Table 2 Assessment of mechanisms to mitigate the disadvantages of APAs

How well does the measure/ mechanism work for each buyer type?

HIC state buyer

LOW – most likely to ‘lose’ from an enforced treaty in terms of volume and speed of access

HIGH – HIC buyers can choose who they pool with and on what terms

DEPENDS on eligibility criteria. Not conceived as the primary channel of access for HICs

MEDIUM—HICs have greater capacity to use market information but probably already have greater access to this information

HIGH – have most buying power to use resale markets to secure if needed; and in face of surplus can recoup some expenditure

MEDIUM – can potentially claim ODA credits and otherwise gain soft power

MEDIUM—Can potentially reduce overbuying, but less to gain than other buyers less able to afford this risk

L&MIC state buyer

HIGH – most likely to gain in terms of volume and speed of access, if treaty provisions can be enforced

MEDIUM – L&MIC buyers can choose who they pool with. But pooling cannot by itself compensate for shared lack of purchasing power

MEDIUM – L&MICs would still need up-front financing for the premium, and eventually the products. Most useful for MICs and for LICs if accompanied by donor subsidy

LOW – this is a weak lever and L&MICs have mixed capability to use the information to make better deals

MEDIUM – on average, these buyers tend to have lower buyer power for left-over doses, so only works well in situations of significant oversupply

MEDIUM – can help L&MICs plan and manage supply from different sources. But would remain dependent on HICs and benefit only if HICs have excess supply

DEPENDS on the context. Less use of APAs by others might allow L&MICs to secure supply, but also reduce donations from HICs

International organization buying on behalf of L&MICs

DEPENDS on the content of the treaty and roles for international organizations in it, as well as on enforcement

N/A – international organizations are already pooling on behalf of L&MICs

DEPENDS on the interface between facility and existing international infrastructure. Call options could be used in COVAX’s ‘self-financing’ stream, the facility could use UNICEF to place deals, or it could be a completely sperate entity

MEDIUM –international procurement organizations are well placed to make good use of market information

MEDIUM/HIGH – with moderate buyer power and a diverse client base, should be able to use resale markets effectively

DEPENDS on whether donations flow through the international organization or outside it through bilateral arrangements with recipients

HIGH – can take advantage of flexibility to obtain better prices and reduce risk of overbuying in environment of adequate supply