It's a stark warning about the future of the pandemic: that without global access to lifesaving vaccines, COVID-19 is here to stay.
The virus has travelled to every continent and infected more than 100 million people globally in just over a year since it was first declared a global health emergency.
Humanitarian activists and experts are raising the alarm about the wide gaps in vaccine distribution between the world's richest and poorest countries.
They have criticised rich countries for buying up COVID-19 vaccine doses as poor countries are left without vaccines in a trend that has continued months after doses first have become available.
"Very rapidly the discrepancy between countries is going to become very important and our main concern is that [rich countries] start vaccinating lower risk groups quite quickly starting from May while on the other side of the world, we are still not able to fully vaccinate health care workers," said Alain Alsalhani, a vaccines pharmacist with the Doctors Without Borders (MSF) Access Campaign.
A study commissioned by the International Chamber of Commerce estimated that the global economy would lose $9.2 trillion (€7.6 trillion) if governments fail to ensure developing countries have access to COVID-19 vaccines.
Low-income countries are thus relying on the global effort to secure vaccines: COVAX (formally known as the COVID-19 Vaccines Global Access Facility), which is led by the World Health Organization (WHO), the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance.
But is it enough? Here's a look at how vaccine distribution is panning out for those with little means.
What is COVAX?
The original idea of COVAX was to coordinate purchases globally to ensure poorer countries were not priced out the vaccine race. But, in practice, it functions more like an aid project, experts say.
The initiative to accelerate access to COVID-19 vaccines was first set up at the end of April 2020 and now plans to distribute more than 330 million vaccine doses to 145 countries in an initial round of distribution by June 2021.
It will cover on average 3.3% of the total population in those countries which range from the rich, such as Canada and New Zealand, who pay for the vaccines, to countries such as Syria and Yemen, who receive them through international donations.
"It took quite a while to set up and because it took so long, [rich] countries didn’t feel confident that it would be a safe way to buy their vaccines from COVAX and they started striking their own bilateral deals to make sure that their populations would have access to the vaccine," said Antoine de Bengy Puyvallée, a political scientist at the University of Oslo.
"Of course that kind of played against COVAX at some point because they were competing for the same doses."
Now, the initiative is months behind rich nations which bought up nearly all of the early doses. The WHO said earlier this month that 90% of COVID vaccines had been given in richer countries.
Many of those countries will have vaccinated much more significant percentages of their populations by June compared to lower-income countries.
COVAX's first contract in August was for the Serum Institute of India (SII) to manufacture vaccine candidates from AstraZeneca and Novavax. But Pfizer and BioNTech, which had their vaccine approved by regulators beforehand, only made an agreement in late January with COVAX to provide 40 million doses, around 3% of what the company aims to produce in 2021.
It's not atypical for how drugs usually come to market, some experts have said, stating that often there are delays getting medicines to low-income countries.
But "it’s a very unique case this idea that actually countries that were able to pay at risk are the ones that today have the vaccines," said Alsalhani at MSF. "Under normal circumstances, the vaccine market doesn’t really work this way."
Why are some rich countries receiving vaccines through COVAX?
There are two parts to the programme - one for 98 countries paying for their own vaccines and another called the COVAX AMC for 92 low and middle-income countries which range from Nigeria, India and Ukraine to Syria, Afghanistan and Yemen.
The goal is to provide vaccinations for "at least 20% of the population" of these low-income countries by the end of 2021 to make "a very real impact towards stopping the spread of the pandemic," a Gavi spokesperson told Euronews.
Canada is currently the only G7 country that will receive vaccines through COVAX and came under criticism at home as people asked if it was taking vaccines from poor countries.
"Our top priority is to ensure that Canadians have access to vaccines," the country's international development minister Karina Gould told CBC, pointing out that Canada is the second-largest contributor to COVAX AMC.
"Our position has always been that you know we need to get vaccines for Canadians but we also need to get them for the world."
While having countries pay for vaccines through COVAX does help the initiative to secure manufacturing deals with pharmaceutical companies, critics say those who already have bilateral deals for vaccines should wait.
"The problem is that some of the high-income countries have bilateral deals and already started receiving doses," said Alsalhani.
De Bengy Puyvallée said he thinks the desire to help others on the one hand and to vaccinate their own populations on the other creates "a dilemma for countries".
But striking bilateral deals while supporting COVAX is also an "ambiguous policy," that "has kind of undermined the global approach at the same time," he added.
The EU has struck deals to vaccinate its entire population twice but also contributed around €850 million to support COVAX. They've also raised money to help European countries outside the EU access vaccines.
Serbia began vaccinating their population early, relying mainly on the Chinese vaccine.
Many countries in the Balkans are relying on COVAX for their first doses, including Bosnia and Herzegovina which has already started received refrigerators from UNICEF to store the Pfizer/BioNTech vaccine which they procured through the initiative.
'Unequal vaccinations could lead to more problems down the line'
Many experts and humanitarian activists are pushing for vaccinations to be distributed more equally, warning that if developing countries do not have access to vaccines, it could cause big problems down the line.
"Vaccinating a lot of people in a few countries, leaving the virus unchecked in large parts of the world, will lead to more variants emerging," said Dr Jeremy Farrar, the director of the charity Wellcome, in a statement.
"The more that arise, the higher the risk of the virus evolving to an extent where our vaccines, treatments and tests are no longer effective."
The WHO's director-general Dr Tedros Adhanom Ghebreyesus had said the world was "on the brink of a catastrophic moral failure" as rich countries rolled out vaccinations months ahead of developing ones.
"It's not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries," he added.
Many humanitarian organisations are advocating for a fairer effort to be launched, urging the UK and EU to share doses before vaccinating younger adults.
Brandon Locke, policy and advocacy manager at the ONE Campaign, said that instead of vaccinating 70% of populations by the summer, as the EU is trying to do, countries should "reevaluate" and "share some of these doses with lower-income countries not after we vaccinate our entire population but now as we’re vaccinating our own health care workers".
"That’s actually what's going to help stop and slow the virus," Locke said.
Scaling up production and manufacturing
But it's also about scaling up production of these prized medicines.
One way many countries hope to do that is by pushing for pharmaceutical companies to be more transparent and to share information with the rest of the world.
South Africa and India have asked the World Trade Organisation to suspend intellectual property laws to increase know-how and some say there needs to be more of an effort for the private sector, which received large amounts of public money, to train others to use their technology.
"It’s quite clear that the business as usual approach that we’re taking with really sensitive issues like intellectual property, competition rights and the way that we work with pharmaceutical companies, it just isn’t working," said Locke.
"We need to look for a long term solution to this problem... there’s no legal or ethical or rational reason not to be doing that."
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