In November 2022 a commentary in The Lancet Global Health reflected that COVID-19 vaccination programmes have been “relatively successful” across the Association of Southeast Asian Nations (ASEAN), which now includes 10 member states. According to the authors, these programmes were effective in “blunting the worst of the pandemic and increasing overall public understanding of and support for vaccination programmes”. However, they identify more to be done.
Inspiration from PAHO’s Revolving Fund
The Pan American Health Organisation (PAHO) has a Revolving Fund, which the authors believe to be a “useful reference” for the formation of an ASEAN Vaccines Revolving Fund (AVRF). With the intention of promoting “long-term vaccine procurement” it would start with COVID-19 vaccines and move outwards to “other vaccine-preventable diseases”.
PAHO’s Revolving Fund was founded in 1977 and “pools the resources” of 41 PAHO states. Each year it is estimated to purchase $1.1 billion worth of 47 vaccines and 29 vaccine-related supplies for 15 million people. Furthermore, it is credited with doubling PAHO vaccination rates. The article reports that it was the 1st of 6 WHO regions to be “certified polio free in 1994”. Later, measles and rubella were “eliminated”.
The AVRF
The suggested objectives for the AVRF are threefold:
- Coordinate pooled procurement of vaccines in southeast Asian countries
- Support country-level delivery
- Build capacity for national level public procurement of other goods and services
“A successful AVRF can increase vaccine supplies, reduce the price for new vaccines, accelerate access to new vaccines, and increase vaccination rates and health equity.”
There are four “structural challenges” identified as barriers to vaccine procurement in southeast Asia. The recommended AVRF would “resolve” these as follows:
- Providing a “strong negotiating position with vaccine manufacturers” by representing 650 million people across the region.
- Modernising procurement through “innovative tools such as value-based purchasing, health technology assessments, demand forecasting, and new types of reimbursement contracts with manufacturers in the short term, while building country-level capacity and harmonising regional standards in the long term”.
- Strengthening local vaccine production and creating incentives for local manufacturers to “expand” production.
- Supporting member countries to “amortise capital spending on expensive infrastructure such as cold chains and data systems”.
The benefits are also “strategic”, the authors indicate. With greater purchasing power will come greater access to cheaper and more reliable vaccines. Additionally, “consistent access” to vaccines will reduce the “administrative and financial burdens of disease” throughout the region. Finally, they hope that an AVRF would “institutionalise modern practices and reduce corruption risks”.
Getting there
The authors recognise that an AVRF will be a “multiyear journey”. The first step would be a coalition, “anchored” by the ASEAN Secretariat or other organisation, such as the IVI in South Korea or the National Vaccines Institute in Thailand. Then it would need to partner with a “geopolitically important country”. The hope is that 3 to 5 founding ASEAN countries would offer “crucial mass” across “population, diplomatic, financial, and technical terms”, with other countries following the example.
The article concludes that an AVRF would help assure “stable, predictable, cost-effective, and early access to new vaccines”. Following the lead of PAHO, and using “political will and skill”, an AVRF can be launched.
“Vaccines have been called public health’s best buys, and an AVRF can make these best buys even better”.
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