white house - As the global program for distributing COVID-19 vaccinations to low and middle-income countries is set to be phased out after next year, experts are warning of a messy transition to ensure countries with the lowest inoculation rates are protected against the coronavirus and new variants are prevented.

The sunsetting of COVAX was agreed to earlier this week in a meeting of the board of the Global Alliance for Vaccines and Immunization known as GAVI. The alliance is the driving force behind the international vaccine-sharing mechanism, along with the World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI).

GAVI said COVAX has enough capacity to continue through 2024. At that point, it plans to phase out the program to 37 developing countries while continuing to provide COVID vaccine doses and the funds to deliver them to 54 of the world's poorest countries who still want them up to 2025, alongside other vaccines it provides.

"While COVAX continues to have in place plans for worst-case scenarios, the board agreed, in principle, to explore integrating future COVID-19 vaccinations into GAVI's core programming," it said in a statement.

Experts say demand for COVID vaccines has significantly dropped worldwide and GAVI shifting focus away from broad COVID vaccination coverage makes sense. However, they warn of a messy transition from the global emergency coordination mechanisms that were set up quickly at the start of the pandemic toward a longer-term COVID management initiative.

"There will be major questions coming from the transition, including how many low- and middle-income countries will continue to receive the financing and logistics support they need, to the impact on GAVI's other immunization programs of integrating COVID-19 vaccination," said Dr. Krishna Udayakumar, founding director of the Duke Global Health Innovation Center.

"There's lack of consensus among the various operating entities and no one person or organization 'in charge' to drive the process," he told VOA. In addition, routine immunizations usually target children while most COVID-19 vaccinations are for adults, so there isn't a clear alignment.

Udayakumar said that the COVID-19 pandemic will continue for some time, and future efforts should support continued vaccination of high-risk populations and preparedness for new variants and future pandemic threats.

U.S. efforts

The U.S. remains the world's largest vaccine donor with a pledge of more than 1.2 billion doses delivered by end of 2022. A significant portion has not been delivered, partly due to reduced demand.

"As of this week, have donated over 670 million doses to 116 countries and economies," a senior administration official told VOA.

In February the administration adjusted its pandemic response strategy to address hurdles faced by lower-income countries to vaccinate their citizens through Global Vax, a program launched late last year by USAID, the U.S. Agency for International Development.

Global VAX is billed as a whole-of-government effort to turn vaccines in vials into vaccinations in arms around the world. It includes bolstering cold chain supply and logistics, service delivery, vaccine confidence and demand, human resources, data and analytics, local planning, and vaccine safety and effectiveness.

The official said the U.S. will continue its efforts. "We are not done fighting COVID. Not at home, and not across the globe. Every country and every organization need to continue their work to fight this virus everywhere."

However, questions remain on funding for U.S. plans to continue its pandemic response including preventing future threats. The administration is calling on Congress, which has until December 16 to pass a critical government funding bill that includes $10 billion to fight COVID at home.

The $10 billion has been pared down from the original $22.5 billion request submitted earlier this year which included $5 billion for its international response that has gone unfulfilled.