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If you’ve ever questioned the crucial role that lawyers play in making the world influential, consider the following example. gabi, the vaccine alliance.
Elena Madir
Gabi
At the beginning of the pandemic, Gavi, a public-private global health partnership focused on increasing immunization in low-income counties, faced the difficulty of leading the procurement and delivery of a Covid-19 vaccine workstream as part of a WHO project. I was facing challenges. Specifically, when a vaccine became available, a plan had to be put in place to ensure that it was distributed fairly and equitably. This meant avoiding the possibility that medicines would only be distributed to a few wealthy countries that could negotiate their own contracts with health care providers.
“We had to find a way to ensure that the poorer countries we represent could also be vaccinated,” said Elena Madir, Gavi’s general counsel and lead lawyer on the project.
Their solution was to set up the Covax program, with Gavi as legal controller, to manufacture and distribute the Covid-19 vaccine. It was a very complex and urgently important undertaking, but thanks to a team of internal and external lawyers, Gavi ultimately delivered nearly 2 billion doses of the vaccine to nearly 150 countries. “Lawyers have been involved from the very beginning, guiding business teams through the maze of legal risks inherent in complex structures and proposing appropriate[solutions],” Madhir says.
The organization has also just won the 2023 Gronin Prize for Law and Social Entrepreneurship.Managed by Gronin Law and the Center for Social Entrepreneurship The New York University Law School recognizes the participation of lawyers in how business increasingly advances sustainability and human development goals.
Vaccine delivery in Bangladesh
Gabi
Funding model
The basic model was that vaccines for low-income countries and low-income countries (92 countries in total) would be funded by donor funds. However, to ensure as much demand as possible, 73 self-financed high- and middle-income countries ranging from Bolivia to Canada also participated, bearing their own doses. At the time, no one knew when a vaccine would be available, but Gabi was aware that high-income countries would compete for dosage. By including them in the contract, “we wanted them to be able to contribute a little bit to the game,” Madir said.
Multiple tricky challenges
At the same time, Gavi had to strike deals with manufacturers to supply the vaccine. It was hard. “Manufacturers are reluctant to agree to scale up production while a vaccine is in development,” Madir said. To avoid potential delays and strife, Madhir and his colleagues struck an agreement to guarantee the purchase of a certain number of doses.
There was also the issue of Gabi’s dangerous position. As an intermediary, if one country doesn’t pay, it could be in trouble. (Some ended up in default, according to Madhir.) With that in mind, the first approach was to ask participating countries for a commercial bank or multilateral development bank guarantee. But it took a long time and the deadline he had was December 2020. So instead, Gavi accepted guarantees from each country’s ministry of finance and eventually got default insurance from a private insurance company.
Madir said the biggest challenge was negotiating supplies. It was difficult to get a solid supply schedule from manufacturers, as it was not known if or when the vaccine would be successful. We also had problems negotiating the lowest possible price. That meant manufacturers would not prioritize deliveries to poorer countries paying such low prices.
Solution: Slot replacement. If high-income countries had the purchasing power advantage but didn’t need so many doses, they would take a step back and let Kovacs take over. They also persuaded wealthy nations, including the United States, which did not participate in Kovacs, to donate excess doses.
template
As you can imagine, it took a lot of legal acumen to make all this happen. That expertise was provided by Gavi’s in-house legal team (which grew from 4 to his 12-person team) and outside counsel. The construction of the facility required a number of complex initiatives, including negotiating agreements with more than 150 governments, as well as separate contracts and insurance policies with 10 manufacturers.
Ultimately, Covax’s facility could have applications in other crises as well. “This is a template for a global risk-sharing arrangement and a foundation for the world to prepare for the next pandemic,” Madhir said.