COVID-19 Vaccine Delivery Partnership

The COVID-19 Vaccine Delivery Partnership (CoVDP) was launched in January 2022 by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and Gavi, the Vaccine Alliance, and is supported by a broad network of partners including the Africa Centres for Disease Control and Prevention  (CDC), World Bank, International Monetary Fund, United Nations organisations, the European Union, the G20 and many others. CoVDP is an inter-agency partnership that works to accelerate vaccination coverage in the 92 “advanced market commitment” countries with a particular focus on the 34 countries that were at or below 10% coverage in January 2022.

CoVDP’s goal is to accelerate COVID-19 vaccination rates in countries with the lowest vaccination rates and support them in reaching their national targets on their way to global vaccination targets, thereby closing the vaccine equity gap that exists between high- and low-income countries. Closing the vaccine gap is essential as a highly vaccinated population diminishes the risk of transmission, lowers the risk of severe illness and hospitalization, and reduces the chances of new variants emerging globally. The CoVDP focuses first and foremost on the vaccination of high-priority groups such as the elderly, the immuno-compromised, pregnant women and health care workers.

During 2021, COVID-19 vaccine supply constraints were the main bottleneck to increasing global vaccination coverage. In recent months, with significant efforts from partners through initiatives such as COVAX and AVATT, the global supply and availability of vaccines has substantially increased. The focus has now shifted to addressing the significant inequities in vaccine access that continue to exist as 61% of the global population is fully vaccinated against only 13% in low-income countries.

Addressing low vaccination rates requires sustained, concerted and country-by-country efforts to identify and overcome the political, financial and operational obstacles that are the primary causes of low vaccination rates in these countries.

The largest vaccine operation in history requires large scale coordination and cooperation, particularly in remote areas and countries dealing with humanitarian emergencies and fragile health systems. For this reason, the Access to COVID-19 Tools (ACT) Accelerator was launched in April 2020 as a global collaboration platform to accelerate development, production and equitable access to COVID-19 tests, treatments and vaccines. 

The COVAX facility is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator whose aim is to accelerate the development and manufacturing of COVID-19 vaccines and to guarantee fair and equitable access for every country in the world. Across its partner agencies – CEPI, Gavi, UNICEF and WHO – COVAX supports the entire value chain of vaccinations from R&D to manufacturing, procurement and delivery.

The CoVDP is primarily focused on supporting the final piece of the vaccine value chain, namely the delivery of vaccines in-country, focusing in particular on country engagement, demand planning, delivery funding, delivery coordination and monitoring. CoVDP works closely with all COVAX partners but focuses on the delivery of all vaccines, regardless of whether vaccines have been procured via COVAX, AVATT, through other partners or bilaterally.

Please see the COVID-19 Vaccine Delivery Situation Reports for information and data on recent progress.

There are multiple causes for low demand and low absorption capacity, and they vary between countries, but they can be grouped broadly into 3 main categories:

• Political bottlenecks: These include a lack of coordinated political leadership at various levels, where COVID-19 is not considered a major priority or where there are competing priorities. Efficient planning and roll-out is not possible without political engagement. This is especially true in countries that experience humanitarian emergencies, conflict and other fragile contexts.
• Funding challenges: These are mainly related to the coverage of operational costs for vaccine delivery, including payments and incentives for health workers, vaccinators and community mobilizers, training costs, transport and logistics. Even where operational funding is available, it is sometimes insufficient or structures in an inflexible way.
• Operational challenges: These are common across most countries and include inadequate cold chain, logistics and transport equipment; insufficient availability of trained health workers, vaccinators and community mobilizers; the complexity of managing multiple vaccines; and demand-side factors such as vaccine hesitancy, misinformation and a lack of information about COVID-19 and vaccines.

There are several ingredients for success to increase demand and absorption capacity:

• Predictable supply: It is important that vaccine manufacturers continue to provide realistic and accurate supply-side data with a 6-month horizon at a minimum.
• Quality dose donations: Vaccines with ample remaining shelf-life are needed to reduce the risk of wastage. A minimum of 4 months of shelf-life is needed but longer shelf-lives are preferred as many countries need more time to plan and deploy vaccines, especially fragile and conflict-affected states.
• Funding: Dedicated, predictable and quickly disbursable financial resources are essential. Funding is needed for a range of operational and support activities around vaccine delivery. Flexibility, such as the ability to use funding meant for vaccine purchases for operational support when the situation requires it, is key to successful vaccine roll out.
• Strong leadership at all levels: The engagement of high-level government officials at the national and regional levels, as well as the involvement of traditional and community leaders are key ingredients in building trust in vaccines.
• Efficient planning: An efficient country coordination mechanism is key for planning and oversight of the COVID-19 vaccine delivery. Detailed microplanning at subnational level is key to optimize delivery strategies. 

At the country level, the CoVDP engages primarily through the One Country Team, a government-led team at the centre of all planning and support activities. The One Country Team represents existing coordination structures put in place at the start of the pandemic.

The exact composition of the One Country Team varies from country to country but generally involves the highest-level government entity in charge of COVID-19 vaccinations (e.g., Office of the Prime Minister, Presidential Task Force, Ministry of Health), the Ministry of Finance, the Expanded Programme on Immunization (EPI) and focal points from partners. 

The COVID-19 pandemic is not over; it continues to affect impact families, communities and countries. COVID-19 vaccinations protect the most vulnerable members of society, healthcare workers and frontline workers as well as the general population against severe disease and death that could overburden countries’ healthcare systems, many of which were already fragile prior to the pandemic.

In addition, the systems required for the COVID-19 vaccine rollout strengthen countries’ existing health systems including cold storage, logistics, health ICT (Information and Communication Technologies) systems and the training of healthcare workers. 

All partners are all working to increase vaccine uptake and minimize wastage wherever possible. Vaccine wastage is not a new phenomenon; it happens in all immunization programmes, including in high income countries, and is to be expected with the rollout of COVID vaccines. While the data is incomplete, low-income countries have achieved relatively low levels of wastage, despite the swift pace of their scaled-up vaccination programmes. 

As countries move from managing COVID-19 as an acute emergency to integration into longer-term disease control programmes, the ACT-Accelerator partnership (including COVAX) is adjusting its ways of working. 

In this context, and given that the last Strategic Plan ran until the end of September 2022, the partnership launched a transition plan running from 1 October 2022 to 31 March 2022. 

The plan outlines changes to ACT-A’s set-up and ways of working, to ensure countries continue to have access to COVID-19 tools in the longer term while maintaining the coalition’s readiness to help address future disease surges. 

ACT-A through COVAX will continue to focus its delivery support, helping the countries identified for concerted support to reach optimal protection, particularly among high-risk groups.

A period of acceleration will continue until April 2023 as countries plan additional campaigns. CoVDP and partners across global, regional, and country levels will continue to support the AMC92 countries with concerted efforts focused on a subset of countries with low coverage rates, particularly amongst high-priority populations. The goals for the coming months are to protect the high-risk groups across the AMCs and to increase booster uptake and monitoring. 

CoVDP and partners will continue to support delivery and transition efforts while also ensuring that the objectives, frequency, and coordination support available to partners are appropriately sized to meet demand.

Specifically, CoVDP will:

• continue to support the acceleration in 3-4 countries where coverage has flatlined through April, with a focus on high-priority groups and boosters;
• undertake high-level political engagement in a set of countries and technical follow-up missions;
• provide quick impact funding and specialized technical assistance to maintain acceleration momentum in countries; and
• in selected humanitarian settings, identify partners to offer a package of health and humanitarian activities, including COVID-19 vaccination. 

CoVDP is consulting with countries and partners on its legacy and operational model to best inform future pandemic planning. These consultations are taking place in parallel with several events to guide the next phase of this pandemic and prepare for future responses.

• Joint Convening on COVID-19 Vaccinations in Humanitarian settings and contribution to broader pandemic preparedness,  to critically review the current global situation of COVID-19 vaccine delivery in humanitarian settings, identify lessons learned, share good practices and develop actionable solutions for immediate implementation as well as to inform future pandemic planning and response. Nairobi, 14–15 Feb, 2023.
  
• A Global Convening on COVID-19 Vaccination Monitoring and Related System Strengthening, to prepare the ground for transition and align data needs and systems for COVID-19 and essential immunization in the future. Geneva, 13–15 March 2023.
  
• Global Stocktake of COVID-19 Vaccine Delivery to reflect on achievements of COVID-19 delivery in concerted support countries, identify lessons learned and good practices, develop critical actionable recommendations for integration into primary health care and where possible support recovery of essential immunization. Addis Ababa, 2–3 May 2023.
  

Finally, CoVDP will continue to engage in strengthening community health systems through a dual track of political engagement and high-level events at the global level, and national consultations to regularize the position of community health workers.

It is too early to know what a future COVID-19 vaccination schedule would look like. The aim is to support integration of COVID-19 vaccination into national immunization services, primary healthcare and other relevant health services, including links to noncommunicable disease programmes or specialized services for the elderly and people with comorbidities. The goal is to reach high-risk groups with primary vaccination and boosters.

AMC-92 countries have access to CDS3 funding to support their vaccination acceleration and integration efforts. 

Successful aspects of the emergency response will guide the design of a future state of coordination on COVID-19 vaccine delivery while strengthening the links between immunization, primary health care and humanitarian infrastructure. The political will demonstrated during the pandemic should be used to help countries recover lost ground in essential immunization and integrate C-19 vaccination into their health systems.  

As a vertical approach to COVID-19 vaccination has diminishing returns, countries are starting to integrate it into primary healthcare services. It is due to this shift that CoVDP is transitioning out of its temporary construct back into the partner agencies. In alignment with ACT-A and its vaccines pillar, CoVDP plans against the WHO base case disease scenario, (with worst-case scenario planning in place) which recognizes the shifts in the external environment.

• Demand: shipments to AMC countries are declining from their peak as priorities shift and primary series coverage increases.
• Supply: shifts in the landscape, with mRNA manufacturers moving their production to variant-containing vaccines. There is sufficient supply for the projected base and worst-case demand over the next 6 months, and equitable access to variant-containing vaccines is being secured.

Recognizing that the pandemic trajectory could change, partners in CoVDP remain nimble and responsive to those shifts and are working on detailed worst-case scenario plans.