The World Health Organization on Monday urged more wealthy countries to join its vaccine agreement — and provided details about how a vaccine, when it is developed, will be doled out.
More than 150 countries, representing 64 percent of the world’s population, have agreed to participate in the Covid-19 Vaccines Global Access Facility, or Covax, which aims to develop and distribute $2 billion in doses of a vaccine by the end of next year.
Under the plan, rich and poor countries pool money to provide manufacturers with volume guarantees for a slate of vaccine candidates. The idea is to discourage hoarding and focus on vaccinating high-risk people in every participating country first.
So far, 64 higher-income countries have signed up, WHO officials said, but they added that 38 more are expected to do so in the coming days. Notably missing: Russia, China and the United States.
China has not made an announcement either way. The White House said this month that the United States would not join, in part because the administration doesn’t want to work with the WHO, and will instead take a go-it-alone approach.
At a news briefing Monday, the WHO called for more countries to sign on. “The race for vaccines is a collaboration, not a contest,” said Director General Tedros Adhanom Ghebreyesus. “This is not charity. It’s in every country’s best interest. We sink or swim together.”
A proposed allocation framework, published Monday, addresses a question critical to every country: Once there’s a safe and effective vaccine, how do you divvy it up?
The WHO’s answer is a two-phase plan that will be closely studied and assessed.
In the first phase, doses will be distributed proportionally, meaning each participating country will get doses for a share of its population: 3 percent to start, then up to 20 percent.
If supply is still limited after the 20 percent threshold is met, the allocation method will switch. In Phase 2, Covax will consider each country’s risk level, sending more doses to countries at the highest risk.
The framework makes clear that each participating country can decide whom to vaccinate first, but it is based on the idea that doses for 3 percent of a country’s population could be used to vaccinate medical workers first and then other high-risk groups.
“Providing each country with enough doses to start protecting the health system and those at higher risk of dying is the best approach to maximize the impact of the small quantities of vaccines,” said Mariângela Batista Galvão Simão, the WHO’s assistant director general for access to medicines and health products.
Analysts said the framework reflects the political nature of the process and the fact that the WHO is a member-state organization.
“It seems like a compromise position,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations and the director of its global health program. “It’s not exactly what you would do if you were driven strictly by public health.”
They argue that it does not make sense to provide the same 3 percent share to, say, New Zealand and Papua New Guinea, given their vastly different needs and resources. A doctor in a rich country could be at lower risk than a member of the general public in a country at higher risk.
The critics argue that distribution should be focused on benefiting people, limiting harm, prioritizing the disadvantaged and showing equal moral concern for all individuals.
Promising vaccines for a proportion of each country’s population is meant, in part, to encourage more countries to sign on.
“It’s a very pragmatic and expedient way of trying to put forward a simple plan and will not ignite a food fight among different member states in the first phase,” said J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies.
“The real food fight,” he said, “will come later” — particularly in Phase 2, when the facility will need to assess risk.
So far, these questions have been at the fringe of the conversation on vaccines, particularly in the United States.
The Trump administration said this month it would not participate in Covax either to secure doses or to offer support.
Under “Operation Warp Speed,” the United States has placed advance orders for hundreds of millions of doses of vaccines, with an aim to secure doses for most Americans, including those who are at low risk, before anyone else.
The strategy comes with risk because it eliminates the possibility of securing doses from one of the Covax candidates. If one of the U.S. picks does not pan out, the country could be shut out.
A worst-case scenario, considered unlikely, is that none of the U.S. vaccine candidates is viable, leaving the United States with no option because it has shunned the Covax effort.
A more likely outcome is that one of the U.S. picks does pan out but the United States hoards doses, vaccinating most Americans, while people in other countries go without.
The problem is that a new vaccine, whenever it arrives, is unlikely to offer complete protection to all people, so a portion of Americans will still be vulnerable, especially as tourism and trade pick up.
Ultimately, analysts say, it’s just the beginning of negotiations and conversation that will be playing out for years. “It still remains very unclear who will get what, in the end,” said Suerie Moon, co-director of the Global Health Center at the Graduate Institute of International and Development Studies in Geneva.
“From what we’ve seen so far, political, industrial and security interests will play a much larger role in determining global vaccine allocation than ethics or public health rationale,” she said.