Evaluating the effectiveness of Covid-19 vaccine delivery by the COVAX initiative

The COVAX initiative was positioned as the global solution to ensure fair access to vaccines for all countries, regardless of national income level.

At its inception, COVAX aimed to deliver 2 billion doses of Covid-19 vaccines by the end of 2021. However, against a rapidly-changing backdrop of complex and evolving challenges in vaccine supply, delivery and uptake, the initiative has had to evolve to meet various challenges, which have affected its ability to meet such ambitious targets.

Our evaluation provides independent and evidence-based learnings and recommendations for Gavi, one of the organisations coordinating COVAX and the legal administrator of the COVAX Facility.

About COVAX

COVAX is coordinated and implemented by Gavi, the global vaccine alliance, working alongside pillar co-leads UNICEF, the World Health Organisation and the Coalition for Epidemic Preparedness Innovations (CEPI) to ensure the smooth procurement, allocation and delivery of Covid-19 vaccines.

To date, COVAX has distributed over a billion Covid-19 vaccines to 144 countries, working in two ways:

1. The COVAX Facility encouraged countries able to self-finance their purchase of vaccines to commit funds to cover up to 50% of their populations upfront, enabling manufacturers to start producing vaccine doses as soon as candidates were approved.By pooling finances and resources, the Facility supported better management of vaccine supply and demand at national and global levels.

2. The Advance Market Commitment (AMC) used fundraising efforts to allow low-and middle-income countries to produce vaccines at the same time as higher-income countries through Official Development Assistance (ODA), private sector financing and philanthropy.

However, as vaccines began to be produced and distributed in early 2021, the shifting context of the Covid-19 pandemic created a number of strategic and operational challenges for the COVAX Facility and AMC.

Insights from our evaluation aim to inform Gavi’s ongoing work on Covid-19 vaccination. They are also an important contribution to the wider global conversation on pandemic readiness and the coordination of future global pandemic responses.

Our role

We were commissioned by Gavi to independently evaluate and document the successes, challenges and lessons from the COVAX Facility and AMC.

Focusing on the COVAX Facility and AMC’s design, how it was implemented and an analysis of initial emerging results, our evaluation (a formative review and baseline study) highlights what COVAX has achieved to date, and what has worked well – and less well – in its efforts to achieve change.

By surfacing these insights, our evaluation provides Gavi with learnings for course correction as its response to Covid-19 vaccine provision evolves, as well as supporting accountability.

Methods and approaches

Our evaluation takes into account the complex and shifting context in which the COVAX Facility and AMC has been operating, and the factors within and outside of Gavi’s direct control.

Our ‘complexity-aware’ approach involves in-depth data collection across the scope of the COVAX Facility and AMC’s operations: from stakeholders involved in its design and implementation, to AMC countries and the wider global health, civil society and vaccine industry actors who have interacted with the mechanism.

Given the importance of learning from the COVAX experience and broader Covid-19 pandemic and the high level of stakeholder interest in this evaluation we regularly engaged different groups as it progressed. For example, a series of sense-making workshops were held in late 2022 to seek stakeholders’ feedback on emerging learnings and to sharpen and nuance the learnings in line with our utility focus.

Impact and outcomes

Our evaluation provides clear, utility-focused learnings and recommendations for the purposes of course correction on the ongoing implementation of the COVAX Facility and AMC. It also shares critical insights and evidence to inform Gavi’s current (5.0) strategy and decisions on the future of the COVAX Facility and AMC.

Furthermore, the evaluation provides a key data point for global health actors, including Gavi, to consider global readiness for the next pandemic, and how coordination and equitable access to life-saving health products can be realised in future disease outbreaks.