When Global Partnerships Scale Up: Lessons from COVAX's Pandemic Response

COVAX was launched in 2020 as a global initiative to ensure fair worldwide access to COVID-19 vaccines, especially for lower-income countries. Its leaders described it as "the only global solution" for vaccine equity. However, by mid-2021, 90% of vaccines had gone to wealthy G20 countries while COVAX had delivered less than 5% of its target. This study examines why COVAX fell dramatically short of its goals. 

The researchers argue the failure was not primarily caused by external forces but by COVAX's own design. COVAX represents a new and experimental institutional form the authors call a "super-partnership": a public-private partnership made up of other public-private partnerships, layered together like nested dolls and involving governments, UN agencies, philanthropic foundations, and pharmaceutical companies. While this structure successfully mobilized resources and delivered doses to over 100 countries quickly, it lacked the authority to prevent wealthy member governments from cutting bilateral deals that competed with COVAX for supply. In addition, it gave pharmaceutical companies significant leverage without requiring equitable pricing or technology sharing in return. 

The broader lesson is that scaling up voluntary, partnership-based governance to solve truly global problems can create tensions that charity-based models are not well designed to handle.

COVAX and the rise of the ‘super public private partnership’ for global health
Authors: Katerini Tagmatarchi Storeng and Antoine de Bengy Puyvallee
Published: 2021, Global Public Health