Drawing upon experiences gained during the COVID-19 pandemic in coordinating the COVAX Strategic Coordination Office (SCO), this paper proposes lessons for future pandemic responses, as well as what might be maintained during intra-pandemic periods, to better prepare for future emergencies.
Download the report hereDecember 2023
The COVAX Strategic Coordination Office
This document published by COVAX partners, including CEPI, Gavi, the Vaccine Alliance, UNICEF and WHO. The contents included are the result of a collaborative process managed by the COVAX SCO. The republication or usage of the content of this document of any kind without written permission is prohibited. Please contact press@cepi.net, media@gavi.org, tingram@unicef.org, mediainquiries@who.int with any requests for use.
COVAX was the global, multilateral initiative aimed at making COVID-19 vaccines available equitably to those that needed them. It was also the largest vaccination programme in history, covering 146 countries and delivering ~2 billion doses over three years.
This paper considers the make-up, attributes, successes and challenges of the COVAX Strategic Coordination Office (SCO), one of the key functions of this effort. It has been authored by members of the SCO, informed by a wide range of interviews and feedback undertaken with leaders and operational teams from across the 30+ COVAX workstreams.
COVAX was co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), working in partnership with developed and developing country vaccine manufacturers, the Pan-American Health Organization (PAHO), the World Bank, civil society organisations, funders, and others.
COVAX was an end-to-end partnership with dedicated groups working along the vaccination value chain: from accelerating the development and manufacturing of COVID-19 vaccines to promoting fair and equitable access for every country in the world, assisting countries with rolling out vaccination programmes and strengthening in-country delivery systems.
The COVAX Strategic Coordination Office (SCO) was the cross-partner secretariat that worked across the network of teams and organisations to align leadership, management and operational delivery.
While this paper draws upon experiences gained during the COVID-19 pandemic, it also proposes lessons for future pandemic responses, as well as what might be maintained during intra-pandemic periods, to allow us to be better positioned to a future emergency.
Governance and coordination. The COVAX SCO provided the secretariat for COVAX cross-partner decision-making, bringing together senior leaders from each partner organisation. At the peak of the pandemic there were a minimum of four, and often more, cross-partner decision-making meetings each week to align on risks and resolutions and make decisions at pace. In addition, working groups and task forces (e.g. on manufacturing, external communications, resource mobilisation, strategy, etc.) were convened during the course of the pandemic. The SCO managed the agendas, schedule, invitation list, content curation and minutes for all sessions. A member of the SCO also chaired the meetings. Furthermore, the SCO organised quarterly leadership "retreats" once these were made possible by global easing of COVID-19 restrictions.
Operations. The SCO coordinated all COVAX operations, working closely with workstream leads across the vaccines value chain. As chair of the main operational meeting, known as SWAT, the SCO played an important role as the "glue" that kept the operational process functioning, and driving actions to overcome problems. During COVAX, the SCO was also asked to surge into operational positions outside of the core scope to provide project management or other skills. The workstreams that SCO members worked on included product management, donations, demand management, allocations, manufacturing and data management.
Strategic projects. The SCO oversaw time-limited, strategic projects. These included coordinating the COVAX Strategy and Budget for 2021–22, writing the COVAX Structures and Principles document, developing the 2023 COVAX Operational Plan, determining the Worst Case Scenario Preparedness Plan and coordinating the COVAX close-down.
Note: Although the core scope and mandate of the SCO remained reasonably stable throughout COVAX, the actual activity of the team was constantly evolving to meet the shifting needs of the pandemic response. Looking back, the SCO updated its approach and team roles approximately every three months. This ability to "evolve on the move" was a core attribute that allowed the SCO to remain fit for purpose as circumstances changed.
Neutrality. The COVAX SCO comprised individuals drawn from the four COVAX partners. Representation from each partner was crucial in making this central function a "team for all". During onboarding, team members were asked to set aside organisational affiliations and act with a "One COVAX" mindset. This helped the SCO foster trust across all partners, allowing it to be an honest broker, even at times of tension or disagreement.
"What we as senior leaders often do if there are bumps, is we talk within our organisation. This is because we don't have a neutral person to raise our grievance with. The SCO neutrality provided a key role."
SCO members did at times face challenges to this approach. First, there were times when there was pressure to advocate for their own organisation’s position. Equally, there were times when it was suggested they were acting in their organisation’s interest. It is likely this tension will always occur in such constructs – particularly where others are in roles that require a less neutral mindset. However, the strong focus on the "One COVAX" mindset from the onset, and the widely accepted principle that the SCO is a "neutral" team, helped to mitigate these challenges. Further, that criticism was received in both directions indicates that the right balance between the two was broadly maintained.
Convene, coordinate, collaborate. Not tell, direct or command. COVAX was not a legal entity. It had no formal board and no formal decision-making powers. There was never any collective COVAX budget that was managed through a central fund and function. Instead, formal decision-making remained within the structures (Boards, line management) of each organisation. Despite this, COVAX fostered enough trust so that the cross-partner forums that were established took collective decisions that each organisation then felt accountable to enact. Working within this construct, the SCO did not have any mandate to task, tell or direct. However, it played a crucial role convening, coordinating and driving collaboration.
"The job and work to bring everyone together and on the same page, to get people to walk in the same direction, at the same pace, has been amazing. The SCO has been crucial to the functioning of COVAX."
Within this model, achieving the pace of progress required during an emergency can be a challenge. A classic, hierarchical management model can establish command and control approaches that quickly direct teams to deliver outputs. COVAX was a networked structure (see Exhibit 2), and therefore delivery had to be achieved through collaborative approaches, given there was no hierarchy among the four equal partners.
The importance of influence, diplomacy, and compromise in this model was much more heightened. Specifically, the SCO was the connector of disparate nodes, investing upfront to try and reach consensus, then convening decision-makers to make collective decisions. This allowed meetings with large agendas to progress efficiently and meant most issues were resolved before large online meetings, where there can be pressure to hold a position.
Balanced skill set and flexibility. In addition to the importance of coordination and collaboration in a network-like structure, the skill sets of the SCO members played an essential role for facilitating cross-cutting problem-solving in an efficient way. Through their diverse backgrounds, the SCO team was able to identify pain points and issues and escalated these to the various governance bodies as needed. The diverse skill sets among the team and the SCO’s connecting position in both operational and strategic discussions also placed the team in a position to not only identify challenges across the COVAX workstreams, but also to provide support where needed. This resulted in the SCO providing surge support across the COVAX value chain during times of necessity. The team’s high level of experience and agility provided them with the resilience and flexibility to quickly assume this operational responsibility when and as needed.
"One learning is that this type of structure is a ‘must replicate’ whenever you have different partnerships. […]. Having a sizeable coordination function, but that is small enough to be agile, and leveraging the knowledge and power of institutions is critical."
The evolving nature of the pandemic necessitated a continual review and update of the focus of COVAX and the SCO. To ensure adaptability and to maintain a fit-for-purpose team, the SCO conducted quarterly reviews of the team structure along with their roles and responsibilities. This quarterly exercise provided the team with the means to reflect effectively on the challenges and successes of the preceding quarter, and efficiently adjust and retool to acclimate to the dynamic needs of COVAX.
Looking across the value chain. Apart from leadership, most teams were positioned at particular points in the vaccines value chain. The SCO was unique in working across the value chain up to arrival in country. It was key that the SCO had their ‘finger on the pulse’ of COVAX throughout its various phases. From this position, the SCO was able to identify and help solve hand-off challenges, connect different teams and have an early view on potential issues before they became too large. The SCO’s view of the end-to-end activities allowed for visibility of the interconnected picture of COVAX, allowing the SCO to pinpoint and escalate any interdependent challenges that needed to be resolved collaboratively or discussed in a higher forum.
"The SCO kept COVAX operations on track and managed to create a process for the partners to interact. COVAX has been pretty remarkable in terms of day-to-day integration, which is largely attributable to the work of the SCO."
Open by design. By having a "One COVAX" mindset, the SCO helped to drive transparency between organisations. In other settings, organisations can be reluctant to share draft versions of documents before they have progressed through the (often many) layers of internal review and sign-off. By nature, many COVAX activities involved inputs from teams across several partners. The result was an "open by design" mentality. The SCO did not solely create this, but by proactively behaving in this way, played an important role in setting the tone for how COVAX teams worked together.
"Non-intrusive and helpful. It is not always the case that you have this kind of set-up. It was neutral and drove things along, linking everyone up. It helped overcome egos and institutional boundaries."
Building the right culture. That the SCO established the above characteristics helped to create a team that was efficient, high-performing and widely trusted. However, these attributes did not develop organically. They were pre-identified during mobilisation and reiterated throughout the pandemic, with new joiners receiving a specific briefing covering neutrality, transparency; being told: "Convene, don’t direct."
Resourcing. Throughout the life cycle of the SCO, recruitment proved challenging. The absence of a team budget and the resulting reliance on agencies’ unaligned funding cycles created recruitment delays. This lack of reliability in the SCO resourcing model led to many short-term contracts, resulting in a lack of continuity, prolonged lead times for recruitment and upskilling, and a sense of frustration within the team due to a lack of uncertainty in the future of their roles.
Section 2 puts forward a set of principles and a potential model for how a similar coordination function might be prepared for and established for a future emergency.
Principles of effective coordination in a global health crisis
While partners frequently work closely together on aspects of outbreaks1, the COVID-19 pandemic was the first time agencies had come together to coordinate a full-scale, pandemic-level response across the full vaccines value chain. The fact that the COVAX Strategic Coordination Office (SCO) was not fully established until April 2021 reflects that it takes time to put such a model in place. Further, establishing such a function from scratch during an emergency presented many resourcing, scoping and process challenges.
Steps should be taken to prepare before time, so that organisations can more quickly scale up this capability as a crisis begins. Below are outlined options for how both an intra- and future crisis coordination function might be constituted.
For all options outlined below, having a clear scope and mandate for the group is essential, as well as the governance mechanisms for each partner to ensure effective decision-making and the capability to quickly pivot between interpandemic and emergency response, when required.
Between emergencies: intra-crisis coordination
Maintain a small number of cross-partner resources in an informal or formal arrangement: the team is tasked with epidemic and pandemic-scale vaccines emergency planning. These resources could then establish and support a working group of wider stakeholders. Examples of types of potential intra-crisis coordination team models include:
During emergencies: coordination in a crisis
It is likely that the next pandemic-scale health emergency will not follow the same form as COVID-19. Different circumstances will require agility in the set-up and running of a response capability – for example, the role vaccines play may be different (e.g. transmission-blocking or not) and the timing of vaccine availability is likely to change.
However, whatever the nature of the outbreak, the benefits of a pre-planned and quickly scalable coordination capability will be significant. Working cross-organisation and with people at regional and country levels, this capability can play a key role in the hopefully speedy tackling of the outbreak – reducing its impact on people’s health and countries’ economies.
This article focuses on the experiences from COVID-19 and future coordination during a public health emergency. However, it is suggested that the principles described for effective crisis management within a network – coordinate not dictate, open by design, remain agile – could be helpful for similar activities in related fields.
The work of the SCO would not have been possible without the commitment of many talented people:
The findings of this paper are with many thanks to the COVAX leadership and operational teams for their insights during interviews for this paper and input throughout COVAX:
COVAX Leadership: Richard Hatchett, Seth Berkley, Soumya Swaminathan, Bruce Aylward, Etleva Kadilli, Ted Chaiban, Melanie Saville, Aurélia Nguyen, Derrick Sim, Kate O’Brien, Andrew Jones, Richard Mihigo, Ann Lindstrand and Benjamin Schreiber
COVAX Chief of Staff: CEPI: Joseph Simmonds-Issler, Kristine Rose, Claire Willman; Gavi: Hannah Burris, Alex Beecher; UNICEF: Tara Prasad; WHO: Catherine Mullholland, Jennifer Barragan, Stephanie Shendale, Brian Riley; and CoVDP: Sona Bari, Nisha Schumann
COVAX Operations: The SWAT leads and many, many passionate and committed teams across the 30+ COVAX workstreams
1. See the Measles and Rubella Partnership and the International Coordinating Group (ICG) on Vaccine Provision