Thread by @MMKavanagh

#Covax is failing. Big picture: even as delivers doses, it won’t deliver goal of EQUITY.
Short term: By June was to reach just 3% of LMIC pops. Delivered only 1/4 of that (88 of 337m forecast).
We need to talk about why & learn real-world, politically-informed lessons
🧵[thread]

The goal: at a high level, COVAX as a pillar of ACT-A aimed to “ensure that every country gets fair and equitable access to eventual #COVID19 vaccines…. By acting as an insurance policy.” At this point, it's clear this model has not been successful /2

Not #VaccinEquity: Dec 2, 11, 21 of 2020 UK, US & EU authorized #COVID19 vaccine.
6mos later, so many ways (data, stories, lives) to see inequity outcome of current vaccine prod & distrib systems.
Here's 👇from @fibke:% pop vs % vax does NOT approach equity /3

Or look at #SouthAfrica, a middle-income country with significant manufacturing capacity that has tried to buy vaccines for its populations through COVAX and directly. Country has been failed by all actors. Now:
dailymaverick.co.za/article/2021-0…

Or look to Latin America where the per-capita mortality rates in countries like Peru, Brazil, Argentina are reaching unimaginably high levels and there's enough vax for maybe 1/3 of the region's population /4
theguardian.com/global-develop…

Meanwhile in the US there are celebrations, economy and life re-opening, celebrating a "Miracle summer" as political and public attention drifts away from #COVID19 pandemic that still rages for much of the world's population /5

While in the U.S. the lowest vaccinated state (MS) has higher vaccination rate than 156 out of 194 countries in the world. 78% of US seniors have been vaccinated while African countries have enough vax to fully vaccinated about 17% of seniors & health workers.

Short term: #COVAX set a remarkably unambitious goal for a pandemic, where speed matters, of reaching just 3% of participating LMIC populations in Q1&Q2 of this year--made country-by-country allocations. But as of today its 249m doses short./7

Why? @TheLancet piece is a great review of some key factors. wish I could agree, though, that its worse than our nightmares. In reality, rich-country heads of state always said they would do whatever it took to get their pops fully covered /8

https://twitter.com/jocalynclark/status/1405948654775640065?s=21

And leaders in low- and middle-income countries had the same aspirations--to stop the pandemic using vaccines! But they had little-to-no decision-making power in the #COVAX public-private partnership that was supposed to address their needs /9

https://twitter.com/MMKavanagh/status/1403807371948855299?s=20

But now there's a push to make #COVAX permanent?
/10

Inequity & power was evident early.
e.g. we wrote May'20 @TheLancet many African countrs couldnt get #COVID19 supplies "as geopolitically powerful countries mobilise economic, political, and strategic power to procure stocks for their populations /11

https://twitter.com/udnore/status/1258702545792401408?s=21

But this is not inevitable. We need pandemic governance & distribution built for equity, with a political analysis focused on how to deliver in the world of intl politics as it exists today--putting the actual interests of all actors on the table, and acting on that basis /12

From early-on leaders like @DrTedros @Winnie_Byanyima have said we needed to combine rapid open technology sharing, production & pooled buying. But @WHO @UN had limited power here and other partners suggested pooled purchase alone could solve problem. This served us poorly /12

A frank political analysis sees that despite good rhetoric, #COVID19 is an existential threat. All the political incentives for leaders of powerful (and less powerful) states was to vaccinate own populations first. So instead..../13

So its fair to ask what would have happened if the political capital global health leaders mobilized focused from the start on demanding shared technology for global production--recognizing that the fate of LMICs was probably tied to where & in what quantity vaccines were made/14

What if the political effort had been built around a race-to-the-top to build #COVIDVaccine production around the world and challenging HIC-leaders to commit to that? If we'd started that in May 2020 many LMICs would perhaps be in a better place in June 2021 /15

As @sciencecohen got the quote of the year on the politics of #COVIDVaccination "surprised, not surprised. Social responsibility is just something you would expect from a decent human being when the whole world is burning" but... /16

https://twitter.com/sciencecohen/status/1405976973260718081?s=20

@sciencecohen ...and that's why today I'm really glad to see @CyrilRamaphosa @DrTedros launching mRNA technology hub--challenging the world to collaborate while moving ahead.
The world can do far better than what's been done so far
/fin.
#PeoplesVaccine #VaccinEquity

https://twitter.com/CyrilRamaphosa/status/1406996099727036424?s=20

To clarify: core point is #COVAX tried to achieve equity w demand-only. Pooling procurement + donations for bargaining pwr + negotiating w monopoly companies. instead of pushing for open tech sharing to radically ⬆️ production
Politics of approach failed, equity not achieved.

Global heath can’t be afraid to recalibrate. can listen to smart political leaders, mostly in Global South, and move now behind them to open the tech, start the factory lines, even as doses begin the roll in from #COVAX and other efforts.