Ending the COVID-19 pandemic means helping countries to catch-up with vaccination, not giving up

Like COVID-19, complacency can be contagious. Dr Seth Berkley argues that during a pandemic complacency can be very dangerous.

Photographed in Abuja Nigeria. Gavi/2022/Ozavogu Abdul
Photographed in Abuja Nigeria. Gavi/2022/Ozavogu Abdul


The governments of predominantly wealthy nations with high vaccination coverage are beginning to relax their covid-19 restrictions and response with an almost audible sigh of relief as societies reopen and life appears to return to normal. However, relaxing restrictions now is without question a gamble and risks sending a message that the pandemic is over. There are 2.8 billion people around the world still unvaccinated, and there is a constant threat of new variants triggering fresh resurgences. We are still very much in a state of global crisis; this pandemic is likely far from over.

With doses now flowing and as our vaccine supplies continue to ramp up, COVAX is entering a new phase and shifting to a more country-centric approach.

The gamble could pay off if global leaders don’t take their eye off the ball. Ending the covid-19 pandemic globally must continue to be a priority, alongside other pressing global crises, such as the looming global recession, the energy crisis and now the devastating conflict in Ukraine. If global leaders fail to finish the job they will reinforce the misleading message that covid-19 is no longer a threat to dozens of countries still struggling with low vaccination coverage. At a time when vaccine doses are finally beginning to flow freely to these countries, that could spell disaster.

With vaccination coverage now high in the global north, doses of covid-19 vaccines are finally flowing unhindered to the rest of the world. For the first time COVAX (the global collaboration to make equitable access to covid-19 vaccines available, led by Gavi, the Coalition for Epidemic Preparedness Innovations, the World Health Organisation and UNICEF) is seeing supply outstripping demand. That is great news for the billions of people still waiting for their first shots. But it also brings into sharp focus one of the toughest challenges faced by the largest and most complex global deployment of vaccines ever – getting shots into the arms of billions of people living in some of the world’s most challenging and resource-constrained environments.

It’s hard to do justice to the scale of the vaccination effort. It means reaching billions of people in dozens of countries, many with weak health systems, often with highly complex and fragile political contexts, and all at the same time. Even well resourced, wealthy countries have struggled with their national covid-19 vaccination programmes during the pandemic.

With over 1.2 billion COVAX doses already delivered to lower-income countries, many have made incredible progress towards their national vaccination targets. However, other countries, particularly low-income countries with poor health systems, are still struggling. The danger now is that complacency sets in, and countries with low coverage stop seeing covid-19 as a priority. This could lead to the entire global effort unravelling.

While it is possible that we won’t have to deal with further covid-19 variants of concern, it seems unlikely given that on average three have emerged each year. If we’re lucky, vaccines will still protect people from severe disease and death when the next variant emerges. In this scenario countries that are heavily vaccinated will do well, but those with low coverage will be at risk. If we’re unlucky, and vaccines are less effective, it would most likely restart the global scramble for vaccine doses as wealthy nations rush to protect their citizens with additional boosters. Either way, countries with low vaccine coverage will lose out and the virus will continue to spread, perpetuating the threat of new variants.

That is why no one can afford to be complacent and why the priority has to be supporting countries to achieve their national vaccination targets and vaccinate health care workers, people at high risk, and the vulnerable. In the face of vaccine hoarding, export restrictions and challenges in scaling-up manufacturing, COVAX’s priority has been securing doses. However, with doses now flowing and as our vaccine supplies continue to ramp up, COVAX is entering a new phase and shifting to a more country-centric approach.

This new phase will make COVAX more responsive to the individual needs of countries in scaling-up their vaccine delivery systems, ensuring they get the right vaccines, in the right volumes at the right time. It will also ensure that donated vaccine doses reach people, by helping lower-income countries with ancillary costs for essential equipment, like syringes, as well as transportation and insurance. To protect COVAX’s supplies from future disruptions we are also requesting additional funding from governments and the private sector to create a Pandemic Vaccine Pool ready to buy doses in case there are any further shocks to global supply or new variant vaccines are needed.

Wealthy governments need to send a clear signal that covid-19 remains a global priority, and the best way to do that is by supporting this additional US$ 5.2 billion effort. The covid-19 omicron variant may have created the impression that covid-19 has become less of a threat, but the world remains at risk of new variants so long as the virus is able to circulate in large populations. Closing the vaccine equity gap is a race against time, and the only way to win it is to help countries catch up, not give up.


Competing Interests: Gavi, is co-lead of COVAX. Seth Berkley has no competing interests.

Acknowledgments: We thank Duncan Graham-Rowe for support writing the article.

Provenance and peer review: commissioned; not peer reviewed.

This article is part of a series commissioned by The BMJ for the World Innovation Summit for Health (WISH) 2022. The BMJ commissioned, edited, and made the decisions to publish. The series, including open access fees, is funded by WISH.