The World Health Organization on Monday will announce which countries have signed on to its vaccine plan — and provide more details about how a vaccine, when it is developed, will be doled out.
More than 170 countries are in talks to join 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 2021.
Under the plan, rich and poor countries will 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.
“If and when we have an effective vaccine, we must use it effectively,” Tedros Adhanom Ghebreyesus, director general of the WHO, tweeted Sunday. “And the best way to do that is to start by vaccinating some people in all countries, rather than all people in some countries.”
But Covax, which launched in June, is not getting the support it hoped for as vaccine nationalism takes hold and big economies buy up stocks for their own populations.
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.
To succeed, the facility must attract wealthy nations. The proposed allocation framework, which was reviewed by The Washington Post ahead of its publication, is part of that push.
The framework seeks to answer 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% to start, then up to 20%.
If supply is still limited after the 20% threshold is met, the allocation method will switch. In Phase 2, Covax will consider each country’s COVID-19 risk level, sending more doses to countries at highest risk.
The framework makes clear that each participating country can decide whom to vaccinate first, but is based on the idea that doses for 3% 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 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.”
In a policy report this month for the journal Science, critics offered an alternate framework called the Fair Priority Model, which is critical of the country-based approach.
They argue that it does not make sense to provide the same 3% share to, say, New Zealand and Papua New Guinea, given their vastly different needs and resources. A doctor in a rich country could be 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.
The WHO and its partners are struggling to get rich countries to participate. Promising vaccines for 3% of each country’s population is meant to encourage them 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 are 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.
Britain and Japan have secured doses through advance-purchase agreements but will also participate in Covax — an option the United States could theoretically pursue.
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.”