Recent graduates of the MSc Health and International Development programme share their insights from their consultancy project with Save the Children UK for which their report focused on designing and optimising the operational strategy for Gavi, The Vaccine Alliance’s African Vaccine Manufacturing Accelerator (AVMA). 

The Problem: ‘Vaccine Nationalism’

Low- and middle-income countries face significant challenges in accessing vaccines, relying heavily on external supply chains. African nations, for instance, consume nearly 25% of the world’s vaccines but produce less than 1% locally. Increasing the supply of vaccine imports alone is not a sustainable solution to meet this demand and ensure equitable access. This reliance on imported vaccines means African countries risk receiving essential supplies last, leaving them vulnerable to supply fluctuations. Vaccine nationalism’ observed during the COVID-19 pandemic served as a wake-up call, highlighting the stark inequities in global access to medicines. In response, COVAX, an initiative aiming for equitable access, planned to deliver vaccines to immunise 20% of populations in 46 African nations, yet only managed to supply coverage to a mere 1.4%. High-income countries stockpiled doses and imposed export restrictions, limiting access in lower-income nations.

The Journey: Research and Methodology

In December 2023, Gavi, the Vaccine Alliance, approved the African Vaccine Manufacturing Accelerator (AVMA). This 1 billion USD financing instrument aims to foster a strong ecosystem to boost African vaccine manufacturing and deliver more than 0.8 billion vaccine doses in the next decade to reduce dependency on imports.

Save the Children UK’s health policy team systematically engages with GAVI policy and governance processes in addition to numerous coalitions and global health organisations. To complement their work on vaccine market shaping, Save the Children UK requested our help in producing a report with best practices recommendations to influence the operation of the AVMA instrument. We began with comprehensive desk-based research, including a detailed literature review of the major barriers vaccine manufacturers face across the entire value chain from research and development to production and deployment. We also assessed AVMA’s potential as an effective financing instrument to incentivise new market entrants, drawing comparisons with previously deployed incentive mechanisms. To gain further insights, we conducted in-depth interviews with leading global health experts, including academics and industry professionals.

Our final report concluded that the vaccine value chain is inherently complex, with challenges across every step, such as limited access to finance, infrastructural and technological inadequacies, regulatory complexities, a lack of trained workforces and incomplete supply chains. AVMA aims to address one of the main barriers-access to finance faced by manufacturers- by creating viable markets.

We made recommendations to Gavi and relevant stakeholders to ensure the successful operation of the instrument moving forwards. First, we suggested the operation of AVMA addresses balancing the need to ensure vaccine quality and public confidence with also providing more affordable regulatory processes for manufacturers. We also recommended greater coordination and support between manufacturers, donors and partners. To achieve effective collaboration more data sharing is necessary, such as creating a shared visibility map of the investment and capacity needs across the continent, as each region has varying levels of manufacturing. We included multiple case studies for different countries, manufacturers and vaccine types. Finally, we made technical recommendations on how to foster strategic alliances, technology transfers and how to promote a setting for pooled procurement.

AVMA is by no means a silver bullet solution but the mood among the stakeholders we interviewed was one of optimism and we concluded that if executed correctly, AVMA could be a catalyst for change in the African continent’s move towards vaccine self-sufficiency.

Looking Ahead: Upcoming Roundtable

Most of the MSc consultancy projects conclude after two academic terms, but we have been fortunate to continue our work with Save the Children UK. We are exploring avenues to publish and disseminate our MSc report titled: Fostering Sustainable African Vaccine Manufacturing Capacity. Additionally, we are co-organising a roundtable discussion and webinar with various stakeholders, including those involved in the development of the AVMA, civil society organisations, and the African manufacturers who will be utilising the instrument.

Challenges and Key Learnings: Advice to Future Cohorts

1. Be prepared for ongoing changes in your project!
When dealing with real-world global health challenges, flexibility is essential. At the outset of our project, we were tasked with evaluating potential financial incentive mechanisms but three months into our work, AVMA was approved by the Gavi Board to go ahead into operation. As a result, we adjusted the scope of our work after meeting with our client at Save the Children UK, and together, we decided to shift our focus from the design process of AVMA to providing recommendations on its governance and operation. Be open to adjusting your approach and research focus as necessary. It’s important to take the initiative to check in with your client regularly to ensure alignment.

2. Teamwork is key!
Success in a consultancy project requires strong teamwork and consistent communication. You will be working in diverse teams with different schedules and commitments, so it is important to actively listen and leverage each other’s unique skill sets. Be empathetic and understand that at times, some team members may be able to contribute more than others — it’s important to be flexible and support one another when this happens. Dividing roles and keeping track of workloads ensures that everyone stays aligned. Additionally, maintaining records of tasks and milestones is a valuable project management skill to develop.

3. Learn from experts!
We were fortunate to have a proactive and supportive client who allowed us to bring our own approach, while being available for regular follow-ups and hands-on guidance when needed. Your client will likely be an expert in the field, so take advantage of their knowledge and advice. Conducting interviews with key stakeholders was also instrumental in shaping our recommendations, as it allowed us to gain further insights into challenges that might not have surfaced in the literature review alone. Not every project may call for this option, but where possible, it’s invaluable to engage directly with stakeholders.

Finally, make sure to enjoy the project! It is a unique opportunity to apply your MSc studies in a professional setting, and we have found it incredibly rewarding. We are deeply grateful to our client at Save the Children UK and to the LSE for this opportunity.

The team has now graduated but are continuing this work and are in the process of co-organising a roundtable discussion and webinar with Save the Children to present their findings to key stakeholders.

The views expressed in this post are those of the author and in no way reflect those of the International Development LSE blog or the London School of Economics and Political Science. 

Featured image: The Save the Children UK – LSE consultancy team.