COVAX and the Race for Pandemic Vaccines

Why poorer countries waited far longer for COVID-19 vaccines than rich ones, what the COVAX facility achieved, and what economists learned about sharing vaccines in a crisis.

When COVID-19 vaccines arrived at the end of 2020, the world faced a huge economic and ethical question: who gets the first doses?

The rush to buy

Rich countries signed advance purchase agreements with vaccine makers early in 2020, before vaccines were proven, often ordering far more doses than their populations needed. This helped fund production, but it meant rich countries were first in line.

COVAX

COVAX was set up in 2020 by Gavi, the World Health Organization and the Coalition for Epidemic Preparedness Innovations to buy and distribute vaccines fairly. The idea was to pool demand from many countries, as Gavi does for routine vaccines, and give lower-income countries doses at no cost.

COVAX delivered around 2 billion doses to nearly 150 countries by the time it wound down. But it struggled early on:

It lacked money at the start, so it could not compete with rich countries’ early orders.
Manufacturers delivered first to countries that had ordered first.
In 2021, during India’s severe second wave, India restricted vaccine exports. COVAX had relied heavily on the Serum Institute of India for doses, so supplies fell far short of plans.

The result

By late 2021, most adults in rich countries had been vaccinated, while only a small share of people in low-income countries had received even one dose. Many deaths might have been avoided with a faster, fairer distribution.

The economics

Global public good: vaccinating everyone reduces the chance of new variants that threaten all countries. Economists estimated that the global economy would lose far more from unequal vaccination than it would cost to vaccinate the world quickly.
Nationalism in a crisis: governments put their own citizens first, a predictable response that global plans must account for.
Manufacturing concentration: when production is concentrated in a few countries, export restrictions can disrupt global supply.

Lessons for the future

Build vaccine manufacturing in more regions, including Africa, which imports almost all its vaccines.
Set up financing in advance, so global buyers can order early.
Agree on rules for sharing doses before the next pandemic. Countries adopted a Pandemic Agreement at the World Health Assembly in 2025, though key details were left for later negotiation.

Two health workers

In early 2021, a nurse in a European hospital receives her second vaccine dose. A nurse in a hospital in a low-income African country treating the same disease is still waiting for her first. The gap reflected who could pay first, not who faced the greatest risk.

Thinking vaccine inequity was only about money

Money mattered, but export restrictions, manufacturing concentration and early purchase deals also shaped who got vaccines first.

Key takeaways

Rich countries secured early COVID-19 vaccine supplies through advance purchase deals.
COVAX pooled demand and delivered around 2 billion doses, but faced early funding and supply shortfalls.
India's 2021 export restrictions hit COVAX, which relied on the Serum Institute.
Regional manufacturing and advance financing are key lessons for future pandemics.