Allocation Mechanism for COVAX Facility

Vaccines
Explainer for countries based on commonly asked questions

November 2020

Purpose of this document

This document aims to explain how COVAX vaccines will be allocated amongst participants.

It is:

• A simple explanation of the guiding principles underpinning the allocation of COVAX vaccines.
• A view on a process which is under development and subject to change as more information
becomes available.
• A focused view on the allocation of vaccines.

It is not:

• An exhaustive description of how the allocation of vaccines will be carried out.

• A static view of exactly how the allocation mechanism will operate.
• A full explainer covering all aspects of COVAX (e.g., procurement, country delivery etc.).
Table of Contents
Allocation Phase 1..............................................................................................................................3
1) What is the difference between Allocation Phase 1 and Phase 2? ....................................................... 3
2) During phase 1, the so-called proportional allocation phase, how will the vaccine doses be
allocated? How many vaccines will each participating country get? ........................................................ 4
Allocation Phase 2..............................................................................................................................5
3) During phase 2, the so-called weighted allocation phase, how will the vaccine doses be allocated?
How many vaccines will each participating country get? ......................................................................... 5
4) How will vulnerability and threat be assessed in practice? .................................................................. 6
5) If a country scores low in vulnerability and threat during phase 2, does this mean that the country
would get no vaccine? ............................................................................................................................... 7
6) How can countries predict and prepare for the doses that they will get on phase 2 if the proposal is
that the allocation may vary based on threat and vulnerability? ............................................................. 7
Allocation of Multiple Products ..........................................................................................................9
7) What will happen if there is more than one vaccine to allocate? ........................................................ 9
8) How will country preferences be accounted for? ................................................................................. 9
Governance ..................................................................................................................................... 10
9) How will the Allocation Mechanism for vaccines be governed? ........................................................10
Prioritisation.................................................................................................................................... 11
10) What is the relationship between the Allocation Mechanism and SAGE recommendations on
immunization? .........................................................................................................................................11
Humanitarian Buffer ........................................................................................................................ 11
11) What is the objective of the humanitarian buffer?...........................................................................11
 Questions and Answers
How will the Vaccine Allocation work in practice?

Allocation Phase 1

1) What is the difference between Allocation Phase 1 and Phase 2?

Phase 1: Proportional allocation up to 20% of total population

Countries receive doses proportionally to their total population given the ubiquity of the threat:

Countries progressively receive doses until all countries reach 20% of their total population (or less if
they so requested).

The rate at which countries receive vaccines depends on country readiness and the availability of doses
(not on threat and vulnerability).

The allocation moves on to phase 2 once all countries have reached 20% coverage (or less if they so
requested).

Phase 2 may start ahead of this if available doses are unable to be allocated to some participants due to
lack of readiness, funding or territory issues. However, these participants would be prioritised to get to
their requested coverage as soon as possible.

Phase 2: Weighted allocation beyond 20% (if supply severely constrained1)

Countries receive doses at variable rates, based on consideration of vulnerability and COVID-19 threat:

In the case of a severely constrained supply, the timing of country shipments would be based on a risk
assessment based on Threat and Vulnerability.

Countries with a higher risk would receive the doses they need faster than others, although all countries
will receive some doses in each allocation round2.

Threats and Vulnerabilities will be based on metrics defined closer to the end of phase 1, potentially
related to the country's vulnerability to severe disease and its healthcare system.

All countries will receive the total doses they have requested as rapidly as possible in phase 2.

1The criteria to establish whether supply is severely constrained will be communicated at a later date.
2An allocation round is when new volumes are made available by manufacturers for allocation to countries
through global access mechanisms, and procurement and distribution are set up to deliver the products to
countries.
2) During phase 1, the so-called proportional allocation phase, how will the vaccine
doses be allocated? How many vaccines will each participating country get?

The quantity of vaccines received in phase 1 will be 20% of each participating country’s total population,
or the coverage percentage that participants have requested (whichever is lower).

The rate at which countries receive vaccines will be such that all countries will achieve the same
coverage at the same time where possible 3.

The allocation moves on to phase 2 once all countries have reached 20% coverage (or less if they so
requested). Phase 2 may start ahead of this if available doses are unable to be allocated due to lack of
readiness, funding or territory issues.

An example of how allocation phase 1 may look in practice given different coverage requests is
illustrated in Exhibit 1.

Exhibit 1: Example for multiple rounds of allocation with increasing supply

3 Some exceptions could be made where this is not practical (e.g., small countries where shipping doses to cover a
low percentage of the population would not be logistically practical)
Allocation Phase 2

3) During phase 2, the so-called weighted allocation phase, how will the vaccine
doses be allocated? How many vaccines will each participating country get?

The quantity of vaccines in phase 2 is based on the coverage percentage participants have requested
beyond the initial 20%.

If there is no severe supply constraint, the rate at which participants receive vaccines is such that all
countries will achieve the same coverage at the same time (up to their requested coverage) where
possible (as in phase 1)3.

If there is a severe supply constraint1, the rate at which participants receive vaccines will be adjusted
based on an assessment of participant risk (threat and vulnerability);

• Participants with a higher risk rating will receive their doses relatively faster, but all countries
will receive the total doses they have requested to access by the end of phase 2.
• At this stage, any delay in receiving doses for participants with a lower risk is imagined to be a
matter of weeks rather than months.

Participants’ risk assessment scores will be weighted and averaged to determine a single score. This
score will inform each participant’s rate of allocation in phase 2. This process is detailed in Exhibit 2.

Details of the criteria and their weighting is under development, though potential criteria are described
in Table 1. More details will be released as they emerge.

Exhibit 2: Phase 2 - weighted allocation system (in the case of severely constrained supply)

An example of how allocation phase 2 may look in practice given different coverage requests and risk
assessment scores is illustrated in Exhibit 3.
Exhibit 3: Example of weighted allocation under conditions of severely constrained supply

4) How will vulnerability and threat be assessed in practice?

Several potential parameters could be used to assess threat and vulnerability for countries. These are
described in Table 1: Potential parameters to assess threat and vulnerabilityTable 1. The parameters will
be reviewed closer to phase 2 as more information regarding the pandemic comes to light.

The numerical assessment will need to be accompanied by a qualitative assessment to make sure
country context is considered.
Table 1: Potential parameters to assess threat and vulnerability

Criteria Parameter Reason for using

Threat Effective Indication of the current state and dynamic of the of the pandemic in a
reproductive country (average number of secondary cases per primary case over time).
number Rt and Could be replaced or supplemented by other epidemiological parameters to
its trend interpret the dynamic of the epidemic in the country.
Hemisphere Other respiratory viruses such as seasonal influenza will i) impact health
location systems functions and ii) increase the risk profile of target COVID-19
population groups
Could be replaced or supplemented by other parameters indicating
concomitant threats.
Vulnerability UHC service Combines several indicators of service coverage and health system
coverage index vulnerability into one.
Health system Indication of whether the country’s health system is saturated, informed by
saturation metric such as % occupancy of hospital beds and % occupancy of ICU beds.
High risk groups Indication of what proportion of the population is at higher risk of severe
disease.
Each country is given an overall risk score based on a weighted average of the parameter scores. This
process is illustrated in Exhibit 4. The weighting used to generate an overall score is under development.

Exhibit 4: Potential risk scores based on sum of potential weighted parameter scores

The numerical risk assessment will need to be accompanied by a qualitative assessment to make sure
country context is considered. The overall risk score will then inform each participants’ rate of allocation
in phase 2, as outlined in Exhibit 2.

5) If a country scores low in vulnerability and threat during phase 2, does this
mean that the country would get no vaccine?

No, every country will get the vaccines they have requested through the COVAX Facility (provided supply
and funds are available).

The score in the risk assessment will determine the rate at which countries will receive the doses, with
countries with a higher risk assessment receiving doses at a faster rate than the others. The risk
assessment defines only the rate at which countries obtain access to vaccines, not whether they do. Risk
assessments will be conducted ahead of each allocation round.

6) How can countries predict and prepare for the doses that they will get in phase
2 if the proposal is that the allocation may vary based on threat and vulnerability?

The total amount of doses allocated in phase 2 will correspond to the amount requested by each
country (minus the 20% already allocated in phase 1), provided funds are available.
Countries will know upfront the total number of doses they will receive and will be able to plan for the
deployment of the vaccine to their populations.

As much as possible, the allocation rounds will be determined and communicated by COVAX well ahead
of deployment to provide enough time for countries to prepare for each round.

In phase 2, supply from manufacturers will be more predictable than in phase 1, and there will be better
visibility on what countries will receive.

Based on likely supply scenarios, the impact of threat and vulnerability on the timing at which a country
receives doses in phase 2 is in the order of weeks rather than months.
Allocation of Multiple Products

7) What will happen if there is more than one vaccine to allocate?

Participants under the Optional Purchase Arrangement will receive options to purchase their pro rata
share of each vaccine.

• These participants will be able to opt-out of certain vaccines.

• The Pro Rata Share is calculated by dividing the estimated number of doses required (the Total
Participant Doses) by the total number of doses that the Facility intends to procure based on
demand from all Participants (the Total Facility Doses).

For other participants, the allocation will strive to allocate products as soon as possible while accounting
for:

• Country preferences based on product characteristics.

• Country readiness.

8) How will country preferences be accounted for?

Participants will be invited to express their preferences regarding the characteristics of the product they
are allocated.

The allocation will strive to accommodate country preferences wherever possible, so that the products
they are allocated match their preferred characteristics. However, it may not be possible to
accommodate these at all times.
Governance

9) How will the Allocation Mechanism for vaccines be governed?

Two new bodies are directly involved in the Allocation of COVAX Facility Vaccines:

o The Independent Allocation Validation Group (IAVG).

o The Joint Allocation Taskforce (JAT).

These bodies will operate in tandem with the COVAX Facility governance.

9.1 Allocation governance structure

The JAT will receive relevant inputs from the Office if the COVAX Facility, WHO Allocation Unit,
procurement agencies (UNICEF SD, PAHO RF, etc.), and participants. The JAT will prepare Vaccine
Allocation Decision (VAD) proposals based on the allocation model, which would then be passed on to
the IAVG.

The IAVG would then validate this proposal ensuring it is technically informed and free from conflict of
interest. The validated VAD would then be passed on to the COVAX Facility, procurement agencies and
self-procuring countries in order to be implemented.

This process is illustrated in Exhibit 5.

Exhibit 5: Allocation Governance Structure

Prioritisation

10) What is the relationship between the Allocation Mechanism and SAGE
recommendations on immunization?

The Allocation Mechanism indicates how vaccines should be allocated among participants of the COVAX
Facility.

The WHO SAGE recommendations advise on how vaccines could be used within countries, prioritising
target populations based on context.

The Allocation Mechanism does not decide on behalf of countries which populations should be
prioritised for immunization.

Humanitarian Buffer

11) What is the objective of the humanitarian buffer?

Given that some populations will not be covered by the global allocation of vaccines, there is a risk of an
equity gap.

The objective of the humanitarian buffer is to cover populations that may not be covered through the
main allocation mechanism for vaccines. Under this objective, potential populations to cover could
include refugees, Internally Displaced People, asylum seekers etc.

The volume of this buffer would be 5% of the volumes supplied by the COVAX Facility (e.g., 100 million
doses by end of 2021).

A technical working group has been convened to further detail the details of this buffer.