Covax has had to renegotiate its contracts with four suppliers of vaccines, to reduce them by between 400 and 600 million doses. Four hundred million doses from Pfizer that were coming as a donation from the United States government have been converted into future options available in 2023.

“We did not massively overbuy,” Dr. Berkley said, adding that he expected the demand by countries that continue to try to do primary or booster dose delivery would largely align with the doses Gavi has available.

“In a pandemic, I would want to err on the side of buying too many doses, rather than err on the side of not having enough doses, particularly given the fact that countries felt that there weren’t enough doses at the beginning,” he said. “If you want to get doses at the beginning, you’ve got to go ahead and put orders in, even if you don’t know if they’re going to work, and that’s risk. You have to have risk.”

The Gavi secretariat is proposing to board members that the organization keep a pool of $1.8 billion that will allow for the acquisition of new doses as required into 2025 and support for the delivery of vaccines.

Dr. Berkley said the “pandemic preparedness pool” is meant to act as insurance against another situation where Gavi needs to procure vaccines for developing countries (against a new Covid variant, for example) and is forced to compete with the deep pockets of richer nations.

Some board members expressed concern at the idea of the organization sitting on these funds.

“We just want to make sure the money is not used until we have a lot more conversations about where we want those funds to go,” one board member said. “We don’t have governance in place right now for how to manage that fund. The important thing is, we don’t want them to use these funds to broaden their mandate.”

Dr. Orin Levine, an epidemiologist who until September 2021 represented the Gates Foundation on the Gavi board, said Covax’s fate was sealed by mid- 2021. “The fact that they were zero on the doses delivered in that period, near zero, is a fundamental blemish for us as a global community,” he said. “We couldn’t get any rich countries to slow down their individual vaccination order to help other people get started on their first ones.”



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