Preparing for the Next Pandemic: Exploring the Design of a New Pandemic Vaccine Facility (“PANVAX”) Through a Qualitative Study

Abstract

The global distribution of COVID-19 vaccines has been inequitable: around 8 in 10 people in high-income countries have had at least one dose, compared with just 1 in 10 in low-income countries. Similar global vaccine inequity was seen in past pandemics, such as the 2009 H1N1 pandemic. The COVID-19 Vaccine Global Access Facility (COVAX), launched by the Coalition for Epidemic Preparedness (CEPI), Gavi, the Vaccine Alliance (Gavi), and the World Health Organization (WHO), aimed to equitably distribute vaccines worldwide. COVAX was an unprecedented mechanism—the first attempt to create a pandemic vaccine buyers’ club for all nations of all income levels. COVAX can serve as a case study: by determining what challenges and successes it has had during COVID-19, we can determine what elements a future pandemic vaccine facility (which we can call “PANVAX”) may need to ensure equity in the next pandemic. In this qualitative study, 14 in-depth interviews were conducted across 4 different stakeholder groups to elicit expert opinions on COVAX and on the design of a future PANVAX. These four stakeholder groups were pharmaceutical company representatives, COVAX administrators, academics, and national governments. Key informants argued that the concept of COVAX was strong and COVAX succeeded in securing participation from pharmaceutical companies, but it suffered from many challenges, including vaccine supply shortages and delays, challenges in negotiating with vaccine companies, internal governance challenges, and a lack of participation by high-income countries in the buyers’ club. They also suggested that in a future pandemic vaccine facility, there needs to be upfront funding, investment into the entire vaccine development process, regional vaccine capacity building, and a ‘day-job’ for the facility when there is no pandemic to keep the facility running. Overall, this study found that COVAX was faced by challenges that were both of its own making and outside of its control. For future pandemics, there is a clear need for a facility that has sufficient upfront funding for purchasing and investing into all aspects of the vaccine process, and that has responsibilities outside of pandemic or emergency response. By focusing on regional vaccine self-sufficiency, several issues can be addressed both for pandemic response and public health benefits.