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Independent review into COVID vaccine procurement released

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The executive summary of an independent review of Australia’s COVID-19 vaccine and treatment procurements has been released, with the Federal Government set to ‘carefully consider’ its eight recommendations.
 
The review, prepared by former Department of Health Secretary Professor Jane Halton, points to ongoing uncertainty surrounding the COVID-19 pandemic and states that the next two years are ‘critical’ to helping Australia’s economy, health and education systems recover.
 
‘Australia and the world are not yet “COVID-stable”, and we are unable to confidently predict the timing or impact of new waves and variants,’ Professor Halton wrote.
 
‘Consideration should be given to the decision-making structures and advice required, and whether new and existing pathways for procurement and distribution of vaccines and treatments should be retained or adapted.
 
‘The availability of efficacious vaccines and treatments will continue to play a key role in ensuring ongoing protection for lives and livelihoods … [and] it is critical that Australia maintains surge capacity in the event of a serious new variant or another infectious disease.’
 
The report goes on to say that pre-pandemic structures and processes were ‘not fit for purpose in an emergency context’, and that ad hoc arrangements put in place at the beginning of pandemic ‘require updating’.
 
The recommendations contained in the review cover:

• the need for public health campaigns around vaccine uptake
• an updated COVID-19 policy framework
• the streamlining of advisory structures
• a review of vaccine distribution arrangements
• the need to ensure adequate supplies of therapeutics and vaccines across 2023 and 2024.

Federal Health and Aged Care Minister Mark Butler responded to the review by thanking Professor Halton for her work, saying the Government wants to ensure it is on the ‘front foot’ in managing the pandemic.
 
‘As a new incoming government, we commissioned this review to make sure future procurement and purchasing strategies are fit for purpose and appropriate,’ he said. 
  
‘The Government will now carefully consider the recommendations in the report as part of its long-term strategy to manage COVID-19.’ 
 
Going forwards, the report forecasts an oversupply of Novavax in 2023, but recommends the procurement of additional Moderna vaccines to meet ‘any anticipated shortfall’ in mRNA vaccines and to ensure access to vaccines for children under five years.
 
And while conceding that forecasting vaccine requirements is an ‘inexact science’, it advocates for an ‘on-demand ordering arrangement’, which would significantly reduce vaccine wastage and therefore decrease the total amount of vaccines required to meet demand in 2023 and 2024.
 
‘Early procurement of vaccines and treatments occurred in the context of uncertainty and a global vaccine shortage – a “sellers’ market”. Agreement to conditions not usually included in ordinary procurement contracts was necessary to secure commitments to supply,’ the report states.
 
‘Minimum endemic, “COVID-stable”, quantities of effective vaccines should form the foundation of 2024 vaccines orders.
 
‘In the event “COVID-stable” has not been achieved a prudent buffer should be based on medium demand options. Specific arrangements to scale up supply in the event of high or emergency demand should be designed and implemented.’
 
Details on the conditions ‘not usually included’ in vaccine procurement contracts were not released, as while the executive summary and recommendations of the Halton report are publicly available, the remainder has been deemed ‘commercial-in-confidence’. 
 
Recommendations in full:
 
Recommendation 1
Public health campaigns designed to encourage sustained booster uptake for those that will benefit should be developed and delivered during 2023 and 2024 to improve coverage.
 
Recommendation 2
A clear, updated, policy framework including objectives for the management of COVID-19 should be developed to inform decision-making, purchasing, clinical decision-making and resource allocation. A statement of risk appetite should form a part of this framework.
 
Recommendation 3
Advisory structures should be streamlined, and advice should be integrated to enable decision-makers to undertake their role. The role of decision-makers and advisors should be clarified. Reasons for decisions should be evidenced including indicating where they are based on judgment. Care should be taken to prevent confusion at the clinical level about who is eligible to receive vaccines/treatments and recommendations for use including in respect of target populations.
 
Recommendation 4
Procurement decisions should be made in the context of agreed policy objectives, risk appetite (the acceptability of failure to supply), knowledge/predictions in respect of the evolution of the virus, and supply constraints including knowledge of market behaviour.
 
Recommendation 5
Vaccine distribution arrangements should be reviewed in order to test value for money and reduce wastage while ensuring timely access.
 
Recommendation 6
New mechanisms to manage stock held by the NMS for use in an ongoing pandemic or epidemic should be developed as a matter of urgency to enable greater transparency about and access to stock held.
 
Recommendation 7
The Department of Health and Aged Care should work with sponsors to ensure that adequate supplies of therapeutics are available to meet reasonably anticipated demand for the next two years. Mechanisms such as guarantees for minimum supply should be explored to ensure availability and access.
 
Recommendation 8
Steps should be taken, consistent with an agreed policy and risk appetite, to ensure adequate supplies of vaccines and treatments are available across 2023 and 2024 including in the event of spikes in demand. This should include additional Moderna vaccines in 2023 and, as a minimum and based on an assessment of ‘COVID-19 stability’, doses necessary to meet baseline demand in 2024.
 
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