We think of a design project as end-to-end when the program is scoped to match the design process through its entire cycle, from informing the program strategy at the start, to implementing solutions at the end. An end-to-end design process is also more likely to match an effective and more seamless innovation process, as a design partner would be well suited to ensuring the continuity of a core group of people and ideas throughout the entire process - from problem framing to concept development to implementation - even if specific specialists come and go.
With design as end-to-end, it is important to think through the burden of proof for your investment. If it is to *develop* a vaccine, design will not likely play a prominent role. However, if it is to design the system needed to track the vaccine, or to consider how to overcome resistance to the vaccine, design will likely have a more important role to play in your investment. The burden of proof will have shifted to open things up to the possibilities of design.
In these types of projects, it has been more common to contract with a design firm who is then tasked with bringing in different types of expertise. Given that design is not fully established in the field of global health and so your design partner might need some guidance in what kinds of partners to bring in - from specialists in certain areas of global health, to experts on country level health systems and how to effectively introduce and implement new solutions in these settings, to key stakeholders who can forge a linkage to large global health governing bodies.