31 March 2021

As countries roll out COVID-19 vaccination, what are the lessons and links with universal health coverage (UHC) and a shared vision to leave no one behind?

Leaving no one behind: COVID-19 vaccine equity and universal health coverage in Ghana

In February 2021 Ghana was the first country to receive COVID-19 vaccine doses through COVAX. To share Ghana’s experience of COVID-19 vaccination planning and rollout, explore the links between vaccine equity and the UHC vision to leave no one behind, and highlight the role of strong primary health care systems in achieving both vaccination and wider UHC goals, UHC2030 and P4H jointly hosted a webinar on 29 March.

Dr Emmanuel Ankrah Odame, Director, Policy Planning, Monitoring & Evaluation, Ministry of Health and Dr Franklin Asiedu-Bekoe, Director of Public Health, Ghana Health Service presented Ghana’s experience, and panellists reflected on key themes and lessons.

Here are five take-away messages.

1. Ghana has made an impressive start to vaccine rollout

Ghana launched its vaccination campaign on 1 March. To help build trust and reduce anti-vaccine myths, the President, Vice-President and First and Second Ladies and other key personalities received the vaccine that day, and the government has communicated the safety and efficacy of the vaccination to the population through radio, television, and mobile outreach. Ghana is largely reaching its initial targets for vaccinations in targeted regions and districts. Ghana received 600,000 doses through COVAX and as of 25 March, nearly 500,000 people had already been vaccinated – of which 52% are female and 48% male, and the largest population sub-group vaccinated is adults aged over 60. Dr Asiedu-Bekoe said, “The challenge we have now is availability of vaccines. We have convinced the population about the safety and efficacy of the vaccine but now we need the vaccines to roll out.”

2. Ghana’s vaccination approach prioritises equity and UHC principles

Ghana’s ambition is that every person in Ghana will receive a free vaccine. This builds on principles of UHC and equity in Ghana’s National UHC Roadmap; the Roadmap’s goal is to increase timely access to quality essential health care and public health services for all by 2030. The vaccination strategy segregated the rollout in terms of geography and population, focusing initially on hardest hit areas, health workers, people over 60 and people with underlying health conditions. Dr Odame explained practical steps Ghana is taking to further promote equity in the context of efforts towards UHC, including information technologies to capture real time data for action, refocusing government’s primary role from sole service provider towards stewardship of diverse providers, and deploying drones so that vaccines can be delivered to hard-to-reach areas.

The panel shared concerns about how to keep equity issues front and centre in all countries. SAGE and WHO have recommended target populations for who should receive the vaccine first, and most country plans are following these recommendations. However, specific analysis is needed on groups such as refugees, internally displaced people, asylum seekers and migrants to ensure that no one is left behind.

3. Countries face a balancing act and high costs to both respond to the pandemic (including vaccine rollout) and sustain other health services

Ghana’s COVID-19 immunization roadmap includes costs of approximately US $220 million for vaccine doses and $52 million for vaccine deployment. Dr Ann Lindstrand, Unit Head, Expanded Program on Immunization, WHO congratulated Ghana for rolling out the vaccine on principles of access and equity which are also the foundations for the COVAX facility. She spoke about the pressure the pandemic response is putting on other essential health services, including routine immunisations. Globally, the COVID-19 vaccine rollout is unprecedented in both speed and scale, with over 450 million vaccine doses distributed so far. The rollout requires significant operational finance and places increased demands on health services and health workers. “When the doses ramp up more and more, the strains on health care systems and the cost to governments of the rollout will be very high. We need a split vision of maintaining our immunisation systems, our primary health care systems and managing the rollout at the same time. It is a fine balance when it comes to access, costs and equity,” she said.

4. Strong primary health care systems underpin both vaccine equity and UHC

Dr Odame said that Ghana plans for primary healthcare (PHC) to provide “smart care for all people”. Ainur Aiypkhanova, Health policy analyst, Kazakhstan spoke about the country’s longstanding PHC approach, in both urban and rural areas, which is now at the heart of efforts to deliver the COVID-19 vaccine to the population. Principles of equity are informing the country’s vaccination strategy. Francesca Colombo, Head of the Health Division, Organisation for Economic Co-operation and Development (OECD), who chaired the meeting, said “as we learn about these efforts to vaccinate the most left behind, we must echo the commitments we have made to achieve UHC which go beyond vaccinations to building strong primary health care systems and making sure essential services are maintained during times of crisis.” She emphasized the relevance of this to all country contexts, irrespective of income level.

5. To control the pandemic, the vaccination rollout demands global solidarity

Dr Odame highlighted the importance of global solidarity in the COVID-19 response. “It is increasingly becoming clear that the future is uncertain, complex and ambiguous. We need to see the world as a global village rather than a constellation of nation states. No one is safe until we are all safe.” Dr Githinji Gitahi, Global CEO, AMREF Health Africa emphasized getting vaccines “from ports to arms” and ensuring equity both within countries and between countries as crucial to save lives. Most countries so far face major shortfalls in availability of vaccines, and costs of COVID-19 vaccination are a much greater share of available health budgets for low-income than high-income countries. This demands global solidarity and a shared global responsibility to protect everyone. Dr Gitahi also argued that knowledge about COVID-19 vaccines is a global public good and should be shared for greater local production and manufacturing of vaccines. “How do we ensure that we accelerate production by releasing intellectual property? Bigger efforts should be made to ensure that more manufacturers can produce the vaccines,” he said.

In closing remarks the panellists again emphasized solidarity. With most countries facing limited availability of vaccines, sharing of costs and of doses (and of therapeutics, diagnostics and PPE) is essential. “Diversity and inclusion are key and we need to reaffirm this locally and globally. It is important to make sure that those who need the vaccine most get it first,” said Ainur Aiypkhanova. Francesca Colombo concluded by saying, “We should not treat the global and the national as something separate but work with values of solidarity and UHC. UHC is a perfect lens for planning, monitoring and assessing our success.” 

Resources

Watch the recording of the webinar here

Living with COVID-19: Time to get our act together on health emergencies and UHC

Photo: © WHO / Blink Media - Nana Kofi Acquah 

On 4 March 2021, Augustine Sagoe, Chief Laboratory Scientist at Ghana Infectious Disease Centre, holds up his vaccination card after receiving a dose of the AstraZeneca/Oxford COVID-19 vaccine at Accra's Ridge Hospital, as Ghana rolls out its national COVID-19 vaccination campaign. 

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