Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with LMIC

By Anaïse Boucher-Browning ‘22 and Manasi Singh ‘24

Although our seminar officially concluded today after an insightful week of critical conversations, the work being done here has just begun. Each of us is committed to carrying forward the ideas and action points we've cultivated this week into our respective spheres within government, nonprofit, private sector, academia and multilateral organizations. We've pinpointed forthcoming forums and conferences as platforms to disseminate the insights gained during this intensive week. Furthermore, we will sustain the collaborative efforts initiated here in Salzburg, dedicating ourselves to refining the frameworks and solutions we've collectively drafted.

We kicked off our day by conducting a comprehensive review of the key themes that have surfaced throughout the week. Subsequently, we divided into three groups to delve into the specifics of how to present each subtopic, ensuring a thorough and cohesive approach to our discussions.

Groups working outside while enjoying the view!

As expected, summarizing the extensive lessons we've learned into concise headlines proved challenging. Our discussions spanned various facets of the vaccine access chain, disease outbreak scenarios, and involvement of national, regional, and international actors, revealing the absence of a universal solution. Consequently, we opted to customize our approach for different audiences, identifying which recommendations to share with which colleagues and partners. We singled out key areas of focus developed this week and pledged to refine these transformative suggestions in collaboration with additional partners who couldn't be present in Salzburg.

Above all, we've invested numerous hours in forging genuine connections and fostering friendships throughout this journey. This week, conversations didn't stop when work hours did. Over meals or while playing an intense game of ping-pong, we found ourselves learning more about each other. It's rare to have such a collaborative workspace as we've had this week. We're grateful for this time together and will nurture the relationships we've built. The Dickey Center at Dartmouth and Salzburg Global Seminar will continue facilitating these ongoing collaborations among the fellows. 

By Anaïse Boucher-Browning '22 and Manasi Singh '24

The seminar transitioned today from gathering thoughts and experiences to developing tangible actions based on our ideas. Our objective now is to formulate a comprehensive set of recommendations concerning vaccine manufacturing, procurement, and distribution. These recommendations aim to influence decision-making processes beyond the confines of this seminar.

We began the morning by jotting down our main points on sticky notes for everyone to review. Then, we dove into our final panel discussion of the day, covering pandemic risk assessments, vaccine development, funding mechanisms, and vaccine nationalism in depth.

Before dividing into working groups to draft recommendations, we held a comprehensive strategy session to outline potential frameworks for addressing the complexity of future pandemic scenarios and the diverse stakeholders involved in vaccine procurement. Our discussions throughout the week have addressed a broad set of challenges. It's been very encouraging to see these ideas beginning to form into a cohesive set of principles.

The African fellows with direct experiences of the national pandemic responses across several African countries gathered in a working group tasked with drafting the framework for actionable principles for recommendation. They presented their findings to the other fellows, emphasizing the importance of tailoring strategies for vaccine access to accommodate numerous shifting variables and scales of response.

We continued the drafting process in small groups later in the afternoon, and we’ll pick up where we left off tomorrow morning to continue the iterative drafting process. 

It’s clear that a lot of incredible work is and will continue to happen here for the rest of the week. However, as our time here in Salzburg approaches its end, we are most excited to see new friendships developing within the group.

By Anaïse Boucher-Browning '22 and Manasi Singh '24

Today, day three, marked the midpoint of our week in Salzburg. Our day began with a thorough review of key emerging themes including regional leadership, strengthening primary healthcare systems, pooled procurement designs, and more. Reflecting on our journey since day one, we've made significant progress in addressing the pivotal questions and potential solutions for designing vaccine procurement processes to best serve low and middle-income countries.

Following group discussions, we broke into three rotating groups for “knowledge cafés” on funding mechanisms for pooled procurement, the role of contracts within negotiations, and sustaining pandemic preparedness networks. Each group was led by an expert fellow who grounded the conversation in past experiences and prompted a consideration of future possible scenarios.

Groups in "knowledge cafés"

In the afternoon, the group took a well-earned break to explore the beautiful city of Salzburg! We ventured on foot to the city center, where we had the wonderful opportunity to listen to a pianist playing an 18th-century Viennese fortepiano in the house where Mozart was born. As we made our way back to the Schloss, the sun emerged, offering us an incredible view of the surrounding Alpine scenery.

Group learning about the famous Hohensalzburg Fortress

We concluded our day by participating in a healthcare funding negotiations simulation. Participants were tasked with embodying real roles through fictitious personas, aiming to set a five-year budget for the vaccine supply for a hypothetical country within certain constraints. Following the simulation, we broke character to discuss the situations each group ran into while negotiating between domestic and international actors.

Discussions in the healthcare funding negotiations simulation

By Anaïse Boucher-Browning '22 and Manasi Singh '24

Even with it only being Day 2 here in Salzburg, we are amazed at the substantial progress already being made in grasping and advancing key themes and ideas essential for shaping a more effective preparedness plan for the next pandemic. Breaking away from the traditional central speaker model, the group of fellows are engaging in iterative conversations centered around sharing information and feedback in real time. These exchanges are laying a solid foundation for the development of key policy recommendations for designing vaccine procurement mechanisms.

This morning, we began with a panel discussion followed by a large group discussion focusing on the lessons learned from African countries' responses and experiences with the COVID-19 pandemic. With important voices present in the room, the fellows were able to share experiences utilizing the COVAX multilateral vaccine procurement mechanism in order to strategize preparations for future pandemics.

In the following sessions, we participated in “goldfish bowl” small group discussions. In each room, a small group (“the fishbowl”) led by one fellow discussed a few key topics while a larger group listened in. Fellows could move in and out of the fishbowl to engage in specific conversation topics as necessary, allowing for a more focused dialogue. Topics included integrated health systems, incentive structures, public trust, vaccine nationalism, regional manufacturing and proactive collaboration. 

"Fishbowl" small group discussions

After a busy day of constructive conversations, the group took a break from the discussion circles to walk and talk with each other about key issues that had come up. On our walk, we enjoyed the beautiful scenery here at the Schloss Leopoldskron, where the Salzburg Global Seminar is held. Fun fact: the Schloss was where the iconic balcony and lake scenes of “The Sound of Music” were filmed!

Group photo from the lake walk

By Anaïse Boucher-Browning '22 and Manasi Singh '24

Four years ago today, the World Health Organization declared COVID-19 a global pandemic.  In the aftermath of the COVID-19 pandemic, we are struck with the work that has yet to be done on improving pandemic response frameworks, access to diagnostics, therapeutics, and vaccines and endless more. Today we began the “Better Preparedness for the Next Pandemic” program at Salzburg Global Seminar focused on developing effective and equitable vaccine access models with low- and middle-income countries. 

Launching the “Better Preparedness for the Next Pandemic” week-long program is significant. Bringing together world-renowned experts here in Salzburg to focus on developing effective and equitable vaccine access models with low and middle income countries is a necessary step that we are excited to be a part of. The program was initiated and developed by the Pandemic Security Project, an initiative of the Global Health and Development program at the Dickey Center for International Understanding at Dartmouth College.

The participants include ministers of health from several African countries, representatives of multilateral public health and development institutions, and academics and industry representatives working on vaccine access. 

Today’s sessions were an inspiring overview that set the stage for complex themes that will be discussed during the week’s workshops. Participants discussed the lessons learned from the COVAX initiative, the trade-offs inherent in various mechanisms for vaccine procurement, and the importance of centering end-users’ input and needs in the design of future vaccine access processes. There was a lively discussion where key topics raised included the international power dynamics involved in the decision making process of vaccine procurement systems, how public institutions and private companies shape the supply and distribution of health technologies, and the importance of putting in place proactive measures and systems to prepare for an agile response to the next pandemic.

The end goal for this week’s gathering of changemakers is to develop a set of principles and recommendations to inform the work of key decision makers globally who are involved in designing global vaccine access mechanisms.

Dawn Carey and Tori Holt introducing the vision for the seminar

Follow along with us* as we share our time in Salzburg Austria, joining Dartmouth colleagues and changemakers from around the globe. Our goal? To develop frameworks and recommendations to ensure vaccines and medical counter measures can reach the people that need them most, in time to do the most good. The goal is a set of key principles in the design of a new mechanism for global counter-measures, which could be brought forward to international decision takers. The week-long think tank session will capture practical insights informing the design of next-generation multilateral procurement mechanisms for pandemics and outbreaks.

We will share stories, interviews, photos, and lessons learned throughout the week. Thank you for joining us!

*Anaïse Boucher-Browning '22
*Manasi Singh '24

(photo below: Yvonne Nkrumah (center) World Bank Institute leads a group discussion in Parker Hall)