A shot in the arm for the COVID-19 vaccine: can the private sector be a critical ally and why strong governance is the key?

Authors: David Clarke, Anna Cocozza, Shalini Desai, Barbara O'Hanlon, Aurélie Paviza, Samir Sodha

At a glance:

  • Many LMICs – and notably countries participating in the COVAX facility – are preparing for the delivery of the COVID-19 vaccines. Supporting UHC principles of equity, quality, access and financial protection will be key to successful delivery and ending the acute phase of the pandemic.
  • Most LMICs governments lack public sector resources to proceed with the necessary speed to get COVID-19 vaccines into the arms of all who need them.
  • By necessity governments will need to mobilize extra resources – and notably private health sector resources – to fill the gap.
  • Strong governance is critical for harnessing the private health sector for a safe, efficient and equitable vaccine rollout.
  • Engaging the private sector presents a number of challenges and opportunities but, if properly managed, can provide the extra expertise and resources necessary to accelerate COVID-19 vaccine uptake and, in the longer term, to build stronger and more resilient health systems.
  • A lesson on private sector engagement from the COVID-19 pandemic underscores the role of effective governance as a determinant of success.

In this blog, we highlight real-world examples of effective governance practices to engage the private sector to accelerate COVID-19 vaccines roll out.

Introduction

The first shipment of 600,000 doses of COVID-19 vaccines arrived in Ghana on 24th February 2021. This marks a historic step towards ensuring equitable distribution of life-saving vaccines globally. Many LMICs – such as Ghana and other African countries - begun vaccinations in these weeks as part of the first wave of countries that will receive vaccines through the COVAX Facility. 

To obtain vaccines through the COVAX facility, a participating country must ensure that crucial governance measures are in place, including confirmation of national regulatory authorization, indemnification agreements with the vaccine manufacturer, national vaccination deployment plans, and other logistical factors necessary for export and import licenses.

Lessons from the beginning of the COVID-19 pandemic highlights strong governance as the cornerstone for a successful response. The ability of governments to exercise effective stewardship is crucial for an effective, safe, and equitable COVID-19 vaccine roll out.

Health system readiness and the importance of strong government stewardship

As the new COVID-19 vaccines begin to ship out to LMICs, the focus now must turn to the readiness of a country's health system to deliver vaccines into the arms of its population. Any weakness in a country's ability to store, deliver or equitably prioritize the vaccines will have dramatic impact on the success of the COVID-19 vaccines roll out. Those weaknesses must be acknowledged and addressed, as a matter of urgency.

Are countries ready? Can they mobilize all possible resources to meet the challenge?  Can they exercise effective governance over the response?

Many countries are struggling and are not fully prepared. Although WHO advises a whole-of-society and whole-of-government approaches to tackle the COVID-19 emergency, these approaches have not been consistently implemented, despite the fact that mobilizing all stakeholders can be the game changer in a successful response that would end the acute phase of the pandemic.

Leveraging the private health sector – both for profit and not for profit - capacity can fill gaps (e.g. provide extra workforce capacity, improve outreach, support logistics), but many countries have yet to consider how to do so and lack the governance ‘know-how’. And while we wait, there are reports of unregulated private markets for the COVID-19 vaccine, raising questions about safety, quality, and efforts to deliver on vaccine equity. Exercising effective governance of the private sector is key to overcome bottlenecks and guarantee a rapid, safe and equitable response.

Engaging and integrating the private health sector is a challenge. But it is not one that countries can shy away from. Effective governance is not a choice, it is a necessity, and many LMICs are successfully navigating this space. Below is a number of real-world examples of how a well-governed private sector – from the health sector and beyond - can be harnessed to safely and equitably scale delivery of the COVID-19 vaccines:

  • Manufacturing:

The private sector can manufacture inputs needed to deliver COVID-19 vaccines, using several policy tools and financial incentives. India invested to develop the material needed in PPEs, fast-tracked regulatory approval the material, and agreed to purchase the first lot of PPEs to develop local capacity to manufacture PPEs within 60 days. Through this government initiative, India has transitioned from a net importer of PPEs to a net exporter.

The private sector also manufactures the COVID-19 vaccine. In India, the Serum Institute of India signed a contract with AstraZenca to manufacture 1 billion doses of CoviShield for low- and middle-income countries. India, as other countries, are starting to vaccinate their population with CovidShield.

  • Procurement:

The private sector can support governments by procuring them with vaccines. The Government of Ghana has signed a public-private partnership with MPharma to charge them to source and provide COVID-19 vaccines for 2.5 million people in Ghana, linking up with manufacturers and private sector actors in the process.

  • Storage, transportation and distribution management:

The private sector can help to manage the supply chain infrastructures or provide the infrastructure necessary to store, transport and deliver COVID-19 vaccines. In Nigeria, multiple private companies have proposed leasing their refrigerators with cold ice capacity so that the government will not have to purchase these highly specialized equipment. 

  • Advocacy and communication:

The private sector can support the dissemination of accurate news and the spread of constructive education on COVID-19 vaccines. Private sector communication experts in the Philippines, in partnership with the Department of Health and the National Task Force against COVID-19, developed an education campaign to inform citizens about COVID-19 vaccine safety and efficacy.

  • Service delivery:

The private sector can provide extra skilled workforce capacity. Village Reach – an NGO – has set up a voice-message based remote training platforms in Democratic Republic of Congo and Mozambique to train community health workers on COVID-19 vaccine administration in preparation for the vaccine introduction.

The private sector can also support service delivery by helping to identify and vaccinate priority populations. A private company in Nigeria has developed a mobile app to 'track and trace' every COVID-19 vaccine entering the country and reports to three government regulators. Several IT firms have developed TravelCards with QRS authentication for those who have been vaccinated.

Summing up

The arrival of COVID-19 vaccines in LMICS offers new hope to protect populations and stem the pandemic. Governments need to exercise effective stewardship over available resources in their health systems to achieve an efficient and equitable response in line with the public interest, to seize the benefits and minimize the risks of mobilizing the private sector and deliver on what the world wants: an efficient and equitable COVID-19 vaccine rollout.

Over the coming months, we will be following developments, providing cross country learning, and providing critically needed governance advice and support for a successful COVID-19 vaccine roll out. Follow us here for coming updates: we will report successful country-specific examples of private sector engagement in the rollout of the COVID-19 vaccines and identify governance tools for countries to effectively regulate and collaborate with the private sector for the COVID-19 vaccine rollout.

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