Milestones :: Perspectives :: Research
Reform of the International Coordinating Group for Vaccine Provision: a new framework for coordination, accountability and transparency
Weekly Epidemiological Record, 6 December 2019, vol. 94, 49 (pp. 581–600)
The International Coordinating Group (ICG) for Vaccine Provision is a mechanism for allocation of vaccines from global stockpiles to respond to emergency requests in major infectious disease outbreaks and humanitarian emergencies.1, 2 There are currently 3 functionally separate ICG decision-making groups, for meningitis, yellow fever (YF) and cholera vaccine allocation, which comprise representatives from its 4 founding partners, the International Federation of Red Cross and Red Cres-cent Societies, Médecins Sans Frontières, the United Nations Children’s Fund (UNICEF) and WHO. The ICG’s guiding principles are to ensure equitable and timely access to essential vaccines while maintaining independent decision-making.1 It has evolved in the face of an ever-changing policy environment and new challenges in infectious disease control.
This paper outlines the timeline of the changes to the ICG mechanism to date, which gives the context for a discussion of current reforms, including changes to its governance structure and measures to ensure account-ability to stakeholders. The implications of these changes for future development of the ICG are then discussed…
The new oversight mechanism preserves the ICG’s flexibility and decision-making independence, while facilitating a new level of coordination between the ICG, its partners and wider disease control initiatives, including the newly established “Defeating Meningitis by 2030” strategy.31, 32 The Accountability Framework, in conjunction with the GOC oversight mechanism, has the potential to enhance stakeholder trust, drive improvements in the effectiveness of the ICG process and respond to new challenges.
In addition to market-shaping and coordination among partners, another area for improvement is the timeliness of vaccine delivery to affected countries. The requirement for licensing and customs authorization for vaccine shipments by national authorities remains a major cause of delays in vaccine deployment. While ICG decision-making groups have a strong record of meeting their time performance targets for circulating requests and reaching decisions on approval or rejection,33 vaccines arrived in affected countries within 7 days for only 18% of approved requests during 2016–2018. Inability to achieve this target is considered to be outside the control of ICG decision-making groups,22, 31 as recognized in the Accountability Framework, which defines the areas of responsibility in vaccine delivery for UNICEF SD, manufacturers and national governments.
Following efforts to fast-track vaccine development in the wake of the 2014–2015 Ebola virus epidemic in West Africa and the recent outbreak in DRC,34 several promising vaccine candidates have been identified.35 The first commercially available Ebola virus vaccine has been licensed and prequalified in November 2019.36 Given the probable need for a coordinated mechanism to ensure effective, equitable allocation of limited vaccine in the event of another large-scale outbreak, proposals for establishment of an ICG-like stockpile mechanism for Ebola virus disease are under discussion. The mechanism would have to be adapted to Ebola virus disease response,18, 36 with a holistic approach including potential prophylactic vaccine use alongside emergency response.
The ICG has pursued its mandate for over 20 years, responded in time to crises, controlled outbreaks, ensured equitable access to vaccines and essential medicines and protected millions of lives.31 Between 2006 and 2018, the ICG decision-making groups handled 291 emergency vaccine requests and approved the release of over 125 million doses of stockpiled meningitis, YF and cholera vaccines.13, 22 In 2018 alone, the 3 ICG groups received 25 requests, of which 21 were approved for over 16.5 million vaccine doses. Its role has been extended to cover new infectious diseases with epidemic potential and its mechanism refined as it has adapted to the persistent challenges inherent in managing vaccine stockpiles, their global allocation and the changing needs and demands of a range of partners and stake-holders. The reform of the ICG not only gives new focus to its work and reaffirms its continuing role in the global response to pandemic-prone diseases but also lays the foundation for further expansion and improvements towards achieving its core objectives.