A new framework for performance analysis
The first shipment of 600,000 doses of COVID-19 vaccines from the COVAX facility in Ghana marked a historic step towards ensuring equitable distribution of life-saving vaccines globally. For countries participating in COVAX, which aims to provide doses to 20% of country populations, this raises several questions:
- Are they ready to deliver vaccines into the arms of their populations?
- Can they mobilize all possible resources to meet the challenge?
- Can they exercise effective governance and oversight in the vaccine delivery?
Any weakness in a country's ability to procure, store, deliver or equitably prioritize the vaccines will have a dramatic impact on the success of the COVID-19 vaccines rollout. Mobilizing all stakeholders and their resources, including for-profit and not-for-profit private health actors, can be the game changer toward success. It compels governments to steward their entire health systems – public and private – to ensure that all stakeholders are aligned with the UHC objectives of equity, access, quality and financial protection.
Readiness and governance capacities for such a massive undertaking are still missing in many poor countries, as reported in the new “Country Readiness Assessments” jointly carried out by the World Bank, WHO, UNICEF, the Global Fund and Gavi. While we wait, unregulated private markets for the COVID-19 vaccine are emerging, raising concerns about safety and quality, and the ability to deliver on vaccine equity.
Engaging and integrating the private health sector is a challenge, but countries should not shy away from it. Effective governance is not a choice – it is a necessity to overcome bottlenecks and guarantee a rapid, safe and equitable delivery of the COVID-19 vaccine. Many Low- and Middle-Income Countries (LMICs) are successfully harnessing the private health sector along the vaccine value chain to roll out the COVID-19 vaccine:
Ways that the private sector is helping manufacture, distribute, and track vaccine deployment:
The private sector can manufacture inputs needed to deliver COVID-19 vaccines (e.g., personal protective equipment [PPEs], syringes, gloves), using several policy tools and financial incentives. The private sector also directly manufactures COVID-19 vaccines. In India, the Serum Institute of India signed a contract with AstraZeneca to manufacture 1 billion doses of CoviShield for low- and middle-income countries. As other countries, India is starting to vaccinate its population with CoviShield. Similar contracts for vaccine manufacturing are being designed and implemented with local companies in Africa, which will hopefully expand vaccine supply for the continent.
The private sector can support governments to procure COVID-19 vaccines. The Government of Ghana has signed a public-private partnership with MPharma to empower them to source and provide COVID-19 vaccines for 2.5 million people in Ghana, linking up with manufacturers and private sector actors throughout the process.
Storage, transportation and distribution management:
The private sector can help to manage the supply chain infrastructures or provide the infrastructure necessary to store, transport and deliver COVID-19 vaccines. In Nigeria, multiple private companies have proposed leasing their refrigerators with cold ice capacity, so that the government will not have to purchase this highly specialized equipment.
Advocacy and communication:
The private sector can support the dissemination of accurate news and spread constructive education on COVID-19 vaccines. Private sector communication experts in the Philippines, in partnership with the Department of Health and the National Task Force against COVID-19, developed an education campaign to inform citizens about COVID-19 vaccine safety and efficacy.
The private sector can provide additional skilled workforce capacity to complement the public sector. In preparation for the vaccine introduction, Village Reach – an NGO – has set up voice-message-based remote training platforms in the Democratic Republic of Congo and Mozambique to train community health workers on COVID-19 vaccine administration.
The private sector can also support service delivery by helping to identify and reach priority populations with vaccinations. A private company in Nigeria has developed a mobile app to 'track and trace' every COVID-19 vaccine entering the country, reporting to three government regulators. IT firms in several countries have developed TravelCards with QRS authentication for those who have been vaccinated.
Good governance is the common ingredient underpinning the success of these initiatives. Irrespective of the way governments choose to engage with the private sector, their ability to exercise effective stewardship is key to ensure that public and private actors collectively deliver on health objectives.
Countries do not have to operate alone as they seek to improve their governance capacities and boost their engagement with the private sector. Their development partners can provide technical assistance, ensure cross-learning and develop guidance. Since the beginning of the pandemic, global partners have worked jointly under the ACT-A HSC workstream on private sector engagement.
As COVID-19 vaccines are rolled out in LMICs, they offer new hope to stem the pandemic and protect populations. To ensure an efficient and equitable COVID-19 vaccine rollout, governments must rapidly mobilize the private health sector and effectively steward all available resources in their health systems toward achieving this life-saving objective.