Corruption in COVID-19 Vaccine Procurement and Distribution: The Case of the COVAX Facility (preprint)

ABSTRACT

Background The COVID-19 pandemic has presented new opportunities for corruption to infiltrate health and pharmaceutical sectors globally, increasing health inequities within and between countries. COVID-19 vaccine procurement and distribution are specific areas that are vulnerable to corruption due to their attraction of large amounts of public and private funding, involvement of a high number of stakeholders, and lack of centralized oversight. We conducted a descriptive, qualitative study of corruption risks and the use of anti-corruption, transparency, and accountability (ACTA) mechanisms in the international COVID-19 vaccine and distribution process.Results We identified 34 academic articles and policy documents and triangulated documentary data with 16 key informant interviews. A review of the literature identified four distinct corruption risks in the international COVID-19 vaccine procurement and distribution process (1) a lack of transparency and accountability in the operation of the COVAX Facility; (2) a lack of transparency in the vaccine procurement process; (3) a risk of bribery; and (4) a risk of vaccine theft or the introduction of substandard and falsified vaccines at the point of distribution. Key informants further articulated concerns about a lack of transparency in vaccine pricing and vaccine contracts and the exclusion of civil society organizations from the vaccine deployment process. Reported ACTA mechanisms implemented across various levels of the international vaccine procurement and distribution chain focused primarily on transparency mechanisms, including institutional oversight processes, blockchain-based supply-chain solutions, and civil society engagements.Conclusion Emergency responses to public health crises expose institutions, such as governments and international organizations, to high risks of corruption without adequate ACTA mechanisms. Experiences during the COVID-19 vaccine deployment process demonstrate that efforts to improve transparency will be insufficient without commensurate sanctions programs in place.