Research and analysis

A review of the Vaccine Taskforce

Updated 31 August 2023

Introduction to the Vaccine Taskforce

On 11 March 2020, the World Health Organization (WHO) declared the spread of the COVID-19 virus a pandemic. The UK government had at this point already been active in funding research into the disease. In early April 2020, the Vaccine Taskforce (VTF) was set up in the Department for Business, Energy and Industrial Strategy (BEIS) to gather together the collective efforts of government, academia and industry to help find a vaccine against COVID-19, to protect and save the lives of UK citizens.

The VTF’s formal objectives were originally formulated between May and June 2020 and have been slightly refined over time. This review seeks to measure the taskforce’s performance against the final objectives in place at the end of the VTF in September 2022. All data in this document is correct as of 30 September 2022 unless otherwise indicated.

VTF objectives (September 2022)

Objective 1: secure access to promising vaccine(s) for the UK population and achieve lasting immunity.

Objective 2: make provision for international distribution of vaccines.

Objective 3: strengthen the UK’s onshore capacity and capability in vaccine development, manufacturing and supply chain to provide resilience for this and future pandemics.

The VTF was established in BEIS with a steering group comprising both external experts and senior civil servants, initially chaired by Dame Kate Bingham until December 2020 and subsequently by Sir Richard Sykes. The team consisted of:

• a strategy directorate
• an international directorate
• a commercial directorate (to lead negotiations with suppliers)
• a programmes directorate (to oversee the day-to-day delivery of the agreements the VTF made)

The VTF mobilised and recruited staff from across the Civil Service, private sector and academia. This provided a breadth of expertise, ranging from clinical and scientific knowledge, through to supply, programme management, delivery and commercial.

The VTF’s formal accountability was through the usual Civil Service procedures. A ministerial panel took all key spending decisions. The panel was made up of the:

• Health and Social Care Secretary
• Business Secretary
• Chief Secretary to the Treasury
• Minister for Government Efficiency at the Cabinet Office

Day-to-day ministerial decisions were taken by the Health and/or Business Secretary, with assurances sought and provided in the usual way, by permanent secretaries and/or accounting officers. The Director General of the VTF was the senior responsible owner of the programme throughout.

In July 2020, the VTF agreed a £5.2 billion programme business case with HM Treasury, supported by funding from the reserve, to fund interventions to help the VTF meet its objectives. At the start of the pandemic, the chances of a single vaccine being found to be safe and efficacious against COVID-19 in the near term were widely believed to be slim: the VTF itself quantified the optimistic scenario of a vaccine proceeding from the pre-clinical phase through to full safety and efficacy as a likelihood of 10%. Therefore, right at the heart of the VTF’s efforts to meet its objectives was a portfolio approach to vaccine procurement - increasing the overall chances of finding a single successful vaccine through multiple ‘shots on goal’.

The VTF became a joint unit between BEIS and the Department for Health and Social Care (DHSC) from August 2021. Accountability for vaccine supply and international distribution moved to DHSC, and BEIS retained accountability for the VTF’s work to support onshoring of vaccine capability. DHSC was responsible for vaccine deployment throughout and the vaccine deployment programme was separate to the VTF.

The VTF continued to support the UK’s vaccine programme throughout all its phases: from the early days of the pandemic and the global pursuit of a safe and effective vaccine, to the need to boost all adults, the introduction of an under-18s programme, and the roll-out of updated bivalent vaccines. This review sets out those phases in greater detail and explains how the VTF evolved its objectives to meet them.

From October 2022, the vaccine supply responsibilities of the VTF moved to the UK Health Security Agency (UKHSA) and established as a permanent function. Responsibility for the VTF onshoring programme moved to the Office for Life Sciences (OLS), a joint unit of the DHSC and Department for Science, Innovation and Technology.

Achievements: objective 1

Secure access to promising vaccine(s) for the UK population and achieve lasting immunity.

Following its establishment, the VTF secured access to a portfolio of 7 vaccines for the UK:

• Oxford-AstraZeneca
• Pfizer-BioNTech
• Moderna
• Janssen
• Novavax
• Sanofi-GSK
• Valneva

Pfizer-BioNTech has been part of the UK’s vaccine deployment programme throughout (from December 2020 to current), Oxford-AstraZeneca from January 2021 to August 2022, Moderna from April 2021 onwards and Novavax from September 2022.

By the time the Vaccine Taskforce closed in September 2022, over 150 million doses of Oxford-AstraZeneca, Pfizer-BioNTech and Moderna had been used in the UK.

The UK was the first country in the world to procure, regulate and deploy the Pfizer-BioNTech and Oxford-AstraZeneca vaccines (first deployed 8 December 2020 and 4 January 2021 respectively). It also procured, regulated and deployed the Moderna vaccine (first deployed in April 2021). These 3 vaccines now account for the most used vaccines in the world by number of countries to deploy them (see figure 1).

Figure 1: most used COVID-19 vaccines in the world, by number of countries to deploy

Developer	Number of countries to deploy vaccine
Oxford-AstraZeneca	185
Pfizer-BioNTech	164
Moderna	108
Janssen-Johnson & Johnson	98
Sinopharm-Beijing	74
Sinovac	41
Gamaleya (Sputnik V)	38
Novavax	32
Bharat Biotech (Covaxin)	30
CanSino	25

Source: Our world in data - Which vaccines have been administered in each country?

The VTF invested in trials to analyse the effect of different combinations of vaccines as a first, second and third dose to help inform deployment decisions (made by the Joint Committee on Vaccination and Immunisation (JCVI)). The UK’s COV-BOOST trial, for example, which tested 7 different vaccines as a booster dose following an Oxford-AstraZeneca or Pfizer-BioNTech primary course, was the first of its kind in the world.

Achievements: objective 2

Make provision for international distribution of vaccines.

In addition to securing access to vaccines for the UK, the VTF has been at the forefront of the UK government’s commitment to help the global fight against COVID-19.

The UK championed setting up COVID-19 Vaccines Global Access (COVAX) as a global initiative to support research, manufacturing, procurement and equitable distribution of COVID-19 vaccines for the benefit of all countries. COVAX’s initial aim was to make available 2 billion doses by the end of 2021, enough to enable participating countries to protect high risk and vulnerable people as well as healthcare workers. COVAX established a fund to support 92 lower income countries in getting equal access to vaccines. The UK provided £548 million through the Foreign, Commonwealth and Development Office (FCDO) aid budget to support this objective. By September 2022, COVAX had delivered over 1.7 billion doses to 146 countries.

COVAX additionally established a joint procurement pool for higher income countries intended to enable them to share the costs and risks of investing in a diverse vaccine portfolio. The UK joined this but procured very few vaccines through this route because of the success of the UK procurement programme.

The UK backed the Oxford-AstraZeneca vaccine with government funding. The UK government played a key role in the licensing of the Oxford University vaccine which made the vaccine available to developing countries at cost. The vaccine was crucial in the global fight against COVID-19. Around 2.5 billion doses had been distributed, at cost, to more than 170 countries by January 2022.

At the G7 Summit in June 2021, the then Prime Minister, Boris Johnson, announced that the UK would donate 100 million surplus COVID-19 vaccines, as part of a G7 commitment to make available at least 1 billion doses in support of WHO’s call to vaccinate at least 70% of the world’s population by the end of 2022. The VTF established a programme with the FCDO to deliver this.

The UK was able to offer 100 million doses for donation and to deliver 84.4 million doses by June 2022. In 2022, delivery of donations was constrained by lack of demand from COVAX and lower income countries. Of the 84.4 million doses delivered, over 75 million were delivered to COVAX, and 7.9 million were delivered directly by the UK to countries in need. These donations benefitted 42 countries.

Achievements: objective 3

Strengthen the UK’s onshore capacity and capability in vaccine development, manufacturing and supply chain to provide resilience for this and future pandemics.

The VTF invested over £405 million to secure and scale up the UK’s vaccine manufacturing capabilities to respond effectively to the pandemic.

This included immediate action to support the pandemic response, including investment in a rapid deployment facility at Oxford Biomedica by temporarily locating new bioreactors in an existing vaccine manufacturing facility and securing ‘fill and finish’ capacity from Wockhardt in North Wales. Both sites went on to prove vital to the UK supply chain of the Oxford-AstraZeneca vaccine, with Oxford Biomedica producing drug substance for over 76 million doses and Wockhardt providing fill and finish for over 87 million doses.

Other investments that were intended as a pandemic response have been transitioned to their longer-term resilience objectives since it became clear they were no longer needed for the initial response. Most notably, this included the government’s investment in:

• the Vaccines Manufacturing and Innovation Centre (VMIC) in Oxfordshire
• support for the Centre for Process Innovation (CPI) in Darlington to develop messenger ribonucleic acid (mRNA) manufacturing capability
• the Cell and Gene Therapy Catapult (CGTC) facility in Braintree

In March 2022, the government awarded a grant of £15.9 million to Croda to increase the UK’s manufacturing capacity of speciality lipids, an essential ingredient in mRNA vaccines, and in October 2022 announced £10.65 million additional funding for the RNA Centre of Excellence in Darlington.

In June 2022, the government announced a long-term strategic partnership with Moderna to open a vaccines research and manufacturing centre in the UK, which will provide the UK population with access to the company’s COVID-19 and other respiratory disease products in future.

Purpose and scope of this review

This review considers the extent to which the VTF achieved its 3 strategic objectives, and the factors which contributed to it doing so. It seeks to draw out learning that can be applied to future government programmes, both in emergency circumstances, such as those in which the VTF was formed, and to business-as-usual activity.

It assesses the VTF’s success against its first 2 objectives.

The objectives have evolved over time, and this review explains when and why. The review sets out the investment approach that the VTF took through its original programme business case (July 2020) and updated programme business case, to include the winter 2021 booster campaign (May 2021). The second objective was delivered in close collaboration with the FCDO which has published information on its programmes to support lower income countries on the UK Development Tracker^{[footnote 1][footnote 2]}.

The review only considers the third objective of the VTF in so far as it applies to the original pandemic response. The VTF’s third objective is longer term in its nature than the first 2 and separate monitoring and evaluation plans are in place for it as part of the onshoring programme, which has now been transferred to the OLS.

Phases of the VTF

Timing: the review splits the taskforce’s existence into 3 periods:

Phase 1: the period to secure a safe and effective vaccine as soon as possible

This phase consisted of:

• the early procurement activity of the VTF (2020)
• the original NHS first and second dose campaign (winter 2020 to spring 2021)

Phase 2: ensuring ongoing protection

This phase consisted of:

• planning for and supporting the first booster campaign for adults (January 2021 to January 2022)
• preparing for and responding to variants of concern

Phase 3: continued protection

This phase consisted of:

• extension of the UK vaccine programme to children (late 2021 to early 2022)
• planning for spring and autumn booster campaigns in 2022
• moving towards ‘business-as-usual’ arrangements, including additional procurements for future years

Questions for the first 2 objectives

For the first 2 objectives, the review considers the following questions:

1. To what extent has the VTF achieved the intended outcomes?
2. What were the causal factors resulting in the outcomes?
3. Were there any unintended consequences?
4. What other factors have influenced outcomes?
5. How effective has the VTF been compared with other countries?

How the VTF’s objectives evolved over time

The VTF was set up by HM Government in April 2020. The Business Secretary asked that the Government Chief Scientific Adviser (GCSA), Sir Patrick Vallance, and Deputy Chief Medical Officer (DCMO), Sir Jonathan Van Tam, provide the VTF with the scientific and clinical leadership needed.

In May 2020, the then Prime Minister, Boris Johnson, appointed Dame Kate Bingham to be the VTF’s first chair. In her formal appointment letter of June 2020, he set her the following 2 objectives for the taskforce to deliver:

• to ensure the whole UK population, or relevant subpopulations, can be vaccinated against COVID-19 as soon as is practicable
• to ensure adequate global distribution of vaccines to bring the quickest possible end to the pandemic and the economic damage it inflicts

The introduction of a formal international objective reflected the extensive efforts of the UK government in the early part of the pandemic to support the global fight against the disease. In addition, the PM put a focus on ensuring long-term capacity for the UK by asking the VTF to “help to develop and agree a wider UK long-term vaccine strategy, to include a broad ‘[UK]’ biotherapeutic and vaccine manufacturing capacity so the UK is prepared for future potential pandemics”.

These were brought together into 3 formal objectives to:

• secure access to promising vaccine(s) for the UK population as quickly as possible
• make provision for international distribution of vaccines
• strengthen the UK’s onshoring capacity and capability in vaccine development, manufacturing and supply chain to provide resilience for this and future pandemics

Later in the VTF’s lifespan, objective 1 was modified, to reflect the growing need to boost all adults.

Key facts and figures

Figure 2: infographic of key COVID-19 related facts and figures^{[footnote 3][footnote 4][footnote 5]}

Sources: Coronavirus (COVID-19) in the UK; VTF as at 30 September 2022; PHE-UKHSA COVID-19 surveillance reports.

Figure 2 gives a visual representation of the key COVID-19 facts, dates and figures set out below.

Key COVID-19 dates

The key dates shown in figure 2 are:

• 11 March 2020: WHO declared COVID-19 a global pandemic
• 23 March 2020: the UK entered lockdown
• 17 May 2020: the UK became the first country in the world to procure a COVID-19 vaccine (Oxford-AstraZeneca)
• 2 December 2020: the first COVID-19 vaccine in the world received regulatory approval (Pfizer-BioNTech in the UK)
• 8 December 2020: the first person in the world received a regulated vaccine outside of a clinical trial (Pfizer-BioNTech in the UK)

UK COVID-19 health data

UK health data (cumulative at 30 September 2020) for COVID-19 cases, hospital admissions and deaths with COVID-19 on the death certificate was as follows:

• cases of COVID-19: 23,695,374
• patients admitted to hospital with COVID-19: 1,009,036
• deaths with COVID-19 on the death certificate: 208,285

COVID-19 doses

The number of COVID-19 doses (all doses) given to people of all ages (at 30 September 2022) was:

• England: 131,176,020
• Scotland: 13,014,285
• Wales: 7,744,873
• Northern Ireland: 3,991,490

UK vaccine portfolio

The original and current UK vaccine portfolio (at 30 September 2022) was as follows:

• Oxford-AstraZeneca (original: 100 million doses, current: 100 million doses), deployed and donated
• Pfizer-BioNTech (original: 40 million doses, current: 189 million doses), deployed
• Moderna (original: 17 million doses, current: 77 million doses), deployed
• Sanofi-GSK (original: 60 million doses, current: 7.5 million doses), reduced order
• Novavax (original: 60 million doses, current: 1 to 16 million doses conditional purchase), donated and reduced order
• Janssen (original: 20 million doses, current: none), donated
• Valneva (original: 60 million doses, current: none), cancelled

Lives saved and hospitalisations prevented

The number of lives saved and hospitalisations prevented from COVID-19 vaccines was as follows:

• 123,100 lives saved (in all ages in England, to 17 September 2020)
• 178,900 hospitalisations prevented (in over 65s in England, to 21 September 2020)

Review of progress against VTF objective 1

Objective 1: secure access to promising vaccine(s) for the UK population and achieve lasting immunity.

Question 1: to what extent has the VTF achieved the intended outcomes?

To enable delivery of its first objective, the VTF secured 3 funding agreements with HM Treasury:

• a £5.2 billion programme business case in 2020
• a £6.1 billion amended programme business case in September 2021 (to take account of both the contracts the VTF had entered into in the summer of 2020 and to anticipate the possible future need for boosters)
• the Spending Review of 2021, which set vaccines budgets through to 2025

The VTF also agreed a budget of £500 million to fund procurement of vaccines through COVAX (see below for details of COVAX).

How the VTF went about securing its vaccine portfolio

In the early days of the pandemic there were believed to be approximately 200 COVID-19 vaccines in early development stage across the world. The chances of any one vaccine candidate being effective and safe were remote, owing to the traditionally lengthy and trial and error approach to the activity in ‘normal’ times, which various estimates suggest can take 10 years from the early research and development (R&D) to regulatory approval and mass manufacture of a successful vaccine. The VTF’s own programme business case quantified the likelihood of any individual vaccine being safe and effective as between 5% (pessimistic scenario) and 10% (optimistic scenario). This range was based on advice from the VTF’s specialists in vaccine development. The VTF’s early priority was therefore to set out to secure a portfolio of promising vaccine candidates, increasing the overall likelihood of finding at least one safe and effective vaccine.

VTF’s direct approach was to evaluate the around 200 global candidates and secure access to a portfolio from these. The VTF assembled a vaccines due diligence team, made up of clinical, scientific and industry experts, to narrow down this large field. The first step was to rule out any vaccine that had no realistic chance of entering clinical trials in 2020, as its route to deployment, if safe and effective, would simply be too long.

Another key early principle was that the VTF wanted to secure access to vaccines across a range of development modalities (as in vaccine platforms), rather than back one type of technology above all others. This would later prove key, as the VTF’s backing for more novel technologies (notably mRNA vaccines) over traditional ones proved to be the correct approach. The VTF due diligence team performed detailed data analysis of the remaining candidates.

The method to securing these contracts was based on treating each as a bespoke deal, rather than approaching each as a standardised procurement activity. This recognised that every developer had a unique product that was potentially the only successful vaccine and allowed the UK to tailor each deal accordingly.

This speed and quality of analysis, supported by a commercial mindset to deal-making, allowed the UK government to move at speed to secure its vaccine portfolio, and heads of terms agreements for all 7 deals were signed by mid-November 2020.

Table 1: original UK vaccine portfolio (December 2020)

Vaccine	Date deal struck	Original doses secured bilaterally (millions)	MHRA approved	Deployed in the UK	Additional information
Oxford-AstraZeneca	17 May 2020	100	Yes (2 December 2020)	Yes	Contract completed (50 million deployed and 50 million donated)
Sanofi-GSK	29 July 2020	60	No[footnote 6]	Not applicable	Order reduced to 7.5 million doses November 2021
Janssen	14 August 2020	30	Yes (28 May 2021)	No	Order reduced to 20 million doses and donated May 2021
Moderna	16 November 2020	17	Yes (8 January 2021)	Yes	60 million extra doses secured December 2021, to cover 2022 and 2023 deployment
Novavax	14 August 2020	60	Yes (3 February 2022)	Yes	Further 14.7 million doses ordered through COVAX donated. Bilateral 60 million dose order reduced to 1 to 16 million doses in July 2022
Pfizer-BioNTech	20 July 2020	40	Yes (2 December 2020)	Yes	Further 500,000 doses ordered through COVAX. 60 million extra doses secured April 2021 for primary and booster campaigns. 35 million extra doses secured in August 2021 for autumn booster campaign. 54 million extra doses secured December 2021, for 2022 and 2023 deployment
Valneva	14 September 2020	60	Yes (14 April 2022)	No	Contract terminated September 2021

Note: UK supply agreement (signed 28 August 2020) with AstraZeneca reflected the agreement between AstraZeneca and Oxford University in April 2020, which included commitment to supply the UK and the license signed in May 2020.

The portfolio included what are now the 3 most used vaccines in the world, by number of countries to deploy:

• Pfizer-BioNTech
• Oxford-AstraZeneca
• Moderna

Pfizer-BioNTech was the first COVID-19 vaccine to be regulated and deployed (both of which happened in the UK) anywhere in the world, with MHRA approval secured on 2 December 2020 and the first vaccine administered in the UK on 8 December 2020. As of July 2022, 164 countries have used this vaccine in their deployment programme.

Oxford-AstraZeneca became the second COVID-19 vaccine to enter deployment in the UK when it was introduced into the vaccine programme on 4 January 2021. As of July 2022, 185 countries have used the Oxford-AstraZeneca vaccine in their programme. The UK was the first country to procure and deploy this vaccine. The UK government also supported the cost of the original phase 1, 2 and 3 clinical trials for the vaccine. The UK procured 100 million doses of this vaccine, of which approximately half have been used in the domestic vaccination programme, and half offered for donation.

Moderna is the third most widely used COVID-19 vaccine in the world, having been deployed in 108 countries. In addition to its original 7 million dose order, the VTF signed deals for a further 10 million doses for the original UK vaccination campaign, and 60 million more doses to support vaccination in 2022 and 2023.

On 15 August 2022, JCVI advised that the Novavax vaccine could be used in the UK in exceptional circumstances. The Novavax vaccine is being deployed in 32 countries. It received UK regulatory approval as a primary course in 2022, when most of the UK population had received their first and second dose of COVID-19 vaccine.

Figure 3: COVID-19 vaccines deployed in the UK

Source: COVID-19: the green book, chapter 14a

Figure 3 shows that, at September 2022, 4 COVID-19 vaccines had been deployed in the UK over the following dates:

• Pfizer-BioNTech: from December 2020 to September 2022
• Oxford-AstraZeneca: from January 2021 to August 2022
• Moderna: from April 2021 to September 2022
• Novavax: from September 2022 to September 2022

The UK’s original vaccine portfolio also consisted of 3 other vaccines:

• Janssen
• Sanofi-GSK
• Valneva

The Janssen vaccine is being used in 98 countries, making it the fourth most widely deployed vaccine globally. The UK reduced its original 30 million dose order to 20 million doses and donated it in full in October 2021, via COVAX.

The Sanofi-GSK vaccine was the final vaccine within the UK’s portfolio to be submitted to the Medicines and Healthcare products Regulatory Agency (MHRA) for approval, and at September 2022 the company was awaiting an approval decision from the MHRA. In 2022, the VTF reduced its original order from 60 million doses to 7.5 million doses, reflecting the maturity of the UK vaccine programme, but acknowledging that, at that point, the latest efficacy data of the vaccine meant it could potentially play a useful role in future adult booster campaigns. Later that year, and following the closure of the VTF, on 21 December 2022 the MHRA granted the vaccine regulatory approval in the UK.

The UK terminated its contract with Valneva in September 2021. The vaccine received regulatory approval as a primary course in the UK in April 2022. It is being used in the deployment programme in Bahrain.

After the conclusion of the original UK vaccine portfolio, and as part of the UK’s strategy to respond to variants of concern, the UK government announced a heads of terms agreement with the developer CureVac in February 2021. This was intended to specifically develop vaccines targeted at new variants quickly and anticipated an initial order of 50 million doses of vaccine for the UK (no pre-payment was made on this order). However, CureVac withdrew its vaccine from regulatory approval later in 2021 following clinical trial data read-outs and, as a consequence, the VTF did not proceed to a final contract.

The UK also joined the collaborative vaccine procurement platform set up by COVAX for higher income countries. VTF paid a £65 million deposit towards procurement of up to 27 million doses (enough for up to 20% of the UK population). COVAX did not secure contracts with vaccine manufacturers as quickly as the UK. COVAX offered the opportunity to procure Oxford-AstraZeneca, Sanofi-GSK and Pfizer-BioNTech in November 2020. The UK opted to procure only Pfizer-BioNTech and was allocated 500 thousand doses. These were delivered to the UK in June 2021 and deployed as part of the domestic programme. In February 2021, the UK decided to take up the offer to procure Novavax through COVAX and was allocated 14.7 million doses. In May 2022, the UK donated these doses to COVAX. The UK did not procure other vaccines offered by COVAX later in the pandemic as these were not needed.

Table 2: table of vaccine purchase opportunities from COVAX to VTF and decisions

Vaccine name	Date of final decision	Decision made	MHRA authorised
Oxford-AstraZeneca	16 November 2020	Opt out	Yes
Sanofi-GSK	16 November 2020	Opt out	No[footnote 6]
Pfizer-BioNTech	4 February 2021	Opt in 539,370 doses	Yes
Novavax	2 June 2021	Opt in 14,706,000 doses allocated	Yes
Janssen	6 April 2021	Opt out	Yes
Clover	21 July 2021	Opt out	No
Sinovac	21 July 2021	Opt out	No
Sinopharm	21 July 2021	Opt out	No
Pfizer-BioNTech (close out)	22 September 2021	Opt out	Not applicable

Note that the Sanofi-GSK vaccine has subsequently been granted regulatory approval in the UK on 21 December 2022.

How the VTF has supported the revaccination of adults through the extension of its portfolio to meet boosting needs

As well as supporting the original COVID-19 UK vaccination programme, the VTF’s further procurement of COVID-19 vaccines has allowed the UK to roll out 3 booster campaigns to date:

• for autumn-winter 2021, where all adults were recommended to be boosted
• spring 2022, where the over-75s and those adults most at risk of severe disease received a further boost
• autumn 2022 (including for all adults aged 50 and over and those most at risk of severe disease)

The VTF anticipated the potential need for boosting immunity of those already vaccinated with their original primary course of COVID-19 vaccine by developing a booster strategy in 2021. Activity to support the strategy included:

• investment in research to establish the relative efficacy of different combinations of vaccines
• further procurement of COVID-19 vaccines in anticipation they might be needed
• renegotiation of delivery schedules for vaccines the UK already had on order, to ensure possible access to them at the start of any booster campaign

The VTF worked with DHSC and the National Institute for Health and Care Research (NIHR) to design a series of studies looking at the effect of different vaccines in combination with each other - both as a mixed dose primary course, and as a heterologous booster dose.

The JCVI’s advice for the original booster programme in autumn to winter 2021 recommended the use of one of the 2 mRNA vaccines in the UK’s portfolio (Pfizer-BioNTech or Moderna) for all eligible people (except where clinical advice recommended a patient should not receive an mRNA vaccine).

The JCVI’s advice was partly shaped by the UK’s world-leading COV-BOOST study, the first such clinical study in the world to test the effectiveness of different vaccines as a booster to the original Oxford-AstraZeneca and Oxford-AstraZeneca, Pfizer-BioNTech and Pfizer-BioNTech primary course. The COV-BOOST trial was funded by £19.3 million of VTF investment, designed by clinical experts, and delivered by the National Immunisation Schedule Evaluation Consortium (NISEC).

The mRNA vaccines have proved to be an effective option for protecting people from the worst effects of COVID-19 disease, including through boosting them with a third dose of vaccine. The VTF’s decision to place the platform as one of the 4 modalities in its portfolio has proved pivotal, as has its decision to ensure security of supply by making an early decision to procure from the 2 developers using the platform: Pfizer-BioNTech and Moderna.

To enable the continued supply of mRNA vaccines across the autumn to winter campaign, the VTF exercised its option to increase its Pfizer-BioNTech order from 40 million to 100 million doses in April 2021, and placed an additional order of 35 million doses in August 2021, followed by a further order in November 2021 for a total of 114 million doses of Pfizer-BioNTech and Moderna vaccine over 2022 and 2023.

Timetable of actions in 2021 to support the adult booster campaign:

• 28 April 2021: VTF secures a further 60 million does of Pfizer-BioNTech vaccine
• Mid August 2021 (interim internal read-out): COV-BOOST results
• 23 August 2021: VTF signs deal with Pfizer for 35 million additional doses
• 14 September 2021: JCVI advice to Secretary of State and start of booster campaign

Taken together, the VTF’s actions on its portfolio meant that 150 million doses of COVID-19 vaccine were administered to those aged 12 and over throughout the UK, its Crown Dependencies and Overseas Territories, up to September 2022.

How the VTF has managed its portfolio to avoid wastage

Particularly in 2021, the vaccines had short shelf life. It was critical to manage deliveries effectively to avoid wastage and ensure efficient use of such a critical resource.

Figure 4: the National Audit Office’s analysis of how cumulative administered vaccines compared with stocks available in England December 2020 to October 2021

Source: National Audit Office - The rollout of the COVID-19 vaccination programme in England

Figure 4 shows how cumulative administered vaccine numbers compared with stocks available in England between December 2020 and October 2021. The UK made sure the stock available at any one time through the COVID-19 vaccine deployment period was never greatly above what was needed to meet the demand of that programme.

In addition to the close working with the NHS to minimise the time from delivery to deployment, specific actions taken by the UK to manage its portfolio included:

• reprofiling of delivery schedules with suppliers wherever possible to best match supply and expected demand
• donation of surplus vaccines, including:
  • the donation of approximately 50 million doses of Oxford-AstraZeneca
  • the donation to COVAX of 20 million doses of Janssen
  • the donation of the 14.7 million doses of Novavax that the UK had secured through COVAX
• optimising the supply of doses with other countries, allowing vaccines to be used where and when they were needed
• the reduction of other contracts. These decisions were taken on a case-by-case basis as the VTF assessed the portfolio and ongoing needs:
  • Sanofi-GSK, from 60 million to 7.5 million doses
  • Novavax, from 60 million to between one and 16 million doses
  • Valneva, terminating the full contract

The active management of supply helped to ensure vaccines were used where most needed. As the National Audit Office report of February 2022 states, up to the end of October 2021, in England, overall wastage rates had been 4%

How the VTF has ensured all 4 nations of the UK have access to vaccines

Procurement of medicines is usually a devolved competency under current devolution agreements, meaning Scotland, Wales and Northern Ireland buy their own medical supplies, such as vaccines for seasonal flu. For COVID-19, however, the UK led all 4 nations in the search for a safe and effective vaccine. The UK government and the devolved governments of Scotland, Wales and Northern Ireland reached agreement early in the pandemic that the VTF would act on behalf of all 4 nations in its pursuit of a vaccine.

On a day-to-day basis, supply colleagues across all 4 nations have worked closely to ensure that health services across the UK are working from the same set of information and assumptions. Examples of the VTF’s contribution to this collaboration include the sharing of short- and medium-term supply projections from suppliers, to enable health services across the UK to plan for the supply arriving to them. The Barnett formula has been applied to UK dose numbers, to ensure the 4 nations have access to a population-based proportion of the VTF’s portfolio.

How the VTF has helped to support the UK’s vaccination campaigns for 2022 and future years

Through the VTF’s original contracts and relationships with developers, it has been able to ensure a continued supply of vaccine to the NHS to meet the needs of booster campaigns in light of evolving JCVI advice.

In December 2021, the government announced the purchase of a further 114 million doses of mRNA vaccines (from Pfizer and Moderna) to support future campaigns in 2022 and 2023. Campaigns supported so far (at 30 September 2022) from this have been:

• from February 2022: the start of a primary course vaccination programme for 5 to 11 year olds
• spring 2022: over-75s and other at-risk groups received a second booster
• autumn 2022: over-50s and others at serious risk from the disease are currently eligible for a further boost

In June 2022, the government also announced that it had entered into a non-binding heads of terms agreement with Moderna for the company to establish a vaccine manufacturing facility and R&D Centre of Excellence in the UK, creating the UK’s first developer-owned end-to-end mRNA vaccine manufacturing facility. The centre will give NHS patients guaranteed access to COVID-19 vaccines, future-proofing the UK against emerging health threats. A final deal with Moderna was agreed in late 2022.

How the VTF invested in domestic manufacturing capacity to support access to a vaccine

The VTF took early steps to invest in domestic vaccine capacity, with the aim of supporting objective 1 by speeding up production and helping guarantee security of supply.

Funding from the VTF temporarily placed new, larger bioreactors at an existing vaccine manufacturing facility, Oxford Biomedica, in Oxfordshire, while longer term solutions were being built. This increased the speed at which the Oxford-AstraZeneca vaccine was manufactured, allowing for faster deployment of the vaccine.

In May 2022, the UK received final deliveries of its 100 million dose order from Oxford-AstraZeneca; it is estimated that 76.3 million of these doses were manufactured at the Oxford Biomedica site.

In May 2020, the government also announced that it was investing a further £93 million in the VMIC in Oxfordshire, to broaden its capacity as a vaccine manufacturing centre, and accelerate its opening. This was followed by further government investment of £48 million in March 2021. In April 2022, VMIC’s board took the decision to sell the facility to Catalent, a multinational company with plans to invest approximately £120 million to develop the site into a state-of-the-art manufacturing facility for therapeutics and vaccines.

The VTF also invested £127.3 million in the Cell and Gene Therapy Catapult (CGTC) in Braintree, Essex, to fund a state-of-the-art manufacturing innovation centre. This facility has a focus on technology innovation for manufacturing of novel cell and gene therapies. CGTC Braintree was not needed to produce COVID-19 vaccines and has pivoted to transition into an advanced therapies medicinal products innovation centre which will have wide-reaching impact across cell and gene therapy innovation and apply to a range of health issues.

VTF also provided £26.48 million of funding to CPI to support the construction of ribonucleic acid (RNA) manufacturing capability in Darlington, and early development and scale-up of RNA vaccine technology. A further £10.65 million was provided to launch the facility as a centre of excellence to support the development of RNA vaccines and therapies.

Originally envisaged as part of the UK’s initial response to the pandemic, VMIC, CGTC and CPI were designed to be manufacturing vaccines for this pandemic as well as providing capacity for future health emergencies. As it turned out, the investment in the facilities at Oxford Biomedica, as well as developers’ capacity abroad, was sufficient capacity to meet the UK’s demand for vaccines when they were needed.

The VTF also secured domestic fill and finish capacity in the UK through an agreement with the company Wockhardt in Wales. This was used in the manufacturing process for the AstraZeneca vaccine.

Since the start of the pandemic, developers have increasingly seen the UK as an attractive place to invest, with over £500 million of private sector investment in vaccine manufacturing confirmed so far, including:

• in December 2021, FUJIFILM Diosynth Biotechnologies, announced a planned £400 million investment package in the UK at its site in Billingham, Teesside. The expansion is expected to create up to 350 highly skilled jobs on Teesside
• Cytiva and Pall Corporation announced a $1.5 billion investment in sites across the USA and UK, including a new 11,000 square metre facility in Cardiff out to manufacture single-use bioprocessing equipment, including jumper tubing assemblies, cell bags and ÄKTA flow kits
• £50 million investment from the Serum Institute of India into the Oxford Biomedica Group to develop advanced manufacturing space
• collaboration between Thermo Fisher Scientific in Swindon and the American pharmaceutical firm Pfizer to provide UK-based capacity to support the company’s ambition to manufacture and supply up to 4 billion doses of the Pfizer-BioNTech COVID-19 vaccine across the globe in 2022

How the UK has invested in trials and research to support the understanding of vaccine effectiveness against COVID-19

The UK has hosted a number of important trials of COVID-19 vaccines through the UK’s world-leading health research infrastructure. Four of the developers in the UK’s original vaccine portfolio conducted some of their studies into the safety and efficacy of their product in the UK:

• Oxford-AstraZeneca (funded by the VTF)
• Novavax
• Janssen
• Valneva

In addition, some developers have conducted other studies in the UK, including:

• Moderna’s COVID-19 Omicron variant study
• Pfizer-BioNTech’s study in expectant mothers

To support this, the VTF invested in the NHS clinical registry, working with NHS Digital and the devolved nations in the world’s first national citizen database where members of the public could volunteer to take part in clinical trials. As of 31 August 2022, volunteer numbers stood at over 540,000. This supported the clinical trials of vaccines such as Oxford-AstraZeneca and Novavax.

The VTF also invested in world-leading studies to look at the effect of different combinations of vaccines. The VTF worked closely with NIHR, and the DCMO to identify gaps in knowledge of the vaccines and consider where government-backed trials could fill these. These included:

• Com-COV and Com-COV2 - to assess the effectiveness of mixing vaccines (Pfizer-BioNTech and Oxford-AstraZeneca in Com-COV and Pfizer-BioNTech and Oxford-AstraZeneca with Moderna or Novavax in Com-COV2) versus receiving the same vaccine for first and second dose
• COV-BOOST - to test different vaccines (Oxford-AstraZeneca, Pfizer-BioNTech, Moderna, Janssen, Novavax, Valneva and CureVac) as a heterologous boost on a Oxford-AstraZeneca and Oxford-AstraZeneca, or Pfizer-BioNTech and Pfizer-BioNTech primary course
• Preg-CoV - to allow evidence-based guidelines to be developed for pregnant women
• ComFluCOV - to inform the logistics of co-administration of COVID-19 vaccines with winter flu vaccines

The VTF also helped develop and fund the Human Challenge project. This study was a partnership between VTF, the NHS, academia and the private sector to develop a greater understanding of the COVID-19 disease itself, and to aid the pandemic response with vaccine and treatment development. Initial government funding for the programme was £33.6 million and funded the trials in full. The first Human Challenge Programme clinical paper was published on the pre-print server Research Square in January 2022. It details the outcomes in 36 young, healthy participants with no immunity to the virus and shows that experimental infection of volunteers is reproducible and resulted in no severe symptoms in healthy young adult participants, laying the groundwork for future studies to test new vaccines and medicines against COVID-19.

Question 2: what were the causal factors resulting in the outcomes?

Ability to draw together expertise from the Civil Service, private sector and academia to expedite and co-ordinate the research and procure successful COVID-19 vaccines

The VTF has utilised the collective expertise of an array of specialists, including from within the Civil Service and wider public sector to achieve its objectives. Examples include:

• private sector expertise: senior leaders from industry were recruited to the VTF Steering Group, including Dame Kate Bingham as Chair in 2020, and Sir Richard Sykes, Chair from 2021 to 2022
• commercial: deal-making expertise was mobilised from elsewhere in government to lead the negotiations and commercial strategy
• programme delivery: experienced leaders with extensive delivery expertise garnered in the public and private sectors were mobilised to the VTF
• manufacturing: working closely with industry experts, both in an advisory capacity, and through formal secondment to working level teams, the VTF developed an early manufacturing strategy
• clinical trials: alongside DHSC, NIHR and the MHRA, the VTF was able to deliver on the priority to support the rapid delivery of clinical trials through, for example, making the UK an attractive place for vaccine developers to trial their products, and manufacturing these products, where applicable
• science in decision-making: the VTF has drawn on expertise across government (including UKHSA,DHSC and JCVI) and in academia to ensure its decision-making on procurement is always informed by the latest scientific and clinical advice. For instance, on issues such as vaccine effectiveness and durability, and the evolution of the disease (including variants of concern)

Dealing with suppliers in a different, more collaborative way to identify and quickly solve problems

The UK’s vaccination programme has involved complex supply chains across multiple borders, at a time when vaccines were a scarce global commodity, and during a period of intense geopolitical uncertainty.

The VTF worked hand-in-hand with developers, proactively managing the journey from manufacturing through to deployment by the NHS. Vital to the success here was the nature of the relationship, with senior VTF leaders working very closely with senior leadership at vaccine developers.

Examples of this novel way of working include:

• regular meetings between senior leaders at vaccine developers and in government to work through and agree solutions to problems as they arose
• daily delivery meetings between delivery teams in the crucial December 2020 to April 2021 period, to ensure continuity of supply to the UK
• establishment of joint working level ‘virtual teams’ to create shared plans and measure progress against them
• greater transparency: sharing of data at regular intervals to make sure problems were solved using a shared understanding of the evidence and information

Creating effective processes that support proper oversight and risk assessment, but also facilitate swift decision-making

The VTF has operated in an agile way, ensuring no delays to key decisions being taken when they were needed. A steering group was established comprised of:

• chair
• director general and 5 directors covering the VTF’s strategy, commercial, vaccine supply, onshoring and international functions
• scientific adviser
• manufacturing adviser
• clinical and public health adviser (deputy chief medical officer)

Together the group provided strategic oversight of the VTF’s work and considered and agreed recommendations to go to ministers. It acted as an escalation point for decisions on strategy and for managing programme-level risks and issues.

Speed of decision-making was also enabled by having a ministerial panel (the list of the ministerial panel members appears in the introduction of this publication).

The ministerial panel provided commercial and financial approvals for:

• all potential vaccine deals
• manufacturing considerations or spend over £70 million
• bringing together ministers from relevant departments to support responsive, robust decision-making on investments, at the pace required for the ongoing commercial negotiations

Investment in world-leading studies, for example COV-BOOST, to supplement developer data and inform JCVI recommendations

In addition to the data being generated by developers on their vaccines through their own studies, the VTF invested in collaboration with DHSC and NIHR in a series of studies run through the NISEC looking at the effect of different combinations of vaccines, either as a mixed dose primary course, or as a heterologous booster dose.

The COV-B study, which looked at different vaccines (Oxford-AstraZeneca, Pfizer-BioNTech, Moderna, Janssen, Novavax, Valneva and CureVac) as a booster dose to a double dose primary course of Oxford-AstraZeneca or Pfizer-BioNTech, was the first such study in the world, and informed the JCVI’s decision-making on the 2021 autumn adult booster campaign, which saw all adults recommended for a boost of an mRNA vaccine.

Engagement led from the top

Officials worked extremely closely with the Prime Minister and other ministers as well as the Chief Medical Officer (CMO) and DCMO, GCSA, UKHSA Chief Executive and NHS leadership. This allowed for swift decision-making and communication between organisations and vital time was saved by escalating key decisions right to the top of organisations as needed. As well as the formal governance mentioned above, the day-to-day work of the taskforce was driven by direct engagement at the top of many organisations across government.

This approach reflected the priority given to the vaccine programme given its centrality to both the public health and economic objectives of the government. During the pandemic, weekly meetings were held with the Prime Minister to brief him on key developments in supply and deployment, as well as daily meetings chaired by the Health Secretary with senior leaders of the vaccine programme in the Civil Service and the NHS, alongside senior clinical advisers.

Question 3: were there any unintended consequences?

The UK secured more successful vaccines than originally expected

Vaccine success of an individual vaccine was estimated at 5 to 10% in the VTF’s programme business case - written when many vaccines were in clinical trials and none had read out on efficacy and safety. This relatively slim chance of success for an individual vaccine was a key assumption for the UK’s portfolio approach.

As it turned out, of the 7 vaccines in the UK’s original portfolio, 6 (Oxford-AstraZeneca and Pfizer-BioNTech in December 2020, Moderna and Janssen in the first half of 2021 and Novavax and Valneva in 2022) have now secured regulatory approval from the MHRA, with the seventh (Sanofi-GSK) currently being considered by the MHRA.

The unexpected success of the vaccines in the UK portfolio has had a number of benefits:

• the UK had access to successful vaccines, but the portfolio approach meant that the UK also had access to the earliest available vaccines that provided material health and economic benefits
• providing optionality between vaccines. This has been especially important for the autumn 2021, spring 2022 and autumn 2022 booster campaigns, where the JCVI indicated a preference for mRNA vaccines, of which the UK has 2 maintained in its portfolio (Pfizer-BioNTech and Moderna). This decision was informed by data both from manufacturers and from the studies funded by the VTF, which provided comparisons between the different vaccines as a booster dose
• accelerating overall deployment by providing a greater total quantity of vaccine doses more rapidly, allowing the UK to move more rapidly away from non-pharmaceutical interventions and the associated economic consequences
• having a number of successful vaccines within its portfolio allowed for flexibility for the UK to respond to clinical advice and changes in the disease. For example, the availability of the Oxford-AstraZeneca vaccine in the autumn 2021 and spring 2022 campaigns provided an alternative for those who should not receive an mRNA vaccine
• enabling the UK to donate surplus vaccines to lower income countries, delivering against the VTF’s second objective to contribute to the global effort to end the pandemic
• the active management of supply, including close monitoring of deliveries, reprofiling of delivery schedules, donation of excess vaccine supply, supply optimisation with other countries and reduction of contracts, helped to ensure vaccines were used where most needed to reduce excess stocks

Question 4: what other factors have influenced outcomes?

Willingness to invest at risk

The VTF invested in manufacturing of vaccines before data on their safety and efficacy was available. This meant that when they were approved by the MHRA for use, supply was available to the NHS quickly.

Huge incentives for companies to develop an effective vaccine

Many pharmaceutical companies across the world moved quickly to refocus their efforts onto COVID-19 vaccines, therapeutics and other drugs. Given the clear commercial opportunities for those able to develop and manufacture successful vaccines, many companies were willing to invest in development and begin manufacture at risk, prior to regulatory approval or signing of commercial contracts with governments, helping to accelerate availability of vaccines worldwide.

Question 5: how effective has the VTF, and the UK, been compared with other countries?

The UK has now deployed over 150 million doses of Pfizer-BioNTech, Moderna and Oxford-AstraZeneca across its vaccination campaigns. As stated above, these are now the 3 most used vaccines in the world, by number of countries using them. The UK was the first country to buy the Oxford-AstraZeneca and Pfizer-BioNTech vaccines.

Table 3: dates that comparator countries signed with Pfizer-BioNTech, Moderna and Oxford-AstraZeneca

Country or area	Oxford-AstraZeneca	Pfizer-BioNTech	Moderna
UK	17 May 2020[footnote 7]	20 July 2020	30 November 2020
EU	14 August 2020	11 November 2020	25 November 2020
USA	20 May 2020	22 July 2020	11 August 2020
Israel	20 November 2020	13 November 2020	17 June 2020
China	6 August 2020	Not applicable	Not applicable
Canada	25 September 2020	5 August 2020	5 August 2020

In selecting the 7 original candidates for its portfolio, the UK included the 4 vaccines currently being used in deployment. All 4 of these are being widely used in comparator countries.

The speed at which the VTF was able to act meant the UK’s vaccination programme began ahead of any other. On 8 December 2020, the UK administered the first COVID-19 approved vaccine outside of a clinical trial, anywhere in the western world.

Conclusion

The VTF procured a portfolio of safe and effective vaccines, enabling the UK to start its deployment programme in 2020. In doing so, the UK became the first country in the world to secure key deals and to deploy a regulated COVID-19 vaccine outside of clinical trials with the Pfizer-BioNTech vaccine. This was followed shortly after by the UK becoming the first country to deploy the Oxford-AstraZeneca vaccine.

The original vaccination programme and the first (and subsequent) booster campaign in autumn to winter 2021 were further strengthened by the availability of the Moderna vaccine, which the UK placed its first order for in late 2020.

The VTF’s proactive approach to its strategy for revaccination, including through its investment in the world-leading COV-BOOST study, and its further purchases of the Pfizer-BioNTech vaccine in April and August 2021, ensured that the NHS’s booster programme began on time in September 2021, and that all adults were able to be offered a booster dose in line with JCVI advice.

Review of progress against VTF objective 2

Objective 2: make provision for international distribution of vaccines.

Question 1: to what extent has the VTF achieved the intended outcomes?

Supporting global access to the Oxford-AstraZeneca vaccine

The UK government invested early in Oxford University’s vaccine development work, supporting their vaccine technology since 2016 and their COVID-19 vaccine since March 2020, with more than £88 million to help research, develop and manufacture the vaccine. The government saw the potential for the vaccine to play a critical part of the global response to the pandemic and supported Oxford University to secure a commercial partner for further development, large-scale manufacturing and licencing and distribution of the vaccine.

On 30 April 2020, Oxford University and AstraZeneca announced an agreement which provided both for the UK population to have access to the vaccine if it proved successful, and for the vaccine to be produced on a not-for-profit basis for the duration of the pandemic. It also enabled manufacturing licencing so that the vaccine could be made available quickly across the globe. The NIHR helped recruit thousands of volunteers from across the UK for the phase 3 clinical trials and supported the researchers, which paved the way for approval by the MHRA.

The Oxford-AstraZeneca vaccine proved crucial in the global fight against COVID-19. By January 2022, around 2.5 billion doses had been distributed at cost to more than 170 countries.

Establishing COVAX

The UK was an early champion of a global initiative to support research, manufacturing, procurement and equitable distribution of COVID-19 vaccines for the benefit of all countries. On 4 June 2020, the UK hosted the Global Vaccine Summit at which a proposal for a global vaccine procurement initiative was launched and the UK announced £48 million to support the initiative. This soon became COVAX and, with the aim of providing equitable global access to safe and effective COVID-19 vaccines as quickly as possible, brought together the expertise and resources of 4 key international organisations:

• Gavi, the Vaccine Alliance
• the Coalition for Epidemic Preparedness Innovation (CEPI)
• WHO
• United Nations Children’s Fund (UNICEF)

In September 2020, the then Prime Minister, Boris Johnson, announced an additional £500 million of support for COVAX to provide vaccines to lower income countries, bringing the UK’s support to £548 million. On 30 September the then Foreign Secretary, Dominic Raab, co-hosted a side event at the United Nations General Assembly to encourage countries to join COVAX and to provide financial support for vaccination of people in lower income countries. The VTF provided 2 secondees to support COVAX with critical work to identify candidate vaccines and to strengthen engagement with countries and develop robust plans for allocation and deployment of vaccines.

COVAX set up a mechanism - the COVAX Advance Market Commitment (AMC) - to support 92 overseas development assistance-eligible countries and territories to access donor-funded COVID-19 vaccine doses. The AMC, combined with additional support from Gavi for country readiness and delivery, was designed to ensure that the most vulnerable populations in AMC countries could be protected quickly against COVID-19 disease, regardless of income level.

COVAX also set up a joint procurement pool, the COVAX self-financing facility, with the aim of enabling higher income countries to share the costs and risks of investing in a diverse vaccine portfolio. In September 2020, the UK joined this initiative but procured very few vaccines through this route because of the success of the UK’s own procurement programme in providing vaccines earlier than in COVAX. Nearly a hundred countries and economies eventually joined the self-financing initiative.

Donation of surplus vaccines

In June 2021, the then Prime Minister, Boris Johnson, called upon G7 leaders to set a goal for the world to be fully vaccinated against COVID-19 by the end of 2022. At the G7 summit, hosted by the UK, G7 leaders collectively pledged to donate at least 870 million doses and a total of 1 billion doses over the year to June 2022 (including previous commitments). The Prime Minister announced that the UK would donate 100 million surplus COVID-19 vaccines. The UK committed to make available 5 million doses by September 2021, a further 25 million by the end of 2021, and the remaining 70 million doses by June 2022. Of the total 100 million doses, 80% would be donated via COVAX and the remainder shared bilaterally.

The VTF worked with FCDO to set up a programme to deliver on the 100 million commitment.

On 28 July 2021, the UK announced plans to deliver 9 million Oxford-AstraZeneca doses through COVAX and bilaterally. The first 300,000 UK donated doses landed in Jamaica on 30 July 2021. The VTF also worked closely with AstraZeneca to arrange for doses for COVAX to go straight from the factory to their distribution hub and thus maximise the available shelf life.

The UK met its commitment to donate 30 million doses by the end of 2021. At this stage global demand for vaccines far outstripped supply and there was extreme competition for doses. The UK’s donated doses therefore helped meet urgent demands to protect the most vulnerable populations.

In October 2021, the UK announced further donations of 20 million doses of Oxford-AstraZeneca and all 20 million Janssen doses through COVAX.

In 2022, the balance between global demand and supply of vaccines began to shift. Global vaccine manufacturing capacity was increasing quickly and higher income countries were making progress on vaccinating their populations and increasing delivery of vaccine donation commitments. Demand from lower income countries was also lower than anticipated as the new Omicron variant caused less severe disease and many lower income countries were struggling with high levels of vaccine hesitancy, challenging vaccine deployment logistics and competing urgent healthcare priorities.

In May 2022, the UK donated all 14.7 million doses of Novavax procured through COVAX.

The VTF continued to identify and offer further donations of surplus vaccines and was able to make offers totalling 100 million, including donations of Pfizer-BioNTech and Moderna vaccines. By the end of June 2022, the UK had donated and delivered 84.4 million doses. This included 76.5 million (91%) via COVAX and 7.9 million (9%) donated bilaterally to 42 low and middle income countries.

Figure 5: doses offered and donated to other countries by the UK by end June 2022

Source: VTF internal management information.

Figure 5 shows the doses offered and donated to other countries by the UK. By June 2022 the UK had offered 100.2 million doses of COVID-19 vaccine for donation:

• 50.5 million doses of Oxford-AstraZeneca
• 20 million doses of Janssen-Johnson & Johnson
• 15 million doses of Moderna
• 14.7 million doses of Novavax

By June 2022, the UK had donated 84.4 million doses of COVID-19 vaccine:

• 76.5 million doses through COVAX
• 7.9 million doses bilaterally

Vaccine optimisation with other countries

In September 2021, the UK government announced initiatives to share 4 million Pfizer-BioNTech vaccine doses with Australia, and 1 million doses with the Republic of Korea. This arrangement was mutually beneficial and ensured that these Pfizer-BioNTech doses, which were not immediately required in the UK, were used to support international vaccination efforts. The same volume of doses was returned later in the year. Sharing doses meant those countries had immediate access to vaccines they could use in their domestic campaigns and enabled the UK to better align timings of its own supply with UK requirements.

Question 2: what were the causal factors resulting in the outcomes?

The UK government’s early support was critical for the rapid development of the Oxford-AstraZeneca vaccine.

The UK championed the establishment and development of COVAX, provided substantial funding for the procurement of vaccines for lower income countries, used its G7 presidency to galvanise donation of surplus vaccines through COVAX, and provided consistent practical support to COVAX (including through secondments).

The VTF built a close partnership with the FCDO and other UK government organisations to deliver the successful vaccine donation programme. The VTF helped drive work forward quickly by drawing on its specialist expertise - including in project management, vaccine supply modelling and commercial negotiations.

Question 4: what other factors have influenced outcomes?

Constraint on supply in 2020 and 2021 meant that countries that had secured deals early got earliest access to vaccines. The UK’s ability to donate vaccines offered for donation was limited by lack of demand from COVAX and lower income countries in 2022. Global supply increased as more vaccine candidates proved safe and effective, manufacturers scaled up production capacity, and other countries scaled up vaccine donations. Global demand was also lower than expected as the Omicron variant spread rapidly and was perceived to cause less severe disease.

Question 5: how effective has the VTF been compared with other countries?

Like for like comparisons between countries are complicated because there are many variables in play. For example, over-ordering for domestic use leaves a country with more capacity to donate and donations delivered may be different from commitments. The following table is presented as a factual summary.

Table 4: vaccine donation commitments of G7 countries

Country or area	Donation commitment (million)	Per capita	Per $m GDP	Per dose administered domestically
UK	100	1.5	38.1	0.71
USA	900	2.7	50.8	1.60
EU	527	1.2	33.8	0.61
France	120	1.8	44.0	0.84
Germany	175	2.1	46.7	1.02
Italy	72	1.2	36.7	0.53
Japan	60	0.5	9.7	0.23
Canada	51	1.3	27.6	0.61

Conclusion

The UK played a leading role in championing the establishment of COVAX as a global initiative to support both higher and lower income countries secure equitable access to safe and effective COVID-19 vaccines as quickly as possible.

The UK was also a strong advocate, including in the G7, for the donation of surplus COVID-19 vaccines as a short-term response to global supply constraints with intention of improving vaccine access particularly in low and middle income countries around the world.

The VTF was able to identify sufficient surplus vaccine doses to be able to offer to donate 100 million doses in line with the UK’s G7 commitment.

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1. COVID-19 vaccine funding for the COVAX Advance Market Commitment (AMC). ↩

2. The sharing of 100 million doses of the Covid-19 vaccines with countries in need. ↩

3. Coronavirus (COVID-19) in the UK - England summary (note: data for COVID-19 cases from Northern Ireland is only available to 15 May 2022; data for hospital admissions for Scotland is only available to 11 September 2022; data for vaccinations in Scotland is only available to 11 September 2022). ↩

4. Excludes deals done through COVAX. ↩

5. COVID-19 vaccine quarterly surveillance reports (September 2021 to June 2023) (see week 46). ↩

6. The Sanofi-GSK vaccine has subsequently been granted regulatory approval in the UK on 21 December 2022. ↩ ↩²

7. UK supply agreement (signed 28 August 2020) with AstraZeneca reflected the heads of terms agreement struck between AstraZeneca and Oxford University in May 2020, which included commitment to supply the UK with 100 million doses. ↩