Sam Halabi

(1) Background: This study addresses two weaknesses in current international efforts to prevent and prepare for the next pandemic: the lack of robust evidence supporting global policy measures and the corresponding extent to which those measures advance equity. (2) Methods: Using UNICEF’s publicly available but underused COVID-19 Market Dashboard database, we conducted a cross-sectional analysis of vaccine deliveries as of mid-2022 and vaccine procurement strategies used by African low- and lower middle-income countries (LMICs) over the course of the COVID-19 pandemic. (3) Results: Pooled procurement of the kind typified by COVAX (a clearinghouse for high-income-country contributions of vaccines and financing toward the end of equitable LMIC procurement) crowded out alternative strategies that must be supported in future: regional procurement, donation, and bilateral procurement (binding agreement between two parties: one seller (i.e., a national government or a vaccine manufacturer) and one recipient (i.e., national government)), which showed a significant relationship with technology transfer and advancing local production capacity. (4) Conclusions: Expanding the scope of vaccine procurement alternatives to COVAX such as regional pooled procurement and bilateral procurement can stratify risk of supply agreements not materializing in actual supply. Sharing the technology necessary to produce vaccines with LMICs can mitigate obstacles to bilateral procurement. A pooled purchase alliance to procure vaccine doses on behalf of participating countries within a given region can benefit LMICs by accounting for infrastructure limitations that these countries share. Finally, donations bolster global redistributed supply essential to LMICs.