Vaccination

CARE Malawi COVID Vaccine Delivery Situation January 2022

“The vaccines are here but support for delivery is most needed, especially at the last mile.” – District Health Management Team member, Ntcheu
As of January 10, 2022, Malawi had delivered 1.84 million doses of vaccine out of the 3.12 million doses it has received so far.1 Many doses in country have rapidly approaching expiration dates, and if they do not get to people fast, they risk expiring on the shelves. To make sure the 1.26 million doses left go to the people who need them most, we must invest more in communication, engagement, and delivery. The $37M granted by the World Bank over the past year is sufficient for covering only 8% of Malawi’s total population. What is more, as the highly contagious Omicron variant spreads worldwide, it is even more critical that more people are vaccinated now. We cannot assume that the Government of Malawi and its current health system can do it alone.

The government and other health actors in Malawi are working tirelessly to vaccinate people, while facing multiple health crises. The health system is building on a base of committed (if overstretched) health workers, an openness to community feedback, and a long expertise of delivering The government is coordinating closely with many actors to reduce gender gaps, get vaccines to the last mile, and keep existing health services open. Nonetheless, the Ministry of Health is under-resourced, and operating in a global system where the vaccine supply that arrives may be close to expiring. For example, doses of the Astra-Zeneca vaccine had to be destroyed in the spring, after arriving in Malawi with only two and a half weeks left before their expiration date.

More investment is needed. To take just one example, the national government has been able to provide one van per district to support mobile vaccination sites, to get vaccines to the last mile. Mobile vaccinations are the most effective way to serve people who live far away from health centers and do not have access to easy forms of transportation. That means that in Ntcheu, one van is expected to serve a target population of 214,929 people living over 3,424 square kilometers. One van cannot serve those people fast enough to make sure vaccines get where they need to in time, especially when an inconsistent and unpredictable vaccine supply could have doses expiring at any time. Read More...

Nepal COVID-19 Vaccine Costing Study

By December 6, 2021, 19.2 million doses of COVID-19 vaccines have been administered in Nepal, enough for 36% of the population to have gotten at least one dose of vaccine. After a rough road with unpredictable vaccine supply, the government has been able to procure several million vaccine doses. Now delivery at the last mile is the biggest hurdle they face. Nepal’s Minister of Health says, “We are not going have shortages of vaccines anymore, but our main concern and focus now is on getting these vaccines to all corners of the country, including the remote mountain areas.”

Based on national data, and in-depth studies in 2 health districts, CARE estimates that delivery costs from “tarmac to arm” for vaccines in Nepal are $8.35 (1,019 NPR) per dose of vaccine administered, or $18.38 (2,241 NPR) per person fully vaccinated.

This is nearly 5 times more expensive than current global estimate for delivery costs. These costs range from $11 per fully vaccinated person in easier to reach areas, to $33 per dose in remote, difficult to reach areas. Gaps in vaccine coverage are particularly acute for mountainous areas, people with low mobility, and communities far from health centers. Even the lowest-cost estimates for the easiest to reach areas are nearly 3 times higher than global average estimates.

70% of these costs are personnel needs to ensure vaccines reach people at the last mile. This points to a major need to improve investments in vaccine delivery, especially the health care workers who administer vaccines and ensure everyone gets vaccinated.
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Fast and Fair Vaccine Update August to October 2021

CARE's Fast and Fair initiative supports countries to equitably deliver COVID-19 vaccines through four pillars: Advocate, Facilitate, Protect and Mobilize.
CARE has identified 22* countries (and counting ) with strong capacity, partnerships, and readiness to scale.
By October 2021, CARE has supported vaccines in districts where 126 million people have delivered vaccines. We have also supported mass media messages promoting vaccines to 263 million people. Read More...

Gender Gaps in Vaccines November 2021

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 22 of 24 countries where CARE has data, women are less likely to be vaccinated and less likely to feel vaccines are safe.

There are massive local and global gaps in who can get vaccinated. Only 4.5% of people in low-income countries are vaccinated, and 79% of vaccinations have been in wealth countries. Tragically, wealth and geography are just two factors that skew access to vaccines. Another is gender. In many low and middle-income countries, women are less likely to get COVID-19 vaccines than men are. This compounds gender inequality women are already facing in health and decision-making Read More...

Who pays to deliver vaccines? An Analysis of World Bank Funding for COVID-19 Vaccination and Recovery

The World Bank is one key source of funding in the global push to vaccinate 70% of the world’s population against COVID-19. Many actors point to this as the funding that will cover any additional delivery needs for COVID-19 vaccines that national governments cannot meet. With $5.8 billion in funding already approved out of a $20 billion commitment, the World Bank funding is an important part of the picture, but the World Bank alone cannot cover the full gap in vaccine delivery needs.

Reviewing 60 funding agreements from the World Bank on COVID-19 vaccination and recovery shows the following insights.

• There is still a gap in delivery funding. The World Bank is currently funding $1.2 billion in vaccine delivery—10% of the total funding allocated for COVID-19 recovery. If that trend applies to the rest of the $20 billion commitment, World Bank funding will cover a between $2 and $4 billion—well below the $9 billion that ACT-A estimates as the lowest possible investment to vaccinate 70% of the world’s population. In contrast, $3.1 billion is going to purchase vaccines.
• Health workers remain underfunded. Only 15 of 60 agreements, just 25% detail provisions to pay health workers. Of those, 7 explicitly fund surge capacity, 3 provide for ongoing salaries, and 4 allow for hazard pay to health workers.
• Countries are taking on debt to rollout COVID-19 vaccinations. 86% of the funding in this analysis is in the form of loans. That gives countries debt that may weaken future pandemic preparedness rather than reinforcing health systems.
• All funders should adopt the World Bank’s commitments to investments in gender equality. 90% of the agreements in this analysis refer to gender inequality and many make corresponding investments—like requiring that 60% of vaccine leadership positions are women—to overcome these barriers. Earmarking exact funds going to advance gender equality would provide further transparency. Nevertheless, this consistent and concrete commitment is commendable, and all actors should strive to replicate it.
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Gender Gaps in COVID 19 Vaccines

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 16 countries where CARE has data, women are less likely to be vaccinated, and less likely to feel vaccines are safe.
There are massive local and global gaps in who can get vaccinated Only 1 9 of people in low income countries are vaccinated, and 79 of vaccinations have been in wealth countries Tragically, wealth and geography are just two factors that skew access to vaccines Another is gender In many low and middle income countries, women are less likely to get COVID-19 vaccines than men are This compounds gender inequality women are already facing in health and decision making Read More...

COVID-19: Impacts, Attitudes, and Safety Nets in Haiti (April 2021)

In April 2021, CARE conducted interviews with savings group members and leaders to understand their experiences of COVID-19, and how it was changing their lives. The survey included 364 women and 175 men, for a total of 539 respondents. This follows a survey done in June 2020 to understand what was happening at that time for members of savings groups. The surveys covered Artibonite and Grand Anse.

COVID-19 continues to have important impacts for women and men in savings groups. In general, men and women in these groups were reporting similar challenges across the sample. 86% of women and men are reporting impacts in their livelihoods, and 98% of people say that COVID-19 is affecting their ability to save. 64% say they can’t meet family needs and hunger has gone up. 90% of people are reporting that COVID-19 is impacting their social lives. More women than men report that Gender Based Violence has gone up. While women are more likely to have lost influence in the household than men (39% compared to 33%), men are more likely to report that they lost social status in the community (48% compared to 43%). Read More...

COVID-19 Vaccination Uptake: A study of Knowledge, Attitudes and Practices of Marginalized Communities in Iraq

CARE Iraq conducted a study to better understand community acceptance of COVID-19 vaccination and existing barriers to vaccine uptake. The objectives of the study were to create an understanding of people’s knowledge, attitudes and perceptions about COVID-19 and the vaccines, establish what reasons undermine the COVID-19 vaccination campaign and inform about the status of vaccine uptake among marginalized communities. The results of the study can inform policy makers and health actors to design awareness campaigns and address barriers to vaccine uptake to increase the vaccination rate.

CARE found that:
• Vaccine hesitancy is high.
• Women have less access to, knowledge of, and willingness to accept the COVID-19 vaccine then men.
• Barriers to access are still high, and higher for women than for men.
• Fear of side effects is the biggest obstacle.
• There is little trust in the vaccination process.
• Many people do not believe vaccines are important.
• People are not confident they have enough accurate information.

Key recommendations
• Social media can be a primary channel for vaccine messaging.
• It’s critical to counteract misinformation.
• Multiple sources of information are critical.
• Focus messaging for women and religious leaders.
• Develop different messages in different areas.
• Build on people’s willingness to be convinced with good information. Read More...

Community Scorecard for COVID-19 Vaccines in Malawi

The significant amount of misinformation surrounding COVID-19 has deteriorated trust in governments and health systems, leading the World Health Organization to claim it as an “infodemic.” As the massive vaccine roll-out efforts launch, systematic trust-building and social accountability approaches are vital to ensure that civil society can hold governments accountable for equitable and people-centered vaccine roll-out that reaches the last mile. CARE knows that epidemics, like COVID-19 and Ebola, start and end with communities, which is why we are working to build meaningful citizen engagement into national vaccine roll-out frameworks to increase trust, accountability, and information dissemination.
CARE’s Community Score Card
The Community Score Card (CSC) was developed by CARE Malawi in 2002 and has been effectively used in a wide range of settings and sectors to ensure that public services are accountable to the people and communities they serve. CSC has demonstrated impact on power-shifting and improving service quality and trust building within and between communities and government actors. When COVID-19 arrived in Malawi during March 2020, CARE adapted CSC for remote use. The remote CSC includes an SMS platform and WhatsApp groups through which groups of men, women, youth, community and religious leaders, and service providers could voice their concerns and hesitancies about the vaccine and other health services. The CSC helped to identify major concerns around the vaccine and aided stakeholders in creating locally-driven solutions to combat vaccine hesitancy and misinformation.
Building on these early experiences, from May to June 2021, CARE further implemented a pilot project designed to support efficient and equitable COVID-19 vaccine roll-out in three locations in Malawi: Kandeu and Chigodi health facility catchment populations in Ntcheu district and the New Hope Clinic health facility catchment population in Ngolowindo in Salima district. In all three locations, key stakeholders included groups of women, men, youth, community leaders (chiefs and religious), district health management teams, and health personnel (including health surveillance staff, health facility staff in-charge, and the health center management committee). CARE Malawi’s CSC team led the implementation of the pilot with support from CARE USA and digital support from Kwantu. Read More...

South Sudan: The True Cost of COVID-19 Vaccines

By July 18, South Sudan was able to administer the nearly all of the 60,000 doses of COVID-19 vaccine they had in stock through a series of smart investments in delivery, training, and social mobilization coordinated with several different partners. As new doses are projected to arrive in country in August, South Sudan continues to reinforce gaps in the health systems to make COVID-19 vaccinations possible without disrupting existing health services.

CARE’s estimated delivery costs from “tarmac to arm”1 for vaccines in these areas are $9.97 per dose of vaccine administered, or $22.22 per person fully vaccinated.

This is six times more expensive than current global estimate for delivery costs. For some actors providing vaccinations in South Sudan, the cost has been as high as $20 per dose administered when they include all costs. That’s because the health system in South Sudan is fragile, and it was already struggling to deliver even routine services. South Sudan is one of many health systems around the world that will need additional personnel, resources, and infrastructure to effectively deliver COVID-19 vaccines to at-risk populations, especially in hard-to-reach areas. The exact cost will continue to evolve as new vaccines arrive in country and the country vaccinates new groups of people. Read More...

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