Background
As of 11th March, the COVID-19 pandemic has resulted in over 117 million cases and 2.6 million deaths worldwide. The virus’s impact has gone beyond health and has had vast adverse economic effects, which has affected countries worldwide. Vaccines have been identified as a safe and effective way of protecting lives and possibly ending the pandemic. One year since the world declared a pandemic, multiple countries are now beginning to deploy vaccines, bringing hope to the fight against COVID-19.
In a bid to ensure that countries, regardless of income levels, will have equal access to vaccines, COVAX, the vaccine pillar of the ACT Accelerator, co-led by Coalition for Epidemic Preparedness Innovations (CEPI), Gavi and WHO, was set up. COVAX is currently facilitating the equitable access and distribution of vaccines to protect people in all participating countries. At present, the facility offers countries that meet its criteria enough vaccines to cover 20% of its population. While this is a significant contribution, many countries still face difficult decisions determining funding options and trade-offs on how to purchase vaccines beyond the COVAX 20%.
Vaccine Introduction and Funding in the Africa Region
While the global rollout of COVID-19 vaccines accelerates, countries in Africa have not been left behind. As of 10th March 2021, 16 African countries (Ghana, Nigeria, Kenya, Cote d’Ivoire, Angola, DRC, Gambia, Rwanda, Togo, Sudan, Sierra Leone, Lesotho, Uganda, Mali and Malawi, Mauritius) have all received COVID vaccines through the COVAX facility with more countries scheduled to receive theirs in the coming weeks. These deliveries signal Africa’s joining of the largest, most rapid and complex global rollout of vaccines in history.
Summary of the FORCE Webinar session
In line with the next step of the country engagement framework, design and implementation of solutions, and due to the topical nature of the rollout of the COVID-19 vaccine programs in Africa, the March FORCE community webinar explored how African countries have designed their COVID-19 response programs, how they intend to fund vaccines for their target population, and factors that informed the decisions and trade-offs. Experts from Rwanda and Nigeria discussed experiences on the COVID-19 vaccine introduction in both countries.
The objectives of the one-hour session were to:
- Explore how African countries have designed their COVID-19 response programs.
- Outline how countries intend to fund vaccines for all of their target population.
- Discuss factors that inform the decisions and trade-offs on how to fund the vaccines
Key Takeaways from Rwanda
- Rwanda leveraged and established a multisectoral COVID-19 response structure that included other ministries, partners, the local government etc., to roll out the vaccine rapidly. This structure played a crucial role in ensuring the prioritisation of vaccine delivery to the districts.
- In preparation for the arrival of vaccines, the country ensured strong operational coordination and efficient dissemination of information across all levels, ensuring that facilities received vaccines within 48 hours of their arrival in the country.
- Rwanda aims to fund more vaccines for the rest of its population by increasing its domestic resource allocation to the health sector. It also plans to leverage its already existing partnerships with donors, partners and the African Union.
- Rwanda does not anticipate any diversion of resources from its routine immunisation as the country built its COVID-19 response program on the existing vaccination programs, ensuring that little if any resources were taken away from the health sector.
- The country leveraged existing platforms and partnerships to make information about the vaccine available to the public, e.g. civil society organisations, community and religious leaders, local forums and other accessible platforms for the general population.
Key Takeaways from Nigeria
- Early lessons published by other countries partly informed the design of the COVID-19 vaccine rollout plans in Nigeria. This ensured the country was able to create a robust distribution and implementation plan before the arrival of the vaccines.
- Multisectoral collaboration and participation were vital in Nigeria’s approach to its COVID-19 vaccine rollout programs. From leadership, governance and coordination to evidence generation for risk communication and demand generation, the collaboration ensured multisectoral ownership of the COVID-19 vaccination rollout plans.
- Nigeria leveraged existing vaccine platforms, which were expanded to accommodate the COVID-19 response. This ensured that very few resources from the health sector were diverted for COVID-19 response.
- The country ensured robust monitoring of vaccine awareness and acceptance by deploying a communication group to track rumours and sentiments using sentiment analysis on social media discussions about COVID-19 and its vaccines. The group also implemented weekly polling surveys using several platforms, including telephone, online surveys for health workers, SMS surveys and community polling to monitor changes in acceptance of the vaccine by health workers and the general public. Results from these sources were used to create and disseminate appropriate information to address concerns and increase vaccine awareness using social and traditional media.
- Nigeria plans to vaccinate 70% of its population by 2022, but current funds can only cater to 40% of its people. However, the country intends to seek support from the African Union credit facility for COVID-19 vaccines, which has secured a provisional 270 million COVID-19 vaccine doses for its member states, including Nigeria and the World Bank. It also plans to utilise a supplementary budget to bridge the current funding gap. Nigeria now has a vaccine first-line charge – a line item for ensuring that sustainable funding for vaccines cannot be diverted for other purposes.
The COVAX plan presents an excellent relief for African governments deciding how to fund their COVID-19 vaccine programs, but experts such as Africa CDC Director Dr John Nkengasong postulate that it is unlikely to be enough. Rwanda and Nigeria have currently vaccinated over 340,000 and 960,000 of their populations, respectively, representing a tiny percentage of their entire population. With previously existing inadequate funding for the health sector, the decline in donor funding and poor international cooperation on COVID-19, African countries continue to face a challenge with fully funding their vaccine programs. To achieve vaccine equity, governments must look inward and make tough decisions on mobilising funds for their vaccine programs.
These decisions will involve multiple stakeholders and trade-offs as policymakers juggle competing needs. Coaches supporting policymakers with these discussions and decisions must be equipped with knowledge about other possible funding sources that may be leveraged and the economic realities and contexts of their countries. They must also be aware of challenges and lessons learnt from countries that have succeeded with their COVID-19 vaccination programs and include them in planning and implementing their vaccine rollout. Finally, as this is an entirely novel approach to vaccine introduction, coaches must be flexible and adaptable and apply new ideas and respond to any challenges quickly and efficiently.
To learn more about the coaching approach, please take the online module here. Join us for our next webinar in April as we discuss the final step of the country engagement framework, evaluation and adaptation.