Why we must remember the roll-out of the Covid-19 vaccine

Today’s anniversary of the first COVID-19 vaccine is a global health landmark with a legacy still to be determined. With serious disease epidemics on the rise, Emily Wegener describes why contract and pricing transparency must be written into international preparations for any future pandemics.

On December 8th 2020, Margaret Keenan became the first recipient of a clinically approved COVID-19 vaccine, which was administered in the UK.

The occasion represented a profound moment in the global fight against the pandemic. With 68.5 per cent of the world population now having received at least one shot of a COVID-19 vaccine, public attention around this pandemic is waning. But researchers estimate that we currently face a two percent chance of a COVID-19-like pandemic in any given year, with climate change and increased human-animal contact among the factors increasing this risk. It’s imperative that health leaders around the world make sure that money spent on pandemic prevention, preparedness and response is not lost to corruption. A prevailing lack of transparency needs to remain a political priority within the global health community.

In particular, it is worth looking at the lessons learnt from the procurement process for COVID-19 vaccines. A concerning lack of  transparency in clinical trials and contracts has already been highlighted by Transparency International Global Health in ‘For Whose Benefit’.

Clinical trials are currently underway for vaccines and therapeutics against the strain of Ebola that has recently broken out in Uganda. If policymakers do not want to repeat the inequitable distribution of medical interventions observed in the COVID-pandemic, and the significant and costly delays in fighting the virus that followed, they need to look at what went wrong and what can be improved.

In partnership with Transparencia Mexicana, Transparency International Global Health is today publishing policy recommendations on how vaccine procurement can be improved in future health emergencies. Its main message: During a pandemic response, urgently needed public goods need to be available for all. This will only happen if procurement processes and negotiations are transparent.

How a lack of procurement transparency undermined the fight against the virus

Much media attention and research has focused on the heavily delayed access to vaccines of countries in the Global South and its effects on the global pandemic response. However, few reports have drawn the connection between this and the lack of transparency observed during the vaccine procurement processes and negotiations. In 2021, Transparencia Mexicana analysed 39 contracts concluded between 15 national governments, the European Union (EU), and different pharmaceutical companies. The results revealed that more than half (59 per cent) failed to contain even the most basic information on the value or the unitary price paid for the vaccine. Almost three quarters (74 per cent) gave no information on delivery schedules

Many contracts were not publicly released. This includes contracts signed by pooled procurement mechanisms such as the COVAX Facility, and contracts of the governments and multilateral bodies that invested heavily in the research and development of the vaccines. Of those that were, Transparencia Mexicana’s report shows that many were heavily redacted, excluding even basic procurement data. Freedom of information requests (FOIRs) did also not get much further in attaining transparency: Of the 21 FOIRs submitted by Transparency International chapters around the world on vaccine contracts, more than half (12) were denied on grounds of classified information. Some might ask: How does this relate to vaccine inequity? The availability of basic procurement data such as unitary price paid and total contract value in an open data format, i.e., on a publicly accessible platform, is essential to avoid market distortions in medicines pricing.  For instance, the recent release  of all previously redacted pricing data from published contracts in Colombia, following the ruling of a local administrative court, reveals that the price paid by Colombia for the Moderna vaccine (US$22) is higher than that paid by the United States (US$15). This is according to UNICEF’s COVID-19 Vaccine Dashboard, reinforcing concerns about  pricing inequity and general overpricing.

Contract transparency enables the public to scrutinise contractual terms and conditions. The few contracts that are publicly available in an unredacted form, generally through leaks, rather than by design, have led to concerns about the indemnification and liability clauses in the agreements. This information needs to be publicly available. Citizens must be able to spot potential mismanagement of public money, particularly as the research and development of the COVID-19 vaccine has relied so heavily on public funding.

Many believe such transparency might have increased trust and mitigated vaccine hesitancy. Inevitably procurement processes are affected by health emergencies. But a state of emergency should not be used as an excuse to permanently keep basic procurement data secret, especially when it comes to vaccines and other medical interventions. Pricing data needs to be available for governments to make evidence-based decisions and for low- and middle-income countries to enter negotiations with pharmaceutical companies on a level-playing field. Weakening their bargaining power only delays an efficient public health response.

Producing a level playing field

The Global Accord on Pandemic Prevention, Preparedness and Response does give cause for hope. This new global agreement currently being drafted by World Health Organisation Member States has the potential to level the playing field for poorer nations if strong safeguards for procurement transparency are included. These include:

• The mandatory publication of medical interventions within 90 days following conclusion of the contract in full, or at a minimum with key contractual terms and conditions, including the price per unit or dose of the product, procured quantity and delivery agreements unredacted.
• The World Health Organisation should provide guidance on the drafting of contracts for medical interventions in health emergencies.
• Push funding and advanced purchase agreements for the development of medical technologies in emergencies must be disclosed upon agreement.

This will pave the way for stronger and safer health systems, leading to more rapid, efficient and sustainable future pandemic responses. Transparency International Global Health has lobbied for transparency measures to feature in the early iterations of the Accord. We are yet to see if such measures will feature in the first draft which is to be discussed later this month. Sustained advocacy will be needed over the next two years to ensure that strong transparency and open procurement policies are included in the final version expected to be ratified in 2024.

In an era when United Nations members states are committed to realising Universal Health Coverage by 2030, our recommendations on vaccine procurement provide a pathway towards equitable access to medical interventions in future health emergencies. Read them in full here.

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Emily Wegener is Research and Reporting Officer at Transparency International Global Health.