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Vaccines: evaluating risk and achieving mission

Author: ICAEW Insights

Published: 12 Jul 2021

Vaccine Alliance organisation Gavi knows all about getting vaccines to where they are needed. It has also harnessed chartered accountancy skills in doing so.

Vaccines have developed a new sort of currency since early 2020. In the developed world we have seen a race to achieve mass vaccination, and what can only be described as ‘vaccine diplomacy’ practised by vaccine-manufacturing nations and being discussed in virtual conference rooms worldwide. 

In the developing world, the narrative around vaccination programmes has been quite different. Sadly, international immunisation programmes started to plateau a couple of decades ago. On a brighter note, this became a rallying call for the international community to act. At its heart was an imperative to enable lower-income countries to have access to life-saving vaccines - that developed nations had benefited from for many years - at economically viable prices. 

A number of countries – and the Bill and Melinda Gates Foundation – came together with development partners, vaccine manufacturers, and key civil society participants to establish a model of co-operation, on a joint venture basis, to enable broader access to vaccines than had been achievable before. This led in 2000 to the formation of Gavi, and ICAEW member Simon Lamb is the Managing Director of Gavi’s Audit and Investigations function. It is their job to help safeguard Gavi’s resources by providing assurance on the effectiveness of Gavi’s risk management. 

Gavi’s role has been vital at this time – both for the work it was already doing but also because it has helped establish the framework under which developing nations have been able to access COVID-19 vaccines. And the reason that Gavi is such an effective vehicle is in part because it is a financial intermediary, operating with the rigorous processes we would typically expect from a sound financial institution. 

“We’re in the vaccine business,” says Lamb, “but essentially we raise money, mainly from governments, though there is significant funding from the Bill and Melinda Gates Foundation, and a growing contribution from the private sector. We buy vaccines (through UNICEF, a partner in the Alliance) and provide cash grants to eligible countries to help them develop the capability to operate vaccination programmes, ultimately independently of Gavi support.” 

He continues: “Gavi provides catalytic investment to help countries get to where they need to be to become self-sustaining and to be able to finance and operate their own vaccination programmes.” This investment could include: solar-powered fridges to operate the cold chain necessary to maintain vaccines as they are distributed in often very hot environments; vehicles to transport vaccines (trucks, motorcycles, bicycles, boats and even drones); training for vaccinators and the promotion of the benefits of vaccination to help encourage parents to bring their children to vaccination centres. 

Rightly, donors have very high expectations on accountability, and the proper use of their funds – this is, after all, largely taxpayers’ money. “We have to be able to show that the money is being used for the intended purpose, and therefore there has to be due consideration of things such as demonstrating the achievement of goals, evidencing effective risk management, and ensuring grants are applied appropriately and to a good end, as intended. The achievement of Gavi’s mission is very quantifiable – the number of children vaccinated and consequently, the number of future lives saved. In principle, it is straightforward to be able to demonstrate the return on the investments that donors are making,” says Lamb. 

What do chartered accountants bring? “An understanding of things like how organisations identify risk, how they manage risk, and the kind of processes and controls they put in place to achieve this. Chartered accountants also have the training and skill set to evaluate how those controls operate in practice to provide assurance to our stakeholders – both to management within Gavi and to our stakeholders, the other Alliance participants.” 

The end goal is that the portfolio of supported countries – originally 73 – reduces in number. “Gavi doesn’t operate the programmes, we don't have doctors and nurses in-country,” he says. “All the programmes are country's own programmes. So, Gavi is providing the vaccines and the financial support to help countries develop their programmatic infrastructure, in a self-sustainable way, in the long term.” “There is a financial threshold based upon the gross national income per capita of the country. Once a country reaches that threshold – as determined by the World Bank – countries start a five-year process of transition away from Gavi support,” says Lamb. “We've already had 15 countries migrate and that is critical to demonstrate the viability of the Gavi model.” 

All the other metrics are equally impressive. There have been over 822 million children vaccinated through routine immunisation against the 11 diseases that the World Health Organisation has recommended children are vaccinated against - preventing over 14 million future deaths. Then came COVID. 

“The vaccine response to COVID was the creation of an agency called COVAX which provides COVID-19 vaccines to the developing world. It is administered by, and sits within, Gavi, and is co-led by Gavi, the World Health Organisation and the Coalition for Epidemic Preparedness Innovations (CEPI), alongside key delivery partner UNICEF,” says Lamb. He adds that the reason COVAX came about so quickly was because Gavi had already established an effective model of co-operation working with partners in the Alliance. 

Lamb is at pains to point out that, while the COVID vaccination programme has been vital, so too has been the continuation of traditional vaccination programmes. He emphasises that undertaking vaccination programmes successfully is very significantly about data and processes. “You have to be able to identify the target population. Do we know who they are, do we know where they are, do we know how to encourage their participation in a programme, are we able to record that they have had two vaccines and need a third? What about those who aren't in the system? One of our big challenges is that about 20% of children in Gavi-eligible countries are under-vaccinated or may never have had a vaccine at all. Who are they, where are they, and how do we identify them?” There is clearly a lot of science and technology supporting immunisation but also a significant emphasis on establishing good processes, which are well-designed and implemented. 

So, what makes Lamb ideally suited to this task? He qualified as a chartered accountant with Deloitte Haskins and Sells (now PwC), working first as a financial auditor then as a management consultant, including two years in Kenya which provided his first exposure to the development sector. Then came a period in financial services, working in internal audit, at Goldman Sachs and BlackRock in London and New York. 

“I learned a lot about investment banking when I was working in that sector. I've learned a lot about vaccines working at Gavi, but it's not the core of my job to be a business expert. My job is to understand, evaluate, check and challenge the effectiveness of risk management, and the processes and controls established to mitigate those risks. Philosophically, that involves the same processes whether you’re talking about vaccines or investment banking – we can apply the same approaches, the same thought processes, to evaluating risk and its mitigation in any sector.”