Launched in April 2020 at the height of the COVID-19 pandemic, COVAX is the global initiative created to ensure fair and equitable access to vaccines worldwide at an unprecedented scale.
COVAX was co‑led by CEPI, Gavi, the World Health Organisation, and UNICEF and operated until 2023 as the vaccines pillar of the Access to COVID‑19 Tools (ACT) Accelerator. By its end, COVAX had delivered almost two billion doses to 146 countries.
Since then, we have been working to understand how effectively COVAX delivered equitable global vaccine access. Lessons from COVAX’s performance provide valuable lessons for future vaccine programmes and pandemic preparedness.
About our evaluation
Itad’s formative review and baseline study of COVAX asks how effectively the mechanism contributed to equitable global access to COVID‑19 vaccines.
In partnership with 3ie, we examined the early design and initial implementation of the COVAX Facility, Advance Market Commitment (AMC) — an innovative financial instrument that enables 92 lower- and middle-income countries (LMICs) to gain access to COVID-19 vaccines for the most vulnerable populations — and COVAX delivery efforts.
In the second phase of our evaluation, we worked with RTI International and Genesis Analytics to undertake a comprehensive, end‑to‑end assessment of the entire COVID‑19 Vaccine Global Access mechanism and its delivery efforts across the full pandemic period.
The evaluation synthesised evidence from global partners and country‑level stakeholders to assess COVAX’s performance and identify lessons for future pandemic preparedness.
COVAX’s Successes and Challenges
COVAX delivered substantial contributions in an uncertain environment, successfully navigating challenges such as vaccine supply constraints and complex geopolitics.
COVAX was established and operationalised at an unprecedented scale and speed. It was able to rapidly mobilise significant resources to support vaccine procurement and delivery for lower-income counties, resulting in:
- Delivery of nearly two billion doses to 147 countries
- Nearly 74% of all COVAX doses delivered to lower-income countries
By investing early in a broad portfolio of vaccine candidates across multiple platforms, COVAX was able to reduce supply risks and enable access to a range of products.
Despite this, we also identified several challenges that constrained COVAX’s ability to fully achieve its objectives:
- Fragmented governance and unclear mandates: the mechanism lacked a single entity with end‑to‑end responsibility. Partners were not always clear on their roles or mandates. This created gaps in accountability, slowed decision‑making and complicated coordination across partners.
- Supply inequities and market dynamics: high‑income countries’ early bilateral deals reduced COVAX’s access to doses during the critical early months of 2021. This undermined the mechanism’s ability to deliver on its equity mandate.
- Delivery bottlenecks at a country level: many countries faced shortages of cold chain capacity, trained personnel and operational funding. Delivery financing arrived late or was insufficiently flexible to meet rapidly changing needs.
- Surge capacity limitations: COVAX partners struggled at times to scale staffing and technical support at the pace that was needed. Its contracting and internal approval processes were not designed for emergency conditions.
- Communication gaps: insufficient communication around supply timelines and allocation decisions created frustration among participating countries and partners.
Key Recommendations
Learnings from COVAX provide a clear direction for strengthening future global vaccine mechanisms and global pandemic preparedness.
Our evaluation draws out four key lessons to ensure fair and equitable vaccine access:
1. Establish a multilateral, end‑to‑end mechanism
No single organisation can manage the full spectrum of pandemic vaccine response. A future mechanism should integrate procurement, allocation, financing and delivery support under a coherent governance structure with clearer roles and mandates to enable accountability.
Implication for funders:
Invest not only in products but in the systems that connect vaccines to populations. Funding should support governance, coordination, and operational infrastructure, not just vaccine procurement.
2. Develop a unified vision for equitable access
COVAX partners often operated with differing priorities. A future mechanism requires a shared and clearly communicated vision that aligns resource mobilisation, portfolio strategy, allocation principles, and communication.
Implication for funders:
Align expectations across agencies and ensure that financing instruments reinforce a common strategic direction.
3. Clarify delivery support objectives across pandemic phases
The evaluation distinguishes between two phases of the pandemic:
- the acute phase, which necessitates flexible and rapid funding, and
- the post-acute phase, where interventions can take a targeted, strategic health system strengthening approach.
During COVID‑19’s acute phase, delivery support often arrived too late or was too rigid to meet urgent needs.
Implication for funders:
Design financing models that can provide the agility to shift between emergency phases and long‑term system strengthening. This may require new instruments or pre‑agreed crisis contingency mechanisms.
4. Address surge capacity challenges
The evaluation calls for a standing surge mechanism with pre‑identified personnel, clear deployment triggers, a simple and efficient contracting process, and a stronger regional presence.
Implication for funders:
Invest in a global surge backbone that can be activated rapidly during crises. This includes financing for preparedness between pandemics, not only during emergencies.
Broader implications for future vaccine programmes and pandemic preparedness
Beyond pandemic response, the evaluation offers lessons relevant to future vaccine introductions and pandemic preparedness:
- Preparedness must be financed between crises: waiting until a pandemic emerges guarantees delays in response capacity.
- Delivery financing is as important as supply financing: vaccines cannot save lives without functional delivery systems.
- Regional manufacturing and regulatory capacity are long‑term investments: supply inequity is a structural issue that cannot be solved during a crisis.
- Inclusive governance is essential: LMICs must have meaningful participation in decision‑making, and governance mechanisms need to adapt to ensure that.
- Risk‑tolerant funding is essential during emergencies: rigid grant structures slowed COVAX’s ability to respond effectively.
To read our evaluation in full, visit Gavi’s website.
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