I'm seeing a lot of posts & articles about #COVIDー19 vaccine "apartheid" or that rich countries are "hoarding" vaccines. This is generating a lot of outrage, but also showing some naivety. As with most things COVID, it's rather complicated. Let's unpack this in a thread ...

There are stories like the US is hoarding a billion doses. What on earth would they need so many for?

1) They have purchased a billion doses, but for delivery over several years. It's not like they're sitting in warehouses. They have only received 11 million so far!

2) Those billion doses are for 6 different vaccines, of which only 2 have been approved by the FDA & 1 more has achieved some results from a phase 3 trial. The other 3 are in various stages of development without a guarantee of success.

3) Countries that advanced purchased vaccines took risks. They purchased things with no guarantee of working. Vaccine trial results have been dramatically better than anyone expected or anticipated. Honestly, countries were purchasing with much lower expectations.

4) For example, Australia advanced purchased 166 million doses of 4 vaccines . However, one of those vaccines has already failed, meaning they now only have 115 million doses of which 51 million are from a vaccine that hasn't released phase 3 results.

5) So countries were really just hedging their bets, for example, purchasing 166 million with the expectation that maybe they would get 40 or 80 million usable doses. That they might get 115 million is a much better return than expected.

6) These advance purchase agreements are really a public good. They contribute to much faster vaccine development & allow vaccine developers to take greater financial risks. There is a good argument that we wouldn't be where we are without them.

7) So why didn't more LMICs advance purchase? The answer is simple: lack of financial clout but also reliance on centralized purchasing through COVAX. Why has COVAX only procured 700 million doses so far? Straight answer: not enough money!

8) It's not that rich countries are hoarding, it's that rich & self-financing countries have simply not paid up. COVAX has raised about $2.4 billion. Some estimates suggest this needs to be $16 billion. This is a real concern!

9) What are rich countries going to do with excess doses? Now that it looks like vaccines are being more successful than expected, countries with advanced purchase agreements will have surplus doses. Hopefully countries will donate them (or sell on the cheap) to COVAX.

10) Allowing COVAX to distribute will achieve a fairer distribution. If countries distribute the surplus directly there is a chance that they get used as a political soft power tool, or more worryingly, even a hard power tool. That is the real danger!

11) And thanks to a friend for reminding me that the recent US stimulus bill commits $4 billion to international vaccination efforts. Hopefully this goes into COVAX & encourages other countries to contribute or increase contributions.