Minister of International Development appearance before the Standing Committee on Foreign Affairs and International Development (FAAE) – Q&A: COVAX – Briefing material

2021-04-29

Q: What is the COVAX facility?

• Launched last spring, the COVAX Facility is led by the World Health Organization (WHO), together with Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations.
• The COVAX Facility works to develop, purchase and deliver COVID-19 vaccines.
• COVAX is founded on the principle of equitable access: this means any country, regardless of their ability to pay, can participate to gain the same access to WHO-sanctioned vaccines.
• 190 countries are participating in COVAX.

Q: How does COVAX work?

• COVAX was specifically designed to pool demand for vaccines among all countries globally in order to secure better access and lower prices for all.
• COVAX has two windows. First, a self-financing window: high and upper-middle income countries such as Canada can join to secure vaccine access for up to 50% of their population. Second, an Advanced Market Commitment (AMC) window: provides 92 low- and middle-income countries access to donor-funded doses of safe and effective COVID-19 vaccines.
• By supporting the development and manufacturing of vaccines through COVAX, countries increase their chances of getting COVID-19 vaccines, and ensure the rest of the world gets access too.
• By investing in the self-financing window, countries are giving COVAX increased buying power and negotiating leverage with pharmaceutical companies to get the best deals for the needs of low- and middle-income countries. 
• COVAX is targeting delivery of at least two billion doses by the end of 2021. This will enable countries to vaccinate 20% of their populations, which is estimated by the World Health Organization to be sufficient to vaccinate healthcare workers and other high-risk groups.

Q: 20% coverage by COVAX isn’t enough to reach herd immunity. Why is the number so low?

• 20% was the initial goal set out by COVAX in order to provide vaccines across the world to ensure vaccination for priority populations, most at risk such as health and social care workers, and elderly populations.
• Specifically for the AMC, the newly announced COVAX Investment Opportunity increases this goal to 30% in 2021.
• COVAX is also working to increase coverage by securing additional doses, including doses shared by countries who have excess supply through a forthcoming dose sharing mechanism being built by Gavi, to which Canada has committed $5 million for its creation.
• Along with the rest of the world, COVAX is working within a period of limited supply of COVID-19 vaccines and will continue to work to seek additional supply for 2021-22, to reach and then exceed these targets.

Q: If Canada didn’t take doses from COVAX, wouldn’t it allow the Facility to attain higher overall vaccination coverage?

• The main objective of COVAX is to ensure equitable access to COVID-19 vaccines, and to vaccinate the world’s highest risk populations as quickly as possible to end the acute phase of the pandemic.
• Buy-in by self-financing participants, including Canada, is key to ensuring and strengthening the purchasing power of the COVAX Facility and enabling it to increase its negotiating power with vaccine manufacturers.
• Canada has provided $5 million to Gavi for the creation of a dose sharing mechanism so that countries with excess supply are able to ensure any doses they are able to donate are allocated in an equitable way.

Q: What is Canada’s role in COVAX?

• Through COVAX, Canada is supporting rapid, fair and equitable access to safe, effective and quality vaccines for all participating countries to help slow the global pandemic.  
• Canada is a leading donor to the COVAX Advance Market Commitment, or AMC and we have also bought in to purchase doses for Canadians through the self-financing window. We have contributed significantly to COVAX because we believe in a coordinated effort to get vaccines to the world. 
• Gavi, the Vaccine Alliance, is the legal entity for the COVAX Facility. As a longstanding anchor donor and strong supporter to Gavi, Canada has a seat on Gavi’s Board.
• As part of our commitment to COVAX, I co-chair the AMC Engagement Group along with the Ministers of Health from Ethiopia and Indonesia. 
• Canada has contributed over $325 million to ensure that COVAX is able to procure and deliver vaccine doses to priority populations, and in particular healthcare workers and high-risk populations, in low and lower middle-income countries as soon as possible. This includes $250 million to the AMC, and $75 million to distribute and deliver vaccines once they have arrived in country.
• This support includes up to $5 million to develop a mechanism to equitably share vaccine doses through the COVAX Facility.

Q: Which budget funds Canada’s COVAX investments/donations?

• Canada’s investment in the COVAX AMC, as well as all its other funding to the ACT-Accelerator, is official development assistance managed by Global Affairs Canada.
• As a self-financing participant, the Government of Canada has committed $220 million to the COVAX Facility. Canada will participate through the optional purchase model to obtain doses for 20% of Canada’s population, the doses needed to protect priority populations once vaccines are available.
• Canada’s procurement of doses for domestic use is led by my colleagues responsible for health and procurement.

Q: Are other G7 countries members of COVAX as self-financing countries?

• Yes. The EU/Team Europe (Germany, France, Italy), Japan, and the UK are all self-financing participants in COVAX.
• While the US has not joined as a self-financing participant, it is the largest country donor to the COVAX AMC.

Q: Why are we not investing more in COVAX? Should Canada’s international response not be equal to our domestic response?

• Our commitments to COVAX and the ACT Accelerator to date have made Canada a recognized leader in this space.
• Canada was an early partner and significant donor to the ACT Accelerator, with investments of $940M across all 4 pillars because we recognize the importance of testing, treatment, and health systems in addition to vaccination.
• While every country needs to step up and continue do more to end the acute phase of the pandemic, it is widely recognized that Canada’s significant contribution in this space has been both timely and impactful.

Q: Why is Canada accessing the doses as part of the COVAX self-financing window? Isn’t COVAX intended for developing countries?

• COVAX is for everyone.
• The Facility was specifically designed to pool demand for vaccines among all countries globally in order to secure better access and lower prices for all.
• By supporting the development and manufacturing of vaccines through COVAX, countries increase their chances of getting COVID-19 vaccines, and ensure the rest of the world gets access too.
• Canada’s investment in COVAX as a self-financing participant has been an important complementary component to the government’s overall domestic vaccine procurement strategy.
• The COVAX portfolio of vaccine candidates also provided Canada access to a wider range of vaccine options to meet domestic needs. This was an important consideration early in the pandemic when there was little visibility on the potential rate of success of vaccine candidates.
• Through COVAX, Canada has procured doses of the AstraZeneca vaccine for Canadians as – alongside other countries – we work hard to vaccinate our most at-risk cross-sections of the population.
• The doses Canada has secured through COVAX complement the bilateral arrangements Canada has in place with vaccine manufacturers and diversifies our sources of supply.
• Other higher-income countries have also invested as self-financing participants and will be accessing doses for their own countries.
• The COVAX AMC, to which Canada has committed $220 million, is providing access to vaccines to 92 low- and middle-income countries.
• COVAX has been negotiating agreements with vaccine manufacturers on behalf of both AMC and self-financing participants.

Q: Why is Canada the only G7 country taking doses as part of the self-financing window?

• Each country has its own approach to vaccinating its population.
• The COVAX Facility is a global procurement mechanism to support the development and equitable distribution of safe, effective and accessible COVID-19 vaccines for all participating economies – of all income levels, population sizes, and needs.
• The doses Canada has secured through COVAX complement the bilateral arrangements Canada has in place with vaccine manufacturers and diversify our sources of supply. 
• The COVAX Facility is designed so that higher income countries like Canada invest in the COVAX Facility and thereby increase the pool of buying power that offers COVAX greater negotiating leverage with pharmaceutical companies for the needs of developing countries. It is for this common global benefit that the Government of Canada has oriented some of its procurement efforts through the COVAX Facility.
• According to the public tracking provided by COVAX, a number of high income G7 and G20 nations have been allocated doses from the COVAX Facility, including Argentina, Australia, Brazil, Canada, India, Indonesia, Mexico, Saudi Arabia, South Africa, the Republic of Korea, and the United Kingdom^{Footnote 1}. As additional COVAX supply from Janssen and Novavax comes on line in the coming months, this is expected to increase.

Q: Is Canada accessing doses through COVAX because our domestic procurement has otherwise been a failure?

• COVAX has always been part of Canada’s overall vaccine procurement portfolio.
• COVAX is being used to complement the bilateral purchase agreements Canada has with the vaccine manufacturers.
• Being allotted vaccines through the self-financing window of COVAX shows that the mechanism is working.

Q: Why is Canada seeking to secure doses through COVAX instead of purchasing more doses directly from manufacturers to vaccinate Canadians quicker?

• COVAX has always been part of Canada’s overall COVID-19 vaccine procurement portfolio.
• At the outset it provided Canada access to a larger pool of potential vaccines.
• By investing in and procuring doses for Canadians through the COVAX self-financing window, Canada is increasing COVAX’s ability to negotiate with vaccine manufacturers to acquire vaccines for low- and middle-income countries in an equitable way.
• We believe that the best way to address this pandemic is through global collaboration.

Q: Canada has procured many times more vaccines than it will need. When will Canada give its surplus to developing countries and how will it be decided who gets what?

• In December, the Prime Minister committed to Canada sharing surplus COVID-19 vaccine doses with the world, should we receive more doses than necessary.
• We expect to have a better sense of any potential supply in excess of Canada’s needs, including possible options through the COVAX Facility, as additional vaccine candidates are reviewed by Health Canada for authorization, and as we confirm supply schedules and domestic deployment plans.
• Canada will work closely with our international partners, including other countries, Gavi, the COVAX Facility, and vaccine manufacturers, to explore all possible options to ensure doses get to people around the world who need them.
• Currently, Health Canada has approved Pfizer, Moderna, AstraZeneca, and Johnson&Johnson’s vaccines for use in Canada.
• COVAX is working to finalize a mechanism via which countries will be able to share surplus WHO EUL-approved vaccine doses equitably with other countries.

Q: Why is Canada committing to sharing vaccine doses before we have fully vaccinated our own population?

• Canada has invested in a diverse vaccine portfolio for our domestic vaccination campaign and the safety of Canadians remains our top priority.
• Ultimately though, our safety at home requires us to beat the pandemic everywhere, and Canada is committed to doing its part to help vaccinate everyone, everywhere.
• As the Prime Minister said, “As Canada gets vaccinated, if we have more vaccines than necessary, absolutely we will be sharing with the world.”

Q: Is Canada “hoarding” vaccines and engaging in “vaccine nationalism”?

• Canada is committed to an equitable, global approach to fighting the COVID-19 pandemic.
• By investing in both the COVAX self-financing window as well as the AMC, Canada is ensuring that we are able to prioritize the vaccination of Canadians while also doing our part to vaccinate everyone, everywhere.

Q: Shouldn’t developing countries have the chance to vaccinate their high-risk populations – especially health care workers - before Canada vaccinates its low risk populations?

• The COVAX fair allocation system has been established with the goal of ensuring all participating countries can vaccinate their high-risk populations, whether they be in high-income or low-income countries.

Q: What is Canada doing to support vaccination efforts within humanitarian settings?

• Canada has been supporting COVAX in the creation of the COVAX Humanitarian Buffer. The Buffer is a measure of last resort that will support access to COVID-19 doses, as a measure of last resort, for Humanitarian Agencies and COVAX Participants to ensure that those living in humanitarian contexts are not left behind.
• We must continue to support other countries in their fight against COVID-19 to protect the most vulnerable, wherever they are.
• Canada has called on countries to include all people within their border, including refugees, internally displaced persons and migrants, in their national vaccination plans.
• Canada has also called on the UN Security Council and all parties to conflicts to fully implement Security Council Resolution 2532 and to ensure rapid, safe and unimpeded access of humanitarian personnel for the provision of all life-saving health services, including undertaking vaccination efforts.
• We believe that civil society organizations, UN and other humanitarian agencies have important roles to play in immunization, not just around service delivery and provision to under-serviced communities, including fragile and conflict-affected communities, but also in planning, oversight and accountability.

Q: How has Canada contributed to the global response to COVID-19?

• Canada has supported the global effort to beat the pandemic from the very beginning. To date, Canada has mobilized more than $2 billion in international assistance in response to the COVID 19 pandemic; this includes:
  • $940 million for the Access to COVID 19 Tools (ACT) Accelerator; this critical international partnership ensures equitable access to COVID 19 tests, treatments and vaccines
  • over $740 million in funding for humanitarian and development assistance to respond to the urgent needs stemming from the COVID 19 pandemic
  • $488 million to adapt existing funding arrangements with partners to ensure their activities are able to address urgent needs in developing countries resulting from the pandemic
• Budget 2021 highlighted additional funding to support the global response to COVID-19 ($375 million).
• In addition, in April 2020 Canada extended a $1-billion loan to the International Monetary Fund’s Poverty Reduction and Growth Trust in relation to the COVID 19 pandemic.

Q: Are women being disproportionately affected by COVID-19? If so, how, and what is Canada doing to address this?

• In line with Canada’s Feminist International Assistance Policy, Canada’s response includes a particular focus on the world’s poorest and most marginalized, and considers the differentiated needs of women and girls.
• Studies show that almost half of women are feeling more anxious, depressed, overworked, isolated or physically ill because of the increased domestic workload stemming from pandemic containment measure.
• As the COVID-19 pandemic deepens economic and social stress coupled with restricted movement and social isolation measures, gender-based violence is increasing exponentially. Many women are being forced to ‘lockdown’ at home with their abusers at the same time that services to support survivors are being disrupted or made inaccessible.
• Women have less capacity to absorb economic downturns from COVID-19 because they have lower earnings, savings and job security, and they are over-represented in precarious informal employment, especially in lower-income countries and humanitarian contexts.
• Women’s unpaid care work burden has increased, with children out-of-school, heightened care needs of older persons and overwhelmed health services.
• Women perform 76.2 percent of total hours of unpaid care work, more than three times as much as men^{Footnote 2}. COVID-19 is showing the stark need for shifts in household norms that mean men assume more unpaid care responsibilities and policy changes to recognize the economic value of care work^{Footnote 3}.
• While early reports reveal more men are dying as a result of COVID-19, the health of women generally is adversely impacted through the reallocation of resources and priorities, including sexual and reproductive health services.
• Women comprise more than 75 percent of the health care workforce in many countries^{Footnote 4}, and given their front-line interaction with communities and their participation in much of the care work, women face a higher risk of exposure to the virus. 
• Canada is working with a number of Canadian NGOs including World Vision Canada, Save the Children Canada, and Plan International Canada to address unpaid care work, informal employment and frontline roles for women and girls as these exacerbate gender inequality in lower-income societies around the world.
• Canada has committed to develop programming that recognizes, reduces and addresses the unequal distribution of paid and unpaid care work; supports and protects the rights of paid and unpaid care workers to address a root cause of global inequality.
• We have also seen the value of amplifying the voices of women and girls in all their diversity, and have been collaborating with partners to do so meaningfully through our work with Generation Equality, and through additional funding for women’s rights organizations and the women’s peace and humanitarian fund.
• We have taken further measures to maintain access to sexual and reproductive health services and help address gender-based violence during the pandemic, as well as to continue to advocate for an end to harmful practices, such as through our leadership of the UN Resolution on Child and Early Forced Marriage.

Q: We’ve seen here in Canada that schools have had to embrace virtual classrooms, and we’re starting to see the effects this is having on children and their learning. What does this mean for countries in which access to virtual resources isn’t as easy as it is here? How is Canada working to ensure our investments in education globally are being leveraged to keep kids from falling behind?

• Schoolchildren in low- and middle-income countries lost nearly four months of schooling in the first six months of the pandemic, compared to six weeks for those in high-income countries.
• This situation affects girls more directly as they are more likely to stay home to shoulder the unpaid care burden due to gender bias and ingrained social norms that favour boys’ education over girls. Some estimates indicate that as many as 10 million more adolescent girls may be out of school at the end of the pandemic.
• Children who are out of school for extended periods of time are less likely to return, especially girls.
• Girls are particularly vulnerable to sexual and gender based violence and to be subjected to harmful practices like child early and forced marriages or transactional sex in order to survive. UNFPA estimates that the pandemic could result in as many as 13 million more child early and forced marriages. 
• Women and girls with disabilities are among the most marginalized and continue to be left behind. They are disproportionately impacted by the pandemic and experience higher risks to exposure, complications and deaths related to COVID, in addition to higher rates of poverty and sexual and gender based violence.
• If the response to the COVID-19 pandemic and its recovery are to be effective and not reproduce or perpetuate gender and health inequalities, it is important that gender norms, roles, and relations that uniquely impact women and girls are considered and addressed across global and national response strategies as well as through governments’ recovery policies, including its education and economic policies and programs.
• Canadian NGOs have been working to lessen these effects and keep as many children in school as possible:
  • Right to Play Canada, with support from Global Affairs, has been working on the ground to train teachers on how to deliver engaging remote lessons for children in grades 1 to 3 as part of their Gender Responsive Education and Transformation (GREAT) program in Mozambique, Ghana and Rwanda.
  • UNICEF Canada started a new program with Global Affairs called Back to School Better that tackles barriers to education for refugee and displaced girls in Burkina Faso, the Democratic Republic of the Congo and Mali, that is working to reimagine education systems so that no child is left behind.

Q: Canada has provided significant funding to Gavi in support of routine immunization in lower-income countries – how is that work being affected by COVID-19? How will our investments in Gavi be affected by backsliding and loss of gains when it comes to routine immunization?

• Vaccination is one of the most cost effective health interventions the world has. It is estimated that for every US$1 spent on immunization, there is a return on investment of US$54. The benefits of immunization extend beyond the individual who receives the vaccine to include family and community members. In this way, we all benefit when people have access to routine immunization.  
• Gavi is a key partner supporting Canada’s efforts to address child mortality through immunization. Since 2002, Canada has provided more than $1 billion in funding to Gavi.
• This funding has helped Gavi to reach more than 822 million children with routine immunizations, such as polio, meningitis, measles, pneumococcal disease, diphtheria, tetanus, and pertussis, among others. Gavi’s efforts have helped to prevent more than 14 million deaths.
• In May 2020, Canada committed $600 million to Gavi to support its 2021-2025 strategic period, to support Gavi’s efforts to immunize a further 300 million children and save an additional 7-8 million lives. 
• Since the onset of the COVID-19 pandemic, there have been interruptions to routine immunization programmes and campaigns. Gavi has been working with country governments to adapt and restart immunization services to catch up on those who were missed both before and during the pandemic. At the same time, Gavi is investing in strengthened immunization systems that will be more resilient and responsive to the communities served.
• Gavi also continues to maintain emergency stockpiles of vaccines for cholera, Yellow Fever, meningococcal disease, and Ebola. These stockpiles means that Gavi can respond quickly to outbreaks, helping to prevent the further spread of disease.
• These efforts will help to minimize backsliding and help to prevent the outbreaks of other infectious diseases.
• While data is not yet available about the impacts of the pandemic on vaccination coverage rates, Gavi and its partners are well-positioned to support countries in their efforts to not only catch-up on immunization programmes, but to expand them to reach those children and communities that previously did not have access to immunization programs.

Q: What is Canada’s track record supporting health in developing countries?

• Good health is central to reducing poverty. Poverty and exclusion are driving forces of health inequities. Health systems have a key role in addressing the relationship between poverty, exclusion and health.
• Canada’s work to fight COVID-19 in developing countries is part of our broader work as a longstanding leader in advancing global health.
• Canada is a long-time donor to Gavi, The Vaccine Alliance supporting routine immunization in lower-income countries. Canada holds a seat on Gavi’s Board, and presently, Gavi also administers COVAX.
• As the largest sector of our development assistance, Canada has improved the lives of millions over the past decade through work in critical areas such as maternal, newborn and child health, reducing infectious diseases, promoting sexual and reproductive health and rights, and building stronger health systems.
• There is a significant risk that health and nutrition gains achieved in recent years, in particular those in maternal and newborn health, will be undermined.
• Canada supports human rights based approaches that put the poorest and most marginalized at the heart of all efforts and approaches that contribute to removing structural and societal barriers to ensure women and girls are not left behind.

Q: How can we support developing countries in building more resilient health systems?

• COVID-19 has highlighted the need to strengthen health systems, primary health care, and community-based care, as key parts of preventing and preparing better for the future.
• Strengthening these systems helps us put gender equality, equity, and human rights, including sexual and reproductive health and rights, at the core of our responses, and to provide sustained support to the most vulnerable.
• COVID-19 poses an opportunity build stronger health systems that are more resilient to shocks and ensure that these services are available to all, including the most remote and vulnerable populations. Canada is committed to supporting low and lower-middle income countries in their efforts on this front. 
• Canada supports the strengthening of primary health care (PHC) approaches in order to achieve Universal Health Coverage. Canada supports PHC through programmatic efforts such as improving the quality and accessibility of health and nutrition services for the poorest and most vulnerable, lowering the burden of infectious disease on health systems through our ongoing efforts related to polio, AIDS, tuberculosis and malaria, among others.

Q: How do we know these vaccines distributed by COVAX to lower-income countries will be used properly? What is Canada doing to ensure that they are?

• As we have seen with every country in the world – including here in Canada –, rolling out an unprecedented mass vaccination campaign is challenging. COVAX and ACT-Accelerator partners are working hard to support countries as they begin vaccinating their populations, and will continue to work alongside governments and health care workers to deliver vaccines to those who need them.
• COVAX is a partnership comprised of Gavi, CEPI, and the WHO, who together have long histories of successful vaccination campaigns around the world.
• As part of the in-country preparation process for vaccine rollout, AMC-eligible countries prepared National Deployment and Vaccination Plans. These are the operational plans to plan for, implement, and monitor COVID-19 vaccine rollout.
• Developing these plans helped countries to prepare for COVID-19 vaccines, identify resource needs, and streamline the process for introducing the COVID-19 vaccine. These NDVPs require approval by COVAX and WHO regional offices prior to countries receiving doses from COVAX.
• Countries have been provided with a number of framework and guidance tools by the WHO to ensure that doses get to those most in need. This includes the WHO Strategic Advisory Group of Experts on Immunisation (SAGE) values framework for the allocation and prioritization of COVID-19 vaccination and the WHO SAGE Roadmap for Prioritzing uses of COVID-19 Vaccines in the Context of Limited Supply.
• Gavi, WHO and UNICEF have been working with implementing countries to ensure readiness and roll out to avoid in-country bottlenecks. This includes $300M in support approved at the Gavi Board to support Technical Assistance, delivery and cold chain needs for COVAX AMC countries.
• Canada is further contributing to in-country support to the roll-out via COVAX and the ACT-Accelerator Health System Connector partners, to reduce and remove bottlenecks to vaccine rollout that have been identified by countries themselves. This includes support in areas such as:
  • guidance on health worker deployment and role optimization;
  • PPE for front-line health care workers;
  • community engagement for people-centred, context appropriate response and messaging;
  • strategies to engage private sector health care actors for faster vaccine roll-out;
  • supporting health budget preparation to ensure sufficient allocated resources for the vaccine roll-out; and
  • assistance in tracking supply chain implementation and performance monitoring.

Q: How many doses has COVAX delivered so far, and to which countries?
Allocation Dashboard numbers as of 22 April:

• 117 countries have received doses through COVAX (this includes AMC eligible countries, as well as self-financing participants)
• 11.3 billion doses secured globally
• 3.56 billion doses secured and optioned through COVAX
• 40.8 million doses shipped through COVAX

Q: Why are we in discussions with the US to get more doses of AstraZeneca from them? Shouldn’t we be encouraging other high-income countries to donate their doses to countries who need them through COVAX?

• It is important that COVID-19 vaccine doses get to those who need them.
• As we have seen over the past several months, the US is fully committed to COVAX, and to ensuring its success. This includes a commitment of US4 billion to the AMC over the coming two years, and recently hosting the launch of the AMC Investment Opportunity.
• As we are doing here in Canada, I know countries are actively managing their COVID-19 vaccine supply, including sourcing doses when needed and managing possible eventual surplus, and are considering all options to ensure doses go to people who need them. 
• Canada’s procurement of doses for domestic use is led by my colleagues responsible for health and procurement.