covax allocation round 4 second dose needs
TRANSCRIPT
Report of the Joint Allocation Taskforce (JAT) on the distribution of COVAX Facility secured vaccines
COVAX ALLOCATION ROUND 4 – Second Dose Needs
Date of report: 8 June 2021
Summary
• COVAX Allocation Round 4 concerns the allocation of AstraZeneca/AZD1222-Vaxzevria (“AZ”)1 to
resolve the second dose needs of COVAX Facility participants who were previously allocated
AstraZeneca/Covishield™ (“SII”) in February 2021. These participants allocated SII doses were
impacted by the unexpected global SII supply shortage and related shipment delays. As such,
Round 4 is an exceptional round. Important considerations for this Round include the following:
o The second dose needs for Round 4 were quantified by matching the equivalent number
of doses delivered to affected participants in their first tranche shipment of the SII doses
originally allocated to them in February 2021. These first tranche shipments were
executed between February and April 2021.
o In addition, five participants who had not received first shipments against their full SII
allocation due to preparedness and/or supply issues have been exceptionally allocated
AZ doses in this Round.
o Supply needs for the Humanitarian Buffer are not factored into this fourth Allocation
Round. This decision, made by the COVAX Allocation Leadership Group, is based on the
principle that no doses should sit idle, and it reflects the fact that there were no
applications for the Humanitarian Buffer at the time that Round 4 was run. Provisions to
the Humanitarian Buffer will be made in following Allocation Rounds.
• The overall number of AZ doses allocated in this Round is 17,366,400 doses to 43 participants.
1 Previously COVID-19 Vaccine AstraZeneca.
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Table of Contents
Summary ....................................................................................................................................................... 1
Table of Contents .......................................................................................................................................... 2
Purpose ......................................................................................................................................................... 2
Overview of Allocations to Date ................................................................................................................... 3
Scope ............................................................................................................................................................. 3
Round 4 Allocation Approach ....................................................................................................................... 4
Supply Reserved for Allocation Round 4 ....................................................................................................... 6
Final Allocation .............................................................................................................................................. 6
Others – Shipment Considerations ............................................................................................................... 6
Conclusions ................................................................................................................................................... 7
Signatures ..................................................................................................................................................... 7
ANNEX 1. Allocation Round 4 Results ........................................................................................................... 8
ANNEX 2. Past Allocations........................................................................................................................... 14
Purpose
This report documents the allocation of AstraZeneca/AZD1222-Vaxzevria (“AZ”)2 during the COVAX
Allocation Round 4 to achieve the following:
i.) To cover second dose needs of COVAX participants previously allocated
AstraZeneca/Covishield™ (“SII”), who had used either the majority or the entirety of their
first tranche shipment as first doses, rather than conserving half of the doses delivered to
complete the vaccine regimen. These participants were subsequently impacted by the
unexpected SII supply shortage3 and related delays in shipments.
ii.) To service a small number of participants who had not received any shipment of SII doses due
to preparedness and/or supply issues, in accordance with an approach developed by the
cross-COVAX Facility SWAT4 team with JAT refinement for consistency.
The importance of addressing second dose needs among participants emerged when COVAX participants largely reported using initial shipments of SII and AZ vaccines to target high priority populations with one dose in conformity with the WHO guidance note on Considerations for optimizing deployment of ChAdOx1-S [recombinant] vaccines in a time-limited constrained supply situation. Reduction in supply and related delays in shipments impacted participants’ ability to serve these populations with a second dose.
2 International Nonproprietary Name (INN): COVID-19 Vaccine (ChAdOx1-S [recombinant]) 3 https://www.gavi.org/news/media-room/covax-updates-participants-delivery-delays-vaccines-serum-institute-india-sii-az 4 The SWAT team is composed of senior representatives from the COVAX partner organizations (CEPI, Gavi, PAHO, UNICEF, and WHO). It is the primary body for operational decision making. The SWAT team’s role and responsibilities include, among others: i) to problem solve operational issues, developing proposals and scenarios to address them as they arise; ii) to escalate decisions to higher levels of COVAX governance, and iii) to coordinate the implementation of operational decisions with workstreams.
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Therefore, this Allocation Round primarily aims to ensure that participants receive the supply required to administer second doses to these target populations who received their first dose through the initial shipment of SII doses. Further guidance published in May 2021 on the implications of delayed shipments on the administration of second doses can be accessed in a technical note on the WHO website.
Overview of Allocations to Date
To date, three COVAX Allocation Rounds have taken place, covering the period January to June 2021 (Q1-
2021 & Q2-2021). For an overview of all allocations preceding Round 4, please refer to Table 6 in ANNEX
2. Past allocations are used as one of the inputs informing the Round 4 allocation decision.
In addition, since the conclusion of COVAX Allocation Round 3, four factors have changed several
participants’ total population coverage through COVAX-secured doses, including:
1. The AstraZeneca/Covishield™ (“SII”) supply shortage;
2. Reallocation5 resulting from preparedness issues or refusals;
3. Redeployment6 of doses; and
4. Donations (“dose-sharing”) received and distributed by the COVAX Facility.7
The final Round 4 allocated volumes captured in this report will be used as inputs for total population coverage in the following Allocation Round.
Scope
The scope of the current report is limited to AstraZeneca/AZD1222-Vaxzevria (“AZ”).
Most participants included in Allocation Round 4 were those who received a first shipment of SII doses
originally allocated to them during COVAX Allocation Round 2.8 Not all COVAX participants9 were
prioritized for Round 4, as this exceptional Round’s primary objective is to cover second dose needs and
to serve participants who did not receive any shipment against their original allocation of SII doses.
Given the above, Table 1 below shows the characteristics of the participants included in Round 4.
5 Reallocation involves redistributing doses allocated to one participant which is not prepared or not willing to receive these doses to another participant which is. There are different reasons for reallocation, including preparedness delays or refusals. Reallocation is necessary to avoid idle doses. 6 The redeployment of COVAX-secured doses allocated and delivered to a COVAX participant occurs when a participant is unwilling or unable to use the COVAX doses already in country to vaccinate individuals in the population. This is a process outside of the standard allocation mechanism and therefore is not managed by the Joint Allocation Taskforce. 7 These include donations from France (for a cumulative total of 1,701,600 doses earmarked to 14 participants in the WHO AFR region) and a donation from New Zealand (211,200 doses earmarked to 6 participants in the WHO WPR & SEAR regions). 8 During Round 2, 60 participants were allocated SII, among whom 47 received their first shipment of SII doses before the supply drop was communicated. 9 At the time of writing, there are 88 Advance Market Commitment (AMC) and 71 Self Financing (SFP) participants to the COVAX Facility.
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Table 1. Allocation Round 4 participants
Eligible participants for Round 4 AMC SFP Total
Participants who received a first shipment of SII allocated during Round 2
47 0 47
− Participants who received a first shipment of SII and additional doses through redeployment and donations to cover their second dose needs
(8)* 0 (8)*
− Participants who received their first shipment, but who requested a redeployment of their doses
(1)* 0 (1)*
Participants who did not receive a first shipment of SII allocated during Round 2 and who are included in Round 4
5 0 5
TOTAL Round 4 eligible participants 43 0 43
Note: *( ) number deducted from the total number of participants eligible to the round.
Round 4 Allocation Approach
The approach to Allocation Round 4 was to address the immediate second dose needs of participants that
had previously received one shipment of SII. To do this, the JAT manually allocated the exact quantity of
doses to match the volume of SII doses delivered from February through April 2021. This was manually
allocated in the Allocation Portal—meaning that, exceptionally, the algorithm was not used.
The exceptions to this allocation approach are detailed in Table 2 on the following page. In sum, there were five participants who were not shipped any portion of their Round 2 SII allocation because they either failed to complete all necessary post-allocation preparedness steps, thereby indicating that they were not ready to receive shipments, or because of the delays resulting from the global suspension of SII supply.
The COVAX Facility decided to include the following five participants to the list of Round 4 eligible participants, with AZ quantities and rationales as outlined below:
• Bangladesh and Pakistan: Both participants allocated 1,000,800 doses each, as there is not enough available AZ in Allocation Round 4 to fully cover the quantity of doses that the participants could have received as first shipment of doses allocated in Round 2.
• Haiti and Kyrgyzstan: Both participants allocated the quantity of doses that would have been shipped as their respective first tranche shipment of doses allocated in Round 2.
• Bhutan: The participant is allocated the total quantity initially allocated to them in Round 2, rounded to Allocation Round 4’s minimum allocation size of 100,000 doses.
The five participants outlined above met the preparedness requirements needed to receive AZ doses at
the time that Round 4 was run. However, there are additional participants who did not receive any
shipment of SII doses following Allocation Round 2 who remain unprepared to receive the AZ vaccine and,
therefore, were not included as eligible participants in Round 4.10
10 The other participants who remain unprepared are Chad, Democratic People's Republic of Korea (DPRK), Myanmar, the Republic of the Congo, and Zimbabwe.
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In Round 4, participants’ absorptive capacity11 was considered to minimize the risks of doses sitting idle
and being wasted.
Table 2. Participants Who Did Not Receive a First Shipment and Rationale for Inclusion in Round 4
Participant Rationale
Bangladesh • Participant did not receive a first shipment despite being ready
• Round 4 allocation is 1,000,800 AZ doses, as there is not enough available overall supply to cover the full amount that the participant could have received as a first shipment for Round 2
• In Round 2, Bangladesh was allocated 10,908,000 SII doses
Bhutan • Participant did not receive first shipment due to preparedness issues
• Participant is now prepared and will receive the amount equivalent to their full Round 2 allocation, adjusted for Round 4’s minimum allocation size (R4: 108,000 doses)
Haiti • Participant did not receive initial shipment due to preparedness issues
• Participant is now prepared and will receive an amount equivalent to what their first shipment amount would have been (R4: 129,600 doses)
Kyrgyzstan • Participant did not receive shipment due to preparedness issues
• Participant is now ready and will receive an amount equivalent to what their first shipment amount would have been (R4: 228,000 doses)
Pakistan • Participant did not receive a first shipment despite being ready
• Round 4 allocation is 1,000,800 AZ doses, as there is not enough available overall supply to cover the full amount that the participant could have received as a first shipment for Round 2
• In Round 2, Pakistan was allocated 14,640,000 SII doses and subsequently received 2,474,400 AZ doses reallocated from other participants either unprepared or unwilling to receive them during the Round’s reallocation process
11 Absorptive capacity pertains to participants’ ability to administer doses received through the Facility before the doses’ expiry date, thereby avoiding doses being wasted or sitting idle. The main objective is to optimize the use of available doses, considering supply constraints.
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Supply Reserved for Allocation Round 4
The supply reserved for Round 4 was calculated based on: i) the overall Q3-2021 supply of AZ for the
COVAX Facility, and ii) the estimated needs as described in the preceding sections of this report.
Table 3 below summarizes the overview of available supply for the product allocated in this Round:
Table 3. Overview of AZ Supply in Allocation Round 4
Product Name WHO EUL Date Supply Allocated in Round 4
(doses)
Min. Shipment Size
(doses)
AstraZeneca/AZD1222-
Vaxzevria (“AZ”)
15 Feb 2021 17,366,400 2,400
Information on supply availability was provided to the Joint Allocation Taskforce by the COVAX
Procurement Coordinator, UNICEF Supply Division.
This allocation proposal was approved by the Allocation Leadership Group on 8 June 2021.
The remaining doses from the overall AZ supply for Q3 will be allocated during the next regular Allocation
Round (i.e. Allocation Round 5).
Considering these supply and demand characteristics the overall number of AZ doses allocated during this Allocation Round is 17,366,400 doses to 43 participants.
Final Allocation
The final list of Round 4 allocations is available in ANNEX 1, Table 4. The average population coverage12
across all participants achieved with doses allocated in this round is 0.85%. The average cumulative
coverage from Rounds 1 to 4 for these same participants is 1.75%.
A descriptive statistics summary of the participants, their allocation, and total coverage is presented in
ANNEX 1, Table 5. A summary of the proposed distribution is presented in ANNEX 1, Figures 1-3.
Others – Shipment Considerations
The Allocation Framework includes principles for the prioritization of shipments for the distribution of
doses allocated in a Round in order to facilitate the logistics planning. A stratified randomization approach
is used for the development of this list to ensure that all participants are given an equal chance in the
initial shipment queue.
12 The population-weighted average coverage across all participants in this round is 0.61%.
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For this round, given its specific aim, the proposition is to follow the same shipment order that was used
for the first doses to limit delays in administering second doses. Participants that have not received any
shipment yet would be positioned first in the order of shipments unless shipments are prioritized for other
participants to ensure their ability to administer second doses within the WHO recommended timeframe.
Date of shipment of first doses are provided in Table 9 in ANNEX 2.
Conclusions
The JAT proposes the allocation amounts detailed in ANNEX 1.
This proposal has been validated by the COVAX Allocation Leadership Group on 8 June 2021.
Considering the exceptional circumstances for Round 4, this proposal does not require approval from
the Independent Allocation of Vaccines Group (IAVG).
The outcomes of Allocation Round 4 will be taken into account to inform Allocation Round 5.
Signatures
Signature Assistant Director General,
Access to Medicines and Health Products, WHO
Signature Managing Director,
Office of the COVAX Facility, Gavi
Provided via email Provided via email
Mariângela SIMÃO Aurélia NGUYEN
On date: 8 June 2021 On date: 7 June 2021
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ANNEX 1. Allocation Round 4 Results
Table 4. Final List of Round 4 Allocations (N=43)13
Participant name WHO Region COVAX Participation Model
Doses Allocated
Afghanistan EMR AMC92 468,000
Angola AFR AMC92 129,600
Bangladesh SEAR AMC92 1,000,800
Benin AFR AMC92 93,600
Bhutan SEAR AMC92 108,000
Bolivia (Plurinational State of) AMR AMC92 228,000
Cambodia WPR AMC92 324,000
Cameroon AFR AMC92 391,200
Comoros AFR AMC92 12,000
Côte d'Ivoire AFR AMC92 355,200
Djibouti EMR AMC92 24,000
Ethiopia AFR AMC92 1,792,800
Gambia AFR AMC92 36,000
Ghana AFR AMC92 249,600
Guinea AFR AMC92 194,400
Guinea-Bissau AFR AMC92 28,800
Haiti AMR AMC92 129,600
Kenya AFR AMC92 765,600
Kyrgyzstan EUR AMC92 228,000
Lao People's Democratic Republic
WPR AMC92 132,000
Liberia AFR AMC92 96,000
Malawi AFR AMC92 360,000
Maldives SEAR AMC92 12,000
Mali AFR AMC92 396,000
Mozambique AFR AMC92 276,000
Nepal SEAR AMC92 348,000
Nicaragua AMR AMC92 134,400
Niger AFR AMC92 254,400
Nigeria AFR AMC92 3,924,000
Pakistan EMR AMC92 1,000,800
13 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
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Senegal AFR AMC92 139,200
Sierra Leone AFR AMC92 96,000
Somalia EMR AMC92 192,000
South Sudan AFR AMC92 60,000
Sri Lanka SEAR AMC92 264,000
Sudan EMR AMC92 828,000
Syrian Arab Republic14 EMR AMC92 256,800
Tajikistan EUR AMC92 192,000
Togo AFR AMC92 16,800
Uganda AFR AMC92 688,800
Uzbekistan EUR AMC92 660,000
Yemen EMR AMC92 360,000
Zambia AFR AMC92 120,000
14 A proportion of the doses allocated will be delivered for distribution through international partners in the humanitarian response, given the unique context.
10
Table 5. Descriptive Statistics Summary of the Participants, Their Allocation, and Total Coverage
Total Participants AMC92 participants
Coverage for round
participants
43 100% 0.6%
Participation Model Average Max Min Average Max Min
AMC92 participants 0.85 6.99 0.1 1.75 7.37 0.33
OVERALL 0.85 6.99 0.1 1.75 7.37 0.33
Total Equity Deviation Preference Deviation Unique Product
0.0014 0 0
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Figure 1. Round 4 Population Coverage
12
Figure 2. Overall Population Coverage after Rounds 1-4 (Only Round 4 Participants)
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Figure 3. Overall Population Coverage for All COVAX Participants Having Received Allocations
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ANNEX 2. Past Allocations
Table 6. Allocations to Date
Allocation Round
Product Name WHO EUL Date
Allocation Approval
Date
Doses Allocated Doses Allocated Adjusted for Supply
Shortages and Redeployments
Description
COVAX-1 COMIRNATY, INN: Tozinameran
30 Dec 2021 29 Jan 2021, 1,200,420 1,200,420 Pfizer Feb-Mar 2021
COVAX-2 AstraZeneca/AZD1222, INN: COVID-19 Vaccine (ChAdOx1-S [recombinant])
15 Feb 2021 23 Feb 2021, IAVG
75,996,000 75,412,800 AZ and SII-AZ Jan-May 2021
COVAX-2 AstraZeneca/COVISHIELD™, INN: COVID-19 Vaccine (ChAdOx1-S [recombinant])
15 Feb 2021 23 Feb 2021, IAVG
161,472,000 29,862,600 AZ and SII-AZ Jan-May 2021
COVAX-3 COMIRNATY, INN: Tozinameran
30 Dec 2021 15Mar 2021, IAVG
14,109,030 14,109,030 Pfizer Apr-Jun 2021
Dose sharing donations
AstraZeneca/AZD1222, INN: COVID-19 Vaccine (ChAdOx1-S [recombinant])
15 Feb 2021 07 May 2021 12 May 2021 19 May 2021
1,912,800 1,912,800 Donations received and allocated to date
TOTALS 254,690,250 122,497,650
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Table 7. Dose Sharing Donations Received Prior to Round 4
Source of Shared Doses
Recipient of Shared Doses*
WHO Region COVAX Participation
Model
Doses Allocated
France Burkina Faso AFR AMC92 115,200
France Cabo Verde AFR AMC92 31,200
France Eswatini AFR AMC92 14,400
France Ethiopia AFR AMC92 391,200
France Kenya AFR AMC92 182,400
France Lesotho AFR AMC92 36,000
France Mauritania AFR AMC92 105,600
France Mozambique AFR AMC92 108,000
France Rwanda AFR AMC92 117,600
France São Tomé and Principe
AFR AMC92 24,000
France Senegal AFR AMC92 184,800
France Somalia EMR AMC92 108,000
France Uganda AFR AMC92 175,200
France Zambia AFR AMC92 108,000
New Zealand Fiji WPR AMC92 2,400
New Zealand Papua New Guinea WPR AMC92 146,400
New Zealand Solomon Islands WPR AMC92 28,800
New Zealand Timor-Leste SEAR AMC92 24,000
New Zealand Tonga WPR AMC92 4,800
New Zealand Tuvalu WPR AMC92 4,800
*Note: All donations distributed through the COVAX dose-sharing mechanism have taken place between Allocation Rounds 3 and 4 at
the time of report writing.
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Table 8. Round 2 – Allocated Doses vs Delivered Doses & Date of Shipment of Round 2 SII Doses
Participant Total Allocated
Quantity
Delivered
Quantity
Delivery Date
(M/DD/YYYY)
Afghanistan 2,580,000 468,000 3/05/2021
Bangladesh 10,908,000
Benin 792,000 144,000 3/07/2021
Bhutan 108,000 -
Bolivia 672,000 228,000 3/18/2021
Burkina Faso 1,380,000 -
Cabo Verde 108,000 24,000 3/08/2021
Cambodia 1,104,000 324,000 3/01/2021
Cameroon 1,752,000 391,200 2/25/2021
Chad 1,080,000 -
Comoros 108,000 12,000 4/11/2021
Congo, Rep. 360,000 -
Côte d'Ivoire 1,740,000 504,000 2/24/2021
Democratic People's Republic of Korea 1,704,000 -
Democratic Republic of the Congo 5,928,000 1,716,000 2/28/2021
Djibouti 108,000 24,000 3/04/2021
Eswatini 108,000 12,000 3/10/2021
Ethiopia 7,620,000 2,184,000 3/06/2021
17
Participant Total Allocated
Quantity
Delivered
Quantity
Delivery Date
(M/DD/YYYY)
Gambia 156,000 36,000 2/28/2021
Guinea 864,000 194,000 4/09/2021
Guinea-Bissau 120,000 28,800 4/09/2021
Haiti 756,000 -
India 49,992,000 10,000,000 1/29/2021
Kenya 3,564,000 1,020,000 3/01/2021
Kyrgyzstan 432,000 -
Lao People's Democratic Republic 480,000 132,000 3/17/2021
Lesotho 132,000 36,000 3/1/2021
Liberia 324,000 96,000 3/03/2021
Malawi 1,260,000 360,000 3/03/2021
Maldives 108,000 12,000 3/05/2021
Mali 1,332,000 396,000 3/02/2021
Mauritania 300,000 69,600 4/11/2021
Mozambique 2,064,000 384,000 3/06/2021
Myanmar 3,600,000 -
Nepal 1,920,000 348,000 3/05/2021
Nicaragua 432,000 135,000 3/14/2021
Niger 1,596,000 355,200 4/11/2021
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Participant Total Allocated
Quantity
Delivered
Quantity
Delivery Date
(M/DD/YYYY)
Nigeria 13,656,000 3,924,000 3/01/2021
Papua New Guinea 588,000 132,000 4/09/2021
Rwanda 744,000 240,000 3/01/2021
São Tomé and Principe 96,000 24,000 3/01/2021
Senegal 1,104,000 324,000 3/01/2021
Sierra Leone 528,000 96,000 3/05/2021
Solomon Islands 108,000 24,000 3/16/2021
Somalia 1,044,000 300,000 3/04/2021
South Sudan 732,000 132,000 3/21/2021
Sri Lanka 1,440,000 264,000 3/05/2021
Sudan 2,904,000 828,000 3/02/2021
Syrian Arab Republic 1,152,000 256,800 4/21/2021
Tajikistan 624,000 192,000 3/07/2021
Uganda 3,024,000 864,000 3/03/2021
Uzbekistan 2,256,000 660,000 3/14/2021
Yemen 1,968,000 360,000 3/28/2021
Zambia 1,212,000 228,000 4/10/2021
Zimbabwe 984,000 -