Northeast Syria COVID-19 | Raqqa Hospital Medical Care
Access to medicines

“Broken” humanitarian COVID-19 vaccine system delays vaccinations

  • People in parts of northern Syria faced delays to receiving COVID-19 vaccinations earlier this year due to an unwieldy humanitarian vaccination system.
  • The COVAX mechanism is failing the people it is meant to serve due to opaque legal frameworks and unfair liability demands.
  • MSF urges the COVAX partners – who include WHO, UNICEF and Gavi – to immediately fix the system and enable people timely access to vaccines.

The COVID-19 vaccine Humanitarian Buffer (HB) is failing its mission to support people hit by the pandemic and struggling to access immunisation, says Médecins Sans Frontières (MSF). The HB is part of the COVAX mechanism*, whose aim is to assist groups of people who do not have access to COVID-19 vaccination in situations of humanitarian emergency. However, MSF’s recent experience in northern Syria has highlighted the system’s limitations and ultimate failure to fulfil its purpose.

In late 2021, when the Delta variant was still predominant, MSF teams observed a significant increase in the number of reported COVID-19 cases in Tell Abyad and Ras Al-Ain. The area, currently under Turkish control, is home to approximately 156,000 people, including almost 70,000 people in need according to the United Nations. Due to its status, the area is not included neither in the UN’s cross-border mechanism for the delivery of humanitarian aid, nor covered by the Syrian government’s national immunisation roll-out plan.

We appreciate the concept of the humanitarian buffer. But the system today is failing its purpose and, more importantly, the people it is meant to serve. Sarah Chateau, MSF’s Programme Manager for Syria

In November of the same year, MSF submitted an application to the UN-led humanitarian emergency COVID-19 vaccine reserve with a view to launching an immunisation campaign in collaboration with our Syrian NGO partner, Al Ameen. However, once the application was approved approximately six weeks after its submission, MSF was confronted with an opaque, unwieldy legal framework placing an excessive liability on field-based humanitarian organisations carrying out the operations. This led to months of consuming contractual wrangling, until the Turkish authorities made alternative plans and the window closed on the opportunity for MSF and Al Ameen to run the planned immunisation campaign.

“For this system to work and allow for a timely intervention, it has to be practical and fair for all partners,” says Sarah Chateau, MSF’s Programme Manager for Syria. “When we started discussing with the rest of the COVAX partners, we realised it was definitely not the case.”

“To start with, we were denied access to some of the legal documents framing the procurement, which were necessary for us to assess the risks we were asked to accept,” explains Chateau.

For this system to work and allow for a timely intervention, it has to be practical and fair for all partners. Sarah Chateau, MSF’s Programme Manager for Syria

Another significant obstacle was the deeply unbalanced distribution of liabilities in the initial version of the agreement framing the supply of the vaccines, which led to months of negotiations. In those agreements, UNICEF, Gavi (the global vaccine alliance) and the vaccine manufacturer transferred to MSF part of their liability for their own roles and responsibilities in the HB, requesting MSF to waive some of our legal avenues against them and, in some cases, indemnify them against their loss and third-party claims. Adding to this, the sheer number of contracts and interlocutors results in a lack of overall accountability for the overall functioning of the system.

As of March 2022, 2.5 million doses have been approved through the humanitarian buffer according to publicly available information and while more applications are in process, this is a small fraction of the 155 million doses announced at the beginning of 2022 as the HB target.

“The Humanitarian Buffer can potentially support millions of people, particularly among hard-to-reach groups of people,” says Chateau. “For the sake of our collective pandemic preparedness, we urge the COVAX partners to work to improve the system: unacceptably lengthy negotiations, excessive contractual complexity, lack of transparency and the unbalanced distribution of liabilities are issues that need an urgent solution.”

“We appreciate the concept of the HB,” says Chateau. “But the system today is failing its purpose and, more importantly, the people it is meant to serve.”

*COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the World Health Organization (WHO) and UNICEF.


MSF has been working in northern Syria since 2011, providing primary and secondary care in an area suffering from 11 years of conflict and hosting 2.8 million displaced persons. MSF activities include supporting hospitals and Primary Health Care centres (PHCs), running mobile clinics and providing water, sanitation and hygiene services in the camps for the Internally Displaced People (IDP).

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