COVID-19 has affected us all. It has devastated the lives and livelihoods of millions, and exposed cracks in the elaborate construct of our economies and societies. It has forced us to rethink how we work, how we buy what we need, how we greet each other, or when we see our loved ones. But it has also done something more profound and rather fundamental to us as human beings: it has reminded us of our humanity and our fragility as a species. And while that is a cause for solidarity, it is also a reason to remember that in fact COVID-19 has not affected us all equally.
The Humanitarian Buffer will be particularly relevant in instances of state failure and conflict, and in covering people in areas controlled by non-state armed groups that are inaccessible to governments.
People of colour have gotten sicker and died at higher rates than others, especially in high-income countries. Women have suffered greater economic hardship than men. Those who were barely making ends meet before the pandemic – as many as 124 million people – have now fallen into extreme poverty. Precarious access to essential health services for those who are too often found on the margins of our societies – asylum seekers, refugees, vulnerable migrants in irregular situations, detainees, people who are stateless and many others – has diminished further.
As the social determinants of health, be they conflict, gender, race or ethnicity-related, have become intertwined with the pandemic, a humane response to our current health crisis cannot be agnostic to these issues. And so we must send reinforcements to the sections of humanity where our defenses are the weakest. We must not wait until there is already a breach.
Since the COVAX Facility’s inception, there was a clear intent to create a flexible, revolving “buffer” of COVID-19 vaccine doses to act as a safety net for people that otherwise wouldn’t receive vaccines through other routes, for instance those in conflict zones and other humanitarian settings.
On 22 March 2021, the Gavi Board approved reserving 5% of Gavi COVAX Advance Market Commitment (AMC) funding for doses to be deployed via the COVAX Buffer, noting that this will be progressively financed as AMC funding increases. The Humanitarian Buffer – a key component of the COVAX Buffer – will ensure access to COVID-19 vaccines for high-risk populations in humanitarian settings. This Buffer will act as the last resort for some of the most vulnerable populations on earth, who have the least resources to cope if they were to get sick from COVID-19.
Co-created with humanitarian agencies, the Humanitarian Buffer has a global scope. All COVAX Facility participants, both self-financing and AMC-eligible lower-income economies, will be eligible to apply for doses through this mechanism. National and international humanitarian agencies are also eligible to apply for doses, including UN agencies, the International Red Cross and Red Crescent Movement, and relevant civil society organisations.
But the Humanitarian Buffer is neither a panacea for the vaccination needs of all high-risk populations of concern, nor is it an alternative to state obligations towards these populations. The UN Security Council (UNSC) has passed a resolution – 2565 (2021) – making it the obligation of countries to ensure access to COVID-19 vaccines for populations in humanitarian settings. UNSC resolutions are generally considered binding for member states. Therefore, the “first resort” for all high-risk populations in humanitarian settings to get vaccinated, irrespective of their legal status, is their inclusion in national COVID-19 vaccination plans and in their implementation.
In order to adhere to the “last resort” principle, careful consideration of each application for the Humanitarian Buffer will be essential - it is only to be called upon where there are unavoidable gaps in coverage. It will also be critical that the decision-making process around the provision of doses through the Humanitarian Buffer is in line with the principles of impartiality, neutrality, independence and humanity. It will require careful assessment of each case by experts who will take into account the incredibly complex and intersecting contexts of the pandemic; of the availability, logistics and roll-out of doses; and of the needs of populations of concern.
The Humanitarian Buffer will be particularly relevant in instances of state failure and conflict, and in covering people in areas controlled by non-state armed groups that are inaccessible to governments. Indeed, disputed territories and areas controlled by non-state actors challenge the standard allocation and deployment scope of COVAX. In such instances, populations of concern served by doses released through the Humanitarian Buffer will be those included in the Global Humanitarian Overview.
The Gavi Board has therefore delegated decision-making on Humanitarian Buffer dose allocation to the Inter-Agency Standing Committee (IASC) Emergency Directors Group. Created by the UN General Assembly in 1991, the IASC is the highest-level humanitarian coordination forum of the UN system.
The IASC estimates that there could be as many as 167 million people at risk of exclusion from COVID-19 vaccination, while noting that these numbers are highly variable and subject to unexpected shocks due to new conflicts or natural disasters. Over two thirds of these people are in Gavi COVAX AMC-eligible economies. The Humanitarian Buffer, however, will not seek to cover the entirety of these populations but rather, in line with Strategic Advisory Group of Experts on Immunization (SAGE) guidelines, only intends to provide sufficient doses to cover high-risk groups within a given population of concern, while also maintaining parity with coverage rates among host communities and broadly in countries.
Operationalising the Humanitarian Buffer will pose its own challenges – ranging from higher delivery costs in low-resource settings, to complex indemnity and liability considerations for ungoverned territories. But it also presents a unique opportunity to leverage the lessons learnt and gains made, to boost access to immunisation for communities currently missing out.
As most children who have not received any routine vaccines are concentrated in fragile and conflict-affected settings, Humanitarian Buffer dose requests will provide further insight into overlooked, high-risk populations who likely do not receive routine vaccines. This could be used to feed into routine immunisation strategies to reach them with an integrated set of health and other essential services.
Ultimately, although it is designed to solve a complex problem, the ultimate aim of the COVAX Humanitarian Buffer is very simple. To leave no one behind.