COVID-19 vaccine procurement: ACA published report on special audit

The procurement of COVID-19 vaccines aimed at providing the Austrian population with vaccines and contributing to overcoming the pandemic. For the ACA, scientific facts are what counts. According to studies, the vaccination, which was developed in a timely manner, helped to prevent deaths and severe cases of the disease. However, the implementation of vaccine procurement had weaknesses, as the ACA ascertained in its report on the special audit „COVID-19-Vaccine Procurement“ (in German), which was performed upon the request of members of the National Council affiliated with the Social Democratic Party of Austria (SPÖ). The ACA notes that COVID-19 vaccine procurement was accompanied by constantly changing framework conditions due to the dynamic trajectory of the pandemic.

In 2020, the EU’s 27 member states agreed to jointly procure COVID-19 vaccines. Sufficient vaccines from different vaccine manufacturers were available in Austria as of June 2021. However, no detailed calculations of the estimated expenditure were performed at the start of vaccine procurement, which began in June 2020, for example. Various needs-based calculations were made in the case of other purchases, but they lacked a documented comprehensible basis. The audited period essentially spanned the years 2020 and 2021.

At EU level, procurement of COVID-19 vaccines was led by the European Commission and accompanied by the EU Steering Committee, in which Austria was also represented. In order to ensure joint procurement across the EU, the European Commission concluded Advance Purchase Agreements with vaccine manufacturers on behalf of its member states. The essential parameters for the vaccine purchases (such as the product description, the price and the delivery modalities) had already been specified in those agreements. The EU strategy stipulated that an EU member state’s access to the jointly procured vaccine doses should be determined by the ratio of its respective population to the EU’s overall population. This means that Austria had access to around two per cent. It was possible to place orders for vaccine doses above and below the population key.

The individual member states – the Federal Ministry of Health in Austria – independently placed the actual orders. This gave them a certain degree of discretion, in particular as regards the quantity ordered.

Austria first placed orders for vaccines below, then above the population key

 Due to the dynamic trajectory of the pandemic, vaccine procurement in Austria was accompanied by constantly changing framework conditions. In addition to emerging new virus variants, these included several lockdowns as well as mandatory vaccination, which was announced, introduced, not applied and finally abolished. Furthermore, there were ministerial changes. In the course of the pandemic, a total of three different persons held the office of Federal Minister of Health. The ACA is aware of the challenging framework conditions faced by the players.

By spring 2021, Austria had procured less COVID-19 vaccines than would have been possible. By 30 June 2021, the Federal Ministry of Health had placed binding orders for 24.32 million COVID-19 vaccine doses of different vaccine technologies. This order volume fell twelve per cent short of the order volume that would have been possible in accordance with the population key. A calculation made by the ACA shows that the hypothetical vaccination coverage of the Austrian population would have increased if Austria had placed orders in accordance with the population key. As at 30 June 2021, initial vaccination coverage would have increased from 53.6 per cent to 56.9 per cent or to 56.2 per cent, depending on the method of calculation.

Starting in October 2021, on the other hand, orders for vaccine doses were placed above the population key in the amount of 14.65 million doses. The underlying assumptions for the purchases differed. In many cases, a documented comprehensible basis, such as decisions or recommendations for use made by the National Vaccination Committee, did not exist. For example, for one needs-based calculation, the Federal Ministry of Health assumed a vaccination coverage of 100 per cent of all persons aged twelve and above. Then, in view of the planned mandatory vaccination, it was agreed at the political level in December 2021 to order “as much as possible” of the Novavax vaccine. This has to be considered against the backdrop of the limited shelf life of the vaccines. 

Vaccine doses tripled, costs quadrupled

In July 2020, the overall budget amounted to up to EUR 200 million. The ACA critically notes that the Federal Ministry of Health did not calculate the estimated expenditure even though it was informed about expected price ranges.

In July 2021, the overall budget increased to up to EUR 1.252 billion.

By end of February 2022, Austria had ordered around 70 million COVID-19 vaccine doses, the estimated expenditure for which amounts to EUR 1.085 billion. This corresponds to almost three times the vaccine volume and almost four times the costs as at 30 June 2021. At the time, end of June 2021, around 24 million vaccine doses were ordered at an estimated cost of EUR 287.42 million.

It is plausible that the level of knowledge about the vaccines’ effectiveness changed in the course of the pandemic and that, for example, the National Vaccination Committee constantly adapted its recommendations for use to the current level of knowledge. The ACA recommends basing vaccine procurement projects on needs-based calculations that are documented in the filing system and are based on comprehensible assumptions.