Past Program

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Issue 1

Issue 2

• To establish key principles in the design of a new mechanism for global counter-measures, which could be brought forward to international decision takers.
• To provide a narrative record to capture practical insights that informed this design of next-generation multilateral procurement mechanisms for pandemics and outbreaks. This approach allows to achieve their full potential to ensure that vaccines and medical counter measures can reach the people that need them most, in time to do the most good. 

1. What are the lessons which might be learned from the experience of COVAX which could help in preparations for a future, and potentially very different, pandemic?   In particular, what did we learn about the pre-funding of Advance Market Commitments and Advance Procurement Commitments?
2. In designing a new multilateral procurement mechanism, how can the voices and experience of end users – from LMIC governments, health departments, and the front line – best be heard and acted upon?  How should this affect the way the hierarchy of performance objectives is set?
3. What experiences of lead user innovation can be transferred from other contexts into this critical arena where it would be a novel approach?
4. How can in-country tools, incentives and constraints be most clearly identified and monitored?  Specifically, how well does the WHO Technology Product Profile process work in identifying country specific requirements for strain selection - efficacy, dose schedule, production capacity, storage, delivery, and administration requirements? 
5. Preferences and conditions do not remain stable. So how can resilience and adaptability best be incorporated in these mechanisms, preparing for feedback loops and real time information sharing?  Can we create a dynamic architecture of model development responsive to a pandemic?
6. What role going forward might or should there be for Special Purpose Vehicles for the negotiation, procurement, and payment for vaccines?
7. How far can or should contextual social, political, and other challenges be taken into account, such as the prevalence and forms of vaccine hesitancy?
8. What would be the key principles – balancing clarity and flexibility – which should be at the heart of a multilateral pandemic accord?
9. Some countries and/or regions set up their own acquisition vehicles (the African Vaccine Acquisition Trust, for example). Why did they do this and what can we learn from these experiences?  Ultimately, are LMICs better off with a multilateral platform or can LMIC’s be best served with a regional production approach? 

The program was highly participatory, with a strong focus on exchanges, building new insights and aggregating key perspectives and experiences. Working groups prepared recommendations to inform the design of next-generation multilateral procurement mechanisms for pandemics and outbreaks which were presented in key international fora. 

Access to suitable and affordable vaccines needed in Low- and Middle-Income countries (LMICs) critically depends on advanced market and purchase instruments, coupled with procurement mechanisms that bring efficiencies to vaccine purchasing once they have been developed and approved or authorized for emergency use. The Vaccine Alliance, GAVI’s pneumococcal Advanced Market Commitment (AMC) and COVAX have contributed to improving access to lifesaving vaccines by ensuring that such vaccines can be developed and distributed based on need rather than the ability to pay. These tools, while critically important and effective, do not function perfectly when supply capacity is scarce. In the case of COVAX, this mechanism was being constructed while high income countries were already negotiating bilateral advanced purchase agreement with pharmaceutical companies, and it did not have sufficient funding to put purchase contracts in place until much later when companies had already committed their first traches of supply to HIC purchasers. The delay in finalized design and funding meant that these countries tied up limited supply for covid vaccines in the critical early days of the pandemic, thereby constraining supply and delaying distribution to LMICs. The power of Advanced Market Commitments (AMCs) and Advanced Purchase Commitments (APCs) comes from being able to fund vaccine purchasing in advance, sometimes even before the vaccine candidate has been approved or authorized. So, in one respect, developing a means to pre-fund AMCs and APCs would pave the way to a more effective mechanism.  

Advance funding will not solve every difficulty encountered with AMCs. The AMC/APC body must construct a portfolio of vaccine candidates (still under development) which it will contract for purchase. The uncertainty regarding which vaccine candidates will meet the desired characteristics for use in LMICs (efficacy, global production capacity, cold chain requirement and deliverability, etc.), means that the agency which carried out the APCs/AMCs needs to consider multiple in-country health system factors and attributes.  For example, COVAX initially decided that vaccines that require ultra cold chain storage may not be suitable for countries with very limited/nonexistent ultra cold chain capacity. There was also a significant geographical concentration in the contracted manufacturers. Export controls imposed by some countries, manufacturing scale-up challenges and demand-side issues with certain vaccines meant the selected vaccines for which COVAX launched the initial APCs did not materialize into significant available supply till late 2021. As a result, when COVAX vaccine shipments started, they were often too large or too small, mis-timed, and generally uncoordinated with the needs and abilities of the receiving country. Some countries preferred to source their vaccines from multiple procurement mechanisms instead of relying only on COVAX as the ability to obtain any vaccine was more important to them than meeting a pre-determined threshold of efficacy or availability of robust trial data. Some regions e.g., Africa setup their own Special Purpose Vehicles for the negotiation, procurement, and payment for vaccines (AVAT, The African Vaccine Acquisition Trust) 

GAVI, CEPI, the WHO, along with many other partners are in discussions with economists, vaccine market specialists, and mechanism design experts to reconfigure a new multilateral procurement mechanism for the next large-scale outbreak. However, such a design must, critically, incorporate the perspective of the end-user. In other words, it must take into account what the health secretary, minister or vaccine procurement director in a country would prioritize, and what their local choice considerations, and incentives may be. This voice is not adequately captured in the design discussions related to multilateral procurement for future pandemics and disease outbreaks. 

This meeting convened health ministers, heads of procurement, and NITAG members from LMICs along with modelers, funders, and pharmaceutical company executives with the goal of gaining a deep understanding of needs, constraints, and operational realities from those who will be in effect the end users of any designed multilateral procurement/advanced purchase mechanism. Such focused understanding of end-user needs and constraints then informed the efforts to design and builded a new model for multilateral vaccine procurement.  

While this was a two-way conversation, most critically, this conference solicited input directly from the countries that were using multilateral procurement mechanisms to ensure that the tools and incentives being developed are fit for purpose. Soliciting input from the users of any new device (in this case, a model) is an important part of the design process - a concept known as lead-user innovation - but, to our knowledge, it has never been undertaken in this critical arena.  This meeting provided a unique opportunity for users and developers to learn directly from one another. The goal was to provide a narrative record to capture practical insights that informed the design of next-generation multilateral procurement mechanisms for pandemics and outbreaks, allowing them to achieve their full potential to ensure that vaccines and medical counter measures can reach the people that need them most in time, to do the most good.