only 2% of global doses were intended to be delivered in the first half of 2021, to immunise 3% vaccines have been of the population of Africa most in need of protection. 53 On 16 September administered in 2021, the WHO said only around 470 million doses are expected to be 54 Africa (to 20 delivered by December, enough to vaccinate 16% of the continent. The WHO has also estimated that 80% of African countries will miss the target to September 2021). vaccinate 10% of their populations by the end of September 2021. 55

The WHO has said vaccine rollouts have been delayed by logistical challenges, such as difficulty in reaching remote locations, and funding shortfalls, which limits communication, training, and data recording. Several states have returned their doses, because of vaccine hesitancy and gaps in local health systems limiting their capacity to rollout vaccines quickly. 56

Gaps in data has resulted in the vaccination of some non-priority groups. 57 Around 450,000 doses have also had to be destroyed from March to July as they had expired. 58

The African Union has secured 400 million doses. China, India, and the United Arab Emirates (UAE) have also donated vaccines. 59

In May, the WB estimated sub-Saharan African states face a funding shortfall of $12.5 billion to vaccinate more than 20% of their populations. 60

Eastern Mediterranean Region (EMR) This WHO region is made up of 22 countries, 11 of which are recipients of Covax doses. 61 355 million Covax doses are due to be received by the end of

50 Reuters, Covax aims to deliver 520 mln vaccine doses to Africa this year, 8 July 2021 51 Al-Jazeera, WHO aims for 30% of needed Africa Covid jabs by February, 14 September 2021 52 WHO, First Covid-19 Covax vaccine doses administered in Africa, 1 March 2021 53 WHO Africa, Covid-19 vaccines, accessed 2 August 2021 54 UN, Africa faces 470 million Covid-19 vaccine shortfall this year, 16 September 2021 55 WHO Africa, Eight in 10 African countries to miss crucial Covid-19 vaccination goal, 2 September 2021 56 Devex, DRC to return 1.3 million COVAX vaccine doses before expiry, 29 April 2021; The Guardian, Malawi to bin 16,000 AstraZeneca doses amid fears of rise in vaccine hesitancy, 16 April 2021 57 WHO Africa, Emerging lessons from Africa’s Covid-19 vaccine rollout, 27 April 2021; WHO Africa, Risks and challenges in Africa’s Covid-19 vaccine rollout, 14 May 2021 58 Devex, African nations have destroyed 450,000 expired Covid-19 vaccine doses, 15 July 2021 59 UNICEF, Covid-19 vaccine market dashboard, accessed 20 September 2021; Duke Global Innovation Centre, Covid-19 vaccine procurement by country, accessed 20 September 2021 60 WB, Calculating Sub-Saharan Africa’s Covid vaccination financing gap, 11 May 2021 61 WHO, The Covax facility: Interim distribution forecast—latest as of 3 February 2021

17 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

2021. 62 The first shipments began in March 2021 and 51.5 million were received by 15 September. 63

At the end of May, the WHO stated “most” countries were behind in their 64 rollouts, including in their vaccination of health care workers. In July, it warned the region was “far behind” its goal of vaccinating 40% of its population by the end of 2021. 65 In September, it estimated nine countries would not achieve 10% vaccine coverage by the end of the month. 66

Although Yemen received the first Covax doses in March, the conflict between the Hadi Government and Houthi rebels and existing humanitarian crisis has hampered the rollout. Observers have cited difficulty in accessing vaccine sites, lack of trust, migrants being stranded, and delays in reaching Houthi- controlled areas. 67 The WHO was to begin vaccinations in Houthi-controlled areas in northern Yemen from 8 June, but this has been delayed. 68

The US will donate 504,000 vaccines directly to Yemen. The first shipment of 151,000 single-shot Johnson & Johnson doses were delivered in August 2021. 69 The UK will fund the rollout costs for the 2 million doses of Oxford Astra Zeneca vaccine allocated to Yemen via Covax. 70

Syria received doses from Covax in April and from the UAE, Russia, Israel and China. 71 Vaccines reached rebel-controlled areas in May. 72

The West Bank and Gaza have received doses from Covax, in addition to doses donated from Russia and the UAE. 73 Israel has also provided vaccinations to Palestinians who travel to Israel for work. 74 In May 2021,

62 Reuters, Covax to supply 355 million vaccine doses for Eastern Med this year—WHO official, 27 January 2021; WHO EMR, Covid-19 vaccines rolled out in the Eastern Mediterranean region […], 21 March 2021 63 WHO EMR, Vaccines now an effective weapon against Covid-19 in all countries in the Eastern Mediterranean region, 7 April 2021; WHO EMR, Statement on Covid-19 by WHO’s regional director, 15 September 2021 64 WHO EMR, Many countries in the EMR lagging […], 26 May 2021 65 WHO EMR, Regional Director’s statement on Covid-19 […], 7 July 2021 66 WHO EMR, Statement on Covid-19 by WHO’s regional director, 15 September 2021 67 Al-Jazeera, War and doubts slow Covid vaccination in disputed Yemen city, 3 May 2021; International Organisation for Migration, IOM supports UN Covid-19 vaccination, 11 May 2021; UN OCHA, Yemen: Situation report, 8 May 2021; Reuters, Yemen starts Covid-19 vaccination campaign, 20 April 2021 68 Reuters, WHO to start Covid-19 vaccination in Houthi-run north Yemen, 1 June 2021 69 AA, 3rd wave of coronavirus hits war-weary Yemen, 31 August 2021 70 FCDO, A moment to inject new momentum to peace efforts in Yemen, 24 August 2021 71 WHO EMR, Update on Covid-19 vaccination in Syria, 29 April 2021; Relief Web/Gov of UAE, UAE dispatches fourth shipment […], 5 May 2021; Reuters, Syria gets donation of 150,000 Covid shots from China, 24 April 2021; Al-Jazeera, Israel paying millions to supply Covid-19 doses to Syria, 20 February 2021; The Independent, Syrian President Bashar al-Assad “vaccinated with Russian sputnik Covid jab,” 3 June 2021 72 France 24, Vaccine rollout begins in rebel held northern Syria, 1 May 2021 73 UNICEF, Arrival of first wave of consignment of Covax Covid-19 vaccine doses to the , 21 March 2021; Al-Jazeera, Covid-19: Gaza starts inoculation drive amid vaccine shortage, 22 February 2021 74 Al-Jazeera, Israel starts vaccinating Palestinian workers after delays, 8 March 2021

18 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

violence between Israel and Palestine temporarily halted vaccinations. 75 In June, it was announced Gaza and the West Bank would receive vaccines from the . 76

South Asia States such as India and neighbouring Nepal, Pakistan and Sri Lanka are participating in Covax. First shipments began in March. 77

Prior to the Covax rollout and crisis in India, India had provided vaccines to neighbouring states through donations and commercial . 78 China has also donated vaccines to South Asian states, and the United States is due allocate seven million across Asia as a whole. 79

Pakistan is one of a few countries that allows the private import and sale of vaccines, raising concerns about access inequality in the country. 80

3.3 How will demand to be met?

While Covax intends to provide doses to cover 30% of the population of AMC The Library Briefing UK economies by 2022, participants will need to use other sources to vaccinate response to Covid-19: the rest of their populations. International aid and Global market diplomacy provides more information on The WB states many seeking to purchase vaccines, such as the African Union 81 support for vaccine and Palestine, face a funding shortfall. The WB expects to provide US$ 50 billion by mid-2021 to 50 countries to support the purchase and rollout of manufacture and 82 vaccines. As of 9 September 2021, the WB has supported vaccine rollout in 55 distribution countries, with US$ 4.6 billion of funding. 83

Strengthening vaccine manufacture Following the suspension of vaccine exports from India in early 2021, the WB has argued the global focus should shift from funding vaccines to expanding global capacity to manufacture sufficient doses. 84 The World Trade

75 New York Times, The assault on Gaza halts Covid shots […], 16 May 2021 76 White House, Factsheet: Biden-Harris Administration unveils strategy for global vaccination sharing […], 3 June 2021 77 UNICEF, Nepal amongst the first countries in Asia to receive Covid-19 vaccines from Covax facility, 7 March 2021 78 Devex, What does the data show about Covid-19 ?, 18 March 2021 79 UNICEF, Covid-19 market dashboard, accessed 17 June 2021; White House, Factsheet: Biden-Harris Administration unveils strategy for global vaccination sharing […], 3 June 2021 80 Devex, In Pakistan, Covid-19 vaccines go on sale, 18 March 2021 81 Reuters, Palestinian Covid vaccine plan faces large funding gap, WB says, 21 February 2021 82 WB, Key facts: WB Group vaccine announcement, 11 May 2021 83 WB, WB support for country access to Covid-19 vaccines, 9 September 2021 84 WB, Remarks by WB Group President […], 15 April 2021

19 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Organization (WTO) has estimated that manufacturing capacity in 2021 needs to triple from 5 billion to 15 billion and said more should be manufactured in Latin America and Africa. 85

In September 2021, the International Federation of Pharmaceutical Manufactures and Associations projected that Covid-19 vaccine production may reach 12 billion by the end of 2021, arguing the focus should now move from scaling up manufacturing to ensuring equitable distribution. 86

The African Union has announced agreements to increase manufacturing on the continent. 87 In June 2021, Egypt is due to start local production of the Chinese Sinovac vaccine. 88 Senegal plans to manufacture doses from 2022. 89

In March 2020, the UK provided £250 million to CEPI to accelerate vaccine manufacture. 90 At the June 2021 summit, the G7 committed to boost vaccine manufacture in more countries, including low-income ones. 91

Waiving patents and intellectual property (IP) rights Covid-19 vaccines such as those produced by Moderna, Johnson & Johnson, AstraZeneca, Pfizer and BioNTech are protected by patents and intellectual property rights. 92 South Africa and India have urged IP rights on Covid-19 vaccines to be waived in order to boost global production. 93 The US, Australia, Italy, and France have supported a waiver. 94

In March 2021, the UK Government said it did not support a waiver of IP rights as the existing IP framework had effectively mobilised and delivered vaccines. 95 The Labour Party has said the Government should participate in talks on waiving IP on vaccines. 96

85 Reuters, New WTO chief calls for tripling of vaccine production, 1 March 2021; Independent, WTO chief calls for diversification of vaccine production, 20 May 2021 86 International Federation of Pharmaceutical Manufacturers and Associations, Momentum of Covid-19 vaccine manufacturing scale up sufficient for step change in distribution, 7 September 2021; Devex, Pharma Industry projects 12b Covied-19 vaccine doses by end of year, 7 September 2021 87 Devex, AU launches partnership for Africa vaccine manufacturing, 14 April 2021 88 Reuters, Egypt to start local production of Sinovac vaccine mid-June—minister, 7 June 2021 89 Reuters, In boost for Africa, Senegal aims to make Covid shots next year, 8 June 2021 90 Department for International Development, PM pledges UK aid backing for coronavirus vaccine search, 27 March 2020 91 G7 2021, Carbis Bay G7 summit, 13 June 2021, para 12 92 World Economic Forum, What does waiving intellectual property rights for Covid-19 vaccines mean?, 6 May 2021 93 Times of India, India, South Africa moot 3-year Covid patent waiver, 23 May 2021 94 Gavi, The US adds it support to patent waivers for Covid-19 vaccines, 7 May 2021; Politico, Macron backs waiving Covid-19 vaccine patents ahead of G7, 10 June 2021; The Guardian, Australia to support vaccine waiver after months of pressure […], 8 September 2021 95 PQ 162614 [Developing countries: Coronavirus], 13 March 2021 96 Emily Thornberry MP for the Guardian, Britain could steer a global vaccination programme—but where is the leadership?, 20 May 2021

20 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

In June 2021, the G7 said it would “engage constructively” at the WTO on intellectual property rights and noted the impact voluntary licensing and technology transfer had made to global vaccine supply. 97

The WTO has argued the licencing process should be improved and greater support provided to boost manufacturing capacity. 98 The WTO Director- General, Ngozi Okonjo-Iweala, had expected a “sensible” answer to the transfer of technology and IP to be made in July. 99 However, no agreement was reached.

In September 2021, the UK Government said they would continue to participate in talks on a waiver, but remained “unconvinced” at how beneficial a vaccine waiver would be. It instead supported voluntary licencing and technology transfer agreements for vaccines. 100

Calls to share doses soon to expire

In September 2021, Airfinity published research estimating the G7 and EU will have around 100 million vaccines that are due to expire in 2021 and are surplus to population need. 101 Gordon Brown has called for an urgent plan to be drawn up to share the doses. 102

Delaying booster shots? Israel, the UK, and US are amongst the countries intending to issue booster shots to their citizens judged most vulnerable to Covid-19. The UK Government intends to start offering booster vaccines for those aged over 50, healthcare workers, and other priority groups from late September 2021. 103

The WHO has urged a halt for booster shots for the remainder of 2021. In September, its Director General, Tedros Adhanom Ghebreyesus, said the doses should instead be made available to poorer countries. 104 The WHO had previously called for a two-month moratorium on booster shots in August. 105

In September, the APPG on Coronavirus argued the UK Government should share doses to vaccinate low-income countries before giving booster jabs to healthy over-50s in the UK. The group supports a booster programme for the vulnerable and immune-supressed. 106 In response to criticism in the House of

97 G7 2021, Carbis Bay G7 summit, 13 June 2021, para 12 98 Reuters, Vaccine patent waiver will not be enough- WTO chief, 20 May 2021 99 Devex, WTO chief to G-20: Donate 2-3B more Covid-19 vaccine doses, 6 July 2021 100 HL Deb, 9 September 2021, c 1048 101 Airfinity, More than 100 million vaccines are set to expire [...], 20 September 2021 102 The Guardian, Gordon Brown calls for urgent action to avert “Covid vaccine waste disaster,” 19 September 2021 103 Department of Health and Social Care, Most vulnerable to be offered Covid-19 booster [...], 14 September 2021 104 AP, WHO chief urges halt to booster shots for the rest of the year, 8 September 2021 105 Al-Jazeera, Citing vaccine inequality, WHO head argues against booster shots, 23 August 2021 106 APPG Coronavirus, Vaccinate low-income countries before giving boosters to healthy […], 17 September 2021

21 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Commons that administering booster shots may undermine the Government’s aim to vaccinate the world by the end of 2022, the Health Secretary, Sajid Javid, said the Government is implementing the advice of the Joint Committee on Vaccination and Immunisation to provide the programme. 107

107 HC Deb, 14 September 2021, c 827

22 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

4 International support for Covax

In June 2021, G7 leaders, including the UK, pledged to drive an “intensified international effort” to vaccinate the world. 108 Prior to the meeting, the UK Prime Minister, Boris Johnson, said he would seek to use the meeting to secure commitments to vaccinate the entire world against Covid-19 by the end of 2022. 109 In September, the US President, , called on leaders to vaccinate 70% of the world within a year. 110

4.1 How many vaccines has the UK provided to individual countries?

Aside from the Overseas Territories and Crown Dependencies, the UK has donated around 10 million doses directly to other states (to September 2021). For donated doses, the UK has signed agreements with: Antigua and Barbuda, , Cambodia, Guyana, Indonesia, , Kenya, , , Philippines, Saint Vincent and the Grenadines, Thailand and Vietnam. 111

Primarily, the UK has provided support via Covax. Data can be found via three sources:

• Gavi, the Vaccine Alliance, publishes country totals of Covax deliveries. • UNICEF maintains a map of COVAX deliveries and planned shipments. • Our World in Data publishes data on the vaccination rollout in states.

4.2 Funding

The Covax AMC is being funded through Official Development Assistance (ODA) and private sector contributions, as well as through a cost-sharing approach for ODA-eligible countries.

108 G7 Summit Communiqué, Our shared agenda for global action to build back better, 13 June 2021 109 G7 2021, PM calls on G7 leaders to vaccinate the world by the end of next year, 6 June 2021 110 CNN, Biden to call on world leaders to commit to vaccinating 70% of world by next year, 14 September 2021 111 Foreign, Commonwealth and Development Office and Department of Health and Social Care, UK begins donating millions of Covid-19 vaccines abroad, 28 July 2021

23 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

The following table shows pledges to Covax that exceeded US$ 100 million from countries and the , up to June 2021. The UK has made the fourth largest commitment (US$ 733 million). A total of US$ 9.8 billion was pledged from all donors. The Bill & Melinda Gates Foundation is also a significant donor, providing US$ 206 million to June 2021. 112

The additional funding pledged in June 2021 will be used to secure an additional 1.8 billion doses for lower-income economies and enable Covax to provide enough doses to vaccinate a total of 30% of their populations.The UK did not pledge additional funds in June. 113

Country pledges to Covax AMC 2021 Pledges over $100m+ only

US$ million, to June 2021 US 3,500 1,070 Japan 1,000 UK 733 European Commission 489 Italy 470 Canada 384 295 France 242 Korea 210 162 Saudi Arabia 150

Norway 141 122 China 100 Australia 100

Total (all donors) $9.8bn

Source: Gavi, Key outcomes of one world protect- Covax AMC summit, 23 June 2021, updated 6 August In 2021/22, the Foreign, Commonwealth and Development Office has said its ODA spending on global health will focus on commitments to Covax, Gavi and the WHO, and on countries where need is greatest. 114 The Government has also stressed its funding support for the Oxford/AstraZeneca vaccine, which saw 97% of its funding come from public sources (such as UK and other

112 Gavi, Key outcomes: Covax AMC 2021, 10 May 2021; Gavi, Covax AMC donors table, 23 June 2021 113 Gavi, World Leaders unite to commit to global equitable access for Covid-19 vaccines, 2 June 2021 114 PQ HL269 [Overseas Aid], 1 June 2021.

24 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

governments, universities and charities). 115 To July 2021, the vaccine accounted for 65% of the 152 million doses provided by Covax. 116

Calls for additional UK funding In August 2021, the UK received around £20 billion ($28 billion) of Special Drawing Rights (SDRs) (a type of reserve currency that can be exchanged for national currencies) from the $650 billion being issued by the International Monetary Fund (IMF). 117 SDRs are being provided to most countries to support them recover from the pandemic. 118

Gordon Brown, UK Prime Minister from 2008 to 2010, has argued G7 states could redistribute the SDRs to low income countries to purchase vaccines. 119 The UK Government says it is lobbying for the recycling of SDRs to low-income states at World Bank-IMF meetings. 120

Funding for the Access to Covid-19 Tools Accelerator The Access to Covid-19 Tools Accelerator (ACT-A) constitutes four pillars, which include diagnostics, therapeutics, vaccines (provided through Covax), and health systems. In addition to Covax, its functions include providing PPE, oxygen, and Covid-19 treatments. 121

Around $15.1 billion has been committed to 13 June 2021, and UNICEF estimates that a further $16 billion is required for 2021. 122 Save the Children estimate that if other priority interventions are included, primary health systems are strengthened, and vaccines and therapeutics continue to need funding, the total funding ACT-A requires over the next two years is $66 billion.

In June 2021, former UK Prime Ministers Gordon Brown and Tony Blair were amongst those who called upon the G7 to pay two-thirds of this sum. 123 G7 leaders confirmed their support for ACT-A but announced no new funding.

115 The Guardian, Oxford/AstraZeneca Covid vaccine research “was 97 percent publicly funded,” 15 April 2021 116 Foreign, Commonwealth and Development Office and Department of Health and Social Care, UK begins donating millions of Covid-19 vaccines overseas, 28 July 2021 117 Centre for Global Development Can special drawing rights be recycled to where they are needed at no budgetary cost?, 21 April 2021 118 IMF, SDRs, 18 February 2021 119 HC Deb, 16 June 2021, c283; The Guardian, Covid: More than 200 leaders urge G7 to help vaccinate the world’s poorest, 6 June 2021 120 HC Deb, 30 June 2021, c368 121 Save the Children, Financing Covid-19 vaccination efforts with equity, June 2021 122 UNICEF, The Act-A partnership welcomes commitments of 870 million vaccine doses […], 13 June 2021 123 The Guardian, Covid: More than 200 leaders urge G7 to help vaccinate the world’s poorest, 6 June 2021

25 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

4.3 Pledges to share vaccines

Distribution of purchased vaccines By mid-March 2021, it was estimated that high-income countries (16 percent of the world’s population) had negotiated agreements amounting to half the global vaccine supply. 124

Analysis by the Duke Global Innovation Centre suggests that many higher- income states have purchased sufficient vaccine doses to have many surplus vaccines. The UK has agreements to provide over 360% population coverage.

Vaccination procurement States/areas with over 100% coverage Population Doses coverage purchased Canada 573% 688.0m Australia 459% 265.8m UK 361% 474.0m EU 354% 4,425m 334% 33.8m Switzerland 265% 58.5m USA 260% 2,510m 253% 90.2m Israel 249% 41.0m Japan 223% 564.0m 201% 232.4m Bolivia 169% 24.3m 160% 93.0m Taiwan 149% 82.3m 142% 131.3m Dominican Rep. 130% 28.1m Turkey 129% 274.5m Brazil 113% 726.0m Malaysia 103% 101.5m

Note: Includes possible vaccination coverage. Excludes donations. Data does not include any unknown contracts, those under negotiation, potential deals, or potential coverage by Covax for participating states. Figures include vaccines not yet approved. The UK, for example, has approved only four of the seven vaccines it has agreements for. Population based on World Bank 2019 estimates.

Source: Duke Global Innovation Centre, Vaccine purchases, accessed 20 September 2021 and Data Notes, 11 December 2020

124 OECD, Access to Covid-19 vaccines: Global approaches in a global crisis, March 2021

26 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

G7 Commitments to share vaccines In June 2021, G7 states pledged to share 1 billion doses, of which 870 million will be shared with Covax. Half the doses for Covax will be delivered by the end of 2021. 125 The G7 have also said that their financial contributions to Covax to June 2021 allowed 1 billion doses to be purchased for the Covax AMC. 126

The UN has said the pledged doses are welcome, but are insufficient in number and are needed now, rather than next year. 127 The NGO ONE estimates that the 1 billion doses are sufficient to vaccinate 5.4% of the populations of lower income countries by the end of 2021. 128

The country breakdowns of doses donated to Covax include the below (this is not an exhaustive list). Countries may also decide to donate bilaterally, rather than via Covax. 129

United States In June, the Biden Administration said the US would share a total of 500 million doses by June 2022. Around 200 million will be delivered in 2021. It will also share doses to support its neighbours and respond to areas with rapidly rising case numbers. This includes the Americas, parts of Asia, and Africa. 130

The US missed its target of shipping 80 million doses by the end of June, citing supply and regulatory hurdles. 131

In September, the Biden Administration said it would purchase an additional 500 million vaccines to donate, bringing the promised US total to 1.1 billion.132

United Kingdom The UK Government has said it will share 100 million doses over the next year and 80% will be shared via Covax. The remainder will be shared bilaterally with countries in need. 133 It aims for 30 million to be shared by the end of 2021. 134

125 Gavi, G7 announces pledges of 870 million Covid-19 vaccine doses […], 13 June 2021. 126 G7, Carbis Bay Summit Communiqué, 13 June 2021, para 9 127 Reuters, “We need more;” UN joins criticism of G7 vaccine pledge, 12 June 2021; Gordon Brown for the Guardian, Despite the grand words, this G7 falls devastatingly short on vaccines, 14 June 2021 128 ONE, With exception of the US, ONE responds to underwhelming G7, 13 June 2021 129 Covax, Principles for sharing COVID-19 vaccine doses with Covax, December 2020 130 White House, Biden-Harris Administration unveils strategy for Global Vaccine sharing […] for the first 200 million doses, 3 June 2021; White House, President Biden announces historic vaccine donation […], 10 June 2021 131 AP, Biden misses vaccine-sharing goal, cites local hurdles, 1 July 2021 132 NPR, The US is donating more Covid vaccines and wants other rich nations to pitch in, 22 September 2021 133 10 Downing Street, UK to donate 100 million coronavirus vaccine doses, 15 June 2021 134 PQ 27285 [Coronavirus: Vaccination], 8 July 2021

27 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

In February 2021, the Prime Minister had said that the UK will “share the majority” of future surplus vaccines. 135 In July, the Government announced the first allocations of UK donations. A total of 9 million doses would be donated: 5 million to Covax and 4 million via bilateral channels. Countries receiving bilateral donations include Indonesia, Kenya, Jamaica and Antigua and Barbuda. 136 The Telegraph reported the “bulk” of the doses are due to expire 137 in September 2021. t

To 14 September, the UK donated 10.3 million doses, including 6.2 million via Covax. 138

Canada Canada has committed to share up to 100 million doses, although a substantial proportion may originate in funding previously pledged to Covax. 139

In September, the UK Government said that Canada had committed to donate 13 million doses at the G7 summit held in June. 140

“Team Europe” and individual EU states ‘Team Europe,’ including France, Germany, Italy, the , , Spain and Switzerland have collectively pledged to donate 450 million doses by mid-2022. 141 In addition to EU contributions, the following countries have pledged the following:

• France: 60 million doses in 2021. 142 • Germany: 70 million. 143 • Italy: 45 million. 144 • Spain will donate 5-10% of its vaccine doses to Latin American and Caribbean countries in 2021. 145 This will total 22.5 million to Covax. 146

135 10 Downing Street, PM announces 100 day target to create new vaccines, 19 February 2021 136 Foreign, Commonwealth and Development Office, Department of Health and Social Care, UK begins donating millions of Covid-19 vaccines abroad, 28 July 2021 137 The Telegraph, “Trojan horse:” Bulk of UK vaccine donations to poor countries set to expire in September, 28 July 2021 138 PQ 45899 [Developing countries: Coronavirus] 14 September 2021 139 CBC, G7 meeting ends with promises on Covid-19, climate, mentions of China, 13 June 2021 140 PQ 45902 [Developing countries: Coronavirus], 15 September 2021 141 Gavi, Global leaders renew their commitment to address urgency of Covid-19 pandemic, 21 May 2021; European Commission, Vaccinating the world: “Team Europe” to share more than 200 million doses […], 22 July 2021; Politico, Von der Leyen: EU will donate 200m more coronavirus vaccines, 15 September 2021 142 UNICEF, 1,484,000 doses of Covid-19 vaccines donated by France and Italy […], 14 September 2021 143 Reuters, Germany will offer Africa up to 70mln Covid-19 vaccine doses, Merkel says, 27 August 2021 144 Reuters, Factbox: What are G7 countries pledging on vaccine doses?, 12 June 2021; Reuters, Italy triples pledge to provide other nations with Covid-19 vaccines, 22 September 2201 145 Reuters, Spain to donate 5 percent-10 percent of its share of Covid-19 shots to Latin America, 21 April 2021 146 Gavi, World leaders unite to commit to global equitable access for Covid-19 vaccines, 2 June 2021

28 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

• : 4 million, via Covax. 147 • Sweden: 3 million. 148 • : 3 million, primarily to Covax. 149

Japan Japan will share 60 million with Covax, other countries and economies. 150

Who has already shared vaccines? There are three main sources on vaccine donations: UNICEF’s Covax dashboard, Duke Global Health Innovation Centre, and the Covid-19 taskforce. These are reliant on publicly available data and may not provide a complete view of vaccines donated.

Counties that have donated, or are donating, vaccines include China, India, Japan, Russia, Israel, and Australia. 151

Recipients include Bangladesh, Myanmar, and Nepal (from India), Pakistan, Laos and Nepal (from China), Nigeria and Ghana (African Union/MTN), and Fiji (from Australia).

China has pledged to share 2 billion doses globally in 2021, and has reportedly donated 770 million doses since September 2020. 152

There are reports China pressurised Ukraine into withdrawing from a multinational statement on human rights in the Xinjiang region of China by threatening to withhold doses in June. However, the Chinese Government has 153 denied this.

The World in Data, using data from the Covid-19 taskforce, has published the cumulative number of doses donated to Covax from select countries, including the UK, US and other G7 states. This does not include commitments to share doses bilaterally between countries. To 16 September 2021, the UK delivered 7% of the 80 million it has pledged to donate to Covax (5.7 million). This was the fourth highest number donated.

147 The Brussels Times, Belgium to donate four million additional coronavirus vaccines to Covax, 31 May 2021 148 Gavi, Global leaders renew their commitment to address urgency of Covid-19 pandemic, 21 May 2021; Reuters, Sweden to donate at least three million vaccine doses to Covax in 2021, 25 May 2021; New Zealand Herald, NZ donates 1.6 million vaccine doses […], 16 April 2021 149 The Local, Denmark to donate millions of Covid-19 vaccines to global scheme, 25 May 2021 150 Gavi, World leaders unite to commit to global equitable access for Covid-19 vaccines, 2 June 2021; Japan Times, Japan to provide 30 million additional Covid-19 vaccine doses, 23 September 2021 151 UNICEF, Covid-19 vaccine market dashboard, accessed 9 July 2021; Middle East Monitor, Palestinians receive 40,000 Covid-19 vaccines from UAE, 11 March 2021; Al Jazeera, Covid-19: Gaza starts inoculation drive amid vaccine shortage, 22 February 2021. 152 AP, China pledges 2 million vaccines globally through to year end, 6 August 2021 153 AP, Diplomats say China puts squeeze on Ukraine, 25 June 2021; The Independent, China says no strings attached to vaccine shipments overseas, 26 June 2021

29 Commons Library Research Briefing, 22 September 2021 Covax and global access to Covid-19 vaccines

Covid-19 vaccine doses donated to Covax Data as of 16 September 2021 Doses not yet Donated but Delivered donated but Total pledged % Delivered not delivered announced US 80.8m 5.2m 204.0m 290.0m 28% EU 13.1m 28.6m 160.6m 202.3m 6% Japan 11.3m 0.0m 18.7m 30.0m 38% UK 5.7m 0.5m 73.8m 80.0m 7% France 5.5m 12.2m 36.3m 54.0m 10% Spain 2.6m 3.8m 16.1m 22.5m 12% Germany 2.5m 5.4m 92.1m 100.0m 3% Canada 2.1m 1.4m 37.2m 40.7m 5% Sweden 1.3m 1.1m 0.6m 3.0m 43% Italy 0.9m 4.1m 10.0m 15.0m 6% Norway 0.7m 0.4m 3.9m 5.0m 14% Belgium 0.2m 1.2m 2.6m 4.0m 5% New Zealand 0.2m 0.7m 0.7m 1.6m 13% Denmark 0.1m 0.5m 2.4m 3.0m 3% 0.0m 0.3m 0.5m 0.8m 0% Switzerland 0.0m 0.1m 3.9m 4.0m 0% UAE 0.0m 0.0m 1.0m 1.0m 0% Total 127.0m 65.1m 660.0m 852.1m 15%

Note: Based on publicly available data only. Data as of 16 September 2021, so does not include any announcements or deliveries since this date. Source: Our World in Data, Covid-19 doses donated to Covax, updated 16 September 2021

30 Commons Library Research Briefing, 22 September 2021

The House of Commons Library is a research and information service based in the UK Parliament. Our impartial analysis, statistical research and resources help MPs and their staff scrutinise legislation, develop policy, and support constituents.

Our published material is available to everyone on commonslibrary.parliament.uk.

Get our latest research delivered straight to your inbox. Subscribe at commonslibrary.parliament.uk/subscribe or scan the code below:

commonslibrary.parliament.uk

@commonslibrary