October 7, 2021
From The Public Source (Lebanon)

The Problem with COVAX

Another example of Lebanon’s no-questions-asked dependency on international organizations for vaccine procurement is the COVAX deal.

COVAX is a global initiative launched in 2020 and led by the WHO and Gavi, a public-private partnership for vaccine access founded by the Gates foundation. For the so-called “self-financing countries,” i.e., middle- and high- income countries, COVAX was meant to push costs down as well as provide an insurance policy of sorts — a way to secure an adequate supply of vaccines should bilateral vaccine deals with companies fall through.

For low and lower-middle income countries, a program called “Advance Market Commitment” (AMC) would allow them to receive vaccines for 20 percent of their population, funded by the higher income countries. The list of 92 AMC-eligible countries includes economies with Gross National Income (GNI) per capita under $4,000, plus other World Bank International Development Association (IDA)-eligible economies, according to a Gavi spokesperson.

Lebanon is not on that list. Instead, the Lebanese government agreed to participate as a “self-financing” country.

A Gavi spokesperson declined to disclose the specifics of the contract with Lebanon, stating, “the details of each country’s individual agreement and as well as their communication with COVAX is for them to announce.”

An employee of the MoPH, speaking on condition of anonymity since they were not authorized to speak to the press, told The Public Source that the conditions of Lebanon’s participation in the COVAX program were strictly defined by Lebanon’s economic status, according to its classification as an “upper middle income” country by the World Bank.

Yet this designation clashes with the realities of Lebanon’s economic and financial crisis, which the World Bank itself ranks in the top three most severe crises globally since the mid-nineteenth century and describes as being in a “deliberate depression.” More than 80 percent of the population has fallen under the poverty line, with the monthly minimum wage about $36 at the date of publication.

According to a World Bank spokesperson, Lebanon still falls in the “upper middle income” category given that its most recent recorded GNI per capita, in 2020, is $5,510, (which falls within the $4,096 and $12,695 range assigned to this category). The spokesperson added: “Lebanon’s recession is likely to be arduous and prolonged given the lack of policy making leadership and reforms. While as of now Lebanon remains an upper middle income country, going forward GNI per capita will be continuously updated to reflect the latest available data.”

The shortcomings of the COVAX scheme are no surprise to Merith Basey, the director of Universities Allied for Equitable Medicines in North America and an activist with “Free the Vaccine,” a movement calling on governments and pharmaceutical companies to ensure that the COVID-19 vaccine is available for all as a global common good. 

Basey pointed out that COVAX mirrors global dynamics where higher-income countries hold the power to shape the deals. “It’s so predictable, this neo-colonialist approach to medicine,” she said.

Lebanon might not be “poor enough,” based on World Bank categorizations, to benefit from donor-funded doses through COVAX, but it is certainly not strong enough to negotiate a fair price either.

Lebanon might not be “poor enough,” based on World Bank categorizations, to benefit from donor-funded doses through COVAX, but it is certainly not strong enough to negotiate a fair price either.

Lebanon’s deal with COVAX is to pay approximately $10.55 per dose (for 2.73 million doses of the AstraZeneca vaccine), the same rate as any other self-financing country. 

For comparison, through its direct bilateral agreement with the manufacturer Pfizer, Lebanon is buying 2.1 million doses for a total of $18 million, or the equivalent of $8.5 per dose. If the $28.8 million spent on the COVAX deal had been used in direct bilateral agreement with Pfizer, Lebanon would have been able to purchase approximately 3.4 million additional doses of Pfizer, i.e. more than 600,000 more doses than it currently gets from COVAX.

The COVAX scenario is reminiscent of the case of pneumonia vaccines, whereby the world’s poorest countries can access them through Gavi at a special price ($8.75 per child), while middle-income countries have to pay between $49 in the Philippines and $245 in Lebanon, per child.

A sustainable vaccination campaign would need to use resources more wisely, especially given that booster shots will be needed in the near future.

Despite the lessons the Lebanese state should have learned by now, its slow, expensive, and inefficient vaccine rollout strategy continues to cost Lebanon’s residents further loss of health and lives. 

Source: Thepublicsource.org