“We’re only safe if we’re all safe,” warns Dr Seth Berkley, CEO of Gavi, The Vaccine Alliance, the international organization coordinating COVID-19 vaccine fundraising for governments and major donors. With the World Health Organization (WHO) reporting new cases for the first week of July exceeded three million globally and total deaths ticking past the four million mark. Billions of additional vaccine doses and billions in additional support will be needed to achieve real herd immunity in most of the world in three years. Even if those efforts are successful, global health experts anticipate vaccine campaigns will remain an everyday reality in the Global South into 2025.
The scale of the global challenge remains immense. In April, the International Monetary Fund (IMF) projected total global 2020-2025 revenue loss of over $28 trillion and issued a plea for greater international coordination to launch a vigorous vaccination campaign. Globally, IMF Chief Georgieva argued, “Vaccine policy this year, probably next year, is going to be the most important economic policy.”
In response, the Biden Administration has committed $4 billion worth of vaccines and vaccine support with 25% of surplus vaccines to individual allies such as India, Canada, and Mexico, and the remainder donated to Gavi. President Biden’s pledge puts the U.S. contribution ahead of fellow donor governments in Germany, the United Kingdom, the European Union, Sweden, Japan, Canada, and Saudi Arabia.
Gavi aims to deliver one billion doses in 2021, vaccinating about 20% of the population across 88 low and low-to-middle income countries (LMICs), enough to slow the pandemic but far short of the 75-85% required to attain herd immunity. Real herd immunity requires $38 billion dollars and 11 billion doses over two to three years.
The good news is that over the next 18 months investments in vaccine production will increase manufacturing capacity as donor nations make additional pledges. But time is not on Gavi’s side. As Berkely pointed out, “With a pandemic, speed is critical; it’s not enough to protect people in just some parts of the world and let the rest of the world wait. To stop transmission, high-risk people need to be prioritized everywhere.”
An effective vaccine campaign requires two components: 1) vaccine procurement, and, 2) vaccine rollout.
Vaccine Rollout Challenges
- Vaccine Introduction: country-by-country assessment of need, absorptive capacity, regulatory challenges, target populations, and demand generation.
- Supply & Logistics: cold chain capacity mapping, procurement of delivery equipment ( vials, syringes, and PPE), waste management and distribution logistics particularly for the last mile.
- Communications, Advocacy, & Training: technical assistance to health professionals, training design, and recruitment and support of health care workers.
- Data Management & Monitoring: collection of patient information (critical for two dose vaccines), post-introduction evaluations, pharmacovigilance, and continuous monitoring, evaluation, and learning.
Vaccine rollout activities currently lag significantly behind the pace of vaccine procurement. As a result, some countries struggle to deploy donated vaccines. In early June, lacking vaccine rollout capability, Malawi and South Sudan destroyed almost 80,000 doses of expiring COVID-19 vaccine.
In addition, vaccine rollout lacks meaningful funding. International development experts estimate the cost of vaccine rollout at about $5 for each $1 spent for vaccine purchases. Gavi does not maintain staff or offices in the countries it supports, leaving the performance or procurement of rollout activities to development actors, notably the United States Agency for International Development (USAID).
In January 2021, USAID allocated $75 million for rollout activities for a subset of LMICs. Biden’s FY22 Budget proposes $355 million to combat COVID and support vaccines globally. The American Rescue Plan Act included $905 million of economic support to USAID that can be used for vaccine procurement and rollout. Vaccine rollout support will be broken down into line-item support by country, putting USAID’s regional bureaus squarely in the programmatic drivers’ seat.
As a practical matter, this decentralized approach delays in-country funding by months. While additional “real time” resources could be drawn from USAID’s PEPFAR and PMI programs, LMICs and multilateral health and development actors must adjust their own vaccine rollout plans.
In addition to traditional supporters like USAID and the WHO, governments increasingly are leveraging private grants from organization like the Gates Foundation and World Bank financing to engage private sector partners, particularly in the technology sector, in vaccine rollout.
Vaccine introduction efforts have relied heavily on collaboration platforms. While USAID deployed COVID-19 technical assistance provided by the University California-San Francisco virtually, the Colombian government partnered with Farmalisto, a fully digital pharmacy service, to provide telemedicine counsel for vaccine patients. In areas like Mozambique and the Democratic Republic of Congo, where WiFi is less accessible, NGOs developed a voice-message-based training system for frontline workers. Equitable access to information, especially when hindered by geographic distances, is a driving force behind the World Bank’s Digital Development Partnership which could play a critical role in providing the cybersecurity, government service platforms, and data management that will underpin vaccine rollouts.
Within the framework of its Digital Strategy and against the backdrop of renewed interest in Development Innovation Ventures, USAID is looking to AI and GIS to model disease progression. On the other end of the vaccine rollout cycle, the World Bank seeks solutions to data disaggregation to ensure both demographic equity in vaccine deployment and data management capabilities and privacy patient date collection, sharing, and storage of patient data.
Google leveraged Facebook’s vast population data into their own geo-spatial mapping capabilities to identify the refrigeration necessary for cold chain supply — an acute logistical challenge in Africa and the Middle East — in Sub-Saharan communities. In Nigeria, commercial refrigeration assets are being leased to the government in public private partnerships. Meanwhile, Gavi partner UPS is tackling the difficulty of African last mile delivery leveraging its freight and supply chain solutions to deliver vaccines to four continents. These solutions and others are being used to improve inventory management practices and technologies.
Meanwhile, in the Philippines, where skepticism of government messaging is prevalent, the government has turned to private sector communications specialists to craft anti-hesitancy campaigns. Similarly, both UNICEF’s Office of Innovation and WHO are turning to digital platforms like U-Report and channels like WhatsApp to monitor and combat vaccine disinformation. WhatsApp and TikTok’s ability to reach vulnerable communities has prompted the CDC to launch its latest anti-hesitancy campaign digitally in a bid to reach broader segments of the U.S. Hispanic population.
With the scarcity of dedicated vaccine rollout funding, achieving herd immunity and defeating COVID-19 will continue to prompt public international organizations and LMIC governments alike to increase their use of these public-private innovations in their bid to achieve herd immunity and defeat COVID-19.
To win this battle, donor and recipient countries and organizations need assistance from technology sector partners to target and manage the distribution of limited vaccine rollout resources.
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Marisa Paul, Guest Contributor |
| FBIQ welcomes Marisa Paul as a guest contributor. Marisa served as the Senior Deputy Director of Response for USAID’s first COVID-19 Task Force (2020-2021). Prior to her Task Force assignment, Marisa led acquisition and assistance reform efforts for USAID and served as an acquisition policy and budget analyst for the Department of Defense. She has also worked as a senior advisor to market-leading multinational R&D and security companies. |