Table 3 ACTA factors that impact access to COVID-19 vaccines

Limited testing capacity led to underestimation and underpreparation for procurement needs[24]

Vaccine card racketeering:

Due to lack of trust in COVID-19 vaccines, people avoided vaccines but paid bribes to get vaccination cards [28]

No evidence was available to prosecute people who were reported to collect bribes for vaccine cards [28]

Shared financing and improved regional capacities for manufacturing, regulation, and procurement of tools allowed equitable and effective access to vaccines and other medical products [27]

Information around funds, disbursements, and contracts was lacking [31, 32]

Financial incentives for lack of distribution logistics slowed distribution of vaccines [24]

Opaque contracts were used when officials from low-income countries purchased vaccines [10, 34]

Existing efficient procurement and distribution protocols were abandoned to set up new special procurement and distribution committees [2]

Prioritizing at-risk (e.g., the aged, communities with high prevalence rates) and critical groups (e.g., health workers) and proper management of the process ensures that the right people get the vaccine

High demand for vaccine but low supply may have encouraged theft and diversion [2];

Health services, logistics and distribution systems were already weak [10]

Access to information regarding how funds are received and distributed was lacking [31]

Creation of an International Pandemic Financing Facility raised additional reliable financing [24]

Exploitative vaccine manufacturers may use their product advantage during emergencies to exploit weaker countries in their aggressive pursuit for profit [47])

Global partners foresee tactical challenges and work to avert them. For example, UNICEF pushed to secure 65,000 solar cold-chain fridges for lower-income countries[43]

Existing design of vaccine distribution systems are focused on child vaccination, not massive roll outs [43]

Equipment required for COVID-19 vaccine storage may differ from existing infrastructure [43]

Weak health leadership meant less readiness and poor vaccine decision-making [27]

Procurement processes were hastened and procedures were waived [25]

Strengthening oversight and monitoring functions by involving local activists, anti-corruption agencies, and NGOs helped in tracking and monitoring progress with vaccines [2, 20, 36, 37](

Fake vaccines may emerge in countries with weak regulatory systems [43]

Vaccines were politicized/weaponized (e.g., Russian Sputnik V vaccine was critiqued for hasty processes in getting through the scientific testing and approval process without having traceable anyway to verify if the right things were done) [42]

Oversight functions were strengthened by involving critical stakeholders, such as country activists, NGOs, and anti-corruption agencies[20, 37]

National frameworks and Technical Working Groups for procurement and distribution were developed [10]

Different country systems (private vs public) may affect vaccine distribution

Arbitrary spending of other health and non-health COVID-19 resources impacted trust on government COVID policies [25]

Deploying digital platforms allowed effective monitoring of procurement and distribution processes [32]

The complexity of COVAX governance structures allows more powerful or wealthier countries and manufacturing companies to have their way and dictate who gets vaccines and when[17, 33, 34]

Efficient procurement and distribution guidelines and operating procedures that functioned pre-pandemic were maintained [32]

Vaccine manufacturers and actors interested in accountability and transparency did not have access to the same information which meant that deeper assessment of the issues cannot be made[18]

Stakeholders insist on technology transfer and waiving of intellectual property rights of vaccine manufacturer during pandemics [20, 35]

Blockchain technology can be used to enhance the procurement and distribution processes [43]

Inadequate communication between government/health parastatals and the general public could trigger stigma and other hesitancy that impact vaccine adoption [44, 45]

Government and other concerned stakeholders should insist on transparency and publicizing information about vaccine contracts and specific actors [32, 46]