Pandemic will not end if we prioritize 3rd dose of vaccine, says director of Covax – Health

To stop the pandemic, it is essential to ensure that vaccines reach all countries equally. The first step towards this is to vaccinate at least 20% of the population of each country, a range that concentrates people at high risk for the Covid-19, such as the elderly and health workers. But the world is far from achieving this goal.

This is what the Argentine defends Santiago Cornejo, Director of Engagement with the Countries of the Covax Facility, in an exclusive interview with State. According to him, the initiative still needs to distribute 1.7 billion doses to reach the goal. So far, 200 million doses have been delivered through the coalition. Cornejo is also director of Immunization Financing and Sustainability at Gavi, the Vaccination Alliance.

So far, 5.4 billion doses of vaccines against covid-19 have been applied worldwide. Despite the high rate – around 40% of the world’s population received at least one injection – the vaccines are not evenly distributed. In low-income countries, only 1.8% of the population had a chance to start immunization. The data is from the platform Our World In Data, linked to Oxford University, from UK.

Read excerpts from the interview below.

How did the Covax Facility come about? Have there been any other alliances like this in history?

​​The threat of the pandemic required action never seen before. When we started to think, at Gavi, what we could do to support the fight against covid-19, we realized, together with World Health Organization (WHO) and to other partners, that we needed a global solution. The first step in this was to implement Covax. It’s the first time in history that we’ve had a global effort to launch a vaccine within a year and make it available in a very wide range of countries with unprecedented levels of coverage. It is a very complex undertaking and the only solution we have to defeat this pandemic.

Could all countries join Covax or just low- and middle-income countries?

All countries could have joined us, we had no eligibility criteria. The only difference between the nations is that Covax pays for the doses distributed to the 92 most vulnerable countries, while the other participants, including Brazil and most Latin American countries, are self-funded. We opened the door to all countries because, when we started working, we understood that the purchase of vaccines was a global problem. So we realized that the only solution would be to bring all countries, organizations and vaccine manufacturers together in Covax to find a solution.

Who determines the amount of doses each country receives?

For the self-financing, middle- and high-income countries, we asked them to set their targets. In general, these nations have asked to be given enough doses to vaccinate between 10% and 20% of their population. For the 92 countries funded by Covax, our goal is to achieve at least 20% coverage. In this way, we can guarantee the immunization of risk groups. We hope to reach the 20% target by the end of the year and continue to support these countries to reach much higher levels of coverage in 2022.


I’m an optimist, so I like to think we’re going to reach our goal. The world needs this to end the most acute phase of the pandemic


Santiago Cornejo, Covax Facility Country Engagement Director

Does Covax have an estimate of how many vaccines are needed to reach this goal?

Our goal is to deliver 1.9 billion doses of covid-19 vaccines by 2021. To date, we’ve distributed 200 million. There are still 1.7 billion doses to go. We have enough vaccines contracted with manufacturers to meet this goal by the end of the year. What we need is for contracts to be fulfilled and for donations promised by other countries to be delivered. I’m an optimist, so I like to think we’re going to reach our goal. The world needs this to end the most acute phase of the pandemic.

Documents delivered to the Parliamentary Inquiry Commission (CPI), which is investigating the government’s role in controlling the pandemic, revealed that Brazil could have asked for enough doses to vaccinate 50% of its population, but chose the minimum quota, 10%. How did Covax see this decision?

Like Brazil, many countries asked for 10%, while others asked for a little more, 20%. I believe this was a national decision, based on the country’s plans, strategies and needs. Brazil is a strategic partner of Covax and we have a great relationship since the beginning.

If the country had asked for as many vaccines as possible, would it have already received more doses through the consortium?

No, Brazil would have received exactly the same amount. We are distributing vaccines in proportion to the population of countries regardless of the number of doses contracted. We have not yet reached the 10% we promised to Brazil, but we hope to meet this percentage by the end of the year. If the country had requested 50%, the main difference would be to receive more doses in the coming months.

Did Brazil even request extra doses from Covax after signing the contract?

Once the contracts have been signed, the conditions will be maintained until the end. No country can request extra doses. What we expect is to fulfill, by the end of 2021, the commitments already signed. And we are working to see how we will be able to support countries in 2022.

Like the United States, Israel and Chile, Brazil plans to apply an extra dose of the vaccine against covid-19 to its most vulnerable population. How do you see this? Is the world ready for the third dose?

This is a very important topic. It is critical that we continue research to develop our knowledge about vaccines and this disease. And, scientifically, what we know so far is that full vaccination protects enough even against variants like the Delta (strain originally identified in India and most transmissible), preventing serious hospitalizations and deaths. The world’s top priority should be to ensure that every country has enough vaccines to meet the current vaccine schedule, and that is what we stand for. That’s what will make it possible to avoid hospitalizations. Once we have more supplies, once we reach this minimum coverage in all countries, we can see how to increase protection with extra doses. If countries start using scarce supplies to give a third dose now, the availability of vaccines will be even more limited.

What is your opinion about breaking patents on vaccines? Could this increase the availability of immunizers?

I think the patent is an element, but it is not the solution or the only solution, especially in the short term. The manufacture of vaccines is very complex. It’s not just the patent, it’s the technology behind it. We need technology transfers to drive production in many parts of the world, not just some places. It takes time for that to happen, but that’s what we need to diversify production. From Covax’s perspective, we believe we need more companies making the vaccines.

Another widely discussed topic is the vaccine passport. What do you think about this?

I think the big issue in all these discussions that are coming up is the same: we need equitable access to vaccines. This is at the heart of what must be debated not only by Covax, but also by governments, vaccine manufacturers and civil society. We need everyone to really work together towards this goal.

Many countries are finding it difficult to expand vaccination coverage even though they have doses in stock. Why do you think this is happening and how to combat the problem?

We are starting to see some countries reach a plateau in vaccination. It’s sad to see this in a pandemic that is taking many lives. One of the causes of this hesitation in receiving the vaccine is misinformation and the spread of false news about immunizers. This has a terrible impact and we cannot pay for it. We need all parties involved to work together. It is not about a single person, but society. The solution is communication, communication and communication. We need countries to provide scientific evidence, in a simple way, so that people can understand the importance of vaccination.

Do you think that unequal access to vaccination contributes to the emergence of more dangerous variants?

For sure. That’s why we always say that we need to vaccinate a lot all over the world. We cannot have pockets of unvaccinated people. It will not be just one country or one region that will defeat this pandemic. That’s impossible, today’s world is connected, people move. We need a global solution.

Several countries, including Brazil, have started vaccinating teenagers. How do you see this?

My point is that we need vaccines for the most at-risk populations. There are still many countries that have failed to vaccinate groups such as health professionals, frontline workers, the elderly and people with comorbidities. This is our priority and must be the priority for the entire world.

The question everyone is waiting for an answer: will mass vaccination end the pandemic?

I wish I could say when and how the pandemic will end, but I can’t. What I do know is that we still have a lot of work to do in 2021 because we haven’t done enough for equitable access to vaccines. And, most importantly, we have already started to prepare for 2022. Next year, we will have to continue prioritizing vaccination. This will be very important if we are to defeat this pandemic.