Reducing Global COVID Vaccine Shortages: New Research and Recommendations for US Leadership

Milestones :: Perspectives :: Research


Reducing Global COVID Vaccine Shortages: New Research and Recommendations for US Leadership
Duke Margolis Center for Health Policy :: Mark McClellan, MD, PhD. Krishna Udayakumar, MD, MBA, Michael Merson, MD, Gary Edson, JD, MBA
Policy Brief – April 15, 2021 :: 12 pages
A small number of high- and middle-income nations and regions including the United States (US), United Kingdom (UK), the European Union (EU), China, and India account for the majority of COVID-19 vaccines administered thus far. The uneven global distribution of COVID-19 vaccines has raised concerns and spurred demand for action to ensure equitable access, including growing calls to waive intellectual property protections. There are a number of challenges to scaling-up global access beyond intellectual property barriers, and addressing these challenges requires a multipronged, coordinated approach. Leadership from the US on safe, effective, and equitable global access to COVID-19 vaccines is imperative.
In this paper, we present the scope of the global vaccine access challenge, and propose a complementary three-part US-led solution that: 1) increases and leverages funding for the global effort to advance vaccine access through COVAX; 2) undertakes coordinated bilateral and multilateral mechanisms to provide excess doses to countries in need; and 3) increases safe and reliable manufacturing and distribution capacity.

[Excerpts p.6-8]
The following key principles should drive the strategy and priorities for access and distribution involving this robust manufacturing capacity:
:: Allocation and distribution should be equitable, based on the evolving burden from COVID-19 and urgency of need relative to available health resources;
:: Each country should have sufficient vaccine supply to protect its own population, while maximizing support for all other nations to do so to end the pandemic as quickly as possible; and
:: Timing is critical – countries with excess doses should release them to other countries provided that domestic needs are met, including “manufacturing slot swaps,” which achieves both adequate supply and accelerates availability to help save lives and protect health systems globally…


Vaccine allocation and distribution could occur through three potentially complementary mechanisms:
(1) Donation through COVAX: As the global multilateral platform for COVID-19 vaccine access, COVAX could channel donated doses through its existing population-based allocation framework and infrastructure. COVAX partners have extensive experience deploying vaccines to low-income nations, working with UNICEF, providing one system for advancing equity across the world. However, this model and COVAX’s tripartite governance is untested at scale against a shifting and massive pandemic challenge. Moreover, in its first phase, COVAX is allocating doses primarily based on population. This could help avoid political biases in allocations, but could also result in vaccine allocation that is less effective in controlling the pandemic.

(2) Bilateral donations or loans (PEPFAR model): The US can lead by example through bilateral donations or loans to specific countries. A complementary strategy to COVAX would be to use a bilateral program, modeled on PEPFAR, that would include supplying not just the doses but also technical and managerial support and funding to assure supply and distribution logistics and training of health workers. For HIV and antiretroviral therapy, PEPFAR brought together the range of resources – including USAID, CDC, DoD, and the Peace Corps – to provide the coordinated support required to address local distribution challenges and uncertainty or hesitancy about treatment. Similar assistance now could build on PEPFAR experience and resources.

Factors for consideration in distributing excess vaccines to countries could include: disease burden, capacity of health systems, US ability to leverage existing distribution systems or provide added technical assistance (existing infrastructure, for example through PEPFAR and bilateral immunization programs, could help deliver vaccines and eventually antiviral treatments), and trade and diplomatic considerations (Mexico, Central and South America). The bilateral approach may be particularly important for efforts to distribute mRNA-based vaccines due to the current cold-chain storage and distribution requirements. In taking these steps, the US should encourage similar initiatives by other G7 countries that could be implemented in parallel to multi-lateral efforts, just as the US coupled PEPFAR with support for the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria. Importantly, bilateral and multilateral efforts should be coordinated such that countries receive the same vaccine from different sources, augmenting distribution capabilities without fragmentation of support.

(3) Use of multi-lateral platforms independent of COVAX: This model would build upon recent announcements regarding the Quad platform to provide financing for additional vaccine manufacturing capacity in the Asia/Pacific region in partnership with India, Japan, and Australia. The US could provide donations of vaccines as well as financing and technical assistance through the Quad and other existing multilateral platforms, such as the African Union/Africa CDC joint COVID-19 African Vaccine Acquisition Task Force (AVATT), and the Africa Medical Supplies Platform (AMSP),and regional bodies such Association of Southeast Asian Nations (ASEAN).

With increasing vaccination and better outbreak control in the US and other high-income countries, the approach used here can facilitate timely redirection of manufacturing capacity to other countries, paving the way to faster global control….