‘Dose Donations are Proving to be a Good Medicine for Vaccine Nationalism’, says UNICEF’s Gian Gandhi Inside View 20/07/2021 • Priti Patniak/Geneva Health Files Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Gian Gandhi, UNICEF COVAX Coordinator for Supply Division As an official partner of the COVAX Facility, UNICEF is responsible for procurement, logistics and delivery of COVID-19 vaccines. PRITI PATNAIK spoke with Gian Gandhi, who coordinates COVAX operations for UNICEF, to get a sense of the challenges faced by the organization during the pandemic in the context of production shortages and realities at the national levels. He also discusses the procedures around the donations of vaccine doses. Priti Patnaik: Can you elaborate on the role of UNICEF in the delivery of COVID-19 vaccines via COVAX? We want to get a sense of the scale of the operations. How many countries have signed procurement contracts with UNICEF? Gian Gandhi: Through the COVAX Facility, UNICEF is working with manufacturers and partners on the procurement of COVID-19 vaccine doses, as well as ancillary supplies such as injection devices and cold chain refrigerators/freezers. In addition, UNICEF is managing freight, logistics and storage – coordinating the world’s largest vaccine procurement and supply operation. In collaboration with the PAHO Revolving Fund, we are leading the procurement and delivery for 92 low- and lower-middle-income countries while also supporting procurement for more than 97 upper-middle-income and high-income nations. Together, these represent more than four-fifths of the world’s population. In doing this, UNICEF has drawn on its experience as the world’s largest single vaccine procurer, wherein normal times, we supply the vaccine needs of around 45% of the world’s youngest children. Even so, procuring and delivering COVID-19 vaccine doses on behalf of COVAX could double the volume of vaccines that UNICEF would normally handle annually and involve a mammoth logistics exercise with freight companies, governments, and partners. The first COVAX vaccine consignment landed in Ghana on 24 February 2021. By mid-July 2021, in spite of severe restrictions in vaccine availability and other challenges, COVAX had delivered more than 126 million vaccine doses to 136 countries and territories around the world. PP: What were some of the key lessons for UNICEF in the past year in the context of procurement and deliveries of COVID-19 vaccines? GG: In the first phase of the pandemic, during the first half of 2020, UNICEF Supply Division’s pandemic response predominantly focused on the supply and procurement of personal protective equipment (PPE) and COVID-19 diagnostics. At that time, we experienced delays in access to PPE driven in large part [by] bidding against higher-income countries – and export controls imposed by country governments where the largest manufacturers were located. We pre-empted these challenges for safe injection equipment by building a stockpile of around half a billion syringes in anticipation of the arrival of the first COVID vaccines. As a result, UNICEF has avoided some of the shortages for most syringes that have plagued some countries. Unfortunately, given the limited number of vaccine manufacturers, we haven’t had a viable means of mitigating the analogous risks for doses. The demand and revealed preferences for particular COVID-19 vaccines, or platform technologies, have been much less stable as compared to most other vaccines that UNICEF supplies. Driven by a combination of new data emerging on an almost daily basis, decisions by regulators elsewhere in the world, we’ve seen government and community demand rise and fall. This has made supply chain operations difficult as plans constantly change. Dose donations are proving to be a good medicine for vaccine nationalism. The pledges by G7 and EU countries, in particular, look set to help COVAX get back on track in the remainder of 2021. However, managing the supply and logistics for donations are more complicated than ‘regular’ procured doses. There are a series of legal, administrative, contractual, and operational barriers that must be navigated for each paid or donor-recipient transactions. UNICEF has been managing vaccine donations for decades so we are well-placed to navigate these issues. But, it’s critical to ensure UNICEF and, more importantly, recipient country governments are able to absorb the doses that will be at their disposal. PP: Top UNICEF officials have said that contracts with vaccine manufacturers will be published after consent from manufacturers. When will these be published? It was also mentioned that UNICEF has had a practice of publishing contracts. Can you explain the importance of publishing supply contracts? GG: We don’t publish the actual contracts and never have. However, for more than a decade, UNICEF has published prices secured under our long-term framework agreements including those on behalf of Gavi, the Vaccine Alliance. However, we have done this with the consent of our suppliers. In addition, we summarize the outcome of previous tenders and market outlooks for vaccines and other commodities. These can be found here: www.unicef.org/supply/pricing-data and here: www.unicef.org/supply/market-notes-and-updates. We are striving to do this for COVID vaccines, but rely on manufacturers’ consent here too. This information can be found in UNICEF’s COVID-19 Vaccine Market Dashboard – a dynamic tool for countries, partners, and industry to follow the developments of the rapidly evolving COVID-19 vaccine market and the efforts of the COVAX Facility to ensure fair and equitable access for every country in the world. UNICEF’s provision of market information including the COVID-19 market dashboard is a testament to UNICEF’s commitment to transparency, and our recognition that the free flow of information and correcting information asymmetries is critical to underpin efficient markets. PP: How important are the issues of liability and indemnification in delivering COVID-19 vaccines to countries? Have they been addressed? Does UNICEF bear any liability in the context of delivering vaccines for the pandemic? GG: Most COVID-19 vaccine manufacturers have made it clear that appropriate indemnity and liability (I&L) coverage, including appropriately capitalized no-fault compensation (NFC) schemes, are critical to facilitate access to COVID-19 vaccines that are being made available exceptionally under emergency use authorizations/listings. All manufacturers that have agreed to provide vaccines to COVAX are indemnified against compensation claims that might come from individuals receiving their vaccines. To that end, COVAX has created an NFC to cover the financial risk associated with any potential compensation claims in the 92 low- and middle-income countries that receive a COVID-19 vaccine funded by the COVAX Advance Market Commitment (AMC). In order to access COVID-19 vaccines including via COVAX, country governments sign I&L agreements (with individual COVID-19 vaccine manufacturers). PP: The UNICEF supply dashboard predicts nearly 15 billion doses of vaccines by the end of 2021. Does UNICEF anticipate an oversupply of vaccines for the pandemic later this year? (We understand that UNICEF is in touch with manufacturers worldwide.) GG: The UNICEF market dashboard reports all available market intelligence that we are able to collate from the public domain. We do not risk-adjust the information (for example to predict possible manufacturing problems, or delays in regulatory approvals). But rather, we publish the information that manufacturers, government, and/or funders release. UNICEF has not published a market prediction, but it is fair to say that we do not anticipate global over-supply in 2021. We do expect that several higher-income countries have excess doses (compared to their need) either already or will have excess doses later in 2021. Accordingly, we have been aggressively advocating for dose sharing – particularly by G7 and EU countries as early as possible (noting the aforementioned challenges in processing donations). PP: How does UNICEF plan to service both commitments to the COVAX Facility and the African Vaccine Acquisition Trust (AVAT) simultaneously? GG: Increased and more equitable access of vaccines remains UNICEF’s priority. The African Union [AU]/AVAT initiative is a home-grown and country-owned initiative that puts Member States firmly in the driver’s seat of their own purchasing and access decisions. UNICEF’s support to COVAX is complementary and supplemental to the doses that have already been secured via the AU/AVAT initiative. Coordination is crucial to ensure there is no unnecessary competition for the vaccines. UNICEF is happy to coordinate and support around 100 countries including to organise the transportation of doses purchased by AU/AVAT, COVAX, or bilaterally, or donated. Recent responses from Gavi on the no-fault compensation mechanism is here. The COVAX Allocation Algorithm for Vaccine Distribution COVAX & the question of liability: COVID-19 vaccines Adapted from the article first published in Geneva Health Files by Priti Patnaik, GHF founder and publisher. Image Credits: WHO, UNICEF. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.