COVID-19 Lessons from UNICEF: Q&A with Gian Gandhi; CEPI's COVAX Marketplace

Newsletter Edition #73 [The Weekly Primer]

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Hi,

As significant parts of the developing world are battered by the surging COVID-19 infections and deaths, Geneva continues to convene its experts to tackle vaccine manufacturing and engage in discussions on the TRIPS waiver.

Every hour of policy-making time can be counted by the number of lives saved or lost. Even as we are engrossed in the here and the now, in the firefighting mode of our lifetime, efforts to determine the cause of the fire took a decisive turn. A new international advisory group to track the origins of novel pathogens is taking shape.

Seldom did science get so inextricably linked to politics. The discussions on the origins of SARS-CoV-2 illustrate this reality. The “origins” debate will determine future pathways in global health security and diplomacy. Even at this grave hour, it is politics and diplomacy that will shape these outcomes.

Despite diplomatic motivations, you will find it striking that even vaccine donations have logistical trappings. In today’s curated edition we bring you an interview that helps understand the role of UNICEF in the delivery of vaccines.

Also, consider signing up to read our exclusive from last Friday that you simply cannot miss: Confidential Communication on the TRIPS Waiver Shows the EU's Unwillingness to Negotiate. Also see this related podcast by Corporate Europe Observatory that I was part of. With fellow panellists we discuss the EU, COVID-19 and Big Pharma.

Write to us with your feedback and suggestions.

Finally, in other news, my son has turned three today. A great milestone for him, and for Geneva Health Files that he has helped contribute to!

Best,

Priti

Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva


I. THE GENEVA HEALTH FILES INTERVIEW

Dose donations are proving to be a good medicine for vaccine nationalism”: Gian Gandhi, UNICEF

As an official partner of the COVAX Facility, UNICEF is responsible for procurement, logistics and delivery of COVID-19 vaccines. We spoke with Gian Gandhi, who leads 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.

1.      [GHF] Can you elaborate on the role of UNICEF in the delivery of COVID-19 vaccines as a part of the COVAX Facility? Can you elaborate on the scale of the operations in the context of this pandemic. How many countries have signed procurement contracts with UNICEF?

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 per cent 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.

2. [GHF] What were some of the key lessons for UNICEF in the past year in the context of procurement and deliveries of COVID-19 vaccines?

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 as a result of 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 have 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.

Image: Gian Gandhi, UNICEF COVAX Coordinator for Supply Division

3. [GHF] On contracts:

·       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?

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.

4. [GHF]  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?

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).

5. [GHF] The UNICEF COVID-19 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.) 

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).

6. [GHF]  How does UNICEF plan to service both commitments to the COVAX Facility and the African Vaccine Acquisition Trust (AVAT) simultaneously? 

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.


See our other related stories on COVAX:

-          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


II. POLICY UPDATES

  • International Scientific Advisory Group for Origins of Novel Pathogens:

    A decisive moment in the COVID-19 policy response.

    Tedros said in his remarks to member states last week: “.…I am pleased to announce that the Secretariat is establishing a permanent International Scientific Advisory Group for Origins of Novel Pathogens, or SAGO.” He added that this new group “will play a vital role in the next phase of studies into the origins of SARS-CoV-2, as well as the origins of future new pathogens.”

    Don’t miss this careful story from Science on this.

  • Statement on the eighth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic: WHO Press statement

  • CEPI’s COVAX Marketplace: Matching suppliers of inputs with vaccine manufacturers

    CEPI announced that it is launching a mechanism to help connect suppliers of critical inputs with vaccine manufacturers. This initiative is being described a key deliverable of the COVAX Manufacturing Task Force.

    CEPI has said that the world is gearing up to produce three times the previous annual vaccine output, in order to reach 11 billion doses of COVID-19 vaccines before the end of 2021.

    “As a result of this historic scaling up, bottlenecks are affecting the global supply chain leading to acute shortages of vital supplies which are preventing COVID-19 vaccine manufacturers from operating at full capacity. This is delaying vaccine production and contributing to inequity.”

    … “It will provide a secure platform for vaccine manufacturers and suppliers of critical inputs to confidentially indicate their needs or available supplies to CEPI, in its role as facilitator. CEPI will identify matching offers and requests and connect potential matches, prioritising based on objective criteria including whether the manufacturer has a COVAX advance purchase agreement and WHO EUL in place, as well as dose volumes and delivery timings. Future versions of the Marketplace may include supplies required to manufacture other lifesaving therapies and vaccines which are also being affected by current global supply shortages.”

    The COVAX Marketplace: CEPI

    We find this articulation very interesting. The causes of acute shortages of vital supplies are many, including intellectual property protection on routine inputs apart from complex inputs that go to produce a vaccine. The marketplace will focus on identified critical supplies such as bioreactor bags, single use assemblies, cell culture media, filters, lipids, vials and stoppers, CEPI has said.

    Also it is not obvious to us, why a central mechanism such as this one, will speed up the process of vaccine manufacturing. Collating critical information in a confidential manner could, in fact, potentially contribute to a bottleneck in our limited understanding.

    We are still waiting to know how the COVAX Manufacturing Task Force for example, will match fill and finish capacities or even ensure technology transfer arrangements at this stage of the pandemic.

    Image credit: Photo by Pixabay from Pexels


III. WHAT WE FOUND INTERESTING

NEWS:

My colleague Rithika has pulled this together for you:

FROM THE JOURNALS/REPORTS

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IV. WHAT WE ARE WATCHING:

  • WTO - TRIPS Council Formal Meeting on TRIPS Waiver: 20 July

  • WTO-WHO HIGH LEVEL DIALOGUE: Expanding COVID-19 Vaccine Manufacture to Promote Equitable Access: 21 July 


V. TWEET OF THE WEEK

Jamie Uhrig, a staff physician at Correctional Health Services in New York City, who has provided technical support on HIV and human rights in many countries, raises an important question:

(Also read this related story on Myanmar:‘Everyone is dying’: Myanmar on the brink of decimation)

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