Deep Dive Discussion
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COVID-19 HFRP
Deep Dive Discussionson Vaccine FinancingMarch 24 & 31, 2021
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More than a year into the pandemic, which has brought unparalleled challenges, we are still looking for solutions to overcome it. With the development of COVID-19 vaccines, the challenges facing countries today in tackling the pandemic are shifting. There are big questions out there, such as how and when countries will get vaccines, how many doses, how countries will pay for vaccines, and how countries will distribute vaccines. In many cases, the answers and solutions are not yet known. Still, countries are working through these challenges every day, so now is an important time for exchanging knowledge and sharing experiences.The COP invited members to come together to discuss vaccine financing and share specific challenges, underlying issues, and solutions from their work. We're sharing these findings with you here. Continue to challenges below, select a challenge, and explore the discussion. Look out for interactive indicators to view additional information. You can also contribute–look for "Share your ideas!"
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Governance across vaccination policies
Parking Lot
HR challenges
Equity & Access - how to make sure no one is left behind
Private sector involvement
Challenges
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Cost of rollout
Resource mobilization constraints
Efficiency - how to align with service delivery channels
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Lack of basic infrastructure
Cold Chain
Planning
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
There were a lot of things we couldn't cover in the discussion, so we added them to a parking lot for later consideration:
- Systems strengthening vs support
- Need solution for financing cold chain
- Public-private sector coordination
- Procurement and choice of vaccines
- Vaccine pricing
- Innovations in how to communicate about vaccines
- How do you communicate shifts in terms of who is prioritized next?
- Challenge of accountability - where are the resources going?
- Task shifting
- How to ensure the most vulnerable are prioritized?
- Challenges with ethical use of data
Challenge: Private Sector Involvement
Underlying issues
Solutions
Success Factors
TRIPS agreement would allow generic or other manufacturers to make more vaccines accessible. Advocacy groups and humanitarian groups are working to address the IP rights – but some countries are trying to protect IP rights.
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Private sector has a role to play across many aspects of vaccine delivery, procurement, distribution, service delivery, communication, monitoring… but lack of government regulations can hinder private sector development
May need changes to industrial policy
Private practitioners don't have access to government vaccine roll-out process
Share your ideas!
One of the challenges is that manufacturing capacity and availability of raw materials is low – IFC is working with countries who invest in strengthening manufacturing capacity
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Resource: WHO Strategy Report: Engaging the private health service delivery sector through governance in mixed health systems
Challenge: Private Sector Involvement
Underlying Issues
Solutions
Success Factors
Clear guidelines/roles for private sector
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Private sector digital solutions
Country: Malaysia Challenge: Private sector involvement Solution: Clear guidelines/roles for the private sector
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Country: India Challenge: Private sector involvement Solution: Digital Solutions - CO-WIN Digital Platform for COVID-19 Vaccine Delivery READ MORE
Challenge: Private Sector Involvement
Underlying Issues
Solutions
Success Factors
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Good balance of regulation without stifling innovations
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Clear phases/priorities in theory, but not implemented in practice
Challenge: Equity - Ensuring No One is Left Behind
Underlying issues
Solutions
Success Factors
It is difficult to identify those at risk (including with co-morbidities)
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It can be hard to prioritize groups
Share your ideas!
Elite capture
Vaccines and other services may not go to vulnerable
Hard to know who is really most vulnerable
Little clarity whether targets are realistic
Vaccine hesitancy among priority populations
Risk of vaccine wastage
Little published guidance on how to prioritize- left to countries to figure out
Timelines and commitments don't align to reality
Difficult to understand risk profile of groups and agree on prioritization
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Equity - Ensuring No One is Left Behind
Underlying Issues
Data used to identify high risk groups could also be used to improve prevention and treatment of NCDs
Opportunity to improve partnership with private sector by linking to app/delivery
Use big data to prioritize population according to morbidities
Door to door identification to find those who can't go to the vaccination site
Data systems put in place for vaccination can strengthen EMR systems in the future
Clarify roles and responsibilities of purchaser
Recalibrate priorities as new priorities emerge, including about variants
Strengthening digital tools to improve continuity of care (supply and demand sides)
Solutions
Success Factors
Expanded government COVID-19 contact tracing app for vaccination
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Expanding internet connectivity and digitization will benefit PHC and the entire economy
Country: Malaysia Challenge: Equity - Ensuring No One is Left Behind Solution: Expanded government COVID-19 testing app for vaccination READ MORE | GO TO MySejahtera Official Website
Country: India Challenge: Equity - Ensuring No One is Left Behind Solution: Door to door identification to find those who can't go to the vaccination site
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Resource: World Bank Digitalizing COVID-19 Vaccination Presentation
Challenge: Equity - Ensuring No One is Left Behind
Underlying Issues
Pre-registration helps better calculation of the demand
Provide mechanisms for addressing grievances
Define prioritization according to risk (example: those in institutions)
Define prioritization according to risk of infection
Ability to make local decisions on vaccine use to avoid wastage
Third party monitoring
Solutions
Success Factors
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Share your ideas!
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WHO/SAGE Guidelines provide some direction, but countries will development context-specific plans
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Country: Lebanon Challenge: Equity - Ensuring No One is Left Behind Solution: Third party monitoring READ MORE
Resource: WHO SAGE Roadmap for prioritizing the use of COVID-19 vaccines in the context of limited supply
Challenge: Equity - Ensuring No One is Left Behind
Underlying Issues
Solutions
People self declared co-morbidities
App previously used for contact tracing
Allowed to match demand and supply
Developers offerered services for free
Links to vaccine management/ supply chain (PHIS)
System owned by government/MOH
Government needs the money to build and maintain database
Built rapidly at the start of pandemic
Success Factors
Use big data to prioritize population according to morbidities
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Expanded government COVID-19 contact tracing app for vaccination
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Block chain -encryption provided, to track and trace
Challenge: Equity - Ensuring No One is Left Behind
Building on polio experience
Tags onto existing PHC resource
Paired with strong IT for contact tracing
Door to door identification to find those who can't go to the vaccination site
Underlying Issues
Solutions
Success Factors
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Share your ideas!
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Governance and Efficiency
Underlying issues
Solutions
Success Factors
Lots of global actors
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Vaccine price is a huge cost driver
Countries are making their own agreements
Don't know where the power for decisions lie
Share your ideas!
Need for education, vaccine hesitancy
Vaccine delivery - outreach can be 3x more expensive
Hard to vaccinate quickly
Gravitation to vertical approaches
Religious reasons for hesitancy
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Governance and Efficiency
Underlying Issues
Solutions
Success Factors
Clear guidelines/roles for private sector
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Advocacy/education
Malaysia community empowerment program
Politicians first to be vaccinated to mitigate hesitancy in the population
Integrated awareness campaign -with National Agenda for Healthy Malaysians
President vaccinated in Kenya helped boost vaccination rates
Communications campaigns can address hesitancy for other vaccines
Country: Malaysia Challenge: Governance and efficiency Solution: Clear guidelines/roles for the private sector READ MORE | GO TO ProtectHealth Website (for private sector roles in National COVID-19 Immunization Programme)
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Country: Malaysia Challenge: Governance and Efficiency Solution: Community empowerment program READ MORE
Country: Malaysia Challenge: Governance and Efficiency Solution: Integrated awareness campaign - with National Agenda for Health Malaysians READ MORE: Opportunity now for healthcare reform | READ MORE: Malaysia Prihatin programme to serve as Covid-19, vaccination awareness campaign platform
Country: Kenya Challenge: Governance and Efficiency Solution: President vaccinated in Kenya helped boost vaccination rates
Challenge: Governance and Efficiency
Underlying Issues
Solutions
Success Factors
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Integrated awareness campaign -with National Agenda for Health Malaysians
New norms of living with COVID (masks, sanitation, etc.)
Malaysia communtiy empowerment program
Leveraged community leaders for vaccine advocacy
Taking action when someting out of the norm happens
Cross-ministry cooperation (MOH and MOSTI helping to lead in Malaysia)
High level of public trust in National Pharmaceutical Regulatory Agency (NPRA) helping to mitigate vaccine hesitancy
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Country: Malaysia Challenge: Governance and Efficiency Success Factor: The Science, Technology and Innovation Ministry (MOSTI) is assisting the MOH to contain COVID-19 READ MORE | NATIONAL COVID-19 IMMUNIZATION PROGRAMME | GO TO COVID-19 VACCINE WEBSITE
Country: Malaysia Challenge: Governance and Efficiency Success Factor: High level of public trust in National Pharmaceutical Regulatory Agency (NPRA) helping to mitigate vaccine hesitancy READ MORE | GO TO NPRA WEBSITE
Challenge: Human Resources
Underlying issues
Solutions
Success Factors
Campaigns/per diems costly
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Not enough staff to roll out and maintain services
Share your ideas!
Majority of personnel of deployment in LICs and LMICs is done by nurses
Challenge for incentives, opportunity for sustainability and preventing brain drained away from PHC
Only few facilities offer services
Nurses being taken from MCH - other services may suffer
Strain on system
Not using other health care workers as in previous campaigns
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Human Resources
Underlying Issues
Solutions
Success Factors
Registry of health care workers can lead to better planning
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Retired health care workers and pharmacists could be brought in for surge capacity
Task shifting exercises can strengthen efficiency of HR distribution - can lead to more efficient distribution of vaccines
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Human Resources
Underlying Issues
Solutions
Success Factors
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Health care workers census, registry, good data systems
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Cold Chain
Underlying issues
Solutions
Success Factors
Need for energy efficient equipment with low GWP refrigerants
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Poor climate friendly solutions
Share your ideas!
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Cold Chain
Underlying Issues
Solutions
Success Factors
Integrate climate-firendly solutions into health system infrastructure
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We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Cold Chain
Underlying Issues
Solutions
Success Factors
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Nothing was mentioned in the discussion...Contribute your ideas!
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Lack of Basic Infrastructure
Underlying issues
Solutions
Success Factors
Lack of basic IT equipment
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Shortage of power supply, acces to safe water and sanitation
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We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Cold Chain
Underlying Issues
Solutions
Success Factors
Multisectoral approaches with energy experts, WASH experts
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We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Lack of Basic Infrastructure
Underlying Issues
Solutions
Success Factors
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Share your ideas!
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Nothing was mentioned in the discussion...Contribute your ideas!
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Planning
Underlying issues
Solutions
Success Factors
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Immunization community typically plans in vertical manner, not looking for synergies, missing opportunities to bring people to care and increasing access to care
Share your ideas!
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Planning
Underlying Issues
Solutions
Success Factors
Multi-sectoral response because multi-sectoral intervention
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NDVP process should take into account need to ensure essential services/primary health care
Establish links between NDVP and other health plans
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Planning
Underlying Issues
Solutions
Success Factors
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NDVP process should take into account need to ensure essential services/primary health care
Establish links between NDVP and other helath plans
Guidance for teams working on NDVP
Making sure participation in NDVP is broad
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Resource: WHO and UNICEF: Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines
Challenge: Resource Mobilization
Underlying issues
Solutions
Success Factors
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Immunization community supports costing, but need to bridge to how to finance
Share your ideas!
Issue of additionality - don't know if resources are coming from other programs
Funding for vaccine through COVAX, but where is money to deliver
Need to cost and plan
Vaccine rollout is expensive!
Issues with transparency and tracking resource flows
Can't leverage international agreements
Unclear how to leverage private sector
Where will the money come from?
PHC is already underfunded/ detracting funding from PHC
Still need for local vaccine production capacity
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Challenge: Resource Mobilization
Underlying Issues
Solutions
Success Factors
Fill and finish vaccine approach
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Start planning for vaccine manufacturing
Establishing COVID-19 fund/not touching health budget
Fiscal space assessment to understand constraints
Monitoring of non-COVID PHC spending
Advocacy around essential services
World Bank Debt Service Suspension Initiative
Unit under MoF tasked with ensuring effective and efficient cross-government execution
GFF essential servcies grants/ WB grants/loans
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Country: Malaysia Challenge: Resource mobilization/cost of roll-out Solution: Fill and finish vaccine approach READ MORE
Country: Indonesia Challenge: Resource mobilization/cost of rollout Solution: Planning for vaccine manufacture
Country: Global Challenge: Resource mobilization/cost of rollout Solution: World Bank Debt Service Suspension Initiative READ MORE
Country: Malaysia Challenge: Resource mobilization/cost of rollout Solution: Establishing COVID-19 fund READ MORE: RM 3 billing for vaccine coming from COVID-19 fund READ MORE: Malaysia sets up compensation fund for COVID-19 vaccination
Challenge: Resource Mobilization
Underlying Issues
Solutions
Success Factors
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Strength of advocacy networks
Global efforts to track resources
Establishing COVID-19 fund/not touching health budget
Act for COVID fund is temporary (3Y)
Advocacy for funds to finance rollout
We welcome your contributions of additional challenges, underlying issues, solutions, and success factors. Submit your ideas on the COP website.
Solutions Map
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Hover your mouse over the map pins to see solutions. Exception: for Malaysia, click on the pin to open a window with several solutions.
Country: Indonesia Challenge: Resource mobilization/cost of rollout Solution: Planning for vaccine manufacture
Country: Malaysia Challenge: Resource mobilization/cost of rollout Solution: Establishing COVID-19 fund READ MORE: RM 3 billion for vaccine coming from Covid-19 fund READ MORE: Malaysia sets up compensation fund for Covid-19 vaccination Country: Malaysia Challenge: Resource mobilization/cost of roll-out Solution: Fill and finish vaccine approach READ MORE: First batch of Covid-19 vaccines filled and finished successfully in Malaysia Country: Malaysia Challenge: Governance and Efficiency Solution: High level of public trust in National Pharmaceutical Regulatory Agency (NPRA) helping to mitigate vaccine hesitancy READ MORE: NPRA compromising on vaccine safety, quality- Khairy GO TO: NPRA Official Website Country: Malaysia Challenge: Governance and Efficiency Solution: The Science, Technology and Innovation Ministry (MOSTI) is assisting the MOH to contain COVID-19 Notes: The Special Committee for Ensuring Access to COVID-19 Vaccine Supply (JKJAV), co-chaired by the Ministry of Health of Malaysia and the Ministry of Science, Technology and Innovation, was established to ensure access to the COVID-19 vaccine immediately, safely, perfectly and effectively for the country. READ MORE: MOSTI begins vaccine tracing project using blockchain READ MORE: National Covid-19 Immunization Programme GO TO: Malaysia COVID-19 Official Website Country: Malaysia Challenge: Governance and Efficiency Solution: Community empowerment program READ MORE: Covid-19: MOH travelled to six states to empower communities Country: Malaysia Challenge: Governance and Efficiency Solution: Integrated awareness campaign - with National Agenda for Healthy Malaysians READ MORE: Opportunity now for healthcare reform READ MORE: Malaysia Prihatin programme to serve as Covid-19, vaccination awareness campaign platform Country: Malaysia Challenge: Private sector involvement Solution: Clear guidelines/roles for the private sector READ MORE: Private Hospitals to be used as Covid-19 vaccination centres GO TO: ProtectHealth Corporation Official Website (for roles of private sector in National Covid-19 Immunization Programme) Country: Malaysia Challenge: Equity - Ensuring No One is Left Behind Solution: Expanded government COVID-19 contact tracing app to vaccination READ MORE: Vaccination feature appears in MySejahtera app GO TO: MySejahtera official website
Country: India Challenge: Equity - Ensuring No One is Left Behind Solution: Door to door identification to find those who can't go to the vaccination site
Country: India Challenge: Private sector involvement Solution: Digital Solutions - CO-WIN Digital Platform for COVID-19 Vaccine Delivery READ MORE
Country: Lebanon Challenge: Equity - Ensuring No One is Left Behind Solution: Third-party monitoring READ MORE
Country: Global Challenge: Resource Mobilization Solution: World Bank Debt Service Suspension Initiative READ MORE
Country: Kenya Challenge: Governance and Efficiency Solution: President vaccinated in Kenya helped boost vaccination rates
Referenced Resources
Digitalizing COVID-19 vaccination
World Bank workshop presentation
02
Engaging the private health service delivery sector through governance in mixed health systems
WHO Strategy Report
03
WHO SAGE Roadmap
Roadmap for prioritizing the use of COVID-19 vaccines in the context of limited supply
04
Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines
From WHO and UNICEF
01
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Challenges
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Below are the four resources referenced within this presentation.
Visit the Health Financing Resilience and Sustainability website for more resources on vaccine financing