Deep Dive Discussion

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

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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

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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

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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

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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

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Success Factors

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Immunization community supports costing, but need to bridge to how to finance

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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

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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

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Engaging the private health service delivery sector through governance in mixed health systems

WHO Strategy Report

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WHO SAGE Roadmap

Roadmap for prioritizing the use of COVID-19 vaccines in the context of limited supply

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Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines

From WHO and UNICEF

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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