Since the first administration of COVID-19 vaccine in December 2020, countries have experienced a range of challenges at different phases of their COVID-19 vaccination programmes. Initially, with limited global COVID-19 vaccine supply, the WHO called for vaccine equity to ensure the most vulnerable people in every country globally had access to vaccine, and COVID-19 Vaccines Global Access was established to facilitate equitable access to COVID-19 vaccine. However, the aims of these initiatives were challenged as many countries secured earlier access to COVID-19 vaccine with direct agreements with manufacturers. During the early stages of COVID-19 vaccination programmes, the rate of vaccine uptake was determined by number of COVID-19 vaccines approved for use and the manufacturing capacity of the manufacturers of these vaccines. It is a very different situation in 2022, where COVID-19 vaccination coverage is no longer determined by access to supply and manufacturers are reducing or stopping production of vaccines completely. Uptake of COVID-19 vaccination in 2022 is dependent on complex issues like vaccine hesitancy. This paper focuses on the Central and West Asia region, where the authors have been supporting COVID-19 vaccination programmes across seven countries in this region. In this paper, we outline and describe the different phases of demand for COVID-19 vaccination as well as the risks and strategies to consider in each of these phases.

Why do some countries (often developing and emerging economies) adopt special laws on PPP, whilst in others PPPs are governed by the legislation on public procurement and related bylaws? This paper explains the above global discrepancies from an institutional perspective. In a contract-theoretical framework we demonstrate how PPPs can enable projects that are not feasible through standard public procurement arrangements. Incentives for private partners are created through extra benefits (often non-contractible) from their collaboration with the government (e.g. risk reduction, reputational gains, access to additional resources, lower bureaucratic burden, etc.). In a well-developed institutional environment these benefits are implicitly guaranteed, suggesting no need in a specialized PPP-enabling legislation. Otherwise, a PPP law should establish an institutional architecture to provide the above benefits.

The ability to support a comprehensive vaccine research and development (R&D) portfolio from a health security perspective has taken on enhanced significance over the past 3 years whereby countries that had existing vaccine R&D infrastructure (G7, Russia and China) have been at the forefront of global efforts to combat COVID-19. Few countries outside of these key players have the infrastructure necessary to develop national vaccine programs, though this is beginning to change with investment across many low- and middle-income countries. These same opportunities exist for countries in Central and West Asia, and in this perspective, we highlight the existing infrastructure and expertise across seven countries (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan) and propose opportunities for enhanced collaboration along with a bold proposal for establishing a new-build, regional vaccine translational research institute to facilitate the development of a robust, regional vaccine R&D environment to combat existing and future health challenges.