In the past few weeks, the world witnessed a glimmer of hope as certain countries began their COVID-19 vaccination rollouts. Thus far, the United Kingdom, United States, and Canada have all administered the first shots of the Pfizer-BioNTech vaccine to their respective populations.

But for poorer countries, the arrival of a COVID-19 vaccine remains uncertain. According to internal documents reviewed by Reuters, the global plan to deliver vaccines to poorer countries faces a “very high” risk of failure, potentially leaving billions of people with no access until as late as 2024.

The COVID-19 Vaccine Global Access Facility, known as COVAX, is the main global scheme to vaccinate people in low- and middle-income countries against COVID-19. It aims to secure at least 2 billion doses by the end of 2021 and ensure equal access for 92 low- and middle-income countries that cannot afford to pay for supplies on their own.

Now, internal documents reveal that the program is struggling from a lack of funds, supply shortages, and risky contractual arrangements that could make it impossible to achieve its goals.

Despite the $2.1 billion it has already raised, COVAX needs an additional $4.9 billion in order to meet its target of vaccinating at least 20% of people in poor countries next year, Reuters reported. 

Uncertainties in the supply chain also threaten the scheme’s ability to meet its targets. 

COVAX currently has no supply deals with Pfizer or Moderna, largely because of their high prices of $18.40 to $19.50 and $25 to $37 per dose, respectively, and also because of their need for ultra-cold distribution and storage conditions.

Instead, COVAX has struck deals with cheaper and easier-to-transport vaccines like Oxford-AstraZeneca, Novavax, and Sanofi to obtain 400 million doses. But all three companies have faced delays in their trials that could push back approvals to the latter half of 2021 or later.

Additionally, the Serum Institute of India, the world’s largest manufacturer of vaccines, announced last month that it would prioritize supplying its own people first before distributing to COVAX, a decision that could further delay access to vaccines for poorer countries. 

The World Health Organization, one of the coordinators of COVAX, said on Tuesday that it was in talks with Pfizer and Moderna to see if they could lower their current market prices to make doses accessible to poorer countries, AFP reported.

Besides supply chain challenges, COVAX also faces risks in its contracts, which include clauses that allow countries to back out of buying doses that they originally committed to for global distribution. Doing so could push up the price of COVAX’s anticipated $5.20 per dose budget and ultimately make the scheme no longer viable, the Guardian reported.

All of these conditions could cause COVAX to fall apart and leave poorer countries significantly behind in the COVID-19 vaccination process. If vaccine prices are higher than expected, supply is delayed, or additional funds are not fully collected, the program could fail.

So far, the UK and the European Union have been the main financial supporters of COVAX, as well as the World Bank and private donors like the Bill and Melinda Gates Foundation. Meanwhile, the US and China have made no financial commitments.

Launched in April by seven global partners, the ACT-Accelerator is a unique coalition aimed at accelerating global efforts against the COVID-19 pandemic. Its members are working together to develop tests, treatments, and vaccines as quickly as possible, while also strengthening the world’s most fragile health systems. 

But the organization desperately needs financial support from governments around the world. You can join us in calling on world leaders to fund the ACT-Accelerator by taking action here.