Access and allocation: how will there be fair and equitable allocation of limited supplies?

This article is part of a series of explainers on vaccine development and distribution. Learn more about vaccines – from how they work and how they’re made to ensuring safety and equitable access – in WHO’s Vaccines Explained series.

As the world continues to fight COVID-19, both alongside each other and in collaboration, many questions are being asked about the allocation of and access to vaccines as they become available.

WHO started work on COVID-19 vaccine research and development in February 2020, after consultations with multiple international scientists and public health experts.

The COVID-19 Vaccines Global Access (COVAX) Facility

The COVID-19 Vaccines Global Access (COVAX) Facility was established by WHO in collaboration with the ACT-Accelerator vaccine partners the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance. COVAX is bringing nations together, regardless of their income level, to ensure the procurement and equitable distribution of COVID-19 vaccines. 

Effective vaccines can take years to develop – and even longer to ensure that they reach all who need them. Work being carried out on potential COVID-19 vaccines follows the same processes as with other vaccines, but given the urgent need to stop the pandemic, some of the steps are being carried out in parallel to accelerate the process. The COVAX Facility will accelerate this timeline by enabling early investments in the development of a variety of vaccine candidates; expanding manufacturing capacity; and accelerating vaccine production ahead of the licencing process so that vaccines can be deployed without delay once they are proven to be safe and effective. 

Core goals

WHO, as the COVAX lead for allocation, proposes that protecting individuals and health systems and minimizing the impact on economies should be the driving force behind the allocation of COVID-19 health products across different countries.

The ACT-Accelerator was set up to contain the COVID-19 pandemic faster and more efficiently by ensuring that successful diagnostics, vaccines and treatments are shared equitably across all countries.

Key to achieving that goal is the design and implementation of a Fair Allocation Framework.

Equitable distribution is particularly important in the area of vaccines, which, if used correctly and equitably, could help to stop the acute phase of the pandemic and allow the rebuilding of our societies and economies.

The Values Framework for the allocation and prioritization of COVID-19 vaccination offers high-level guidance globally on the values and ethical considerations regarding the allocation of COVID-19 vaccines between countries and offers guidance nationally on the prioritization of groups for vaccination within countries while supply is limited.   

Prioritized groups

While resources remain scarce, immunization programmes will have to prioritize certain groups over others before progressively expanding distribution to all population groups. When a COVID-19 vaccine becomes available, to reduce severe disease, deaths and protect health systems, it’s important that priority groups receive the vaccine first.

The definition of priority groups should be based on the most thorough analysis of evidence, including differences across diverse geographical and social settings.

These priority groups, at present, as determined by WHO’s Strategic Advisory Group of Experts on Immunization are:

• Frontline workers in health and social care settings
• People over the age of 65
• People under the age of 65 who have underlying health conditions that put them at a higher risk of death

Phase one

Countries that are members of the COVAX Facility will have access to enough vaccines to immunize their population’s priority groups. In the first phase of allocation, doses will be made available to participating countries simultaneously until they can cover approximately 20% of the population of every country. The first group prioritized would be frontline workers in health and social care settings in most countries.

By choosing to set an initial prioritization for health workers (in most countries this is 3% of less of the population), WHO wants to ensure that volumes meet the needs of well-resourced health systems while not penalizing countries with a lower proportion of health and social care workers. Additional portions will follow gradually as more supply becomes available until 20% of the national population is covered in all participating countries. For 92 low and middle-income economies, reaching 20% is contingent upon raising funds for the COVAX AMC, the financing mechanism which will support their participation in the COVAX Facility.

Phase two

Once countries have been allocated enough doses for 20% of the population, additional doses will be made available depending on funding. In this second phase, the pace at which countries would receive additional doses of vaccine would be determined by an assessment of their risk at any given time, if there remains substantial supply limitations. Consideration will be based on an evaluation of threat (the potential impact of COVID-19 on a country, assessed using epidemiological data) and vulnerability (the vulnerability of a country, based on health systems and population factors).

Using these criteria, the analysis will identify countries with the highest risk, which will receive vaccines at a faster pace than those considered at lower risk. Special consideration will be given to countries that may suddenly face major outbreaks or national disasters throughout the allocation process.

Humanitarian buffer

In addition to the vaccine allocations in phases one and two, some doses of vaccine are proposed to be reserved as part of a “humanitarian buffer”. A small buffer of up to 5% of the total number of available doses will be set aside as a backstop mechanism to serve as a provider of last resort for if/when national, government-led processes fail to reach certain populations.  For example populations living outside government-controlled areas and those who work within these settings could be served through the Humanitarian buffer if necessary.

Governments and states are encouraged to include all high-risk individuals and populations, according to the WHO SAGE recommendations, independent of their residency and legal status, including internally displaced populations, refugees, migrants and detainees.

Transparent allocation and use

The WHO Secretariat recognizes the right of each country to decide how the vaccine will be used within their territory, but it encourages countries to consider the recommendations regarding target groups issued by WHO’s SAGE committee, and to be transparent about their decision-making processes and ultimate use of the vaccine. 

SAGE

The Strategic Advisory Group of Experts (SAGE) is the principal advisory group to WHO for vaccines and immunization. Throughout the development, production and distribution of vaccine candidates for COVID-19, SAGE is providing independent expert advice and recommendations on how best to safely and equitably distribute an approved vaccine.

The world has united in the fight against COVID-19. We must continue to work together until everyone is protected and safe.

Read the next "Vaccines Explained" topic: Country readiness for COVID-19 vaccines