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.

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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

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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

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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 -