World Health Organization says its Covid-19 vaccine program has secured 2 billion doses

After months of effort, a World Health Organization program has reached an agreement to obtain nearly 2 billion doses of Covid-19 vaccines and expects to begin distribution in the first quarter of 2021, which means shots can start reaching dozens of low and middle-income countries that must rely on patronage for supplies.

The move is a notable step forward for the program, which is known as COVAX and was launched in hopes of closing a widening gap in access to Covid-19 vaccines. Over the past several months, wealthy nations have struck bilateral deals with different vaccine manufacturers, raising alarm that the poorest countries will be unable to effectively combat the pandemic.

COVAX is attempting to pool purchasing power and line up funding so that vaccine makers agree to participate. So far, a total of 190 countries have signed on, but financial targets have not yet been met. The program has raised $2 billion, but needs another $6.8 billion next year for research and development, advanced market commitments and delivery support.

Nonetheless, the COVAX organizers touted the newly achieved commitments for obtaining 2 billion doses, a goal that was targeted when the program was launched several months ago. COVAX cleared that hurdle by signing an advance purchase agreement with AstraZeneca (AZN) for 170 million doses and a memorandum of understanding with Johnson & Johnson (JNJ) for 500 million.

“Securing access to doses of a new vaccine for both higher-income and lower-income countries, at roughly the same time and during a pandemic, is a feat the world has never achieved before – let alone at such unprecedented speed and scale,” said Seth Berkley, who heads Gavi, the Vaccine Alliance, which handles COVAX procurement and delivery, in a statement.

As a result, COVAX expects to distribute at least 1.3 billion doses to 92 low and middle-income countries next year. Ultimately, the program hopes to provide enough vaccine doses to cover up to 20% of the population in each of those countries by the end of 2021. Overall, COVAX has secured first right of refusal of 1 billion vaccine doses.

“The arrival of vaccines is giving all of us a glimpse of the light at the end of the tunnel,” said WHO Director-General Tedros Adhanom Ghebreyesus, in a statement. “But we will only truly end the pandemic if we end it everywhere at the same time, which means it’s essential to vaccinate some people in all countries, rather than all people in some countries.”

COVAX already struck a deal with the Serum Institute of India, which is manufacturing vaccines for Novavax (NVAX) and AstraZeneca and its development partner, Oxford University. Serum agreed to supply 200 million doses, with options for up to 900 millionmore of either vaccine. COVAX also has a statement of intent for 200 million doses of a vaccine from Sanofi (SNY) and GlaxoSmithKline (GSK).

As of earlier this week, high-income countries have reached agreement to purchase more than 4 billion doses, while upper middle-income countries are on tap to buy nearly 1.1 billion doses, according to the Duke Global Health Innovation Center. All totaled, 10.1 billion doses were reserved before any of the Covid-19 vaccine candidates reached the market.

On its face, the latest announcement is good news, but there are caveats to consider, such as the extent to which the vaccines COVAX hopes to purchase prove to be sufficiently safe and effective, according to Kenneth Shadlen, a professor of international development at the London School of Economics, who studies pharmaceutical pricing, patents and access issues.

The frontrunners in the vaccine race — Pfizer (PFE) and its partner BioNTech (BNTX), as well as Moderna (MRNA) — have not yet signed on to the COVAX program. Meanwhile, the two vaccines these companies have developed have demonstrated roughly 95% effectiveness and which regulators have said appear safe.

Shadlen also questioned how COVAX has described some of its arrangements. For instance, COVAX has not made clear which vaccines are covered by a first right of refusal and has also not explained what is covered by either a memorandum of understanding or statement of intent. “My reaction is that its good news, though how good the news is, of course, depends on lots of details and unknowns,” he wrote us.