By Francesco Guarascio

BRUSSELS (Reuters) – In March, as wealthy Britain led the world in vaccination rates and almost half its people had received a shot, the organisation meant to ensure fair global access to COVID-19 vaccines allotted the country over half a million doses from its supplies.

By contrast Botswana, which hadn’t even started its vaccination drive, was assigned 20,000 doses from the same batch of millions of Pfizer (NYSE:) mRNA vaccines, according to publicly available documents detailing COVAX’s allocations.

Britain received far fewer shots as other poorer countries with relatively new vaccination campaigns. Togo and Rwanda each received approximately 100,000 doses and Libya, nearly 55,000.

COVAX (a program co-led the World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI), and the Global Alliance for Vaccines and Immunization (Gavi) drove distribution. The distribution of doses has been proportional to its member countries since January. It does this regardless of vaccine coverage.

These arrangements made rich nations with multiple vaccines, as well as countries without vaccines, eligible for COVAX dosages.

According to Reuters, COVAX plans to change the way it allocates vaccines to take into consideration the percentage of a country that have been vaccinated. This includes shots purchased directly from pharmaceutical companies.

This proposal will be brought up at Tuesday’s Gavi board meetings. It could then be adopted in the fourth quarter this year.

Large, prestigious institutions such as the WHO or U.S. Centers for Disease Control, have struggled at times to adapt and change course when new information has been received. The COVID-19 Pandemic presented a unique challenge.

Bruce Aylward (a COVAX senior official) answered Reuters when asked why the total vaccination coverage wasn’t used sooner. He said that COVAX has more than 140 members countries and the terms of the allocation cannot be modified without their consent. However, he didn’t elaborate on how they reached consensus.

Hard data about vaccine efficacy was available, which further strengthened his case.

It is now that there has been a divergence between deaths and cases as a consequence of vaccine coverage.

The best indicator of mortality is coverage in all areas, and not only COVAX.

SHORTAGE OF SHOTS

Britain will overall be a net donor in money and vaccines. COVAX is a fund that has received 71million pounds ($97,000,000) from the British government. This allows them to buy as many as 27 million vaccines. In addition, they have begun donating nine million shots via COVAX this summer.

There has been wealth inequality in the world since vaccines were made, and governments from London, Washington DC, Ottawa, Brussels, and elsewhere, including many COVAX member countries, have each secured large quantities of supplies beyond the program.

COVAX refocused its original ambitions to be a global vaccine clearinghouse in June and focuses on the countries most in dire need. However, it continued to assign vaccines based on the country’s population size rather than total coverage.

COVAX’s 15-month history has seen vaccine shortages. This was initially due to the hoarding of small doses by wealthy nations.

As a result, supplies have been affected by problems with drugmakers ramping up production in India and restrictions on exports to India. These issues led to delays in delivery of large quantities of AstraZeneca’s (NASDAQ:), vaccine that COVAX had allocated late February.

It has been unable to reach poorer countries due to these issues. So far it has sent 300 million doses in 140 countries. That is far below its goal of 2 billion by year’s end.

TOP OF GLOBAL RANKINGS

The March 15 allocation of the Pfizer shots, among about 50 countries, showed up the weakness in the COVAX methodology.

After a smaller initial batch of 1.2million shots, the U.S. drugmaker had distributed 14.1 million vaccines to 18 countries. WHO records show that this was the first major allocation.

Many countries hadn’t yet begun their vaccination campaigns at that point, largely due to a lack of vaccines. Even the European Union countries were struggling to find sufficient vaccines.

Britain was however successful in its vaccination drive and gave at least one dose per person to more than 40%. It was also in the top three for administering doses proportional in population. These figures are from One World in Data.

Gavi stated that 539,000 shots were given to the country at June’s end. There were seven countries that received more than the Philippines and Brazil. A total of 200,000 doses were given to the UAE.

While the British government stated that they had received half a billion doses of COVAX, the dates for delivery were not provided.

COVAX was also funded by other developed countries. However, some of these nations chose not to take their doses as they were able to rely on the millions of doses that are available through bilateral agreements with drugmakers.

Gavi reported that the UAE failed to accept its March allocation. Requests for comment were not answered by the UAE.

NO FREEZERS, NO VACCINE

The allocation also highlighted another driver of unequal access, this one specific for vaccines like Pfizer’s based on new mRNA technology: a country’s capability to handle the shots, which needed to be transported and stored at temperatures of around minus 70 degrees Celsius.

Only 50 countries, ranging from Brazil and Britain to Angola to Bolivia and Brazil could receive the Pfizer doses. This was because COVAX only allowed them to be considered to possess the “ultracold chain” equipment.

Many countries from the developing world were excluded.

Gavi’s spokesperson said that only a few countries had been deemed fit to receive Pfizer doses. He was asked why the UAE and Britain were not among those first recipients.

Gavi did not initially consider it important to invest in ultra-cold chains equipment for mRNA shots. Gavi’s December public board records show that Gavi preferred cheaper, easier-to-administer vaccines such as AstraZeneca, which doesn’t have extreme temperatures requirements.

Officials from WHO and Gavi said this was consistent with the requests of poorer countries.

In fact, the AstraZeneca doses of 240,000,000 were given to 140 more countries in February. But, due to India’s import restrictions, only around 80 million AstraZeneca cases had been distributed as of August.

Heather Ignatius is Path’s managing director of Advocacy. She said, “Preparing an extremely-cold supply channel is a risky undertaking.” Noting that there was no guarantee of delivery, it makes little sense to purchase expensive freezers.

Gavi decided to change course regarding ultra-cold supply chain investments when the United States promised to give hundreds of millions worth of Pfizer vaccinations to COVAX.

Gavi spent up to $25million on the freezers necessary to keep the vaccine safe, a spokesperson for Gavi told Reuters.

An official who is familiar with the situation said that money started to be used in August. Gavi is now planning to provide freezers for about 50 less developed countries through UNICEF. UNICEF handles COVAX logistics.

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