As Omicron Spreads, Who Is Funding Global Vaccine Equity? What Challenges Are They Up Against?

Back in October, the World Health Organization outlined global vaccination targets in an effort to knock back the COVID pandemic: jab 40% of the world’s population by the end of this year, and 70% by mid-2022. We won’t hit those targets due to global inequities that have enabled wealthier countries to vaccinate upward of 70% of their populations, while poorer countries are left behind. In fact, recent estimates for Africa put the vaccination rate at just 6% to 10%, with some countries even below those low levels.

That inequity is a big problem—and not only for the people in poorer countries who are more likely to get sick because of low vaccination rates. The rise of the omicron variant—itself a direct result of allowing the virus room to evolve and mutate unchecked in unvaccinated populations—has only served to underscore the importance of vaccine equity in the fight to protect people’s health everywhere.

“Now you see the true global health security risk of leaving people unvaccinated,” said Bruce Gellin, chief of global public health strategies at the Rockefeller Foundation. “As we see the ability of this virus to create variants, it accentuates the problem more than ever before.”

The global vaccination effort is, of course, not a job for philanthropy alone. But the inequitable distribution of COVID vaccines has undercut the sector’s broad efforts to respond to the pandemic—and it will only continue to do so. In the nearly two years since the outbreak began, we’ve seen countless philanthropies pivot, expand and adapt their giving to meet the urgent needs of the communities they serve. Often, giving has been local or with a focus on a specific demographic—such as artists, youth, medical professionals, etc. Fewer funders and donors have engaged in the work of global pandemic management and health infrastructure, as IP’s Philip Rojc recently pointed out, in response to a new alliance of familiar players taking on the challenge.

There are, however, some funders that are working to curb vaccination inequity around the world, and according to experts in the field that I spoke with, they face some unique and difficult challenges ahead. For starters, philanthropy’s piecemeal nature presents limitations when tackling such a global, borderless issue. But there are also obstacles specific to this particular problem, including long-standing weaknesses in healthcare infrastructure, that are making it more difficult for partners across the sector to approach that 70% vaccination target.

Who’s supporting global vaccine equity?

Philanthropy responded broadly and generously to the pandemic in many ways, but a handful of funders stand out for their focus and investments specifically on global vaccine equity. Often, they partnered with government agencies and public-private international aid organizations like GAVI to address global equity’s initial problem: supply and distribution for less wealthy countries.

Most recently, a global alliance of several major grantmakers banded together to urge concerted action on vaccines and other COVID health responses. They include U.S.-based organizations, among them Open Society Foundations, and the Gates, Ford, Rockefeller, Hewlett and Conrad N. Hilton foundations. Internationally, the alliance includes Mastercard Foundation, Aliko Dangote Foundation, the Children’s Investment Fund Foundation, Fundación Saldarriaga Concha, Kagiso Trust, and others. They have so far released statements on vaccine inequity, promising to boost giving and resources, and calling for coordinated efforts to reach the ambitious but needed vaccine targets for low- and middle-income countries where rates lag.

In addition, here’s a list of some of the top organizations funding global vaccine equity and what they’ve been doing:

The Bill & Melinda Gates Foundation, which has given more than $1.75 billion to COVID response globally, has committed at least $600 million toward vaccine-specific efforts in low- and middle-income countries. Gates also committed at least $50 million to COVAX, an international collaboration designed to procure and supply vaccines to poorer countries.
Back in June, the Mastercard Foundation announced it would deploy $1.3 billion over the next three years in partnership with the Africa CDC to support vaccinations and strengthen public health institutions.
UNICEF, though historically focused on children's health in poorer nations, is playing a key logistical role in COVAX, drawing on its experience as the world's biggest vaccinator, to help deliver the shots and supplies on the ground, set up cold-chain infrastructures, and work to engage local healthcare workforces and communities.
The LEGO Foundation became the single largest contributor to UNICEF's COVID response with a $70 million donation.
In September, Open Society Foundations pledged $30.5 million to advance vaccine equity as part of its larger commitments to global COVID-related causes.
The Rockefeller Foundation, long a champion of improved public health in the Global South, has been advocating heavily for increased spending and efforts by G7 countries and other donors, including to fund the COVAX vaccination initiative.
In addition to funding vaccine and therapeutics research, Wellcome has been an advocate for vaccine equity, and is a convening partner (along with Gates and others) of the Access to COVID-19 Tools (ACT) Accelerator, housed at the WHO. Wellcome has made dozens of COVID-related grants, including support for low- and middle-income countries.

What’s holding back success on vaccine equity?

So what are the real barriers to reaching something like the 70% global vaccination rates that health advocates are calling for? The vaccine equity problem started out as a supply-and-demand marketplace issue. You’ve probably seen headlines recently about COVAX, the public-private initiative created in April of 2020 to ensure fair access to vaccinations globally. The organization has struggled to procure the necessary vaccines because, when vaccines became available in the early months of 2021, wealthy countries were first in line with their checkbooks and COVAX didn’t initially have sufficient financing to compete.

This didn’t mean that wealthy countries totally ignored the plight of poorer nations. “Money poured into COVAX from richer countries,” said Lily Caprani, UNICEF’s head of advocacy for health and vaccines. “But while money poured in, a lot of wealthy countries bought up all the supplies.”

Fortunately, COVAX has been able to build up its stock of shots. Even as a vaccine supply drought set in during the past year, richer countries donated some of their previously purchased shots to COVAX. The supply has been further aided as wealthy counties successfully vaccinated (the willing) portions of their populations, slowing their own demand for new shots. “In some ways, we’re coming to the end of the supply problem,” Caprani, of UNICEF, said.

Which brings us to a thornier problem of vaccine equity—what Caprani calls “absorption and rollout.” (It should be noted that, in Africa at least, the continent’s low average vaccination rate obscures great differences between countries. Morocco, for example, has vaxxed about 68% of its population; Chad is only at about 2%.) Many poorer countries have long suffered from insufficient public health infrastructure and shortages of trained healthcare workers, and as hard as COVID stressed healthcare systems in places like the U.S., the impact was far worse in countries with thinner infrastructure. Bottom line: Even if you have the shots, you need facilities to store and transport them, and clinics and workers to get them into people’s arms.

As a result, said Caprani, UNICEF is concentrating on these infrastructure needs, such as setting up the cold chain storage and transport needed for the vaccine rollout. “A lot of it is about working with the healthcare workforce, training, support and communications,” she said.

The organizations on the ground in Africa and other regions will also face a good deal of vaccine resistance and misinformation, just like in the U.S. It’s been suggested, for example, that the CIA’s fake hepatitis vaccination plan in Pakistan, a ruse to find Osama bin Laden, has fueled vaccine hesitancy. “There’s a lot of distrust of Western medicine, or fears that the vaccine carried the virus, or was a method to control Africans,” said Tanya Gulliver-Garcia, director of learning and partnerships for the Center for Disaster Philanthropy.

This is going to make outreach and community engagement a crucial part of the vaccination effort, such as programs to engage trusted members of communities to convey accurate information about COVID and the vaccines, and build trust and buy-in among the population, said Gulliver-Garcia. There are also cultural and very practical obstacles to global vaccination. In India, during the height of the spread of the delta variant, Muslims were not clear if getting a vaccine during Ramadan represented a breaking of the fast. For countless people, issues like childcare and transportation will determine whether they get vaccinated. (Read about philanthropy’s efforts to combat vaccine hesitancy and inequity in the United States here.)

The limits of philanthropy

A big part of the reason philanthropy and NGOs have been unable to make much of a dent in global vaccine access, and one potential reason many have shied away, is the fact that the problem is reflective of disparities that have existed for many decades between the Global North and Global South—disparities that require global leadership and systems change.

Developing the healthcare infrastructure and workforce throughout under-vaccinated countries in Africa has been a long-neglected need, said Aggrey Aluso, the Nairobi-based health and rights program manager for Open Society Foundations’ Initiative for Eastern Africa. And global philanthropy is not likely to be the solution—in fact, Aluso says, philanthropy and global support may have an inadvertent chilling effect on healthcare systems development by essentially helping to let political leadership off the hook.

“The landscape of healthcare is heavily externally funded, which has created an expectation that someone else is filling the gap for you, so (government leadership) hasn’t planned,” Aluso said. “The entity ultimately responsible for managing the healthcare system is the government, and it’s not doing much in terms of ramping it up. We feel disappointed with our leadership and with the global leadership. We can’t rely on philanthropy.”

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