Supplying the World With Vaccines: Q&A With Etleva Kadilli

In September, UNICEF was appointed to lead the procurement and supply of COVID-19 vaccines in what is likely to be the largest and fastest operation of its kind. Every Woman Every Child interviewed Etleva Kadilli, Director of UNICEF’s Supply Division, to learn more about the background of the new initiative, possible timelines, and how this specifically helps women and children.

Originally published by Every Women Every Child on 6 October

Can you tell readers a little more about how the new initiative came to be? I know that UNICEF is already the main procurement partner of GAVI—did working together on COVID-19 vaccine procurement seem like a natural extension of this work?

The COVAX Facility is a key pillar of the global ACT-Accelerator—the global collaboration to accelerate the development, production, and equitable access to tools to fight COVID-19, including diagnostics, therapeutics and vaccines. 

As the world mobilizes for the introduction of COVID-19 vaccines, UNICEF has been appointed to lead efforts to procure and supply doses of COVID-19 vaccines on behalf of the COVAX Facility for 92 low- and lower middle-income countries, and will also serve as procurement coordinator to support procurement by 80 higher-income economies.

What does UNICEF bring to this role? We are the largest single vaccine buyer in the world, procuring nearly 2.5 billion doses of vaccines annually on behalf of nearly 100 countries, reaching nearly 45 per cent of the world’s children under 5 years of age for routine immunization and outbreak response. We are the main procurement partner of Gavi, the Vaccine Alliance, which over the last 20 years has reached more than 760 million children with life-saving vaccines, preventing more than 13 million deaths. 

UNICEF also has a long history of working with governments, manufacturers, global and local partners to align supply and demand of vaccines to achieve vaccine security, ensuring that there is sufficient supply of vaccines, and ensuring equitable access to meet immunization coverage goals in low- and middle-income countries alike. 

Beyond market shaping and procurement, we also work closely with these stakeholders to strengthen supply chains for vaccines, including cold chain infrastructure, freight, logistics, and storage to keep vaccines safe through their journey from manufacturer to the child.   

In this new central procurement role on behalf of the COVAX Facility, UNICEF will leverage its unique strengths and expertise in vaccine procurement and market shaping, to support these global efforts to ensure equitable access for all countries to COVID-19 vaccines.

How will the new initiative benefit women and children? Both are at lower risk for infection than other groups, but have suffered greatly because of the knock-off effects of the lockdowns, so I’d love to hear about the effect vaccine procurement will have on their lives.

Indeed, the pandemic and its secondary effects are taking an unprecedented toll on the health and well-being of children around the world, threatening to roll back years of progress. Disrupted immunization programmes are leaving children vulnerable to vaccine-preventable diseases. Disrupted food supply chains are leaving children vulnerable to malnutrition. School closures are leaving children without access to learning. More children are confronting poverty than before. And the list goes on…

Ending the pandemic and addressing these consequences will require strong collaboration, and a combination of products and interventions. 

While it will not be an immediate silver bullet, vaccines are a critical element to these global efforts to end the pandemic. A coordinated approach to their rollout is also critical. When the vaccines first become available, there will be limited numbers of doses until global supply can be scaled. The COVAX Facility is planning to allocate these initial tranches according to the greatest public health impact, with the goal of to delivering 2 billion doses globally by the end of 2021. The primary objective of the COVAX allocation strategy is to reduce mortality and protect health systems. Therefore, the first doses of vaccines will target health and social care workers. By protecting the health of these frontline workers, we are ensuring that these essential services can continue to serve children and their communities. These are critical services without which millions of children’s lives are at stake, given the widespread disruptions to services during the lockdowns. We cannot let one disease lead to an outbreak of another.

The span from development to production could be one of the fastest timelines in history, with manufacturers potentially able to produce the vaccine in 1 to 2 years. What are some other possible timelines? What are some other factors that will affect the timeline?

According to the timelines indicated by vaccine manufacturers, the span from development to production is likely to be one of the fastest scientific and manufacturing leaps in history: from a decade or more, down to 18-24 months. And in turn, once the vaccines are available, this will be the largest and fastest procurement and supply operation ever. 

The situation is evolving rapidly – just between April and August the number of vaccine candidates in the pipeline doubled. And we are seeing more and more are entering clinical trials, and some are in late stages. Of course, the timelines will also depend on these clinical trial outcomes, however we are proceeding with the assumption that a vaccine will be available by early 2021. 

Given the urgency and the unprecedented scale of this operation, the COVAX Facility stakeholders are mobilizing plans now to prepare for procurement. It is imperative that once the COVID-19 vaccines are approved and available for distribution, that we are fully prepared to get them to countries as quickly as possible. This means addressing a spectrum of considerations along the supply chain, from freight – to logistics – to storage, and supporting countries to prepare for introduction and rollout.

As the largest vaccine buyer in the world, UNICEF already has much of the infrastructure in place for supply and procurement . What are some new challenges (or opportunities) when it comes to procurement for the COVID-19 vaccine?

At this point in time, the central challenge from a procurement perspective is managing the unknowns. Of the approximately 200-300 COVID-19 vaccines currently under development, we do not yet have certainty how many will demonstrate sufficient safety and efficacy to achieve approval by a stringent regulatory authority, be recommended for use, and eventually reach the countries that UNICEF serves. And we do not know with certainty the details product features of vaccines that might be licensed, such as the number of doses per course, the specific cold chain requirements, and shelf life. Manufacturers are also facing unknowns with regards to their production yields and hence their likely levels of output and cost of goods – both of which inform their pricing decisions. These uncertainties all add considerably to the complexity of the procurement process.

Despite the unknowns, it is imperative that we lay the groundwork now to ensure swift procurement once vaccines become available. For example, we are already preparing to tender and enter into supply agreements with a wide range of manufacturers, with the procurement of doses conditional on products achieving regulatory approvals.

Challenges aside, the COVAX Facility also presents opportunities to accelerate our efforts to reach children with immunization programmes more generally. There will be opportunities to further improve the cold chain capacity in countries, and to sensitize populations to the benefits of vaccines. It will also bring opportunities to strengthen routine immunization services in countries, and to intensify efforts to restore previous immunization coverage levels and reach ‘missed children’. Building back better with efficient, integrated and sustainable approaches will be key. 

From procurement, to supply, to delivery – UNICEF works together with partners and leverages every ounce of its strength and expertise to meet this enormous challenge before us: to procure and deliver safe and effective COVID-19 vaccines, on an accelerated timeframe, and at an unprecedented scale – to protect the most at-risk, wherever they may be in the world.