How the UN is vaccinating staff in 152 countries
We interview Christian Saunders on the massive task of vaccinating UN field staff and peacekeepers.
26 Apr 2021
  1. You are in charge of vaccinating UN staff. How many vaccines have you procured, which are they and when will they be made available? Are you making use of Russia’s kind offer to donate vaccinations to staff?

The United Nations has thus far purchased sufficient quantities of vaccine to vaccinate half a million UN and related personnel. We purchased the AstraZeneca vaccine from the Serum Institute of India. A first consignment of 100,000 doses has been received and our Global Vaccine Deployment Team is working with the country teams and field missions to prepare them for the receipt of the first shipments and the subsequent administration of the vaccine.

Last week, vaccine administration began for our frontline personnel in Afghanistan, and we expect at least 10 other countries to begin administering vaccines before the end of the third week in April with others following closely behind.

The Government of India also generously donated 200,000 doses of the Astra Zeneca vaccine for our uniformed (military and police) peacekeepers. Several other Member States have also expressed interest in donating vaccine to the UN, including the Russian Federation and China, but we need to wait until they have completed the requirements for the WHO (EUL) before we can accept these donations.

We are in close contact with most of the major vaccine manufacturers and following closely the progress of new vaccines coming to the market. The Secretary-General has been very clear in his commitment to provide all UN personnel with access to a safe and effective vaccine, and that is what we will do!

  1. How will you decide which duty stations get the vaccine and how will staff know if their duty station has been chosen?

Even though a major principle of the vaccination strategy is that UN personnel will be part of the national vaccination programmes in the countries in which they are working, it is anticipated that we will likely run UN vaccination programmes in as many as 152 countries and our team is already actively engaged with 84 of these countries.

We have developed a very intricate country prioritization model based on key indicators developed by the Division of Healthcare Management and Occupational Safety and Health (DHMOSH) and the UN Medical Directors Working Group such as the medical infrastructure, security, UN case and medical evacuation rates, and hardship considerations. However the pandemic is very dynamic and thus we need to remain responsive to changes on the ground.

The country prioritization is also just the first step in the process, as there are other important considerations, such as a country’s readiness to receive the vaccine. There is no point in our shipping vaccine to a particular destination if it is then going to sit at the airport in the hot sun because the customs clearance has not been taken care of. Thus, before we ship, its really important that all the arrangements are put in place to receive the vaccine and to ensure it gets into people’s arms as quickly as possible.

We have been working really closely with DGC, the different agencies and with the country teams on communication with staff, which is absolutely critical to the success of this type of programme.

  1. Who will be giving the vaccine?

How the vaccines will be administered very much depends on the local circumstances. Every field mission or country team needs to put in place a local vaccine deployment plan before the shipments reach them. This includes the need for a careful assessment of available resources and capacities.

In certain situations, vaccines will be administered by UN personnel, military or civilian in peacekeeping clinics, IOM and UNDP clinics while in other locations third party arrangements will be put in place to administer the vaccine.

To ensure quality and consistency, anyone  who is involved in the vaccination campaigns will need to complete a number of specific training modules.

  1. What do you say to staff who are worried about adverse events and the blood clots that have been reported after receiving the AstraZeneca vaccine, and are wondering if its safe to take the vaccine?

It is certainly plausible that the blood clots are associated with the AstraZeneca vaccine – with an incidence of 1 in 1 million to 1 in 100,000 – but the evidence is not conclusive and it  is an area of ongoing study. The WHO however has clearly stated that the benefit of vaccination far outweighs the risk of these very rare events that have involved blood clots and thus we continue to encourage UN personnel to take the vaccine. 

  1. Will you also vaccinate staff members’ families, consultants, UNVs and interns? Are specialized agencies covered?

We wanted the programme to be as broad and inclusive as possible while at the same time it is important that we not compete with COVAX or the national vaccination programmes. We also needed to recognize that access to sufficient supplies of vaccine was going to be an issue in the short to medium term.

It was thus agreed to include all UN personnel from across the system, their recognized dependents and retirees. UNVs, consultants, interns, contractors and other close partners are also included; in essence, all those closely involved in the delivery of mandates should be included.

However, it is important to note that even though a wide range of personnel and dependents are eligible, we are following strict prioritization guidelines – based on the  prioritization roadmap of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) – which means that those most at risk and the most vulnerable will be the first to be vaccinated. We will continue to run the programme until everyone who wishes to be vaccinated has been vaccinated.

  1. How are you organizing to get the vaccinations to the various missions and country offices? It must be quite a logistical exercise.

This is quite an undertaking that requires careful coordination and planning, particularly as the cold chain needs to maintained at all times. It’s the UN at its best, with teams from across different disciplines and different agencies working closely and effectively to get the job done. The Global Deployment Team is also working very closely with colleagues on the ground to ensure that that part of the operation is taken care of and that they are ready to administer the doses the moment they arrive.

  1. What about staff living in duty stations that are caught in the middle i.e. too developed to qualify for the UN programme but with governments not rich enough to procure vaccinations in sufficient quantities for their populations? Will those staff be given time off to get vaccinated elsewhere?

We will be running the UN vaccination program in 152 countries which I think will cover most of these countries. The situation is pretty dynamic at present and we are monitoring closely and keeping in touch with the UN country teams. If we need to step in to vaccinate personnel in a particular country that is not currently on the list, then we are ready to do so. 

  1. Will the UN be issuing vaccination passports to those who get vaccinated?

There is no decision either way at this point. We will be working with WHO and other relevant UN entities and will follow their guidance on this matter. All those vaccinated through the UN System-Wide COVID-19 Vaccination Programme will however receive a certificate of vaccination. We have developed an online registration platform through which all those participating in the programme register. The system can then generate a certificate once vaccination is completed. 

  1. How is the vaccination programme paid for?

The costs will be covered through a cost share arrangement between participating entities. Again, in demonstration of the phenomenal team work associated with this endeavour, the controllers and their teams have been really  supportive.  

  1. Many governments have complained at the way vaccination manufacturers handled procurement negotiations. What was your experience?

In general I don’t think people really appreciate how complex procurement and in particular public procurement is at the best of times. Regulatory and compliance requirements, lead times, the risk management, ensuring best value for money in spending public funds and the requirement for complete transparency along the length of the process, are just some of the issues that need to be addressed on a daily basis.

COVID-19 was a particular challenge to procurement offices around the world due to a confluence of factors, the global economy in which we live and the fact that many suppliers were half a world away from where the supplies were needed, a tremendous increase in demand over a very short period of time not allowing for supply to catch up and a shipping shortage due to the closure of ports and airports around the world and the grounding of aircraft. Initially it was PPE, ventilators and other ICU equipment and consumables, then it was diagnostics or testing, and now it’s vaccines.

The procurement of vaccines is in itself a complex area that requires specialized expertise, with COVID-19 vaccines posing their own particular challenges. This includes the speed at which they were developed and brought to market, the regulatory uncertainty concerning approvals; residual safety and health concerns; an extremely limited supply market along with very high demand.

Many high-income countries (and some lower income countries) hedged and during the course of last year placed advanced orders with multiple different manufacturers for billions of doses of vaccine, in some instances for quantities that far exceeded their national requirements.

Regardless of the significant challenges, the UN made good progress in securing an initial quantity of vaccines – what did we do? we started early, we listened, we researched, we followed the market closely and opened dialogues with many of the different vaccine manufacturers and then we acted decisively when it came to placing the order.

One of the biggest challenges for us was to get the attention of the vaccine manufacturers given the relatively ‘miniscule’ quantities that we were seeking to purchase when compared to the ‘major’ orders being placed by multiple competing governments. We also didn’t want to compete on the market with COVAX. We are fully supportive of its mandate and have had good collaboration with both UNICEF and WHO in all matters related to this initiative.

  1. Once this mission is completed, what would you like to do next?

This has been a unique undertaking and hopefully has provided us, the UN with valuable knowledge should there be another public health crisis of this magnitude in the future.

On a personal level, I have had some really interesting and challenging assignments during my career, some of them were perhaps not the most sought after of assignments, but without exception they all turned out to be hugely rewarding. I have seen the UN at its absolute worst but I have also seen the UN at its very best, and the latter fortunately predominates! I don’t mind what I do next as long as it is challenging and an opportunity to make a difference. It probably comes across as trite, but you only have one life and you need to make it count! 

I am the face of the vaccine initiative but it would be very remiss of me, if I didn’t  pay homage to Atul Khare, the USG for Operational Support, who has been totally supportive from the start and who has stepped in to open doors and provide support whenever there was a need and to AnneMarie Van Den Berg and the absolutely brilliant team we have working on this from across the different disciplines of supply chain.

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* Ian Richards is Deputy Editor of UN Today.
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