Plummeting interest in Covid-19 vaccination has prompted Gavi — the organization that’s sought to bring vaccines to developing countries through its COVAX program – to try to square its supply with demand. It’s in the difficult spot of trying to figure out how much vaccine to procur, so that shots aren’t wasted, without any certainty about Covid’s evolution. It’s a big shift from earlier in the pandemic, when COVAX struggled to deliver due to tight vaccine supplies and fierce competition for them among wealthy countries. COVAX has now shipped nearly 1.9 billion vaccine doses, most of them to the poorest countries. Carmen talked with Seth Berkley about Gavi’s plans. The interview has been edited for length and clarity. What did the Gavi board decide about COVAX at its meeting last week in Geneva? We've been looking at how long we keep COVAX running and should we keep COVAX running. So the first thing is: COVAX will continue through 2023 the way it has operated. The second discussion we had on the board is what should go on longer term. And the true answer for that is: We don't know what the epidemiology is going to be. Are we going to this winter in the Northern Hemisphere have another series of waves or not? Is the virus gonna change again? Are we going to need new vaccines, different vaccines? Will we get outside of the immunity of existing vaccines? And we don't know that. But the current hypothesis is that what's likely to be needed is at least boosters for high-risk populations. We’re at 81 percent coverage for health care workers and we’re at 66 percent of the elderly populations in the 92 poorest countries. We’d like to get that higher. The hypothesis then is, for 2024, the program would cover high-risk populations, probably one booster dose once a year for those populations. But at the end of the day, what will define that is what the epidemiology is. And we'll come back to the board in June of 2023 with a firm decision one way or another. What countries will be supported after 2023? Another decision that was taken in principle — not a firm decision — was that for Gavi countries we will provide the continued full support of vaccines in 2024 and 2025 and we will also provide delivery finance: around 70 percent of what we think the cost will be to deliver those vaccines as part of assistance to those lowest-income countries. For the other countries, which are not traditionally part of Gavi [because they have more income], that we brought in for COVAX, we would continue to have vaccines available for them. And in 2024 and 2025, we would give them catalytic support, but we would consider transitioning out of support over time if they are able to support themselves since they are wealthier countries. How many countries still have a Covid-19 vaccination rate of under 10 percent? We started in January 2022 with 34 countries under 10 percent and today we’re at eight countries under 10 percent, of which seven are quite fragile countries: the Yemens, the DRCs, the Haitis of the world. And we haven’t stopped, we're continuing to work with those countries and trying to provide support for them. In fact, we just had a new country join COVAX last week, Burundi. So we're continuing to work to get that coverage up. In places that are very fragile, the health systems are quite weak and it's difficult to get coverage up and they have other issues going on at the current time that also is competing for their attention.
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