Executive Summary
It is in every country’s interest to vaccinate the world as quickly as possible. Failure to do so risks new variants emerging that could evade vaccines and undo all the hard work that has been done to date, as well as lead to deaths, overwhelmed health systems and untold economic damage.
While much of the developed world has aligned on this objective, the question of how has primarily focused on vaccine supply. This is a key part of the equation, and it is right that the world commits to a bold, ambitious target of vaccinating as many people as possible in 2021. Modelling from our previous paper Vaccinating the World in 2021 found that we could strategically vaccinate the world in 2021 by using the available supply to inoculate the 3.2 billion people that make up priority populations (such as health-care workers, clinically vulnerable people and those in densely populated urban areas) in order to help minimise mortality, maintain essential services and reduce viral transmission.
Supply is, however, not the only component of this unprecedented challenge. We must do all we can to ensure that when doses are received by countries, they can actually be administered. We call this absorptive capacity, and countries in the developing world must begin building and scaling it now.
Already we have seen countries around the world disposing of expired doses, and many more struggle to vaccinate amid rising hesitancy. In May, Malawi destroyed almost 20,000 doses of the AstraZeneca vaccine. In June, South Sudan destroyed 59,000 doses and handed back 72,000 of the 132,000 doses it received through COVAX. The Democratic Republic of the Congo was unable to use most of the 1.7 million AstraZeneca doses it received under COVAX and was forced to redistribute them. All three countries were unable to administer their supply by the expiry date. This will become more acute as supply increases. Indeed, to fully account for incoming vaccine supply from COVAX and other bodies to the countries most in need of vaccines, our modelling shows that a global increase in their absorptive capacity from 170 million doses to 410 million doses per month will be needed by the end of 2021. This is the absorption-capacity challenge – and it requires a plan.
Of course, the context of each country is different. Factors including a country’s existing health-care capability combined with budgetary and political constraints create a unique set of circumstances that will shape requirements. This should not preclude the creation of a central framework and an internationally coordinated approach to building capacity.
In this paper we offer a framework that is adaptable to specific contexts, drawing on examples from the developed and developing world, along with lessons from historic vaccination programmes. Starting with an assessment of the strategic needs for a country, this framework will ensure that capacity is focused in the right places to facilitate targeting vaccines at those most vulnerable to Covid-19 infection or those most likely to transmit the virus. At the same time, sustainability should be part of this endeavour: we should build absorptive capacity that readies us for future pandemics, as well as tackling this one.
We recommend that countries introduce measures for what we call the four S’s framework: setting and supply chains; staffing and equipment; systemisation and data; and strategic communications and community engagement – as the key pillars to guide a successful vaccine rollout.
Any investment in strengthening absorption capacity has the dual impact of benefiting the populations of individual countries and protecting previous investments in aid and development abroad. Therefore, donor countries should ensure that sufficient concessional financing is available through grants and other special drawdown mechanisms, and they should lead an effort to track this funding to avoid duplications or gaps.
The IMF estimates that at least $6 billion is needed for delivery costs to achieve 60 per cent vaccine-coverage rates – a relatively low price compared to the total amount spent on overseas development aid each year, which exceeds $150 billion. As these figures help to highlight, vaccine delivery is an investment to ensure that spend on other development programmes is effective and to minimise how much the pandemic derails other development efforts.
We have previously argued that there is a need for strategic allocation of vaccines to health-care workers, vulnerable populations and people in densely populated urban areas. We similarly believe that a strategic prioritisation of investments to support absorption capacity is required to maximise return on investment, avoid duplications and minimise financing gaps to the extent possible.
Recommendations
We recommend that the G20 – as the premier global body accounting for the majority of the world’s economy and with representation from the Global North and Global South – set up a task force with the Access to COVID-19 Tools Accelerator (ACT-A) with the following mandate:
Quantify and centralise country-level financing requirements for the rollout of vaccines.
Determine which strategic investments in absorption capacity have the greatest impact in terms of number of people vaccinated.
Set and commit to a realistic financing target to deploy those strategic investments, including through repurposing of existing funds.
Channel funds through key multilaterals (e.g. Gavi for supply chain and logistics, Global Fund for Community Engagement).
Track investments to specific country needs in a centralised and coordinated manner in order to maximise return on investment, avoid duplications and minimise financing gaps to the extent possible.
Prioritise vaccinations of health-care workers, vulnerable populations and people in densely populated urban areas to maximise lives saved and minimise viral transmission.
In parallel, in-country efforts to strengthen absorption capacity require leadership by national and local governments of each country, supported by local partners to provide technical assistance and implementation