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Effective, Efficient, and Equitable: How Open Government Can Deliver on Vaccines

Efectividad, eficiencia y equidad: El gobierno abierto y las vacunas

Renzo Falla|

COVID-19 vaccines are an essential tool in the race to save lives and rebuild economies during the pandemic. As more vaccines become available, ensuring their distribution is an urgent, global challenge. At the time of writing, several types of COVID-19 vaccines are in circulation, with more than 200 in development. Yet this unprecedented scale presents a series of challenges that are becoming increasingly clear:

  • Corruption risks: Health procurement – particularly during emergencies – is prone to corruption risks, including conflicts of interest, nepotism, favoritism, and diversion of emergency funds. We are already seeing cases of “vaccine capture”, where the powerful and well-connected have been able to cut the line to receive a jab.
  • Effectiveness and efficiency: Although a well-planned distribution and supply chain is critical, the WHO has found that many countries are not prepared for the roll-out. We see reports of health facilities throwing out unused and spoiled vaccines, and vaccine wastage rates are rarely reported
  • Equity: Vaccines are disproportionately going to well-off populations. Globally, more than 50% of all vaccines have been reserved by high-income countries representing 13% of the world’s population (see map below). And COVAX, a global initiative aimed at equitable access to COVID-19 vaccines, remains underfunded. At the domestic level, early numbers show that racial minorities and marginalized groups are getting vaccinated at lower rates – even though they suffer a higher burden of disease.

COVID-19 Vaccine Doses Administered in OGP Countries

As of 15 March 2021. Data from Our World in Data.

The Open Government Approach

Open government can help to achieve the effective, efficient, and equitable delivery of vaccines. Applying the pillars of transparency, civic participation, and public accountability throughout the life cycle of vaccines can mitigate corruption risks, achieve value for money, build public trust, and ensure that vaccines are reaching the people who need them most.

Open Review and Approval

Involving non-governmental expert scientists in the initial authorization process and being open about the safety and effectiveness of particular vaccines is critical for addressing vaccine hesitancy, particularly given the accelerated timelines of current approval processes. Research shows that government transparency around vaccine safety, combined with frequent communication throughout the regulatory process, increases trust in vaccines.

Open Contracting

Open procurement processes – from tender to execution – ensure value for money, reduce corruption, and boost public trust. They are particularly important given early evidence of unfair pricing practices. Investigations show that pharmaceutical companies are requesting sovereign assets as collateral for legal costs, are being exempted from financial liability through public funds, and are often charging lower-income governments more than high-income ones.

Open Distribution

Publishing timely information and partnering with citizens are essential to an open roll-out. Our analysis of vaccination data shows that several countries are not regularly disclosing basic data on recipients, highlighting the scarcity of details that can help ensure both a more equitable distribution and data privacy. In the United States, for example, state-level data on the number of vaccinations by race has spurred new vaccine equity policies. On the engagement side, involving civil society in the planning and implementation of roll-outs can help tackle misinformation, address vaccine hesitancy, and empower marginalized groups to understand how to obtain vaccinations.

Monitoring and Oversight

Establishing multiple, public-facing channels for monitoring – such as formal oversight bodies, corruption hotlines, and grassroots social accountability initiatives – can help to detect waste, fraud, and abuse. Governments should commit to 1) enabling space for civil society to play a monitoring function and 2) quickly addressing any deficiencies identified. This includes setting up grievance mechanisms that allow citizens to achieve redress if they are unfairly denied vaccines. 

Moving From Ideas to Action

The Open Government Partnership (OGP) provides a platform for government and civil society reformers to weave open government approaches into their vaccination policies. Although OGP members have not yet made commitments specifically about COVID-19 vaccines, other existing health-related commitments could be expanded to cover them, such as:

  • Argentina expanded health contracting disclosures to include agreements signed with laboratories, open data on individual purchases, and a list of most-procured medications.
  • Liberia committed to disclose supply chain management decisions and updates, including on emergency procurements during the pandemic. 
  • Colombia committed to establish citizen audits for government expenditures on COVID-19 emergency measures.

With more than 100 OGP members co-creating action plans this year, reformers can take advantage of this opportunity to make concrete commitments that apply an open government approach to vaccines. Doing so will be critical to ensure an effective, efficient, and equitable vaccine distribution, and by extension, to save lives and livelihoods.

 

Featured Image Credit: MarsBars via iStock

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