Coronavirus disease (COVID-19): Vaccine access and allocation
WHO believes that everyone, everywhere who could benefit from safe and effective COVID-19 vaccines should have access as quickly as possible, starting with those at highest risk of serious disease or death.
WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) released two key documents to help guide the allocation and prioritization of populations to receive COVID-19 vaccines:
The Values Framework for the allocation and prioritization of COVID-19 vaccination, which offers high-level guidance globally on the values and ethical considerations regarding allocation of COVID-19 vaccines between countries, and offers guidance nationally on the prioritization of groups for vaccination within countries while supply is limited.
The Roadmap for Prioritizing Population Groups for Vaccines against COVID-19, which recommends public health strategies and target priority groups for different levels of vaccine availability and epidemiologic settings.
The SAGE Roadmap has now been updated and offers recommendations on how vaccines should be prioritized in countries with limited supply for maximum public health impact, taking into account the most recent evidence on COVID-19 vaccines and on the ongoing supply constraint issues faced by the COVAX Facility. This update reflects data that has become available from clinical vaccine studies, as well as lessons learned from the early implementation of programmes.
The recommendations include expanding the groups included in Stage II of the prioritization roadmap to include pregnant women and children with underlying health conditions, and updates regarding clinical trials for lactating women.
In addition, WHO led the development of a Fair Allocation Framework that aims to ensure that successful COVID-19 vaccines and treatments are shared equitably across all countries. This framework is a key part of the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines. The framework advises that as safe and effective COVID-19 vaccines are authorized for use, all countries should receive doses in proportion to their population size to immunize the highest-priority groups. In the second phase, vaccines would continue to be deployed to all countries so that additional populations can be covered according to national priorities.
What is WHO doing to ensure that COVID-19 vaccines will be allocated fairly?
WHO is one of the leaders of a global alliance known as COVAX, the vaccine pillar of the ACT-Accelerator collaboration, which is working to accelerate the development and manufacturing of COVID-19 vaccines and ensure that there is fair and equitable access to these vaccines for all countries.
COVAX has allocated more than 170 million vaccines across 138 countries according to a framework developed by an expert group that includes ethicists, scientists, and other public health specialists and vetted by WHO’s Member States. It continues to work to diversify both its portfolio of vaccines and channels for access to vaccines, Under this framework, COVID-19 vaccines are being rolled out in two phases. In the first phase, they have been allocated proportionally to the population size to all participating countries at the same time, so as to protect those people at greatest risk of infection and of severe disease. In phase II, vaccine will be allocated to target countries with higher threat and vulnerability.
WHO’s Strategic Advisory Group of Experts (SAGE) has provided recommendations about which populations should be prioritized first. These include frontline health and care workers at high risk of infection, older adults, and those people at high risk of death because of underlying conditions like heart disease and diabetes. In the second phase of the roll-out, as more doses are produced, vaccines can go to groups less at risk of being infected or of suffering badly.
COVAX aims to provide at least 2 billion vaccine doses by the end of 2021 and 1.8 billion doses to 92 lower income economies by early 2022.
The Facility has the possibility to increase those doses by another 1 billion as right of first refusal for several candidates in clinical trials supported by CEPI. Although these doses are not enough for everyone in all countries, it may be enough to end the acute stage of the crisis and put the world on the road to ending the pandemic.
The number of countries willing to donate vaccine has been increasing. It is important that they do so using the COVAX mechanism so the vaccine are allocated to countries that need them most. At least one billion doses could be donated by high income countries in 2021.
COVAX’s need for doses is greatest right now. Countries with higher coverage rates, which are due to receive doses soon should swap their places in supply queues with COVAX so that doses can be equitably distributed as quickly as possible. COVAX continues to be in close dialogue with countries who have expressed interest in sharing doses with the Facility and expects further announcements on this to take place over the coming weeks and months.
How is WHO helping countries prepare for COVID-19 vaccines rollouts?
Along with accelerating COVID-19 vaccine research and helping scale up manufacturing capacity, WHO is working in close partnership with countries, regional colleagues, and other partners to develop needed policies, strengthen regulatory capacity, training courses, and guide countries in all the needed preparations for a programme to deliver COVID-19 vaccines. WHO, UNICEF, and partners are supporting countries in preparing for COVID-19 vaccine introduction. The Country Readiness and Delivery workstream – which is part of the ACT Accelerator – has developed a toolbox with guidance, tools, and trainings.
WHO’s Strategic Advisory Group of Experts (SAGE) has issued interim policy recommendations for the rollout of all of the COVID-19 vaccines approved for emergency use. These recommendations can guide and support country decision-making bodies, such as the National Immunization Technical Advisory Groups, on the optimal use of existing COVID-19 vaccines.
WHO has also developed detailed technical guidance and adaptable planning tools and templates to help countries plan for COVID-19 vaccines considering the many aspects of readiness that need to be put in place. These areas include planning and implementation, data and monitoring, supply and logistics, and acceptance and demand. To support initial preparations, a vaccine introduction readiness assessment tool (VIRAT) has been developed and disseminated. It provides countries with an integrated roadmap of milestones and a framework for self-monitoring progress in preparing for vaccine introduction. This will help ensure that COVID-19 vaccines reach those in need as soon as they are available.
WHO advises every country to develop a National Deployment and Vaccination Plan (NDVP) for COVID-19 vaccines. Having one plan in each country, that comprehensively describes all elements of the country’s approach to COVID-19 vaccine rollout will be crucial for a coordinated effort. Guidance on developing that plan is available from WHO, including all elements that a country needs to consider.
