Incentivising wealthy nations to participate in the COVID-19 Vaccine Global Access Facility (COVAX): a game theory perspective

A game theory analysis suggested ways in which bilateral deals could potentially improve the global supply of vaccines, for example, if the manufacturer involved in the deal shares know-how or if the deal expands the global supply of critical inputs that might otherwise constrain production of COVAX vaccines. Unfortunately, we failed to learn from the H1N1 pandemic—rich nations are again flexing their market power by entering into bilateral purchase agreements with COVID-19 vaccine manufacturers (table 1), potentially hoarding the global supply.3 Such ‘vaccine nationalism’ is a major threat to reaching global herd immunity and a return of normal social and economic activity.4 5 Table 1 Selected examples of bilateral COVID-19 vaccine purchasing agreements, as of November 12, 2020 (source: https://launchandscalefaster.org/COVID-19) Purchaser (country) Vaccine manufacturer Number of doses committed by manufacturer to purchaser, millions Total number of doses committed to purchaser, millions USA Oxford University 300 810 Janssen (J&J) 100 Moderna 100 Novavax 110 Pfizer 100 Sanofi-GSK 100 Canada Novavax 76 358 Medicago 76 Sanofi-GSK 72 Moderna 56 Janssen (J&J) 38 Oxford University 20 Pfizer 20 UK Oxford University 100 340 Novavax 60 Sanofi-GSK 60 Valneva 60 Janssen (J&J) 30 Pfizer 30 Japan AstraZeneca 120 240 Pfizer 120 The COVID-19 Vaccine Global Access Facility (COVAX) The new COVID-19 Vaccine Global Access Facility (COVAX)—led by Gavi, the Vaccine Alliance (Gavi), the Coalition for Epidemic Preparedness Innovations (CEPI), and the WHO—attempts to overcome vaccine nationalism. Gavi states that it will try its best to support COVAX self-financing participants to choose a particular vaccine from the COVAX portfolio, even though it still remains uncertain which vaccines will be available, when, and at what scale.8 Gavi is also establishing a COVAX Exchange—a marketplace for both self-financing and funded countries—to ‘facilitate trading of allocations of vaccine for all participants’.8 If a wealthy country is already doing deals on its own to secure vaccine, often with a manufacturer based in that country (eg, the US government with the US company Novavax—table 1), participating in COVAX could still be valuable as an insurance policy. Game theory analysis has been used to address various global health challenges, such as in predicting (1) the prescribing behaviour of physicians in the face of rising antimicrobial resistance13 14; (2) population behaviour under v