The COVAX question: Blameshifting or truth-bomb detonations?
IPresident Mokgweetsi Masisi recently revealed government’s growing frustration with the slow pace of vaccine distribution from the COVAX facility, as cases and deaths in the country rise. The omission of Botswana’s name from the 180-country strong facility has fuelled further concerns about where the local vaccine programme is headed. Staff Writer, MBONGENI MGUNI writes
t is all a simple error, COVAX authorities say when asked why Botswana does not appear in the last updated list of countries participating in the facility. Run as an arrangement between the World Health Organisation, the GAVI Alliance as well as public and private donors, COVAX involves more than 180 countries grouping together to approach vaccine manufacturers for equitable distribution.
Botswana is one of just five African countries self-financing their participation in COVAX as the rest are supported by either donors or debt. Botswana was also one of the first African countries to pay into COVAX, depositing a reported $7 million last November.
The omission of Botswana from the list of self-financing parties on the GAVI website, coming as it did after President Mokgweetsi Masisi expressed frustration with the pace of distribution coming out of the facility, triggered foreboding from citizens monitoring the supply of doses.
“Thanks for flagging that Botswana doesn’t appear on the list of Facility participants,” a GAVI spokesperson told Mmegi this week. “This is a technical issue.
“We’ll update the document as soon as possible.”
Masisi, speaking during tours he conducted last week at vaccination sites in Greater Gaborone, said the government was concerned that after paying into COVAX, it appeared the country was not getting its money’s worth.
His remarks triggered fact-checking by citizens and the media who picked up the omission of Botswana from the COVAX list. Masisi repeated his previously made statement that wealthier countries had pre-booked more doses than they needed at manufacturers, meaning countries such as Botswana, even though they had paid, would only get sufficient doses next year.
This allegation was also fact-checked by social media sleuths who discovered a UNICEF dashboard on vaccines indicating that Botswana signed its agreements in April this year and while this was ahead of other African countries, the timing was after other developed nations had sealed theirs.
Laying the groundwork,
the detective work being done around COVAX and other distribution lines has led to criticism, as expressed mainly on social media, that local authourities sat on their hands while other countries prudently negotiated deals for vaccines. Publicly available information and previously reported by Mmegi indicates that Botswana initially put its trust in COVAX through the November 2020 deposit, but always had an eye on securing bilateral deals for supply. From the figure reported by Reuters in November of the 900,000 AstraZeneca doses secured, this whittled down to just under 120,000 by February when GAVI officially revealed the numbers each participating country would receive.
By March, when GAVI released a document indicating allocations, Botswana’s share had been reduced to 100,800 of which 62,400 has been delivered and another special allocation of 19,890 Pfizer shots supplied.
Donations made by the Indian government of 30,000 COVISHIELD (AstraZeneca licence from India) were donated by the Indian government and another 200,000 donations from China of Sinovac doses, helped kickstart the vaccination programme from March, while local authorities scrambled to secure bilateral supplies outside of the COVAX facility.
Official COVAX agreements allow countries to make their own bilateral deals, but these have to be officially notified to the facility in order to aid its planning in distribution.
In April, after the whittling down of the COVAX allocation, Botswana had secured provisional supply deals with Moderna, AstraZeneca, Johnson & Johnson, Sputnik as well as the Indian and Chinese producers. At the time, the Presidential COVID-19 Task Force Team deputy coordinator, Mosepele Mosepele warned that the quantities could change depending on the availability from producers and local assessments of effectiveness.
The Task Team’s spokesperson, Kago Mmopi explained what ‘securing vaccines’ meant in the context of a global scramble for doses. Securing supply simply means entering into an agreement to be supplied. Payment is required once the shipment is ready from production.
“When they come off the production line, we have to pay so that they are shipped to us,” he told Mmegi.
“There’s nothing being stored; as soon as they are produced, they need to be shipped out because the demand globally is very high.
“Before COVID-19, global vaccine production was about five billion and it has skyrocketed to more than 10 billion.
“The demand outstrips the supply.”
The deals secured were expected to be enough to cover 1.9 million people in the country, more than the estimated 1.6 million people eligible for the vaccines. Eligible persons for the vaccination programme are those aged 18 and above. The vaccine programme for those aged 55 years and above kicked off in March with the donated and purchased vaccines and by Tuesday this week, 121,518 people had received both doses. The vaccination campaign has now shifted to the 30 to 54 age range, which not only has the highest population numbers in the country’s demographic but represents the most economically active group.
Masisi, meanwhile, recently announced that 500,000 doses of the single-dose Johnson & Johnson vaccine and 50,000 doses of the Moderna vaccine, which requires two shots were due by December. Both deals are confirmed by UNICEF’s COVID-19 dashboard, as well as Moderna’s own statement. In total, Botswana has signed up for 1.1 million doses of Johnson & Johnson and 500,000 doses of Moderna due to arrive by next year.
So has COVAX been unfair to Botswana?
The COVAX facility has released its distribution plans for the fourth round allocations to be done immediately and Botswana does not appear on the list, a fact that local commentators say again puts a cloud on the local vaccination programme.
COVAX documents suggest Botswana was not included in the fourth round allocations because these were meant for those countries that had supplies disrupted by India’s decision to suspend vaccine exports. Botswana as a self-financing participant was signed up for AstraZeneca from its European or South Korean plants, not India. COVAX officials explained how the allocation works for each round of distributions.
“This fifth round of allocations took place as per the Fair Allocation Mechanism for COVID-19 vaccines through the COVAX Facility, which was developed by WHO in consultation with its member states.
“This allocation framework for fair and equitable access to COVID-19 health products sets forth the criteria and approach to the allocation of vaccines through the COVAX facility.”
Botswana, however, also does not appear in the fifth round allocations published by COVAX. Here, the country appears to have grounds to complain.
According to the Fair Allocation Mechanism, WHO member states and COVAX agreed that there would be an initial proportional allocation of doses to countries until all countries reached enough quantities to cover 20% of their population. A follow-up phase would be done to expand coverage to other populations. If severe supply constraints persist, a weighted allocation approach would be adopted, taking account of a country’s COVID threat and vulnerability.
Countries not receiving doses under COVAX in the fifth round, cover the period between now and September, either elected to skip this particular allocation round, opted out of receiving the Pfizer vaccine or had already reached 20% total population coverage. While local officials were not available for comment, it is known that Botswana is far from reaching 20% total allocation of its population coverage from COVAX. The country has thus far received 512,300 vaccine doses or about 16% of the amount required for the eligible population under a double dose vaccination regime.
Other analysts, however, point out that COVAX only ‘owes’ Botswana 38,400 doses of AstraZeneca out of the 100,800 secured, a number that falls far below the amount required to effectively push the 30 to 54 years demographic. Analysts however caution that COVAX remains important to Botswana as donor countries such as the US, Canada and the European Union, who are sharing vaccines with Africa, are using the COVAX facility to distribute.
Meanwhile, another less mentioned facility is the African Union’s African Vaccine Acquisition Task Team (AVATT), which has reportedly secured 220 million Johnson & Johnson doses for distribution to African states. While the World Bank and the Afreximbank are funding countries’ uptake of the doses as they become available, Botswana was once again among the first to pay its own way into the deal. Since news of the deal broke in February, the AVATT has not been mentioned by either Task Team members or other health authorities in their updates on vaccines, as the focus has shifted to bilateral arrangements. “It is possible COVAX and AVATT see Botswana’s signing of bilateral deals as a signal that the country is able to not only self-finance but secure its own supply outside of these arrangements,” a local doctor told Mmegi, requesting anonymity for professional reasons.
“The country’s upper-middle-income status may also count against it as even donors such as the US, which is giving Africa 25 million doses, will want to start with those countries least capable of helping themselves.
“However, the pace of infections in Botswana is one of the world’s fastest and it is clear rapid interventions are needed, no matter where they come from.”
A deadly waiting game
In all the uncertainty, Masisi last week said a consignment was due this week. Vaccination of the 45 to 54 year age group is ongoing, at different paces, throughout the country, using the little available supply. The response from this age group has been robust, with reports that supplies have become strained.
Vaccines have become Masisi, his cabinet and the Task Team’s chief headache. The President recently revealed he had personally spoken to the CEO of one of the vaccine manufacturers seeking an intervention to boost supply.
Help may come from South Africa, where local production of licensed vaccines is due from October. Other commentators have urged the government to not only open up but encourage the private sector to source vaccines for itself, as a way of providing relief to the public healthcare sector, the budget and to help the economically active population.
Players such as Bomaid, one of the country’s largest and oldest medical aid societies, have indicated a willingness to procure vaccines for members. De Beers, one of the biggest corporate actors in the country, has also demonstrated a willingness to partner with government on both vaccine acquisition and the roll out. The diamond giant, which holds equal equity in Debswana alongside government, recently donated P55 million towards the country’s COVID-19 recovery. “We continue to engage with government and the COVID-19 Task Team in support of the vaccine acquisition and roll out as part of our corporate citizenship focus,” De Beers’ executive vice-president, Commercial and Partnerships, Alessandra Berridge said yesterday.
Berridge separately told Mmegi that talks were also focused on how best to use the funds already provided. “We are talking to government about how best to spend the funds we have provided so far for the vaccine programme and we would like to put that to funding the acquisition of vaccines
“That is going on and we are remaining close on those talks.” With the third wave in Botswana apparently having reached or nearing the peak, the next few months will be critical in deciding which direction the pandemic will take in the country. Should vaccines delay, the country will be faced with the possibility of a fourth wave sometime in the future. Should they arrive on time, the pace of hospitalisations and deaths should begin a stable southward trajectory, easing the pressure on the healthcare system and the economy.