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African perspectives on lessons learned from the COVID-19 pandemic about vaccine procurement
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From syringes to storage facilities, vials to funding strategies, every detail matters in a pandemic. The COVID-19 pandemic exposed the inequalities in healthcare around the world and the pressing need to address them before the next pandemic. This begins with identifying the challenges that low- and middle- income countries (LMICs) faced during the pandemic. During a health program on "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-income Countries", Salzburg Global Fellows Henry Mwebesa and Patrick Amoth elaborated on the experiences of two African countries and the lessons the world can learn from this.
Securing vaccines was a pressing priority for all, but for many African countries, it was a long and delayed process layered with obstacles. After initially receiving one million doses of COVID-19 vaccines in March 2021, Dr. Henry Mwebesa, Director of General Health Services at the Ministry of Health of Uganda, revealed that it took another three months for the next batch of vaccines to arrive. As the pandemic progressed and Uganda received more philanthropic funds, securing vaccines in time remained difficult, as “we made orders, but they did not supply in time,” Henry recalled. To make matters worse, rigid contractual terms forced upon LMICs made it impossible for them to penalize untimely deliveries.
Lacking bargaining power and the financial means to access vaccines, most of the vaccines for LMICs came from donations. However, they often came with a very short shelf life and did not consider the needs of LMICs. Patrick Amoth, Director General for Health at the Ministry of Health in Kenya, alluded to one donation where the packaging was so voluminous, that it overwhelmed the storage capacity at the national vaccine depot and crowded out routine vaccinations. Patrick referred to this as “dumping vaccines”. LMICs often receive vaccines that are near expiration, which inadvertently creates more burdens than benefits, as the cost of destroying these vaccines is borne by LMICs.
Equitable access to vaccines will be crucial in the next pandemic. Reflecting on the COVID-19 pandemic, Henry believes that COVAX has the potential to be strengthened into a more equitable arrangement for the future. During the pandemic, the price for vaccines rocketed as high-income countries hoarded doses. COVAX should continue to pool vaccines, but Henry added that the key was to ensure adequate stock levels and strengthen COVAX as an “arbiter” and a “more genuine engine”.
A strengthened COVAX would also efficiently allocate vaccines, allowing individual countries to apply and buy from the pooled stock according to their own needs. This corresponds with Patrick’s takeaway that “requests should actually come from the receiving countries”. Patrick explained, “we should be able to customize based on our own individual context”. LMICs differ significantly in infrastructure, and it is necessary to develop solutions adapted to the regional needs and capacities of LMICs.
Despite facing challenges in vaccine access, African countries fared better against COVID-19 than the world expected. Learning from the HIV pandemic in the 80s and 90s, Kenya institutionalized “home-based care” where people who were not severely ill were treated at home by professional healthcare providers and community health workers. “This platform worked very well during the pandemic,” Patrick explained, “not on a single day was our healthcare system stretched to the limit”. The solidarity and communal support demonstrated by Kenyans is a testament to a recurring message of the program, the need for a bottom-up approach. As has been the case in COVID-19, when one region cannot gain access to healthcare, every country is at risk. Such is the importance of global solidarity in the next pandemic. As Patrick concludes, “No one should be left behind.”
The Salzburg Global Fellows featured in this article attended the Salzburg Global Health and Health Care Innovation program "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-income Countries" from March 11 to 16, 2024. This program convened nearly thirty Fellows, including healthcare practitioners, policymakers, researchers, and representatives from health ministries in several African countries, for crucial discussions on access to suitable and affordable vaccines in low- and middle-income countries (LMICs). Central to the discussions was a focus on understanding end-user needs and constraints to inform the design of a new model for multilateral vaccine procurement.