Paragraphs highlighted in green indicate diagrams or tables that shall be shared in the “Case exhibits” section.
Paragraphs highlighted in blue shall be verbally communicated to the interviewee.
Paragraphs highlighted in orange indicate hints for you on how to guide the interviewee through the case.
Part 1 – Case Opening
Our main goal is to ensure the world's most at-risk populations receive a safe and effective COVID-19 vaccine in the next six months.
A great solution starts with great questions. Examples of relevant questions:
- Objective: does the WHO have a specific target in terms of number of vaccine doses?
- Scope: is the scope global, or has the WHO already decided to focus on specific countries? Has a specific manufacturer/pharma company been selected, or is there scope to choose from multiple manufacturers?
- Constraints: does the WHO have a pre-defined budget to purchase and distribute the vaccines?
EXAMPLE OF AN EXCELLENT ANSWER
An excellent answer would cover the supply and demand drivers, including a governance model bringing together different stakeholders and enabling key decisions:
- Procure enough doses of safe and effective vaccines from vaccine manufacturers and allocate them fairly to the high-risk groups globally
- Distribute vaccines efficiently at the right conditions (i.e. cold storage) to avoid losses. Link different forms of transportation (e.g. plane, train, truck) to reach remote and rural communities
- Stop corrupt practices (i.e. stolen and counterfeit vaccines)
- Guarantee financial resources: subsidise vaccines for developing countries with the help of richer countries; offer incentives (e.g. tax credits) for vaccine manufacturers to reduce their profit margins, establish financing systems for low-income countries (e.g. payment in instalments) and co-participation (population pays for part of the vaccine costs)
- Streamline the regulatory approval process: faster approval without compromising safety and efficacy
- Estimate the size of the target population: total number of people in high-risk groups globally
- Increase compliance rates: ensure the population is well informed about vaccine benefits and risks; fears and concerns are addressed
- Set-up tracking systems: integrated systems to track who has taken the vaccine
- Develop a governance model bringing together the relevant stakeholders ensuring key decisions (e.g. vaccine selection, allocation, financial planning and resource sharing) are made effectively
Answers need to be specific to the client (e.g. the WHO). The candidate may be tempted to do a full cost analysis of vaccine development (e.g. R&D, facilities, raw materials, labour, distribution, etc), which would have been relevant if the client was a vaccine manufacturer. The WHO would be mostly interested in the cost/dose of vaccines (purchased directly from the manufacturers), and distribution costs. Although distribution costs could in reality be shared between manufacturers and the WHO, we will assume the WHO will cover them.
Top strategy firms love hypothesis-driven thinking. As the candidate explains the framework, expect a few strong hypotheses for the key drivers. Hypotheses must be specific to the problem and connected to the client's goal. Some examples:
- Vaccine demand: it is important to shape public perception to increase compliance rates as vaccination campaigns only work if a high percentage of the total population takes the vaccine
- Financing: it is likely that many poorer countries cannot afford the vaccine, so richer countries may need to contribute with a bigger share
- Vaccine supply: collaboration between multiple vaccine manufacturers (or choosing multiple vaccines if possible) may be needed given the urgency to produce and distribute a large number of doses on a global scale in a short period of time
- Governance: to achieve its objectives, the model needs to bring the right stakeholders to give the right input at the right time, with enough oversight to ensure decisions are aligned towards a common goal
Part 2 – Governance model
After the structure, verbally communicate the information below, followed by Exhibit 1.
The WHO has assembled a taskforce called COVAX, which brings together governments, global health organisations, vaccine manufacturers, universities, the private sector and civil society. The COVAX has four objectives:
- Map demand from high-risk groups globally
- Select the best vaccines taking into account clinical data, manufacturing capacity and costs
- Plan vaccine distribution to ensure fair allocation across different countries
- Define financing schemes, pooling funds from wealthier nations to support poorer ones
In order to achieve its goals, COVAX has established the governance model shown on Exhibit 1. After analysing the model, please answer the following question: what are the strengths and weaknesses of the COVAX governance model?
Show Exhibit 1.
You can ask probing questions in case the candidate finds it challenging to interpret the model:
- Is the model comprehensive in terms of stakeholders and type of decisions needed to select, finance and allocate vaccines fairly?
- Is the right input and oversight given?
- What is the level of complexity? Is there significant task duplication?
EXAMPLE OF AN EXCELLENT ANSWER
An excellent answer should highlight the high complexity of the governance model, and some of its pros and cons:
- Fairly comprehensive and relevant in terms of roles and functions, including input from technical experts
- Broad oversight provided by a dedicated Office and board
- Stakeholders from different sectors
- High complexity. Relies on the interconnection between different groups working really well. Operational bodies have to work efficiently to ensure the different groups provide the right input to each other and actions are aligned towards a common goal
- Task duplication. (e.g. operations are overseen by multiple bodies; vaccine portfolio decisions are made both by the COVAX office and the technical advisory body). The Technical advisory body and the Allocation governance could be merged into one as they deal with very interconnected decisions (i.e. vaccine selection and allocation). Task duplication may result in members not completing tasks as they may think another group will complete them instead
- Vaccine compliance is not considered as part of the selection and allocation process
- Low or no representation from low-income countries
Part 3 – Demand Analysis
After the governance question, verbally communicate the information below to the candidate, followed by Exhibit 2.
COVAX needs to estimate the demand from high-risk groups around the world. Based on exhibit 2, how many doses of vaccine in total are needed to serve the high-risk groups?
Assume the world has 7 billion people
Ignore people over 65 years who are also healthcare workers
Compliance refers to the % of people willing to take a COVID-19 vaccine
Loss rate refers to the % of the vaccines wasted during transportation or at the point of administration
Show Exhibit 2.
After the candidate has given you the results and intepretation, ask the following question:
In order to increase compliance rates, how would you shape public opinion to address misconceptions around vaccination? What should you consider as part of an effective communication strategy?
EXAMPLE OF AN EXCELLENT ANSWER
- Total number of people taking the vaccine= 65-year olds (7 billion * 10% * 75%) + Healthcare workers (7 billion * 5% * 90%)= 525 million + 315 million= 840 million
- Total number of doses required= 840 million * 2 doses/person= 1.7 billion doses are needed
- Total number of doses produced= as we have a 20% loss rate, we need to produce more than 1.7 billion doses. As 1.7 billion doses equal to 80% of X (100%), X= 2.1 billion doses
For a vaccination campaign to work, a very high percentage of the population must be vaccinated, so compliance is key driver. Addressing public mistrust is complex and context-dependent; it is important to act at global and national levels. An effective communication strategy should:
- Consider the background level of scientific literacy when explaining terms such as efficacy, safety and the importance of population-wide coverage
- Avoid suggestions of enforcement
- Choose channels (e.g. TV, radio, social media) according to local preferences
- Ensure social media companies are held accountable for spreading misleading information
- Address community-specific concerns (e.g. elderly people may be afraid to go to public places so could administer vaccines at their homes instead)
- Involve leaders of civic, religious and fraternal organizations
- Leverage impartial and well-regarded NGOs such as the Red Cross and Doctors without Borders
- Be sensitive to religious or philosophical beliefs
Part 4 – Supply Analysis
After the demand questions, verbally communicate the information below to the candidate, followed by Exhibit 3.
As part of the vaccine selection decision, COVAX has obtained clinical, manufacturing and cost data for six vaccines at late stages of development. All six vaccines are produced by different manufacturers. After analysing the data on Exhibit 3, what are your conclusions?
Show Exhibit 3.
Alternatives to make the 2.1 billion doses
At this point the candidate should have concluded that no single vaccine meets the safety and efficacy criteria AND is capable of producing all the required 2.1 billion doses. If the candidate does not proactivelly describe different options to meet the 2.1 billion dose target, ask:
What are possible options to ensure all 2.1 billion doses get produced in the next six months?
EXAMPLE OF AN EXCELLENT ANSWER
No single vaccine simultaneously meets safety and efficacy criteria and is capable of producing all 2.1 billion doses. As a result, we could explore two options:
Option 1: Source from more than one vaccine manufacturer (e.g. vaccines E and B):
- Vaccine E: the preferred choice as it meets clinical goals, cheapest and can produce the highest number of doses (1.8 billion) out of the clinically acceptable vaccines
- Vaccine B: clinically equivalent to E and the second cheapest.
- Ideally, the WHO would purchase 1.8 billion doses of vaccine E and the remaining (0.3 billion) of vaccine B. In reality, producing a vaccine involves very high fixed costs (e.g. R&D, facilities, equipment) so the manufacturers of vaccine B would probably require the WHO to commit to a larger quantity to make it financially viable
Option 2: Increase production of vaccine E:
- Further investment (e.g. new facilities). Vaccine E may deploy resources to increase capacity and may ask the WHO to take some of the share. As a result, we need to analyse the trade-off between the cost of new investments and savings from using Vaccine E (the cheapest on a per dose basis). It is likely that the incremental savings from the 0.3 billion doses do not offset new investments. However, this could change if Vaccine E is rolled out beyond high-risk groups (e.g. to healthy people) so more units would be needed
- Tech transfer: other manufacturers transfer technology royalty-free/for humanitarian reasons to make Vaccine E’s production faster. Governments could offer incentives (e.g. tax credits) for companies to tech transfer
Part 5 – Prioritisation Decision
After the supply questions, verbally communicate the information below to the candidate, followed by Exhibit 4.
In case of severe supply constraints, COVAX designed a risk scoring system to determine the speed at which vaccines are delivered to different countries. Countries with a higher risk score receive vaccines faster. The scoring system does not impact the total number of vaccines allocated to each country. A country’s risk score is calculated based on specific parameters, grouped into two categories: “threat” and “vulnerability”. After reviewing the information on Exhibit 4, Which country (A or B) should take priority?
Show Exhibit 4.
What are the strengths and weaknesses of the scoring system? Would you add or remove any parameters?
EXAMPLE OF AN EXCELLENT ANSWER
The candidate needs to do a weighted average taking into account the weight and the scores for each parameter:
- Country A: (5*8)+(2*1)+(4*4)+(5*8)+(4*6)/(5+2+4+5+4)= 6.1
- Country B: (5*5)+(2*10)+(4*5)+(5*6)+(4*8)/(5+2+4+5+4)= 6.4
Therefore country B should take priority.
Interpretation of the scoring system:
- Most parameters (Rt, healthcare system infrastructure and occupancy and % of high risk groups) are relevant
- Although it is important to capture a country's development (e.g. people living in crowded conditions are more likely to spread the infection), Hemisphere location is not the best measure (e.g. New Zealand is in the southern hemisphere but is very developed). Can replace with indicators such as GDP per capita, Human Development Index (HDI), etc
- Could introduce an indicator to measure the level of comorbidities (i.e. underlying health complications that lead to worse outcomes from COVID-19) in the population.
Part 6 – Conclusion
"You have one minute to present your findings to the WHO's Director General. What are you going to say?"
EXAMPLE OF AN EXCELLENT ANSWER
RECAP THE OBJECTIVE
An excellent candidate would start with a small recap of the objective:
"In order to meet its goal to provide enough doses of safe and effective COVID-19 vaccines to high-risk groups globally in the next six months, the WHO should..."
A great candidate would provide and answer-first approach to the question, highlighting three main actions:
In order to deliver 2.1 billion doses of COVID-19 vaccines, the WHO should work on three fronts: improve compliance rates, streamline its governance model, and choose the best combination of vaccines:
1. Improve compliance through public campaigns that target global and local drivers of resistance and misconception around vaccines
2. Streamline its governance model through a simpler and more inclusive model to make decision making more effective and ensure fair allocation of doses
3. Choose the right combination of vaccines by undertaking a full cost and capacity analysis to determine whether to combine Vaccines E and B, or to increase capacity of Vaccine E, working closely with vaccine manufactures throughout the process
- Vaccine manufacturers do not deliver on their production targets, and/or different manufacturers do not share best practices to ramp up production
- Distribution: high loses; distribution in remote areas is challenging; poor infrastructure to deliver the vaccines
- Funding: issues in getting the funds needed, especially if richer countries decide not to take a share of the poorer ones
- Poor compliance: public opinion can shift dramatically towards resistance to vaccination
- Challenges in tracking populations, especially in developing countries, as a significant proportion of the population lack formal IDs
- Vaccine nationalism: poor cooperation; countries sign unilateral agreements with vaccine suppliers to secure their own supplies, leaving poor nations to miss out
Thank you for completing my case! I hope you enjoyed it and learned as much as I did putting it together :)
Do you have any feedback or questions on the case or on your preparation? Feel free to reach out!
Finally, I found a brief summary of the latest trends in healthcare which you may find helpful here
Wish you all the very best in your preparation,