A critical analysis of COVAX alliance and corresponding global health governance and policy issues: a scoping review

INTRODUCTION: The COVAX alliance is a novel approach to international partnership in global health intended to achieve the worthy goal of ‘COVID-19 vaccine equity’. This study aimed to identify the implementation challenges and framework gaps of COVAX and to explore the interconnected global health policy and governance gaps in ensuring equity, accessibility and affordability of vaccines. METHODS: A scoping review was conducted to identify the implementation challenges and framework gaps of COVAX and related global health policy and governance gaps. A search was carried out in PubMed, Scopus, Springer Link and Embase databases. Manually searched the grey literature, such as official reports and articles. EndNote V.20 was used to manage the evidence screening, and data extraction was carried out in Microsoft Excel. RESULTS: Searches of four electronic databases and official UN, GAVI and WHO websites identified 4686 pieces of evidence. The 937 duplicates were removed, and the remaining 3749 articles were screened for the title and abstract. Most articles were eliminated as they do not address global COVAX or COVID-19 vaccine equity. The remaining 53 pieces of evidence were reviewed for full text, and ultimately 40 articles found eligible were included in the scoping review. CONCLUSIONS: The implementation challenges of COVAX were attributed mainly to the phenomenon of vaccine nationalism by rich countries. The future global health policy and governance structure must be re-examined to address the inadequacies of such novel super public-and-private partnership models.