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We are facing an unprecedented global challenge to protect every country from COVID-19

Test COVID-19 à Madagascar. © Henitsoa Rafalia/Banque mondiale Photo: Henitsoa Rafalia/World Bank

The COVID-19 pandemic is having a devastating impact on public health, societies, and economies around the world: it could push up to 150 million people into extreme poverty by the end of 2021.  Countries cannot recover until all their people can live their lives with confidence.

To save livelihoods as well as lives, we need to reach people with vaccines as soon as these are available. Doing this on an unprecedented global scale poses a huge challenge, especially for developing countries. 

Both Pfizer-BioNTech and Moderna have announced that vaccines could be available soon; other trial results are imminent. So, the question is moving from if we’ll have vaccines to when and how we can get them to people everywhere.

We want to make sure that low- and middle-income countries have fair, equitable access to vaccines , with priority for people who need it most urgently. In many places, we’ll also need to strengthen health systems and build logistical capacity for vaccination to succeed.

This is where the World Bank Group plays a key role. In October, the World Bank approved up to $12 billion to help developing countries purchase and distribute vaccines, tests, and treatments.  IFC, our private sector development arm, is making $4 billion available for manufacturers of vaccines and related supplies in low- and middle-income countries. Our staff have expertise ranging from public health to procurement to transport and logistics, and we have a strong presence on the ground in developing countries worldwide. 

"We aim to support vaccination for up to a billion people. And once vaccines can be purchased, distributing them will be complex. Large-scale immunization needs careful planning, skilled personnel, and reliable health infrastructure. Three areas will be critical."

First, logistics. Governments will have to ramp up transport and storage to maintain an unbroken cold chain for the vaccines. Some countries will need help to reach remote areas and to expand storage, build cold chains, and improve health facilities. We can learn from experience in West and Central Africa, where countries successfully deployed an Ebola vaccine requiring storage at around -60 degree Celsius – comparable to that needed for the BioNTech/Pfizer Covid vaccine – with dry ice packs on motorbikes reaching the remotest villages.

Second, delivery. Today, most countries immunize infants, but not large swathes of the adult population. Each will have to prioritize who gets the vaccine first. For example, frontline health care workers, the elderly, people with pre-existing conditions, and providers of public services like teachers, the police, and grocery workers. Most countries will be further stretched as they aim to restore other health services that have been disrupted.

Countries also need systems to track that medicines reach people and are distributed as intended, including the second dose that most vaccines require.   Digital and technological innovation can help. In Pakistan, for example, the World Bank has supported polio vaccination with digital data tools to locate infections, guide vaccinators, and monitor progress. This can help prevent pilferage and diversion of vaccines as well as minimize risks of fraud in administration of vaccines.

Third, public acceptance. Governments may face widespread hesitancy whether the new medicines, developed at record speed using new technologies, are indeed safe. Recent Ebola outbreaks highlighted the importance of building trust in immunization. In the Democratic Republic of Congo, this involved hiring local staff, engaging with community and religious leaders, and conducting campaigns in local languages to counter rumors and misinformation. 

Over the next 100 days, the World Bank aims to help at least 100 countries get ready to deploy COVID-19 tests, treatments, and vaccines.  We are coordinating closely with Gavi, UNICEF, WHO, CEPI, and the Global Fund and offering financial and technical support. We’ll start by helping countries assess their readiness, quantify cost gaps, and boost health systems to implement vaccination.

IFC recently invested in BioE, an Indian vaccines manufacturer, and expects to help other manufacturers in developing countries expand local production when vaccines are available. Innovative solutions include the repurposing of food distribution channels to deliver vaccines and the use of blockchain to trace the delivery.

The Bank Group’s vaccine work builds on our pandemic emergency response. Projects in 112 countries are helping save lives and build stronger health systems.  Yemen and Ethiopia needed better facilities as well as medical supplies and equipment.

In Afghanistan, our support has boosted laboratory systems and delivery of services. We’ve helped Egypt launch a national campaign on COVID prevention and continue routine medical services. And we’ve helped acquire medical equipment in Argentina, Ecuador, Indonesia, Haiti, Senegal, Somalia, and Ukraine.

"The challenge of distributing COVID-19 vaccines demonstrates the need for strong, inclusive health systems in every country. We need to take a broad view and build more resilience, because it’s certain that there will be future health emergencies."

The urgent need for vaccination can also bolster broader health efforts: for example, Afghanistan’s polio program and Nigeria’s routine immunization program have strengthened primary health care by improving common platform systems, including logistics and cold chain capacity.

I’m confident that we can focus our energies, and build a broader international coalition than ever before to overcome a challenge that affects each of us , rich or poor, in every country. I’m hopeful that this moment can be a watershed, where all of us recognize that no one’s health is fully protected until all of us are.

This Op-Ed was originally published in The Telegraph, and a French version of this piece was also published in Le Monde.


The World Bank Group and COVID-19 (coronavirus)

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David Malpass

Former President, World Bank Group

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