Relying solely on philanthropy or existing manufacturers has not produced enough vaccine doses—and is unlikely to do so in the future. COVAX promised to send 2 billion doses to participating countries this year. Six months in, it has managed to ship only 81 million doses. All four Western vaccines in use—those made by Pfizer, Moderna, Johnson & Johnson, and AstraZeneca—have been struggling to overcome production problems and meet their commitments to rich countries, leaving their ability to do any more for poor countries, at least this year, in doubt. “Funding for COVAX is not the problem; the $9.6 billion pledged by a host of rich countries has ensured that,” Ayoade Alakija, the head of the African Union Africa Vaccine Delivery Alliance, told us. “The problem is that COVAX, like everyone else, has no immediate access to vaccine supply. Relying on pie-in-the-sky delivery predictions from major pharmaceutical companies is not the answer either. We need rich countries to share doses immediately and open up manufacturing of vaccines to everyone who is capable of making them.”