In May of 2020, the United States government struck a deal.
$1.2 billion would go to the British drugmaker AstraZeneca,
to speed up their Covid-19 vaccine research.
In exchange, AstraZeneca promised the US 300 million doses
if the vaccine made it through safety and efficacy trials.
Earlier that month, the United Kingdom signed a similar deal with the same company,
to secure 90 million doses.
These types of transactions, where a country makes a deal directly with a company,
are called bilateral deals.
And in 2020, rich countries made a lot of them.
Those billions of dollars helped fund research
that brought us the world’s leading Covid vaccines in record time.
But that money also determined where those vaccines would go.
By January 2021, 96% of the Pfizer-BioNTech vaccine doses
that were scheduled to be produced by the end of the year, had already been bought.
And 100% of Moderna's.
Countries representing 16% of the global population
held over half of the doses from the most promising vaccine developers.
Basically: rich countries got vaccines. Poorer countries didn’t.
In Brazil and India, health systems are being pushed to the limits
at the same time that the US is quickly opening up vaccinations for anyone.
"That's making the pandemic last longer.
It's allowing infections to rage, and new variants to arise,
and at the end of the day, more people are dying than need to be."
The same deals that helped develop vaccines,
are making it harder to get them around the world.
Now what?
"What's happening now, with the Covid-19 vaccine inequality,
isn't at all unprecedented."
In 2009, the World Health Organization declared Swine Flu a pandemic.
"We are all in this together."
After securing their own vaccine deals, these nine higher-income countries
pledged 120 million doses to the WHO for lower income countries.
But they only started sending those donations after they realized
the outbreak wasn’t as serious as everyone initially thought.
"For years, we've seen how technology is rolled out in rich countries,
and it takes decades for them to trickle down to poorer countries."
The problem starts with the vaccine market itself.
Getting a vaccine from development, to manufacturing, to distribution
is a multi-step process.
By making bilateral deals with developers and suppliers early on,
rich countries got in line here: at manufacturing.
But there was no guarantee that any given vaccine would work,
or get past regulators to reach the market.
If a vaccine fails shortly after funding, those billion-dollar investments are lost.
So, to offset that risk, countries invested in multiple options and suppliers,
often securing enough doses to cover their populations several times.
As of March 2021, Canada had secured over 300 million doses:
Enough to cover their population five times over.
And the deals the US made were enough to cover its population at least twice.
Which worked out for them,
because even though they secured 300 million doses of AstraZeneca a year ago,
as of April, it still hasn’t been approved for use in the country.
But the Pfizer and Moderna doses that the government pre-purchased
are still enough to cover most of the population.
Most countries can’t afford to make multiple high-risk investments early on,
so they wait until the vaccine is further along in the approval process.
And by then, they’re already at the back of a very long line.
Peru, for example, made a bilateral deal with AstraZeneca,
but won’t see those doses until at least September.
"Those that purchased first, or made the biggest orders,
or invested into the research and development, are standing at the front of the line.
Which is why the US has gotten 240 million doses of vaccine so far, at least,
and most of the poorer countries in the world don't have 240 million doses combined."
So, is there a way to get a lot of money here,
without creating a priority line over here?
Maybe.
One program underway is designed to work as a sort of middleman,
between countries and the drug companies making vaccines.
It’s called Covax.
It’s an initiative formed by three global health groups,
including the World Health Organization.
And its main objective is to provide vaccines to 92 middle- and low-income countries
that were shut out from making their own deals.
"Covax is kind of like the Paris Climate Agreement of the vaccine world.
So it's this multilateral effort, with almost 200 countries that have joined.
And the idea is that everyone has access to Covid-19 vaccines,
regardless of the country's GDP."
It does this using a two-part system.
The first part allows high-income countries to buy into and access multiple vaccines at once.
So, instead of one country giving $2 billion directly to AstraZeneca,
they’d give the money to Covax, which would use it to fund several different vaccines.
This way, if one or two of them failed early on, it wouldn’t be a total loss;
the other vaccines in the portfolio would make up for it.
It’s a multilateral system that’s much lower-risk for those countries than a bilateral one.
The idea is that Covax could use that larger purchasing power
to negotiate deals with manufacturers and developers on a global scale,
which would drive the costs down, and fund vaccine development.
The second part buys vaccines for lower-income countries.
It's funded by donations from wealthier governments and charities.
The US alone has pledged $4 billion to this fund.
As vaccines become available, Covax hands them out to every country at once,
so rich countries and poor countries all get a fair share.
At least, that’s the idea.
"The biggest problem with Covax is these bilateral deals we talked about."
For Covax to work as intended, it needs most countries to be using its multilateral system.
But Covax was formed a month into the pandemic,
when many countries had already invested in bilateral deals.
So the incentive for rich countries to join Covax was low.
But without them, Covax might be underfunded.
So it let them have it both ways:
Rich countries could join Covax, and keep their bilateral deals
that would get them more vaccines, faster.
"And those basically undermined Covax,
because they put themselves at the front of the line,
ahead of the access that countries will get through this collective agreement."
The US, for example, has donated the most money to Covax,
but is also still at the front of the manufacturing lines,
waiting for its own doses.
The US and UK have both promised to donate some surplus doses to Covax,
but neither country has said when.
"This means rich countries, like the US, decide who gets what, when.
Instead of some global collaborative process of vaccine allocation."
Experts are skeptical Covax will meet its original goal
of delivering 2 billion vaccine doses by the end of 2021.
As of April, they’ve only purchased around half that amount,
and delivered 45 million doses.
"So they've reached a huge number of countries,
but nowhere near enough to cover even frontline health workers,
or other essential workers, in most of the countries that these vaccines are going to."
Meanwhile, as of April, the US has already administered over 200 million doses.
"What Covax is setting out to do is hugely challenging.
They probably won't meet their own first targets.
But they are getting vaccines into countries
that probably wouldn't otherwise have them this quickly."
Vaccine inequality is bigger than just bilateral deals.
It’s in every step of the process,
from limited manufacturing to cold-chain distribution;
even debates around the intellectual property of vaccines.
Our current system is not a well-oiled machine at all,
and there’s a lot of work to do if we want to be better prepared for the future.
"One of the things that we've learned about pandemic preparedness is,
you can't really build it after the fact. And that's still what we're doing."