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A scientist’s opinion: Interview with Aurélia Nguyen about the Global Alliance for Vaccines and Immunisation (Gavi)

Aurélia Nguyen, Covax vaccine against COVID-19. Glass medical vials with liquid on the background Covax company logo. Ampoules with coronavirus vaccine on a medical glass table

We spoke to Aurélia Nguyen, Managing Director of the COVAX Facility at Gavi.
Gavi was founded in response to a market failure: by the late 90s, many powerful vaccines were becoming available, but they were too expensive for low-income countries, and millions of children were unable to benefit from them.
In 1997, the Bill and Melinda Gates Foundation and partner organisations set up a mechanism through which vaccine manufacturers would lower their prices in return for a promise of predictable long-term, high-volume demand.
This original idea led to the formal creation of the ‘Global Alliance for Vaccines and Immunisation’ in 2000; it is now called Gavi, the Vaccine Alliance.

What experience has Gavi brought to the COVAX programme from its previous missions to vaccinate children around the world? Is COVAX comparable to anything that you’ve done before?

Aurélia Nguyen: Vaccines have been one of the greatest public health success stories over the last century. They are the frontline weapon in fighting global pandemics and thanks to them some global killers, like smallpox and polio, have been totally or nearly eradicated. And since 2000, Gavi has helped vaccinate more than 822 million children in 77 countries, preventing more than 14 million future deaths.

Rolling out vaccines to many countries simultaneously is a massive challenge, but it’s one we know we can handle with the right support from all our partners and supporters. COVAX is undertaking quite possibly the largest and most complex global vaccine rollout in history. Through it, we are attempting to do what has never been done before: ensure no country misses out on vaccines in the midst of a pandemic.

What are the unique challenges of the COVAX programme?

Aurélia Nguyen: One current challenge is that everyone is facing unforeseen delays to the supply timelines that were originally agreed with vaccine manufacturers, due to a host of issues such as reduced yields, time needed for regulatory approvals and the complexity of vaccine distribution and logistics.

COVAX is unfortunately not immune to this and we cannot operate with the level of accuracy and predictability that routine immunisation programmes normally see. However, we are actively monitoring developments and using all possible levers to ensure that vaccine supply can flow to participants as quickly as possible.

COVAX is in the process of fulfilling its first round of allocations to 142 participating economies, having delivered to over 100 economies in its first six weeks. But there is much left to do as we seek to deliver two billion doses this year, including 1.8 billion for 92 lower-income economies funded by the Gavi COVAX Advance Market Commitment (COVAX AMC).

Are there country- and region-specific barriers and challenges?

Aurélia Nguyen: Several critical pieces must be in place before COVAX can deliver vaccine doses. These include national vaccination plans for lower income countries that receive vaccine through the COVAX AMC as well as other logistical factors such as export and import licenses. Gavi and its COVAX partners have been supporting governments and partners to get ready to receive vaccines by developing these plans with guidance from WHO, and partners also provide technical support.

Have lessons been learned from the roll-out since it began in Ghana on 24 February 2021?

Aurélia Nguyen: COVAX has built a diverse portfolio of vaccines suitable for a range of settings and populations. We have established a method to support the allocation of vaccines secured through the COVAX facility. This involves consolidating supply information to create a forecast for allocation and then determining which participants can receive which products.

In order to start receiving vaccines, each country will have been allocated the vaccines by the Joint Allocation Taskforce/Independent Allocation of Vaccines Group; signed an indemnification and liability agreement; and issued a regulatory approval and import licence.

One key lesson that we’ve learned from this pandemic is that nobody is safe until everyone is safe because infectious diseases do not respect borders. Therefore, global equitable access to vaccines, particularly to protect health care workers and those most at risk – wherever they are, and whatever their income level – is the only way to lessen the public health and economic impact of the pandemic on individuals, communities, and nations.

This is why the COVAX facility was set up in the first place. This unprecedented international collaboration in technological innovation, funding for vaccines and new models of public-private cooperation to enable rapid roll-out is going to be a valuable learning experience for future pandemics.

Who decides which groups and individuals are first in line for a vaccine? Again, does this differ by country?

Aurélia Nguyen: We believe it is absolutely critical that when doses first become available, they go where the impact will be the greatest. This initially means ensuring that the needs of high risk and priority groups are met in all participating countries, according to WHO’s Strategic Advisory Group of Experts (SAGE) framework for COVID-19. We are working with authorities everywhere to help ensure doses go to people who need them most.

Recently, we have heard of a shortfall in vaccine doses available through COVAX due to export restrictions from India, hoarding and supply shortages. How is COVAX responding to that?

Aurélia Nguyen: COVAX deliveries continue to take place, with the roll-out of the AstraZeneca and Pfizer/BioNTech vaccines continuing at a steady pace. As India opens up vaccinations to all its adult population in response to its catastrophic COVID surge, it is using more of the vaccines produced by its Serum Institute (SII). This is one of the most important sources of COVAX vaccines, but we remain in close contact with the Indian government about restarting deliveries from SII to countries in the COVAX AMC as soon as possible.

However, COVAX anticipated these types of barriers and therefore sought to diversify its portfolio from the beginning. As a result, we are talking to other vaccine manufacturers about supply schedules, and we will announce further rounds of allocation in due course. We also anticipate announcing new deals for vaccines and vaccine candidates, and CEPI (the Coalition for Epidemic Preparedness Innovations) is already expanding its R&D portfolio further to account for the emergence of new virus variants. We also expect higher-income countries to donate their excess vaccine supply, or transfer their allocated doses, to lower-income countries through COVAX.

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