The Center for Policy Impact in Global Health at the Duke Global Health Institute is conducting a study to assess country-level capacity for delivery of COVID-19 vaccines in low- and middle-income countries.
Why this study is needed: In order to achieve herd immunity for COVID-19, the world would first need to develop a successful vaccine, and then countries would need to ensure that these vaccines are successfully delivered to their populations. While ongoing efforts to develop a vaccine currently dominate the global agenda, little is being done to address country-level capacity to cope with the financing and logistic challenges needed to deliver on this unprecedented effort.
This study is important for three reasons. First, developing a successful vaccine is necessary but not sufficient for achieving herd immunity. Once the problem of lack of an effective vaccine is solved, the rate limiting step to achieving herd immunity will be country health systems capacity. Second, health systems strengthening and capacity building require significant investments in time and money. Even in situations where money is available, the lead time required for implementing systems strengthening before results can be seen is substantial. This can severely limit the success of a large scale health intervention such as COVID-19 vaccination scale-up. Third, there is remarkable variation in the vaccination delivery capacity of different countries; so, solutions for one country may not be applicable to others.
Study approach and outcomes: Our study will use a mixed-methods approach that identifies potential health systems challenges to COVID-19 vaccination scale-up. It has three objectives:
- To estimate a global price tag for the delivery of a successful COVID-19 vaccine to the target populations in low- and middle-income countries.
- To understand and quantify major health systems barriers that low- and middle-income countries will face in scaling-up access to a COVID-19 vaccine. We will do this by conducting a survey across 60 low- and middle-income countries; circulated across policymakers and key stakeholders who are part of COVID-19 vaccine task forces and committees, government officials working on vaccine delivery issues, and non-government entities (donor, academic, private sector stakeholders) supporting governments in their planning efforts. The survey aims to identify critical challenges in country-level planning and health systems capacity as well as vaccine uptake challenges, and thereby facilitate policy discussions and interventions needed to address these issues.
- To explore potential solutions to achieving effective scale-up of COVID-19 vaccination. We will conduct a bottleneck analysis to assess feasible policy options that address barriers to COVID-19 scale up. Bottleneck analysis recognizes that several factors can affect the capacity of a health system to deliver on its objectives. These factors include financing, human resources for health, quality of care, delivery systems, and acceptability of the intervention by the end-users; each plays a significant role in determining the level of success a country will have in scaling up a COVID-19 vaccine. We are developing quantitative models to assess the interactions of these factors and potential policy solutions. Our final report will describe health systems bottlenecks for each country while comparing the costs and effects of potential policy solutions.
To achieve these goals, we will organize our work in a way that enables the generation of insights and evidence useful for policy makers at the country-level. In addition to broad general analysis (e.g., estimation of the global price tag), we will conduct in-depth analysis in each of the four selected countries.