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Visualized: The World Leaders In Positions of Power (1970-Today)

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Who were the world leaders when the Berlin Wall fell? How many women have been heads of state in prominent governments? And who are the newest additions to the list of world leaders?

This graphic reveals the leaders of the most influential global powers since 1970. Countries were selected based on the 2020 Most Powerful Countries ranking from the U.S. News & World Report.

Note: Switzerland has been omitted due to the swiftly changing nature of their national leadership.

The 1970s: Economic Revolutions

Our graphic starts in 1970, a year in which Leonid Brezhnev ruled the Soviet Union, while on the other side of the Iron Curtain, Willy Brandt was presiding over West Germany.

In the U.S., Richard Nixon implemented a series of economic shocks to stimulate the economy, but resigned in scandal due to the Watergate tapes in 1974. In the same time period, China was undergoing rapid industrialization and economic hardship under the final years of rule of communist revolutionary Mao Zedong, until his death in 1976.

In 1975, the King of Saudi Arabia, Faisal bin Abdulaziz Al Saud was assassinated by his nephew. The decade also marked the end of Park Chung-Hee’s dictatorship in South Korea when he was assassinated in 1979.

To cap off the decade, Margaret Thatcher became the first female prime minister of the United Kingdom in 1979, transforming the British economy using a laissez-faire economic policy that would come to be known as Thatcherism.

The 1980s: Reaganomics and the Fall of the Wall

The 1980s saw Ronald Reagan elected in the U.S., beginning an era of deregulation and economic growth. Reagan would actually meet the Soviet Union’s president, Mikhail Gorbachev in 1985 to discuss human rights and nuclear arms control amid the tensions of the Cold War.

The 1984 assassination of the Indian prime minister, Indira Gandhi was also a defining event of the decade. She was succeeded by her son, Rajiv Gandhi for only seven years before his own assassination in 1991.

The ‘80s were clearly turbulent times for world leaders, especially towards the end of the decade. In 1989, the Berlin Wall fell and Germany was reunified under chancellor Helmut Kohl. 1989 was also the year when the devastating events occurred at the Tiananmen Square protests in China, under president Deng Xiaoping. The event left a lasting mark on China’s history and politics.

The 1990s: War 2.0 and the Promise of the EU

The beginning of a new decade marked the end of the Cold War and the fall of the Soviet Union, leading to Boris Yeltsin’s position as the first president of the Russian Federation. A sense of peace, or at least the knowledge that a finger wasn’t floating above a nuclear launch button at any given moment, brought a sense of global calm.

However, this does not mean the decade was without conflict. The Gulf War began in 1990, led by the U.S. military’s Commander-in-Chief George H.W. Bush. In the mid-90s, prime minister Yitzhak Rabin of Israel was assassinated by Jewish extremists.

In spite of this, the ‘90s were a time of optimism for many. In 1993, the European project began. The European Union was founded with the support European leaders like the UK’s prime minister John Major, France’s president Francois Mitterrand, and chancellor Helmut Kohl of Germany.

The 2000s: Historic Firsts and Power Shifts

The dawn of a new century had people feeling both hopeful and scared. While Y2K didn’t end the world, many transformative events did occur, such as the 9/11 attacks in New York and the subsequent war on terror led by U.S. president George W. Bush.

On the other hand, Angela Merkel made history becoming the first female chancellor of Germany in 2005. A few years later, Barack Obama also achieved a momentous ‘first’ as the first African-American president in the United States.

The 2000s to early 2010s also revealed rapidly changing power shifts in Japan. Shinzō Abe rose to power in 2006, and after five leadership changes in seven years, he eventually circled back, ending up as prime minister again by 2013—a position he held until late 2020.

Country Number of Leaders Since 1970
🇯🇵 Japan 25
🇹🇷 Turkey 18
🇮🇳 India 12
🇦🇺 Australia 12
🇬🇧 UK 10
🇺🇸 USA 10
🇰🇷 South Korea 10
🇮🇱 Israel 9
🇨🇦 Canada 9
🇷🇺 Russia 7
🇫🇷 France 7
🇨🇳 China 6
🇩🇪 Germany 5
🇸🇦 Saudi Arabia 5
🇦🇪 UAE 2

The 2010s: World Leaders Face Uncertainty

The 2010s were more than eventful. The Hong Kong protests under Chinese president Xi Jinping, and the annexation of Crimea led by Vladimir Putin, uncovered the wavering dominance of democracy and international law.

UK Prime Minister David Cameron’s move to introduce a Brexit referendum, resulted in just over half of the British population voting to leave the EU in 2016. This vote led to a rising feeling of protectionism and a shift away from globalization and multilateral cooperation.

Donald Trump’s U.S. presidential election was a shocking political longshot in the same year. Trump’s stint as president will likely have a longstanding impact on the course of American politics.

Two countries elected their first female leaders in this decade: president Park Geun-Hye in South Korea, and prime minister Julia Gillard in Australia. Here’s a look at which global powers have been led by women in the last 50 years.

Country Female Leader
🇦🇺 Australia Julia Gillard
🇨🇦 Canada Kim Campbell
🇩🇪 Germany Angela Merkel
🇮🇳 India Indira Gandhi
🇰🇷 South Korea Park Geun-Hye
🇹🇷 Turkey Tansu Ciller
🇬🇧 UK Margaret Thatcher
🇬🇧 UK Theresa May

2020 to Today

No one can avoid talking about 2020 without talking about COVID-19. Many world leaders have been praised for their positive handling of the pandemic, such as Angela Merkel in Germany. Others on the other hand, like Boris Johnson, have received critiques for slow responses and mismanagement.

The year 2020 packed about as much punch on its own as an entire decade does, from geopolitical tensions to a nail-biting 2020 U.S. election. The world is on high alert as the now twice-impeached Trump prepares his transfer of power following the riot at the U.S. Capitol.

The newest addition to the ranks of world leaders, Joe Biden, has recently taken his place as the 46th president of the United States on January 20, 2021.

Editor’s note: We’ll continue to update this graphic on world leaders as time goes on. Unfortunately, we were unable to include world leaders from more countries, as we were limited by the graphic format and user experience.

Source: https://www.visualcapitalist.com/visualized-world-leaders-in-positions-of-power/

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UN peacekeepers get vaccine boon from India

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UN peacekeepers attend to a child in the Congo. Image credit: MONUSCO Photos, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons

A spokesperson for United Nations (UN) Secretary-General António Guterres has expressed that the Secretary-General is “extremely grateful” after India granted UN peacekeepers 200,000 COVID-19 vaccine doses.

Minister of External Affairs Subrahmanyam Jaishankar announced the gift during a meeting of the UN Security Council. India, Jaishankar said, has already supplied vaccines to 25 countries and anticipates to ship more doses in the days to come.

“The pharmacy of the world is stepping forward to meet the global vaccines challenge,” Jaishankar said. “We are, of course, a significant source of supply to the COVAX facility. But in addition, India is also directly sending vaccines to friends and partners.” The COVAX facility is an initiative led by the World Health Organization (WHO), Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi to ensure low- and middle-income countries (LMICs) have access to vaccines amidst growing concerns over unequal access to vaccines at LMICs’ expense.

“Starting with our immediate neighbours, 25 nations across the world have already received Made in India vaccines,” Jaishankar outlined. “49 more countries will be supplied in the coming days, ranging from Europe, Latin America and the Caribbean to Africa, South-East Asia and the Pacific Islands. Keeping in mind the UN Peacekeepers who operate in such difficult circumstances, we would like to announce today a gift of 200,000 doses for them.” 

The UN has stated that “peacekeeping missions are putting in place a series of mitigation measures to promote the safety, security and health of all UN personnel while maintaining continuity of operations. Leadership is in regular contact with troop- and police- contributing countries and working closely with the Department of Operational Support, the Office of Military Affairs and the Police Division to monitor the situation and advise governments according to the latest developments.” 

The impact of COVID-19 on those affected by conflict is substantial. Research published last month by The Lancet outlined that “new health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision” as it found “the number of women and children affected by armed conflict has grown steadily since 2000, due to a combination of increasing population sizes, urbanisation of many conflicts, and a steady rate of conflict events around the world. 

“In 2017, at least 630 million women and children—ten percent of women and sixteen percent of children worldwide— were either displaced by conflict or resided dangerously close to armed conflict events.”

As such, the role of peacekeepers is vital. COVID-19 and conflict zones are, as UNICEF states, “a deadly combination” with the pandemic serving to “[deepen] acute food insecurity in countries already under intense strain, leaving millions of children at risk of famine – and their futures in jeopardy.” Without vaccinations, exiting the pandemic is out of reach for economically vulnerable countries and especially those ravaged by conflict. India is positioned to assert a centric role in inoculating the global population against COVID-19; its vaccines commitment to UN peacekeepers reflects its role in the pandemic era. 

Source: https://www.healthissuesindia.com/2021/02/19/un-peacekeepers-get-vaccine-boon-from-india/

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Vaccine stockpiling flagged by group

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An anti-poverty advocacy group has flagged COVID-19 vaccine stockpiling by high-income countries in a new report.

An analysis by the ONE Campaign, a movement which seeks to end poverty and preventable disease by 2030, said a cohort of wealthy nations had stockpiled more than a billion COVID-19 vaccine doses than required. The report examined contracts with five leading manufacturers of COVID-19 vaccines – AstraZeneca and the University of Oxford, Johnson & Johnson, Moderna, Novavax, and Pfizer and BioNTech. It found that Australia, Canada, the European Union, Japan, the United Kingdom, and the United States had secured through deals more than three billion vaccine doses, despite only needing 2.06 billion to fully vaccinate their populations. 

The report’s findings, according to the ONE Campaign’s senior director for policy Jenny Ottenhoff, represents “huge excess” and “the embodiment of vaccine nationalism.” Ottenhoff acknowledged that “rich countries understandably hedged their bets on vaccines early in the pandemic but with these bets paying off in spades, a massive course correction is needed if we are going to protect billions of people around the world.” 

Vaccine nationalism engendering vaccine stockpiling has been called out repeatedly in recent months, as the global race to develop vaccines against the novel coronavirus which causes COVID-19 has yielded results and countries – including India – have commenced campaigns to inoculate their populations. However, there are striking global disparities in access to COVID-19 vaccines at the detriment of countries at lower levels of economic development.

Earlier this week, United Nations Secretary-General António Guterres condemned that “progress on vaccinations has been wildly uneven and unfair. Just ten countries have administered 75 percent of all COVID-19 vaccines. Meanwhile, more than 130 countries have not received a single dose. Those affected by conflict and insecurity are at particular risk of being left behind.”  

Prior to Guterres’s remarks, the incoming World Trade Organization chief Ngozi Okonjo-Iweala highlighted that “no one is safe until everyone is safe. Vaccine nationalism at this time just will not pay, because the variants are coming. If other countries are not immunised, it will just be a blow back.”

The COVAX facility, designed to ensure access to COVID-19 vaccines for low- and middle-income nations, has inked deals to procure 2.27 billion doses this year and aims to deliver doses to at least twenty percent of the populations of the world’s most impoverished countries. India is a key player, being home to the Serum Institute of India – the world’s largest manufacturer of vaccines. India’s seeming embrace of vaccine diplomacy is manifest in recent developments which have witnessed large-scale distribution to other countries. As reported by Health Issues India earlier this week

“Last month, the country commenced exports of COVID-19 vaccines. As of the second week of February, the country had exported more than 1.6 crore vaccine doses to twenty countries of which 37 percent were grants. The remaining 63 percent of doses shipped overseas were sales. The countries to have received vaccine exports from India include Afghanistan, Algeria, Bahrain, Bangladesh, Barbados, Bhutan, Brazil, Dominica, Egypt, Kuwait, Maldives, Mauritius, Morocco, Myanmar, Nepal, Oman, Seychelles, Sri Lanka, South Africa, and the United Arab Emirates.”

Vaccine stockpiling engendering a surplus in wealthy nations could fortify COVAX initiatives if surplus vaccines are donated, the ONE Campaign report suggests. Countries including France and the United Kingdom are onboard with such a notion. French president Emmanuel Macron proposed wealthier countries dedicate up to five percent of their vaccine reserves to Africa, where vaccine supplies are lacking. British prime minister Boris Johnson is expected to pledge donations of the UK’s surplus vaccine supply to low-income nations at today’s G7 summit. COVAX is also the beneficiary of a US$4 billion donation from the U.S. government. Ultimately, we are not safe until we are all safe. COVID-19 does not discriminate and does not respect borders. As such, when it comes to protection via vaccination, universalism and by extension cooperation is the need of the hour. 

Source: https://www.healthissuesindia.com/2021/02/19/vaccine-stockpiling-flagged-by-group/

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New Analysis: Updated State Data Continues To Show Wide Disparities in COVID-19 Vaccination Rates by Race/Ethnicity

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KFF has an updated analysis of state-reported data as of February 16, 2021 on COVID-19 vaccinations, cases, and deaths by race/ethnicity.

New to the analysis are comparisons of vaccination rates in each racial/ethnic group based on state-reported data of total people who have received at least one dose of the vaccine. Among just over half of states reporting data, the vaccination rate among White people is over three times higher than the rate for Hispanic people (10% vs 3%) and twice as high as the rate for Black people (10% vs. 5%). The vaccination rate for Asian people is closer to the rate for White people in most reporting states, although they are less likely to have been vaccinated in most reporting states.

Across the 34 states reporting data on vaccinations by race/ethnicity, there is a largely consistent pattern of Black and Hispanic people receiving smaller shares of vaccinations compared to their shares of cases and deaths and compared to their shares of the total population.

For example, in Texas, 20 percent of vaccinations have gone to Hispanic people, while Hispanic people account for 42 percent of COVID-19 cases, 47 percent of deaths from the virus, and 40 percent of the total population in the state. Similarly, in Mississippi, Black people have received 22 percent of vaccinations but make up 38 percent of COVID-19 cases, 40 percent of deaths, and 38 percent of the total population in the state.

The share of vaccinations among Asian people was similar to their share of the total population in most states and when there was a disparity in most cases the differences were small. White people received a higher share of vaccinations compared to their share of cases and deaths and their share of the total population in most states reporting data.

Vaccination patterns may change as more data is available and more parts of the country gain greater access to vaccines. Eighteen states and Washington DC are not yet reporting vaccinations by race/ethnicity and some states have high shares of vaccination data with unknown race/ethnicity and/or reporting “other or multiple races.

Source: https://www.kff.org/coronavirus-covid-19/press-release/new-analysis-updated-state-data-continues-to-show-wide-disparities-in-covid-19-vaccination-rates-by-race-ethnicity/

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COVAX and the United States

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Key Points

  • One of the most daunting and urgent challenges facing the world as it seeks to address the COVID-19 pandemic is ensuring broad access to vaccines, without which it will be impossible to achieve needed levels of global population immunity.
  • To date, the majority of vaccine doses (56%) have been purchased by high-income countries, who only represent 16% of the global population, locking in much of the market. In addition, while many high-income countries have started to vaccinate their populations, as of February 8, fewer than 100 doses have been administered in low income countries.
  • COVAX, an international partnership led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the World Health Organization (WHO), was created to respond to this challenge. Its goal is to distribute 2 billion doses of a safe and effective COVID-19 vaccine to the most vulnerable by the end of 2021.
  • While virtually all countries are participating in COVAX, until recently, the U.S. was one of only a handful to sit out formal participation, when the Trump administration decided not to join, although Congress did provide $4 billion in emergency COVID-19 relief to Gavi in support of COVID-19 vaccine access, which Gavi says it will use to support the AMC. On January 21, 2021, soon after taking office, President Biden announced that the U.S. would join COVAX and play a more active role globally on COVID-19.
  • Although COVAX has purchased 1.1 billion doses to date, with most of these doses to be distributed to lower-income countries, it ended 2020 with a funding gap of $755 million and faces a gap of $6.4 billion in 2021. There are also numerous other challenges including competing with bilateral and regional agreements to secure vaccine doses and navigating diverse regulatory landscapes.
  • There are also key questions about the nature of U.S. participation including how much funding the U.S. will provide for COVAX going forward, either as a self-financing country to access vaccines in the COVAX portfolio and/or as a donor to the COVAX advance market commitment intended help supply vaccines for low- and middle-income countries, and if the U.S. will donate surplus doses to COVAX in the future.

Introduction

One of the most daunting and urgent challenges facing the world as it seeks to address COVID-19 is ensuring broad access to vaccines, including in low- and middle- income countries (LMICs). Not only has this been seen as a moral imperative, it is critical for achieving the levels of global population immunity needed to curb the ongoing pandemic. In addition, a recent analysis found that high income countries will bear significant, additional economic costs if broad, global vaccine access is not achieved. Yet most vaccine doses have already been purchased by high-income countries; whereas they represent just 16% of the global population, high income countries have purchased 56% of vaccine doses. In addition, while many high-income countries have started to vaccinate their populations, as of February 8, fewer than 100 doses had been administered in low income countries. Furthermore, due to development and manufacturing constraints, it is estimated that there will not be enough vaccine doses to cover the world’s population until at least 2023, or, by other estimates, 2024. COVAX, an international partnership led by CEPI, Gavi, and the WHO, is a global partnership created to respond to this challenge. Virtually all countries are participating in COVAX

While the United States has historically played a major role in responding to global health emergencies, the Trump administration decided not to join COVAX, making the U.S. one of only a handful of countries not to do so. Soon after taking office, on January 21, 2021, President Biden announced that the United States would join COVAX and play an active role globally on COVID-19.

This brief provides an overview of COVAX and identifies key questions and issues to consider for U.S. engagement.

History & Mission

In April 2020, at an event convened by the World Health Organization (WHO), France, the European Commission, and the Bill & Melinda Gates Foundation, the Access to COVID-19 Tools (ACT) Accelerator was launched to help the global community combat the COVID-19 pandemic. The ACT Accelerator brings together governments, scientific and regulatory experts, philanthropies, and global health organizations to focus on four main pillars: 1) diagnostics, 2) treatment, 3) vaccines, and 4) health systems strengthening. Each of the pillars is led and coordinated by different multilateral institutions. COVAX is the vaccine pillar of the Act Accelerator. COVAX’s goal is to distribute 2 billion doses of a safe and effective COVID-19 vaccine to the most vulnerable by the end of 2021.

Organizational Structure

Governance

COVAX’s three lead organizations—CEPI, Gavi, and the WHO—coordinate its various operations. Vaccine development and manufacturing functions are led by CEPI, procurement and delivery functions by Gavi, and allocation policy by the WHO.

  • CEPI – CEPI manages the COVAX R&D vaccine portfolio including the selection of potential candidates as well as providing direct financial support for vaccine development. The portfolio includes multiple vaccine candidates in order to mitigate the risks of one or more candidates failing to be proven effective and safe. CEPI also secures agreements with manufacturers to accelerate scale-up and production. As of January 2021, CEPI had reserved manufacturing capacity with 13 manufacturers.
  • Gavi – Gavi leads the COVAX Facility, which is the procurement mechanism of COVAX. Gavi works with manufacturers, participating countries, and private donors to secure vaccine dose orders. In addition, Gavi assists low- and middle-income countries with delivery preparedness through technical assistance and financing cold chain equipment.
  • WHO – The WHO leads the development of an allocation policy framework to establish guidelines for equitable and effective distribution. The WHO also provides all countries with guidance on delivery preparedness, and, similar to Gavi, assists low- and middle-income countries with delivery preparedness through technical assistance and financing cold chain equipment.

Country Participation

While participation in COVAX is entirely voluntary, almost all countries are participating in some way, including 190 governments and economies as of January 2021. Countries may join as either “self-financing” countries (high-income countries) or “funded countries” (low- and middle-income countries) (See Table 1).

  • Self-Financing (High Income) Countries: Self-financing countries are responsible for paying for their participation in COVAX, including providing upfront payments and procurement costs, to have access to the COVAX portfolio. To date, 90 countries and 8 economies have committed to join COVAX as self-financing, and an additional 6 countries have signaled intent to participate.
  • Funded (Low- and Middle-Income) Countries: Low- and middle- income countries are eligible to participate in the Gavi COVAX Advance Market Commitment (AMC), a financial mechanism to enable them to access vaccines that they would otherwise be unable to afford. 92 countries are eligible to participate in the Gavi COVAX AMC as funded countries. Funding for the AMC is through provided by separate contributions from public and private donors.

With 190 governments involved, more than 90% of the global population is affiliated with COVAX.

Self-financing countries Funded countries
Number of participating countries 90 countries and 8 economies have signed commitment agreements and an additional 6 have signaled intent to participate. 92 countries are eligible to participate in the AMC.
Eligibility requirements None GNI per capita less than $4,000 or World Bank IDA-eligible
Deadline for countries to commit The original deadline to commit was September 18, 2020, with upfront payments due October 9, 2020. Applications to confirm participation opened on November 13, 2020 and were due December 7, 2020. 88 countries have submitted vaccine requests.
Funding structure Two payment options:

  • Committed purchase option – Cost of this plan includes an upfront cost of $1.60 per dose and purchasing agreement of $8.95 per dose. (30 countries have agreed to this option.) Countries with this agreement may only opt out of purchasing a vaccine candidate if they have indicated in their commitment agreement to not purchase vaccines with prices exceeding $21.10 per dose.
  • Optional purchase option – Cost of this plan includes an upfront cost of $3.10 per dose, purchasing agreement of $6.20 per dose, and risk-sharking cost of $0.40 per dose. (39 countries have agreed to this option.) Countries under this agreement can decide to opt out of purchasing certain candidates either before entering the COVAX Facility through its participation agreement or once the COVAX Facility confirms orders with a manufacturer.

Additionally, all self-financing countries will be required to pay a speed premium (used to accelerate manufacturing) and a COVAX Facility operation fee.

The Gavi COVAX AMC is funded primarily through contributions from public and private donors which in turn support the provision of vaccine doses to funded countries. Funded countries wishing to receive more than their allotted amount of doses may elect to provide additional funds through a tiered cost-sharing obligation. Support from multilateral development banks may be utilized to cover cost-sharing obligations.
Initial doses countries in financing group may receive Self-financing countries can request enough doses to vaccinate 10-50% of their populations, depending on their level of investment. Funded countries will receive enough doses to vaccinate up to 20% of their populations.
Projected doses to be received from COVAX in 2021 485 million 1.8 billion

Activities

Vaccine Research & Development and Manufacturing

COVAX supports the research and development as well as manufacturing of vaccines through the establishment of a vaccine portfolio managed and led by CEPI. CEPI, after expert review, determines whether or not to include a vaccine candidate in its portfolio and oversees the financing of vaccine candidate development. In addition, CEPI identifies potential manufacturing partners and provides technical and financial support in preparation for the eventual production of an approved vaccine (see Financing section). There are currently 11 vaccine candidates, with 9 in clinical trial phases, in CEPI’s portfolio. COVAX has the right of first refusal of approved vaccines from candidates included in the CEPI portfolio (currently up to 1 billion doses). However, COVAX is not limited to procuring vaccines from the CEPI R&D portfolio and can also secure doses from candidates that have not received CEPI funding.

Vaccine Procurement and Delivery

As mentioned above, the COVAX Facility, led by Gavi, is a centralized purchasing mechanism. It is responsible for negotiating pricing with manufacturers through pooled purchasing that is made possible because of advance purchase agreements with participating countries. Any country may participate in the COVAX Facility, with terms of participation differing based on income level (see Country Participation section).

To date, COVAX has purchased 1.1 billion doses through signed agreements, with an additional 900 million optioned. COVAX also anticipates securing additional doses through the CEPI portfolio. The COVAX procurement portfolio includes a mix of vaccine candidates not included in the CEPI portfolio (3 developers), candidates included in the CEPI portfolio (2 developers), as well as right of first refusal to CEPI-funded candidates that have not yet received regulatory approval. However, the majority of the doses secured by COVAX are from manufacturers that have yet to receive regulatory approval for their vaccines, including those from Janssen, Sanofi/GSK, and Novavax.

Developer/manufacturer Doses Confirmed or reserved CEPI-funded Clinical trial and licensure phase
Pfizer 40 million Confirmed No Approved for emergency use by the WHO.
AstraZeneca 270 million Confirmed Yes Approved for emergency use by the WHO.
Janssen 500 million Confirmed No Regulatory review
Novavax 100 million Confirmed Yes Phase III
Sanofi/GSK 200 million Confirmed No Phase I/II
AstraZeneca/Novavax 900 million Optioned Yes Various stages of development and licensure
CEPI R&D Portfolio 1 billion Confirmed Yes Various stages of development and licensure

COVAX also plans to create a COVAX Exchange. The COVAX Exchange will act as a marketplace for countries, including high income countries, to trade allocations of vaccine doses they may not want or need. Countries may also donate unwanted doses to funded, or AMC-eligible, countries. For example, Norway announced plans to donate its extra vaccine doses through the COVAX Facility, and other countries are considering doing the same including the U.S., which has announced that it will develop a framework for donating its surplus vaccine, including through COVAX.

In addition to vaccine procurement, COVAX is coordinating efforts to help prepare low- and middle- income countries for vaccine delivery, including procuring equipment necessary for the delivery of a COVID-19 vaccine such as syringes and cold chain storage, as well as providing guidance and assessment tools to support all countries in their vaccine delivery efforts.

Related to vaccine delivery, COVAX plans to create a no-fault compensation fund to protect LMICs from liability issues resulting from vaccine-related adverse events. LMICs wishing to participate will be required to indemnify manufacturers against liability claims in order to utilize this fund to compensate affected individuals. The fund will be funded by a levy of $0.10 per dose. COVAX is also currently working to identify a third-party to cover the costs of damage claims on behalf of funded countries in cases where the claimant pursues damages under local law.

Vaccine Allocation

COVAX plans to follow an allocation framework proposed by the WHO in order to ensure equitable distribution among all participating countries. The framework recommends that all countries, regardless of income, receive an initial supply sufficient to cover 3% of their populations, targeting health care and frontline workers, and then receive enough additional doses to vaccinate a total of 20% of their populations to cover higher-risk individuals (Phase 1). After this, countries may receive doses to vaccinate an additional 30-50% of their populations, depending on their agreements with COVAX (Phase 2). COVAX may give prioritization to certain countries based on factors such as threat (a country’s risk of severe impact from COVID-19) and vulnerability (a country’s ability to address threat based on its health system capacity). COVAX will also maintain a buffer supply of approximately 5% of available doses to respond to acute outbreaks or humanitarian needs.

COVAX plans to begin distributing vaccine doses to all AMC countries for the vaccination of health and social workers in February 2021. In the second half of 2021, additional doses will be delivered to cover the remaining portion of the Phase 1 population, for a total of 1.8 billion doses in 2021. Phase 2 delivery is not expected until 2022. For higher-income countries, COVAX expects to deliver 485 million vaccine dose orders beginning in the second half of 2021. COVAX recently released its early 2021 distribution plan, stating its intent to deliver 336 million doses of the AstraZeneca vaccine and 1.2 million doses of the Pfizer vaccine in the first half of 2021.

Phase Population Estimated percentage of population to be covered Delivery timeline
Phase 1 – Tier 1 Frontline workers in health and social care settings 3% February 2021
Phase 1 – Tier 2 High-risk individuals 20% Second half of 2021
Phase 2 Weighted allocation based on country’s risk assessment. 30-50% 2022

Financing

To date, COVAX has received approximately $6.35 billion in funding to support its efforts. This funding is comprised by a mix of direct contributions from donor governments, multilateral organizations, and private organizations ($3.95 billion) as well as prepayments from self-financing countries ($2.4 billion) (See Vaccine Procurement and Delivery section above). Despite the significant resources that have already been made available, it is estimated that an additional $6.4 billion will be needed for 2021 to support research and development, manufacturing, procurement, and delivery of a COVID-19 vaccine (see Table 4). Funding amounts and sources by area (R&D and manufacturing, procurement and delivery, and allocation) are detailed below.

COVAX Activity Deliverable 2020 needs 2021 needs Totals
Target Gap Target Gap Target Gap
Research & development Accelerate clinical trials to bring vaccine to licensure $1.595 billion $262 million $855 million $855 million $2.45 billion $1.117 billion
Facilitate global Solidarity phase III trial for up to 10 candidates
Support regulatory networks
Manufacturing and procurement Invest in manufacturing and procure doses for AMC-eligible countries $2 billion $0 $5 billion $4.6 billion $7 billion $4.6 billion
Allocation and delivery Ensure equitable allocation through policy guidance $642 million $492 million $983 million $983 million $1.625 billion $1.475 billion
Ensure country readiness for delivery
Provide country-level technical assistance
TOTAL $4.237 billion $755 million $6.838 billion $6.438 billion $11.075 billion $7.192 billion
NOTES: These estimates exclude costs financed by self-financing countries.

Vaccine Research & Development and Manufacturing Financing

Funding from donor governments and private organizations (e.g. philanthropies) is provided directly to CEPI to support the research and development of vaccine candidates included in CEPI’s portfolio. In addition, this funding supports increasing manufacturing capacity in preparation for the eventual approval of a vaccine. To date, CEPI has received $1.41 billion in financial contributions largely in support of the research and development component. However, CEPI estimates it needs $2.5 billion to progress up to three vaccines through phase III trials, licensing, and to support national regulatory authorities. Funding for manufacturing capacity is provided through CEPI as well as from Gavi through the COVAX Facility using payments by self-financing countries.

Vaccine Procurement and Delivery Financing

Vaccine procurement is funded by self-financing countries and through donor contributions, with an option to purchase additional doses through cost-sharing, that support funded countries. To date, $2.4 billion has been secured in upfront payments from self-financing countries and $2.4 billion has been secured in donor contributions for funded countries through the Gavi COVAX AMC (See Vaccine Procurement and Delivery section above).

Vaccine delivery support will be provided by Gavi to low- and middle-income countries through technical assistance and the purchasing of cold chain equipment. An initial investment of $150 million has already been made by Gavi to support these delivery preparations, however, an additional $983 million will be needed for 2021. Further, UNICEF is planning to stockpile 1 billion syringes by 2021 for vaccine deployment, an effort that will be reimbursed by Gavi.

Vaccine Allocation Financing

To date, the WHO has received $160 million for all its ACT-Accelerator responsibilities, which includes the vaccine allocation work for COVAX, as well as the therapeutics, diagnostics, and health systems strengthening pillars. It is estimated that $2 million will be needed for WHO to establish allocation policy guidance for equitable distribution.

U.S. Engagement in COVAX

The Trump administration chose not to join COVAX, making the U.S. one of the only countries in the world not to formally participate in the initiative. While Congress provided $4 billion in emergency COVID-19 relief to Gavi in support of COVID-19 vaccine access, which GAVI says it will use to support the AMC, the absence of U.S. leadership in COVAX, and the ACT Accelerator, marked a break from how the U.S. has responded to most other recent global health emergencies. The Biden administration has said it is committed to multilateralism and President Biden announced shortly after taking office that the U.S. would support the Act Accelerator and join COVAX, and would develop a framework for donating surplus vaccines once there is sufficient supply in the U.S. to countries in need, including through COVAX (the Trump administration had included similar language in a December 2020 Executive Order, although the Order was largely focused on ensuring American access to vaccines). The Biden administration has not yet released additional details about its participation in COVAX.

Discussion & Challenges

While COVAX represents an innovative approach to the current global emergency and has made significant progress, it faces a number of challenges ahead. There are also several outstanding questions regarding U.S. engagement in the initiative.

  • Can COVAX fill the funding gap? One of the most significant challenges facing COVAX is funding. Excluding payments from self-financing participants, COVAX has an overall funding target (2020-2021) of $11.1 billion but faces a $7.2 billion funding gap. Given the economic crisis that has gripped much of the world due to COVID-19, it is not yet clear how this gap can be filled.
  • Can COVAX be a successful antidote to global vaccine inequity? Many countries, especially higher-income countries, are working to secure doses for their populations primarily through bilateral or regional purchase agreements, but at the same time are supporting access through COVAX. The competition between COVAX and these other agreements for a limited supply of vaccines may generate higher prices and result in more restricted or delayed access for low- and middle-income countries. While countries may choose to trade or donate surplus doses secured through bilateral or regional purchase agreements to lower-income countries through COVAX, there is no requirement to do so. So, countries will have to consider how best to balance domestic COVID-19 concerns with support for COVAX.
  • How can COVAX quickly navigate the complex regulatory approval process in multiple countries? COVAX will also need to address the challenge of obtaining regulatory approval in multiple countries. Countries may approve a vaccine for use through a variety of regulatory authorities, such as a national regulator, regional regulator, or WHO prequalification. COVAX will need to navigate and obtain approval from these numerous regulatory mechanisms, which is not guaranteed, before a vaccine can be delivered to a country.
  • Will the U.S. join COVAX as a self-financing member? While the U.S. has signaled its intent to participate in COVAX, the details of participation are unclear. If the U.S. joins COVAX as a self-financing member, its prepayments would support the AMC (and thus broader access) and also give the U.S. access to additional vaccines or doses if needed. At the same time, this would also require payments above the billions the U.S. has already made to support vaccine R&D and purchase vaccines through its own bilateral deals.
  • Will the U.S. provide additional funding to COVAX? In its last emergency COVID-19 relief bill, the Congress included $4 billion to Gavi for COVID-19 vaccine procurement and distribution, which it says it will use to support the COVAX AMC. It is unclear if the Biden administration will request additional resources, and how such a request might be received by Congress.
  • What framework will guide U.S. donations for any excess vaccine supply? While the U.S. has stated its intent to develop a framework to donate additional COVID-19 vaccine doses to low- and middle-income countries, including through COVAX, this donation will only occur after sufficient supplies have been secured for the U.S., which could be many months away as supply is limited and the U.S. may yet have enough doses for its own population for the time being. This could also get more complicated if booster vaccines, or modifications to or new vaccines, are required to address variants of the virus going forward.

Source: https://www.kff.org/coronavirus-covid-19/issue-brief/covax-and-the-united-states/

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