Covid-19 has had a major effect on all of our lives. There is a sense of isolation and separateness that is heightened by restrictions on international travel. It has also got us thinking of the importance of international co-operation, and why and how we should share resources. Proper consideration of affordability and sharpening the focus of healthcare budgets are two important issues.
This is particularly so with regard to access to vaccines. We all now know why we should have as many people vaccinated as quickly as we possibly can: we want to reduce the systemic health, socioeconomic and commercial costs that have heightened the current palpable sense of uncertainty and insecurity felt throughout the world.
The more difficult question is how to do this. If we agree with UK foreign secretary Dominic Raab, among others, that we need to, and can, bring the date of an adequate level of global vaccinations forward from 2024 to the end of 2022, we need to get our skates on. This is particularly so in developing countries, notably in Africa, where a large proportion of the population remains unvaccinated.
What needs to be done to bring the date forward? To start, I think the overconcentration and, at times, emotional debate on vaccine equity is an unnecessary distraction. It was always going to be the case that Covax donor countries would have vaccine access levels greatly higher than those of recipient countries. It was also always going to be, as with any project requiring international co-operation, that there was going to be some politics and sense of injustice, real or perceived.
Yet the nature of the pandemic is that it’s in everyone’s self-interest to have vaccines distributed as widely and as quickly as possible. Policy that provides access solely based on ability to pay would be a grave error. The pandemic does not recognise that some parts of the world have limited economic significance. The contribution of 500-million doses by the US and 100-million by the UK, other donations to Covax and similar initiatives, suggests donors want to avoid this error.
Such contributions should be seen as just that — they do not negate primary accountability of recipient governments to their citizens. Since budgets are tight, allocative efficiency is critical. Though somewhat counterintuitive, some form of co-payment, that is a subsidy on the full price, but which still requires most recipient countries to make a payment, is likely to be helpful in enhancing efficacy in accountability and distribution of vaccines.
A recent Go Give One campaign for Covid-19 vaccines in developing countries suggests that $5 will provide one dose. This enables a back-of-the-envelope calculation that it would cost about $14bn to provide two doses each to about 1.4-billion people in Africa. If we add a 5% margin for costs of distribution, transportation and construction of refrigerated storage and absorptive capacity where needed, the total bill for the 53 African countries would still be less than $15bn.
As new strains of the virus emerge there is a possibility that a third vaccine top-up dose may be required. This could push up overall costs to about $20bn. This is a large number, but in relative terms it is not unaffordable and with appropriate international co-ordination is certainly fundable. In the broader scheme of things, it should not alter the capacity to meet the overall vaccination objective.
Further, though the continent’s GDP dropped by about 3% in 2020 from its 2019 level, the combined GDP of African countries was about $2.5-trillion. Therefore the $20bn cost is less than 1%-2% of aggregate GDP. Given that, and irrespective of factors such as increased debt to GDP ratios, tightened fiscal space and high levels of poverty and inequality, this figure is not so large that Africa needs to depend solely on donor support for total payment.
With most donor countries also struggling to rebalance their own budgets, African countries need to do more in bringing the vaccine date forward. Apart from increasing the size of budget allocation, redistribution of existing budgets could go a long way in improving Covid-19 vaccine delivery on the continent. Governments and policymakers can do this by taking some practical steps to improve the level of overall healthcare delivery and accountability.
Placing greater budget and capacity emphasis on field and rural direct healthcare community outreach, particularly in low-income areas — where the actual need far exceeds access levels, would be useful. This can be funded by reducing the size and relative level of public sector healthcare bureaucracy and indirect administrative costs, thereby improving the balance and overall delivery capacity of healthcare systems. Where this can’t be funded directly from budget changes and reallocation the World Bank and other development agencies could provide appropriately means tested subsidised loans to enable countries to buy these vaccines.
Introducing more information technology to support real-time monitoring and control of vaccination programmes is likely to support accountability. In a continent where 68% of the population is below the age of 30, more use of social media platforms and local influencers to communicate with young people is also likely to increase Covid-19 awareness.
Finally, challenges in meeting the quick rollout of vaccines could also be ameliorated by public-private partnerships, as is now taking place in SA and some other countries, and by healthcare NGOs such as AMREF Health Africa. The date can be brought forward.
• Okeahalam chairs NGO Amref Health Africa.
Article first published on businesslive.co.za