Gavi and humanitarian agencies partner to deliver COVID-19 vaccines to the most vulnerable people in the world

Gavi, the Vaccine Alliance (Gavi) and the member agencies of the Inter-Agency Standing Committee (IASC) the humanitarian system’s main coordinating body1, are working together to ensure that the most vulnerable people caught up in humanitarian crises have access to COVID-19 doses.

Vaccine inequity remains a key challenge in humanitarian settings. Over half of the countries with a humanitarian appeal still do not have enough doses to vaccinate even 10 per cent of their population. Five of the poorest countries in the world only have enough doses to reach less than 2 per cent of their population (Chad, the Democratic Republic of the Congo, Haiti, South Sudan, and Yemen). And those countries with the lowest number of COVID-19 doses – often in situations of violence and conflict – struggle the most with getting COVID-19 shots into people’s arms.

However, in recent months, the COVAX Facility has begun to deliver a steady increase in COVID-19 vaccine doses to countries with a humanitarian crisis, and this trend is expected to continue over the coming months. The challenge will be to ensure vaccine equity within countries, so at risk and vulnerable populations, often in remote locations, are included in vaccination rollouts.

Gavi and IASC agencies are working together to overcome these ‘last mile’ delivery challenges to vaccinate vulnerable people in hard-to-reach locations, while ensuring that humanitarian agencies can also offer these communities the full range of life-saving humanitarian assistance that they need – such as food, clean water, and shelter – and simultaneously address record levels of humanitarian need across the world. This includes working together to reach “zero dose” children and communities to protect them against preventable diseases such as measles, polio, and diphtheria, and addressing the needs of women and girls who have been disproportionately impacted by the pandemic.

In a critical step forward in access to COVID-19 vaccines for those living in humanitarian crises and other vulnerable groups, the COVAX Humanitarian Buffer has delivered its first doses this week to increase coverage among people in Iran displaced by regional conflict. By the end of the year, a second batch of doses from the Humanitarian Buffer will be delivered to vaccinate high-risk groups in Thailand. In total, these deliveries will vaccinate almost 800,000 vulnerable people, an important first step for the Humanitarian Buffer in support of the international effort to ensure that those affected by crises are not left behind in the global COVID-19 vaccine rollout.

Gavi and the IASC now call on those vaccine manufacturers that have not already done so to waive indemnity requirements for humanitarian organizations, enabling further deliveries of vaccine doses to at-risk communities across the world.

Gavi, which co-leads COVAX and administers the COVAX Facility, and the IASC, established the COVAX Humanitarian Buffer in 2021 to ensure COVID-19 vaccines reach the most vulnerable at-risk groups around the world. This came out of concern that people living in humanitarian crises and vulnerable groups of people, including refugees, asylum seekers, stateless people, internally displaced people, migrants, minorities, and people living in conflict affected areas, risk being left out of national COVID-19 vaccine roll-out plans and activities, and recognizing that the impact of COVID-19 on women within those groups is particularly significant.

As a first resort, all Governments should include everyone living in their territory in national COVID-19 vaccination campaigns, regardless of legal status – but the Humanitarian Buffer was established to mitigate the risk of vulnerable groups being neglected and situations where unavoidable gaps in coverage may arise.

The Humanitarian Buffer’s independent decision body, established under the auspices of the IASC and staffed by experts from humanitarian agencies, allocated these first doses to vulnerable groups in Iran and Thailand as they were the first applicants to meet the criteria to receive Buffer doses.

“These first deliveries to vulnerable communities in Iran and Thailand via the COVAX Humanitarian Buffer are an important milestone in the push to ensure that no one is left behind: those most at risk everywhere must be able access COVID-19 vaccines, regardless of their circumstances,” said Dr Seth Berkley, CEO of Gavi. “This is even more essential for those with the smallest safety nets – such as people living in humanitarian crises and other vulnerable groups. Gavi is privileged to be working with the member organizations of the IASC, including our COVAX partners WHO and UNICEF, in support of these populations, and we call on manufacturers and Governments to support us in this critical effort.”

All COVAX Facility participants, as well as national and international humanitarian agencies, are eligible to apply for doses from the Humanitarian Buffer. They can also request related equipment, such as syringes and funding for delivery costs. Gavi and the IASC estimate that more than 167 million people – or 80 percent of people most at risk of being omitted from national vaccine plans and who may require support from the Humanitarian Buffer– are living in low- and lower-middle-income countries.

“Humanitarian organizations stand ready to help bring vaccines to those who need them the most”, said Martin Griffiths, Emergency Relief Coordinator and Under-Secretary General for Humanitarian Affairs, who chairs the IASC, “But to do this we need support from vaccine manufacturers and governments regarding the legal and financial risks involved.”

In normal circumstances, manufacturers assume the risk in most markets of having to provide compensation for adverse events linked to the use of their products. But when it comes to COVID-19 vaccines and the pandemic, manufacturers have required all buyers and recipients of doses, including countries and humanitarian agencies, in the case of the Humanitarian Buffer, to take on this risk instead.

For the Humanitarian Buffer to be able to respond to the demand from vulnerable communities for vaccines, current indemnification requirements from vaccine manufacturers must be waived for humanitarian agencies. UN agencies, the Red Cross and Red Crescent Movement, and international and local NGOs cannot take on the burden of risk that, in principle, is the responsibility of manufacturers, and that poses financial, legal and ethical challenges. Unless this issue is resolved, it will become a barrier to humanitarian agencies accepting and distributing these vaccines to some of the most vulnerable people around the world. It also means that COVAX will be unable to use its full portfolio of COVID-19 vaccines to deliver to the most vulnerable communities and puts consistent supply availability to the Humanitarian Buffer at risk.

So far, four manufacturers – Clover, Johnson & Johnson, Sinopharm and Sinovac – have agreed to work with COVAX to waive indemnification requirements for humanitarian agencies delivering doses to these populations. The IASC and Gavi welcome this as a significant step towards ensuring that the Humanitarian Buffer can deliver vaccines to those most at risk of being left behind in the global vaccine roll-out. We urgently call on all other manufacturers in the COVAX portfolio to follow suit. As vaccines are rolled out at scale and data becomes available, we encourage manufacturers to regularize their practices and go beyond short-term waivers to assume full liability for COVID-19 vaccines. This is the accepted practice for most vaccines in the contexts where Gavi and humanitarian agencies operate.

National Governments can also play a part by advocating with manufacturers in the COVAX portfolio to support this critical moral and public health imperative.

The only clear path to global recovery from the pandemic is one that includes all marginalized groups and people caught up in humanitarian crises.

1. The IASC includes COVAX co-lead WHO and delivery partner UNICEF