Vaccines Save Lives - A World Bank Group Perspective

[HEADLINE] Vaccines Save Lives – World Bank Steps up providing relief for vulnerable

COVID-19 vaccines, alongside widespread testing, improved treatment and strong health systems are critical to save lives and strengthen the global economic recovery. To provide relief for vulnerable populations, low- and middle-income countries need fair, broad, and fast access to effective and safe vaccines.

That’s why the World Bank (WB) is building on its initial COVID-19 response with $12 billion to help poor countries purchase and distribute vaccines, tests, and treatments. The first WB-financed operation to support vaccine rollout was approved in January 2021.

As of April 16 the World Bank has approved vaccine projects in 18 countries amounting to $2 billion. We expect to reach 50 countries amounting to $4 billion by mid-year. All approved projects are summarized here.

Table of Contents – [sample] 1. Press Release: World Bank Approves $12 Billion for COVID19 Vaccines 2. Story: The World Bank Group Mounts the Fastest and Largest Health Crisis Response in its History to Save Lives from COVID-19 3. Blog: COVID-19 vaccines – A path for recovering human capital 4. Blog: Strong health care systems are key to deliver COVID-19 vaccines 5. Blog: Finding Exemplars of Restored Vaccine Confidence: A Pathway for COVID-19 Recovery 6. Report: Assessing Country Readiness for COVID-19 Vaccines - First Insights from the Assessment Rollout

World Bank Approves $12 Billion for COVID-19 Vaccines

WASHINGTON, October 13, 2020 – The World Bank’s Board of Executive Directors today approved an envelope of $12 billion for developing countries to finance the purchase and distribution of COVID-19 vaccines, tests, and treatments for their citizens.

The financing, which aims to support vaccination of up to a billion people, is part of an overall World Bank Group (WBG) package of up to $160 billion through June 2021 to help developing countries fight the COVID-19 pandemic. It adds new financing to the World Bank’s COVID-19 emergency response programs that are already reaching 111 countries.

This financing package helps signal to the research and pharmaceutical industry that citizens in developing countries also need access to safe and effective COVID-19 vaccines. It will also provide financing and technical support so that developing countries can prepare for deploying vaccines at scale, in coordination with international partners. In implementing the program, the World Bank will support multilateral efforts currently led by WHO and COVAX. “We are extending and expanding our fast-track approach to address the COVID emergency so that developing countries have fair and equal access to vaccines,” said World Bank Group President David Malpass. “Access to safe and effective vaccines and strengthened delivery

systems is key to alter the course of the pandemic and help countries experiencing catastrophic economic and fiscal impacts move toward a resilient recovery.”

Developing countries will have different ways to acquire and deliver approved vaccines.

The approach draws on the WBG’s significant expertise in supporting large scale immunization programs for vaccine preventable diseases, as well as public health programs to tackle infectious diseases such as HIV, tuberculosis, malaria and neglected tropical diseases.

In addition to purchasing COVID-19 vaccines, the WBG financing will also support countries to access to COVID-19 tests and treatments, and expand immunization capacity to help health systems deploy the vaccines effectively. This includes supply chain and logistics management for vaccine storage handling, trained vaccinators, and large-scale communication and outreach campaigns to reach communities and households.

The new financing builds on the broader World Bank health program, which focuses on strengthening the health systems and health service delivery. The Bank’s robust network of technical advice and implementation support capacity, already working on the ground in many developing countries with partner agencies, will help to further strengthen these systems.

The International Finance Corporation (IFC), the WBG’s private sector arm, is also investing in vaccine manufacturers through its $4 billion Global Health Platform. The aim is to encourage ramped-up production of COVID-19 vaccines and therapeutics in advanced and developing economies alike—and to ensure that emerging markets gain access to available doses.

World Bank Group COVID-19 Response The World Bank Group, one of the largest sources of funding and knowledge for developing countries, is taking broad, fast action to help developing countries strengthen their pandemic response. We are supporting public health interventions, working to ensure the flow of critical supplies and equipment, and helping the private sector continue to operate and sustain jobs. We will be deploying up to $160 billion in financial support over 15 months to help more than 100 countries protect the poor and vulnerable, support businesses, and bolster economic recovery. This includes $50 billion of new IDA resources through grants and highly concessional loans.

The World Bank Group Mounts the Fastest and Largest Health Crisis Response in its History to Save Lives from COVID-19 It’s seven o’clock in the morning in Conakry, the capital of Guinea. Dr. Haba Eveline arrives at the COVID-19 Treatment Center. As soon as she enters, she washes her hands before starting her daily shift. A mother of five, she leads the Risk Management Unit which is now open 24/7.

She is one of the frontline health workers helping her country fight the COVID-19 (coronavirus) pandemic. “As a doctor, I am a fighter and I am proud to bring my experience to the response against this pandemic,” she said.

Long before the first cases of the virus surfaced in Guinea, the country, with support from the World Bank and the international community, had devised a response strategy. It was therefore equipped with knowledge gained from combating the Ebola epidemic in 20142016.

A health worker in Guinea © Papa Youshoupha Seck/World Bank

For other countries however, COVID-19 brought disruptions in health systems and uncertainty about what would be next.

Describing the precautionary measures recommended by health workers, Qamara, a resident in a village west of Jalalabad city, Afghanistan said: "They advised us to use masks and gloves and wash our hands frequently with soap and water."

Governments struggled to contain the spread of the virus and looked for emergency solutions. The World Bank Group responded immediately.

An emergency response to save lives Within just a few weeks, we prepared a global COVID-19 emergency health response, working closely with national teams, the World Health Organization (WHO), UNICEF and other international partners.

Building on our accumulated experience with health crises over the past 20 years, we mounted the fastest and largest crisis response in our history.

Health care workers in Afghanistan. © World Bank

Our first operations focused on strengthening health systems to tackle the immediate challenges of COVID-19. In countries ranging from Afghanistan and Haiti to India, Mongolia, and Tajikistan, our financing brought more medical staff onboard and ensured that they were well trained and equipped to deliver emergency care. In countries like Ecuador, we helped ensure that public outreach messages to citizens on prevention and protection

were quickly disseminated. In Djibouti and Ethiopia, we provided more resources to fight the pandemic in the long-term, by strengthening and building the capacity of the national health system.

Through a combination of new projects, restructuring and emergency components of existing projects, and deployment of our disaster finance instruments, the World Bank Group’s response is targeted in four key areas: saving lives, protecting the poor and vulnerable, ensuring sustainable business growth, and working to build a more resilient recovery.

View the full infographic here.

Today, we are making good progress on the 15-month target of providing up to $160 billion in surge financing to help address the health and economic impacts of the pandemic– including $50 billion of new resources from the International Development Association (IDA) for the poorest countries. Our emergency health support has so far reached 111 operations. 30 percent of these cover 900 million people in countries affected by conflict, fragility and violence—where the most vulnerable populations live.

Altering the course of the pandemic with vaccines In March 2020, the World Bank Group was already one of the first organizations to begin thinking about the rapid development and scale-up of COVID-19 vaccines, bringing together key partners to discuss fair and equitable access to vaccines, once available, for developing countries.

We are providing a financing package of up to $12 billion to help low- and middle-income countries finance the purchase and distribution of COVID-19 vaccines, tests, and treatments.

While purchasing vaccines and receiving treatments are straight forward, ensuring that they are deployed and reach those who need them the most is much more complicated. The pandemic compounded a problem that existed already before.

Across the globe, it highlighted the urgent need to strengthen health systems that showed a lack of sufficient trained health workers, limited storage and transport capacity of vaccines to store and ensure cold chain to remote areas, and in some countries, inadequate number of health centers equipped for vaccinations.

To tackle these challenges, the World Bank Group is helping countries assess their readiness to deploy vaccines, identify and address any challenges, so they are equipped to deliver the vaccines and treatment fairly, efficiently and safely.

Working with the private sector, the International Financial Corporation (IFC) –our private sector arm– launched a Global Health Platform, through which we will support companies in delivering health products and services – including vaccines – to developing countries.

"The international community must respond quickly and decisively to save lives and protect the delivery of these essential services as part of a robust recovery from the pandemic."

Muhammad Pate World Bank Global Director, Health, Nutrition and Population ｜ Director, Global Financing Facility for Women, Children and Adolescents (GFF)

Strengthening countries’ health systems Well before the unprecedented crisis, the consequences of weak health systems were visible in countries’ health results. The pandemic put the spotlight on what happens when resilient, high-quality primary healthcare is not in place.

Many countries realized that their hospitals were unprepared and underequipped when COVID-19 struck. In communities, under-resourced surveillance networks failed to promptly detect the spread of the virus. Shortages of supplies and equipment left health workers without protective gear. System fragmentation hampered the efficient flow of patients, staff, and supplies.

Given the intersection of these challenges and the rapid nature of this crisis, the World Bank’s emergency support focused the procurement of new intensive care beds and ventilators, strengthen testing laboratories, and other life-saving medical equipment and materials.

In Georgia, the Bank helped the Ministry of Health purchase 1,185,000 polymerase chain reaction tests (PCR) and 1,247,000 Rapid COVID-19 test kits to strengthen public health laboratories and epidemiological capacity. At the end of September 2020, an average of 9,000 PCR tests and 1,700 rapid tests were being performed daily.

A health worker in decontamination at the Republican Hospital in Georgia. © Leonid Mujiri/World Bank

In Yemen, six central public-health laboratories have opened, and 930 health professionals have been trained in COVID-19 case management.

By strengthening countries’ health systems, our operations are also addressing the secondary health crisis triggered by significant disruptions in essential, lifesaving services, particularly for women, adolescents and children.

A crisis within a crisis, COVID-19 is exposing an underlying structural inequality that has already left many behind.

As Dr. Muhammad Pate, Global Director of Health, Nutrition, and Population at the World Bank said, “These disruptions confirm our early warnings that secondary health impacts caused by COVID-19 are putting at risk many years of hard-fought gains in women’s and children’s health and nutrition. The international community must respond quickly and

decisively to save lives and protect the delivery of these essential services as part of a robust recovery from the pandemic.”

The Global Financing Facility for Women, Children and Adolescents (GFF) has been playing a key role complementing the Bank Group COVID-19 response in supporting its 36 partner countries providing both technical and financial assistance to protect and support the continuation of essential health services for women children and adolescent health while responding to the pandemic.

According to our estimates, global extreme poverty is expected to rise this year for the first time in a generation. COVID could push up to 150 million people into extreme poverty (defined as living on less than $1.90 a day) by the end of 2021.

Preparing countries to fight the pandemic and build better The pandemic is stressing the need to invest in comprehensive preparedness and prevention within countries and across borders.

Using our global expertise, we are helping Sub-Saharan African countries fight by building on the lessons and systems put in place during the Ebola outbreaks. For example, Guinea was prepared when the first case was registered because it had a strategy, infrastructure and knowledge gained from combating Ebola.

A health worker at a testing center in Nigeria. © Sanumioluwa Dawodu/World Bank

We are working with and funding regional centers of excellence that make scientific contributions including sequencing the COVID-19 genome. Some of these include: the Regional Disease Surveillance Systems Enhancement Program (in West and Central Africa), the Africa Centres for Disease Control and Prevention (Africa CDC), the East Africa Public Health Laboratory Networking Project, and the West African Health Organization (WAHO).

We are assisting countries in their efforts to prevent, detect and respond to COVID-19, while strengthening national public health preparedness systems. We are also restructuring, redeploying, and reallocating some existing resources in financed projects.

In India, the health emergency project is upgrading the disease surveillance system, strengthening preparedness for disease outbreaks and revamping infectious disease hospitals.

A man’s temperature is taken at a COVID-19 testing center in India. © Shutterstock

Adapting the emergency operations to context and epidemic status of a country, the support to East Asia and Pacific region have been tailored to address specific needs.

In Mongolia, for example, the Bank is strengthening capacities for a multi-sectoral response, particularly the interface of environmental, veterinary, and public health services to contain the spread of new viruses of animal origin at their source.

In addition to the growing human and economic toll, the pandemic brought social isolation, bereavement, financial hardship, and interrupted health care services – which are negatively impacting the mental well-being of people.

In many countries, including Cambodia, Guatemala, Lesotho, Liberia, Mali, Marshall Islands, Morocco, Niger, Nigeria, Republic of Congo, and Sri Lanka, Bank projects are supporting psychosocial interventions to help people deal with the negative psychological effects from stressors such as lockdowns, self-isolation and quarantines, infection fears, inadequate information, job and financial losses, and stigma and discrimination.

Health authorities in Phnom Penh conduct check-ups on health workers returning from the provinces after the Khmer New Year celebrations, amid concerns over the spread of COVID-19. © Chor Sokunthea/World Bank

Engaging local communities With increased poverty, climate change, food shortage, COVID-19 is having the most devastating impact on poor and marginalized groups. The World Bank is tackling this by using all existing platforms to reach the most vulnerable.

Working through community-driven development programs to provide cash and resources quickly to communities, the World Bank’s support is targeting migrants, the disabled, women, unemployed youth, the elderly, and indigenous peoples.

Through these operations, we are using technology and innovations to ensure people have the information they need about the coronavirus.

In Afghanistan, for example, we are working with communities to share COVID-19 prevention messages through WhatsApp and telegrams to reach the people most disproportionately impacted by the crisis, including displaced people, those with disabilities, poor women, and nomads.

Community outreach in Afghanistan. © World Bank

To fight the pandemic, community outreach is playing a crucial role with front-line health workers. Local communities and traditional leaders serve as critical links to the whole community. They help improve public understand of the treatment, dispel misinformation and noncompliance with health instructions and medical guidelines.

Reflecting on his experience combatting the Ebola virus in the Democratic Republic of Congo, Professor Muyembe, the eminent Congolese virologist who discovered the Ebola virus in 1976 and the current Ebola and COVID-19 response coordinator in his country says: “We have seen the importance of community engagement and awareness-raising campaigns to get people to understand the gravity of the situation and get involved.”

A health worker at the Port of Kinshasa, DRC. © World Health Organisation/Hugh Kinsella Cunningham

While these examples provide a glimmer of hope, much more is needed. The pandemic continues to take a toll across most of the globe, with many countries already battling a second wave.

As vaccines trials are progressing, we will continue to be flexible and agile in our health response, while saving lives and supporting the next phase of our country responses.

The profound impacts of the health crisis stress on the need to achieve universal health coverage to allow countries to protect and invest in their people and build a resilient future.

Going forward, the World Bank’s work will focus on strengthening health systems. It will soon release a new report that contributes evidence and analysis to a growing consensus that health leaders will achieve best results if they build system reforms around primary health care.

Health workers consult with patients at a testing center in Turkey. © Anadolu Agency

Working with partners Future preparedness, prevention, and crisis responses must be global and collaborative. Not a single country can do this alone with adequate control, much less prevent the type of emergency the world is now experiencing.

To help address a global challenge like a pandemic, we need to work together. Over the next 100 days, we hope to help at least 100 countries get ready to deploy COVID-19 tests, treatments, and vaccines.

As part of the Access to COVID-19 Tools Accelerator (ACT-A), we are partnering with GAVI, CEPI, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and WHO to ensure global, equitable access to COVID-19 vaccines, tests and treatments for the poorest and most vulnerable countries. Our $12 billion financing is fully aligned with the ACT-A principals and goals.

Governments can use our funds to purchase vaccines and treatments through the COVAX facility. It will ultimately be up to countries to decide where to spend this financing and through what channels.

While many challenges and uncertainties lie ahead, we need to move forward and help countries to make health systems stronger, while recognizing the need to be flexible to adapt our approaches and self-correct when needed. This is what we believe in and what we are doing at the World Bank.

COVID-19 vaccines – A path for recovering human capital LAURA RAWLINGS | RAMESH GOVINDARAJ | DAVID WILSON |JANUARY 21, 2021

A man fills a syringe from a vial, Nigeria. Photo © Dominic Chavez The Global Financing Facility The COVID-19 pandemic presents a global health emergency and an unprecedented economic crisis. In addition to the loss of life and productivity directly attributable to COVID-19, the pandemic poses risks to human capital through several other pathways, key among which is the disruption in the provision of essential primary health, education, and community services.

COVID-19 threatens to reverse hard-won human capital gains of the past decade.

A recent World Bank report estimates that the level of both schooling and learning will fall due to COVID-19, resulting in a loss of between 0.3 and 0.9 years of schooling, adjusted for quality. Measures taken to contain the pandemic are also unleashing severe consequences for livelihoods and food security, and the stress of insecurity, isolation, and quarantine are associated with an increase in depression and domestic violence. These effects are exacerbating pre-existing inequalities, especially for vulnerable populations including women and girls who bear a disproportionate impact from disruptions in core services.

Simulated results from the 2020 Human Capital Index report show that without any remediation, COVID-19 impacts could leave an entire generation behind, and a decade of human capital progress reversed. The implications for future productivity are sobering. In

20 years, roughly 46 percent of the work force in a typical country (people ages 20-65) will be composed of individuals who were either in school or under the age 5 during the COVID-19 pandemic. Protecting investments in the human capital of this generation is critical.

The development and deployment of vaccines is key to helping countries recover from setbacks in human capital outcomes.

The emergence of new, more transmissible variants has led to further large-scale shutdowns and redoubles the urgency of vaccination. Recovering from setbacks in human capital outcomes will depend greatly on the successful deployment of vaccines. The reopening of early childhood development services and schools is essential to a recovery in learning and years of schooling, and to caregivers’ return to work. Restored access to health services and relief to overburdened health systems are needed to restore preventive health services and control infectious diseases and non-communicable diseases.

With a re-opening of the economy, there will be an increased availability of jobs, improving labor productivity, helping to restore remittances, address supply disruptions, and leverage decreases in poverty and hunger.

Dedicated national and international coordination across a wide range of stakeholders is needed to successfully deploy vaccines.

Vaccine deployment will require a national level “whole of society” approach, including: mobilizing financing; leveraging private and public actors within the health system; infrastructure support for vaccine delivery including energy solutions for cold chains and digital information systems to monitoring delivery; and civil society support for delivery, communication, and setting behavioral norms.

While vaccination coverage expands, risk reduction measures must be maintained. This includes social distancing, face and eye protection, hand and surface sanitation, a preference for outdoor activities, and the avoidance of large superspreading events.

Finally, international solidarity and cooperation are critical. From clinical trial collaboration to technology transfer, from procurement and logistics assistance to implementation support, COVID-19 vaccination requires dedicated national and international coordination across a wide range of stakeholders as illustrated in this theory of change. Financial assistance, including debt forgiveness and concessional financing, will be important to ensure access to vaccines and recovery/restoration of human capital, particularly in lowincome countries.

These international efforts are needed to combat vaccine nationalism and ensure equitable global access to vaccines. According to a recent RAND estimate, the unequal allocation of COVID-19 vaccines could cost the global economy up to $1.2 trillion a year in GDP. A nationalistic stance toward the pandemic will only prolong this global health and economic crisis.

That’s why the World Bank Group is building on its initial COVID-19 response with $12 billion to help poor countries purchase and distribute vaccines, tests, and treatments, and strengthen their health systems to ensure the vaccines reach everyone, especially the most vulnerable. World Bank financing will complement and work alongside other efforts, such as COVAX, a global partnership to promote equitable access to vaccines.

Strong health care systems are key to deliver COVID-19 vaccines MUHAMMAD ALI PATE |NOVEMBER 12, 2020

Woman getting vaccinated. Ghana. Photo: © Curt Carnemark / World Bank During the World Bank’s 2020 Annual Meetings last month, we had our focus firmly on the coronavirus pandemic and how it’s affecting lives and economies around the world. During the Global Health Roundtable we discussed how the world can invest in COVID-19 vaccines as well as strengthen the health systems that deliver primary care.

As we met, there had already been more than 41 million infections and more than 1 million deaths worldwide and COVID-19 infections were on the rise again around the world. The World Bank estimates that the pandemic will push up to 150 million people into extreme poverty by the end of 2021.

Against this urgent backdrop, the roundtable convened more than two dozen government ministers from developing countries, along with heads of UN agencies and international health organizations. Participants agreed that the world’s most pressing immediate priority is to speed the development and delivery of vaccines that can control the spread of COVID-19. And we need to ensure that vaccines are available equitably to all countries – particularly the poorest, which have the least resources to procure and deploy them.

Helping the poorest countries to fight COVID and build resilience People everywhere deserve access to health protections, and in a pandemic, no one is fully protected until all of us are protected. Everyone around the virtual table agreed on these

points, but we also recognized that it will be an enormous challenge to ensure fair and equitable distribution to the countries and people that have few resources.

At the World Bank Group, we’re determined to do all we can. During the meetings, President Malpass highlighted the announcement of a $12 billion financing package – the largest health financing package ever provided by the Bank – to help countries purchase and deploy COVID-19 vaccines, tests, and treatments. In addition, the Bank has COVID-19 emergency operations underway in over 100 countries. Through the Bank, IFC, and MIGA, the World Bank Group expects to make $160 billion available through mid-2021 to help low- and middle-income countries mitigate the pandemic’s health, social, and economic impacts.

Beyond the urgent response to COVID-19, we need to help countries build resilience. Our new Health Emergency Preparedness and Response Trust Fund (HEPRTF), for example, can help developing countries prepare better for disease outbreaks, including when they can’t access our regular financing. The fund just made its first allocation to Sudan, and we’re grateful to our donor partners: Japan for leadership in establishing the fund and the United Kingdom for ongoing technical assistance.

Strengthening health systems and primary care Delivering vaccines quickly and equitably will demand tremendous collaboration. Roundtable speakers highlighted the need for robust supply chain infrastructure – such as transportation systems, logistics, and ultra-cold freezers – to deliver vaccines and treatments, including by using new digital technologies and information systems. The aviation industry will be particularly important in distribution. As one speaker noted, “vaccines don’t deliver themselves.”

Strengthening primary health care systems has long been central to the World Bank’s work in developing countries. Resilient systems will now be key not only to distributing vaccines, but also to ensuring that other critical services, especially maternal and child health, continue during a pandemic. Early estimates suggest that child mortality could rise by 45% with health services curtailed and less access to food.

Ministers agreed that the COVID-19 response needs to prioritize health and community workers and other high-risk populations , and that it’s vital to ensure vaccines are affordable by addressing payment and access bottlenecks.

They also described the challenge of raising sufficient domestic financing both to tackle the huge cost of fighting the pandemic and to strengthen their health systems for future outbreaks. Through IDA, the World Bank is working to provide critical investments in the poorest countries, as well as technical assistance and public expenditure reviews to help improve spending efficiency. International donor cooperation will also remain important to ensure timely financing and support.

Participants noted that private sector collaboration will be crucial to vaccine manufacturing and delivery in developing countries . IFC, the Bank Group’s private sector arm, has

announced a $4 billion global health platform to help ramp up production of COVID-19 vaccines and therapeutics in advanced and developing economies alike – and to ensure that emerging markets can access them. IFC is also working with the vaccine partnership, CEPI, to map vaccine manufacturing capacity and identify bottlenecks.

Debunking misinformation The roundtable underscored concerns about the spread of misinformation, myths, and skepticism about COVID-19 vaccines and immunization generally. Participants agreed that national and community-based communication campaigns are needed to defuse growing vaccine hesitancy and educate people about protecting themselves and their families from the virus. This includes the use of community and religious leaders as trusted channels to communicate correct information.

Partnering and investing for resilient recovery Strong partnerships and cooperation, within countries and across regions, are at the heart of effective action to combat the pandemic. The Bank Group is collaborating on an extraordinary scale with a diverse coalition of international partners, including bilateral donors, multilateral development banks, UN agencies, foundations, health organizations, the private sector, and civil society.

For example, we are partnering with the Access to COVID-19 Tools Accelerator (ACT-A), a global collaboration aimed at speeding the development and availability of COVID-19 tests, treatments, and vaccines and we support the COVAX facility led by Gavi, WHO and CEPI. We believe that benefits can be achieved through a pooled risk-sharing mechanism for accessing vaccines and we will continue to collaborate with Gavi and other partners in refining it.

The road to a resilient recovery will demand massive investments across countries, as well as sustained commitment and financial support from the international community. Rebuilding better will require bold reform agendas, with policies that create fiscal space and ensure more and better investment in health and pandemic preparedness . Given the unprecedented blow to countries’ human capital, we must also keep children learning, improve digital access, and speed up job creation.

The World Bank Group stands ready to support developing countries as they fight this crisis and work toward a more resilient and inclusive recovery.

Finding Exemplars of Restored Vaccine Confidence: A Pathway for COVID-19 Recovery HEIDI J. LARSON |OCTOBER 28, 2020

We found that the overall confidence in the safety and effectiveness of vaccines was mixed, similar to COVID-19 vaccine acceptance surveys.

These are troubling times. We are in the throes of a disabling pandemic that has sparked a cascade of effects. Beyond health, efforts to stop COVID-19 have caused wider societal disruption and exacerbated both inequities and growing distrust in government while, in the background, one question persists: what’s next?

One antidote to so much uncertainty is to rebuild public confidence by recognizing needs beyond COVID-19: normalizing life by slowly reintroducing familiar health interventions. As the Bill & Melinda Gates Foundation’s 2020 Goalkeepers Report called out, “we’ve been set back 25 years in 25 weeks.” Catching up on millions of missed childhood vaccinations is one tangible way to make up for lost time, but also to use the opportunity to talk with parents about other concerns, including access to a possible COVID-19 vaccine.

Ten years ago, I founded the Vaccine Confidence Project to measure the complicated issue of public sentiment surrounding vaccines. We knew that emotions, individually and collectively, were already taking a toll on vaccine uptake, disrupting immunization programs in some settings. But we did not have a sense of the scope or scale of their

impacts. Nor did we have a measure of public confidence in vaccines that we could track over time to anticipate future changes.

In 2015, a broader team launched the Vaccine Confidence Index (VCI)TM to investigate vaccine confidence and reasons for low confidence in five countries with histories of vaccine crisis: Georgia, India, Nigeria, Pakistan, and the United Kingdom. Based on our analysis, we narrowed down what had the most influence on vaccine acceptance – including whether vaccines are important, safe, effective, and compatible with religious beliefs. And recently, we incorporated COVID-related questions into VCI surveys to explore sentiment around government response and the public’s anticipated willingness to accept a COVID-19 vaccine.

This month, the VCP published new research in The Lancet mapping trends across 149 countries and over 284,000 adults. We modelled the relationship between vaccine uptake in each country and demographics (i.e. age, sex, religious beliefs), socioeconomic factors (e.g. income, education), and source of trust (e.g. family, friends, health professionals) from 2015-2019.

We found that overall confidence in the safety and effectiveness of vaccines was mixed, similar to COVID-19 vaccine acceptance surveys (see chart above). We found that vaccine confidence – including perceptions of safety, effectiveness, and importance – has fallen in Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, the Philippines, Serbia, and South Korea. It remains high in India and is growing in many European countries. Brazil showed a

trend of slightly declining confidence. These changes suggest that trust building to support routine vaccination – and a potential COVID-19 vaccine – is still needed.

The Philippines provides some guidance on how this could be achieved. In 2018, a reported risk from a dengue vaccine (Dengvaxia), a year after its introduction, led to a dramatic drop in public confidence and routine vaccine uptake. The Philippines dropped from being in the top 10 countries with the highest overall vaccine confidence in 2015 to ranking no higher than 70th in 2019. But, concerted efforts by health authorities, including innovative online resources and conversations around vaccines and the health system more broadly, led to a rebuilding of confidence (see below).

© de Figueiredo A, et al. Lancet 2020. Used with permission.

Indonesia also witnessed one of the largest falls in public trust on vaccinations. This was triggered by some Muslim religious leaders that questioned the safety of the measles and rubella (MR) vaccine, and issued a fatwa (religious ruling) claiming the vaccine was forbidden, as it contained ingredients derived from pigs. In an effort to build confidence, the government and partners produced videos featuring other Muslim leaders persuading parents to vaccinate their children, and created other targeted communications to garner acceptance.

These are different kinds of “Exemplars.” They are countries that invested in recovering from a vaccine confidence crisis and in doing so, built more resilience to potential future shocks, including one that might be felt by an eventual COVID-19 vaccine. But like in all “Exemplars,” they proved that targeted investments can lead to results.

It’s why I’m hopeful that the World Bank’s recently approved $12 billion to finance the purchase and distribution of COVID-19 vaccines will also help us answer what’s next. By focusing some of that investment on deployment, including large-scale communication and outreach campaigns that target communities and households in low-income countries, this will help build trust and make up for some of the time we’ve lost time in other health interventions. Because to get us out of this pandemic, we must optimize uptake of not only life-saving vaccines, but health efforts more broadly. Trust will be fundamental if we are to regain the 25 years of progress lost in 25 weeks.

This article first appeared on Exemplars in Global Health, a new initiative incubated by Gates Ventures and its partners to research positive outliers in global health so that other countries might learn from them and improve health outcomes.

Assessing Country Readiness for COVID19 Vaccines - First Insights from the Assessment Rollout

A healthcare worker holds a vial of the Pfizer-BioNTech Covid-19 vaccine during the first phase of the country nationwide vaccination drive at the Hospital UiTM in Sungai Buloh, outskirts of Kuala Lumpur. Credit: SOPA Images Limited/Alamy Live News

The global COVID-19 vaccination campaign will be the largest in history. The delivery of COVID-19 vaccines presents challenges unprecedented in scale, speed and specificities, especially in low- and middle income countries. In November 2020, anticipating the availability of safe and effective vaccines for COVID-19, the World Bank together with WHO, UNICEF, the Global Fund, and Gavi rolled out readiness assessments in more than 100 low and middle-income countries.

MAIN REPORT FINDINGS 1. As countries ramp up efforts to vaccinate their populations against the deadly COVID-19 disease, the world’s poorest countries show varying degrees of readiness for this massive undertaking.

2. The existence of well-functioning child immunization systems is not a strong predictor of country readiness to deliver COVID-19 vaccines.

3. Most countries are focusing on strengthening essential aspects of the vaccine delivery chain –enough to advance vaccination schedules and begin inoculating their populations.

4. Few countries are using the opportunity provided by the deployment of COVID-19 vaccines to strengthen health systems and find long-lasting solutions for similar future challenges 5. COVID-19 vaccination campaigns offer unique opportunities for countries to digitize their information systems for tracking vaccines and monitoring vaccinations 6. The COVID-19 vaccine rollout is an opportunity to create environmentally-friendly cold chain that could be of use well beyond the current crisis 7. More countries are using indicative top-down methodologies instead of the new assessment framework and associated tools to cost gaps in readiness