This article has been written by Ms. Pooja Padmanabhan, a 3rd year student of VIT, University Chennai. 

ABSTRACT

The COVID-19 Pandemic was tackled by the world through its collaborative efforts, as the disease had initially created a first-of-its-kind scenario with the lockdown and curfews. The efforts to find the vaccine cure for the same were being coupled with the efforts to ensure equitable access to the same at a global level owing to how the disease was spreading. Thus the world organizations together opted to take the unprecedented initiative of the COVAX facility which aimed at ensuring equitable access of vaccines to the global village. The world came together to contribute to the same and it did achieve the numbers that it aspired to. But beyond the same, this alliance of public-private partnerships indeed shaped a new way of governance. This indeed helps in solving the research gap for future pandemics and also anticipates the scantiness that led to hurdles in the COVID-19 pandemic through the COVAX facility. This article will examine the beneficial experiences through the COVAX Facility and also the bitter learnings that the world had to endure during the pandemic. 

Keywords: COVAX facility, equitable access, policy, governance, COVID-19, vaccine, countries, collaboration, funding, framework, management 

INTRODUCTION

The COVID-19 Pandemic that the world faced was in its way a first of its kind. COVID was not merely limited to the health crisis, that it was, Overtime, it became a point of ethical and policy issue. Owing to the pace of production of vaccines, there was a lot of discussion on equitable global access to vaccines. The unexpected nature of the pandemic has itself explained the preparedness that the world lacked.  However, every such line of justification has the rebuttal of how COVID was not the first pandemic that the world ever faced, indicating the need for its preparedness. However, the main arena of consideration in this article is limited to “The Global Vaccine Access Facility (COVAX): Lessons from the COVID-19 Pandemic”. UN considers COVAX the backbone of the COVID-19 Tools Accelerator (ACT). The organization COVAX had the leadership and support from its delivery partner, UNICEF, Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, and the World Health Organization (WHO). 

WHAT COVAX DID?

One of the most prominent initiatives, at a global level about providing solidarity toward equitable access to vaccines, is COVAX. The varied experience, through COVAX, has indeed helped the world understand the significance of taking into account, governance, public policy, funding considerations, and the science of public health management to have preparedness and design a framework for spontaneous action.

WHY ACHIEVE EQUITABLE ACCESS?

Though this comes across as an act of magnanimity of the developed countries, beyond everything, it is indeed a basic human right of the citizens to have equitable access. Moreover, in an era where we have corporations being embodied with corporate social responsibility, the COVAX initiative helped in finding the stakeholders having acute interest owing to their social and political responsibility.

ROLE OF COVAX facility AND THE ASSOCIATED EXPERTISE 

The number of individuals infected with the disease, increasing indeed, pressurized the medical field with the need for a vaccine on a very urgent basis. Achieving equitable access is indeed a big learning through the COVID pandemic, as this is indeed critical and more the same owing to the pandemic. In every such, massive vaccine production, there are bound to be associated uncertainties around the R&D, scale-up manufacturing, need to work on the constantly evolving science and data amongst others. The pandemic also highlighted the dynamic needs of countries and vulnerable populations and their own municipal policies. Implementation of a program like COVAX doesn’t end with the funding, it needs tremendous information, and continuous communication around the world with individuals and organizations at all spectrums ranging from its partners to global and regional organizations. Moreover, the shortest duration taken for the development of an entirely new vaccine is 4 years, in the pre-COVID era. But, COVAX created an ambitious goal of deploying 2 billion doses before the end of 2021. Moreover, there was also a problem of funding for this initiative.  This in itself is one of the key lessons of learning from the COVAX initiative, as it has brought out an output with incredible efficiency and effectiveness. COVAX Facility is within the COVAX pillar. 

Hatchett, understood from the 2009 H1N1 pandemic experience, that wealthy nations would have the capacity to purchase and hoard the same, unless “aggressive action” , as he calls it is taken to curb the same. ( Hatchett had previously served in the Obama and George W. Bush administrations ). Moreover, the same was looked after in the COVID-19 pandemic, by having developing countries enter into advance purchase agreements with the manufacturers so that they are not solely reliant on the vaccines donated to them at a very later stage. Though developing countries are rooted in this facility, the developing countries saw this as no less than a diversified procurement strategy. However, the facility indeed could expand access and minimize the delay in the availability of such vaccines to the LMICs.  

The public-private partnership of COVAX helped in delivering the first dose to Ghana on 24 February 2021. Beyond this initiative, international law has also indeed been a great role player in the moulding of this initiative.  In fact, in 2015, the Sustainable Development Goals of the UN called for “ensuring healthy lives and promoting well-being for all at all ages” to be embraced by all members of the UN. In keeping with this, on May 19, 2020, the World Health Assembly, the primary body of the WHO and home to representatives from every Member State, passed a resolution designating COVID-19 vaccination as a “global public good”. The primary worldwide framework to date for realizing this goal is the COVAX (COVID Vaccination) Initiative, which is being led by the WHO. 

The COVAX facility reached out to all the candidates producing the vaccine and entered into a wide range of agreements with manufacturers. Astra Zeneca and even with the Serum Institute of India. The advance purchase agreements that the COVAX facility entered were indeed a significant takeaway for the future to curb vaccine nationalism. However, this aspect had its own advantages, like the priority over the AstraZeneca/Oxford Vaccine to the HICs.  

Witnessing the COVID-19 response thus far demonstrates how production shortages and high costs resulting from intellectual property (IP) regulations have impacted access to life-saving items. For instance, during the current pandemic, access to ventilator valves and N95 respirator masks has been restricted. The unwillingness of the COVID-19 vaccine producers to share their innovations and license their intellectual property (IP) to manufacturers in low- and middle-income countries has been called out by critics as a factor limiting the equal distribution of vaccinations.

There prevailed a clear-cut distinction between the self-funded countries and the funded countries. Self-funded countries mostly comprised of the developed countries and the latter accounted for the developing countries. The participation of the countries in the COVAX was classified into the upper middle-income countries ( UMIC) and the lower income countries (LIC) as self-funded and funded respectively. Thus such participation did impact the method of allocation. Self-funded countries ( as guaranteed ) are provided to immunize about 20% of their population. The metrics for allocation were governed by the WHO’s Global Allocation Framework. There were many other logistical drawbacks. One of these is the cold chain infrastructure required to transport the vaccine but the vaccine that uses mRNA platforms requires more sophisticated infrastructure ( AstraZeneca). Though the countries and Gavi were prepared for this cold chain infrastructure, certain nations will have an added advantage over others, which could constrain the other nations from being prioritized during the initial phases. This yet again is another lesson from the COVAX facility as there were countries that were not ready to receive the vaccines. Thus COVAX mainly fulfilled their obligations to countries based on the income status of the participating countries and the proportion of older people in the population. 

The crucial arenas of decision-making in reference to the equity challenge include:

• HICs to limit the supply by purchasing through the Advance Purchase Agreements which could curb the global distribution
• Tariffs on the cross-border transfer of the vaccine might hinder equitable vaccine distribution. ( import) 
• Prior established trade agreements may constrain the access opportunity of the LMICs.
• The capitalistic interests of the manufacturers may run into a conflict with the necessity of equitable distribution. 
•  Limited rationality associated with the rationale and the justifications for the decision of the distributors.
• “Two-tiered” system of vaccine distribution which advanced a sense of purchasing priority to the HICs.

The WHO’s proposed Global Allocation Framework,  will not be adequate to support the facility’s two billion dose aim or uphold its own “fundamental principle” that states that countries will get doses at the same rate. In actuality, not every country has the infrastructure in place to deploy and use doses efficiently, therefore the facility won’t be able to supply doses to nations at the same rate. The point of relevance is this, is one of the key areas where there is a need for immediate attention in the instant pandemic, as it hindered the functioning of the vaccine deployment initiative during the 2009 H1N1 outbreak. 

In order to prepare with limited or unknown resources in the face of uncertainty, COVAX partners incorporated risk sharing and mitigation into the model, often improvising and changing it as necessary. These steps included assembling over 190 participants to pool demand, investing in a wide range of qualified applicants, and establishing safety nets like the cost-sharing mechanism in case donor funding was insufficient or more doses were required, allowing countries to still buy doses at COVAX-negotiated rates. The COVAX partners employed novel financing arrangements, both newly developed and pre-existing, to reduce investment risk or provide backup money for previous investments. 

CONCLUSION

This COVAX Facility has indeed been a noteworthy attempt to put together multi-lateral cooperation to collect and distribute vaccines by not giving up on the basic principles of equitability.  The hurdles of funding, vaccine nationalism, emergency licensure, and bilateral advance purchase were all indeed tackled in the best way possible and are indeed a readily available piece of learning to understand how management, public policy, budgeting, and governance play a key role in shaping such crisis beyond the technical aspects of the vaccine. In situations when international agreements to restrict bilateral sales are lacking and countries are still able to purchase vaccines outside of the facility, COVAX as a platform has served as an intermediary option for cooperation. From a goal to donate the vaccine to vaccine equity, COVAX indeed highlights the urge to empower low and middle-income countries during such pandemics. 

REFERENCES

This article was originally published on the WHO website. The link for the same is herein. https://www.who.int/initiatives/act-accelerator/covax

This article was originally written by Jamie Ducharme and published on Time website. The link for the same is herein. https://time.com/6096172/covax-vaccines-what-went-wrong/

This article was originally published on the UN website. The link for the same is herein. https://sdgs.un.org/goals/goal3

This article was originally written by Thomas J. Bollyky and published on JSTOR website. The link for the same is herein. https://www.jstor.org/stable/resrep27671 

This article was originally written by Armin von Bogdandy and Pedro A. Villarreal

and published on Zeitschrift für ausländisches öffentliches Recht und Völkerrecht/Heidelberg Journal of International Law, 81(1), pp.89-116  website. The link for the same is herein. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/1468-0009.12503

This article was originally published on the UNICEF website. The link for the same is herein. https://www.unicef.org/supply/documents/key-learnings-future-pandemic-preparedness-and-response

This article was originally written by Mark Eccleston-Turner and Harry Upton ( Keele University) and published on THE MILBANK QUARTERLY, A MULTIDISCIPLINARY JOURNAL OF POPULATION HEALTH AND HEALTH POLICY. The link for the same is herein. https://www.researchgate.net/publication/349736048_International_Collaboration_to_Ensure_Equitable_Access_to_Vaccines_for_COVID-19_The_ACT-Accelerator_and_the_COVAX_Facility 

This article was originally published on the GAVI website. The link for the same is herein. https://www.gavi.org/vaccineswork/gavi-ceo-dr-seth-berkley-explains-covax-pillar 

This article was originally published on the SCIENCE website. The link for the same is herein. https://www.science.org/doi/10.1126/science.369.6503.489