Luca Marchina l Palladium - Jun 10 2021
Reaching Those in Need: Accelerating the Vaccine Rollout in Low-and Middle-Income Countries

Source: National Cancer Institute

An average of one in three people have received at least one dose of the COVID-19 vaccine in high-income countries worldwide. But the story of vaccine roll-out in low- and middle-income countries (LMICs) is vastly different. For example, across Africa, only one in 46 people have received at least one dose of the vaccine, compared to the U.K. where 70 percent of their population is expected to receive their first dose by the end of June.

The COVAX Facility, established as a global risk-sharing mechanism for pooled procurement and equitable distribution of COVID-19 vaccines, set the goal of vaccinating at least 20 percent of the population in 92 LMICs by the end of 2021. But COVAX has been derailed by several factors, including a severe reduction in available doses due to the current crisis in India and faces a shortfall of 190 million doses.

It’s possible to bridge this gap, but only if high-income countries share their surpluses. Many high-income countries have purchased enough surplus vaccine doses to vaccinate their population several times over. And as many of these richer countries are moving towards ‘normal’, LMICs are being left behind and vulnerable without access to adequate vaccines.

Recent research concluded that ‘the U.S., the U.K., the E.U. and other high-income countries combined could lose about USD 119 billion a year if the poorest countries do not receive a supply. On the other hand, if these high-income countries paid for the supply of vaccines, there could be a benefit-to-cost ratio of 4.8 to 1. For every USD 1 spent, high-income countries would get about USD 4.80 in economic value, making vaccine equity economically beneficial for everyone in the long term.

In the United States, the Biden Administration committed to sharing at least 80 million U.S. vaccine doses globally by the end of June 2021, 75 percent of which will be shared through COVAX. The remaining 25 percent will be allocated directly to countries experiencing surges. In addition, the U.S. is buying 500 million doses of Pfizer vaccine to donate worldwide by the end of 2022. As the G7 convenes for annual meetings in the U.K., there’s an opportunity for other members and high-income countries at large to follow suit and commit to sharing excess doses with LMICs, answering UNICEF’s recent call for G7 countries to share 20 percent of their supplies by August 2021.

Equitable distribution of vaccines is not only morally just but also a matter of self-interest. If more countries follow the U.S.’s example and deliver vaccines directly to LMICs, we will move quickly towards global immunity and restarting the economy.

"There is a crucial opportunity for high-income countries to deliver solutions that lead to the sustained development of supply chains and health systems beyond the pandemic."

But that’s only half the story.

If high-income countries go beyond the COVAX facility and work directly with LMICs, there’s an obligation to also ensure that the required infrastructure is in place to administer the vaccine and get shots in arms. There are three critical factors to take into account for a successful vaccine rollout engagement with LMICs:

1. Efficient processes to transfer vaccines to LMICs

Due to the legal and commercial framework surrounding vaccine allocation, transferring vaccines already committed to a particular country can be challenging. Therefore, donating countries should plan well in advance to avoid unexpected bottlenecks that could derail or slow down the process.

Critical things to consider are the location of the surplus doses (e.g. doses sitting at the factory gate are easier to donate than doses sitting in countries’ warehouses); contractual terms and conditions with manufacturers such as liabilities, indemnifications, and limitations in how the doses should be used; contractual terms and conditions with the national or international entity receiving the surplus and local regulations.

2. Robust supply chains are essential to delivering vaccine doses before they expire

In April 2021, there was a wastage of expired vaccines in Malawi and South Sudan. This was largely due to inefficiencies in the supply chain and distribution challenges on arrival. Avoiding these instances requires bespoke end-to-end cold chain solutions and supply chains, from warehousing to customs and registrations, international air freight and field transportation up to the actual vaccination.

There’s also a need for advanced tracking systems to ensure the traceability of each product throughout the full supply chain (e.g. vaccine batches) and ensure they maintain the target temperature. Finally, coordination with key stakeholders across the vaccine supply chain reduces duplication and maximises impact on the ground.

3. LMICs must be prepared to receive the vaccine, communities sensitised, and health systems ready for rapid inoculation

According to the World Bank, only 30 percent of countries have the capacity to train the number of vaccinators needed for a large-scale vaccination campaign, and only 27 percent have created social mobilisation and public engagement strategies to increase vaccine uptake.

Both LMICs and high-income countries should be cognisant that the work does not end once the vaccines arrive in-country but should be complemented by strategies to improve LMIC readiness. For example, leveraging existing strengths and infrastructures from past immunisation programs to incorporating lessons learned and best practices from other countries and COVAX such as modelling vaccine allocation with equity in mind and designing strategies to scale up and down. Work must also be done to build trust in the vaccination through the design and dissemination of social and behaviour change communication and engagement with hard-to-reach and marginalised communities.

Sharing vaccines, whether via COVAX or directly with LMICs, is in global best interests. Doing so will help reduce the spread and further mutation of the virus and allow countries and economies to recover fully. But just as important is ensuring that when surplus is shared, it is done in a manner that does not leave LMICs isolated in the deployment and ensures that doses effectively reach intended patients.

There is a crucial opportunity for high-income countries to step up and deliver solutions that lead to the sustained development of supply chains and health systems beyond addressing the current pandemic and building reliance against future global health crises.

Luca Marchina is a Senior Manager in the Complex Delivery Solutions team for EMEA. He leads the Project Management Expertise portfolio and the vaccine roll-out task force for the EMEA region. For more information contact