First, logistics. Governments will have to ramp up transport and storage to maintain an unbroken cold chain for the vaccines. Some countries will need help to reach remote areas and to expand storage, build cold chains, and improve health facilities. We can learn from experience in West and Central Africa, where countries successfully deployed an Ebola vaccine requiring storage at around -60 degree Celsius – comparable to that needed for the BioNTech/Pfizer Covid vaccine – with dry ice packs on motorbikes reaching the remotest villages.
Second, delivery. Today, most countries immunise infants, but not large swathes of the adult population. Each will have to prioritise who gets the vaccine first. For example, frontline health care workers, the elderly, people with pre-existing conditions, and providers of public services like teachers, the police, and grocery workers. Most countries will be further stretched as they aim to restore other health services that have been disrupted.
Countries also need systems to track that medicines reach people and are distributed as intended, including the second dose that most vaccines require. Digital and technological innovation can help. In Pakistan, for example, the World Bank has supported polio vaccination with digital data tools to locate infections, guide vaccinators, and monitor progress. This can help prevent pilferage and diversion of vaccines as well as minimize risks of fraud in administration of vaccines.
Third, public acceptance. Governments may face widespread hesitancy whether the new medicines, developed at record speed using new technologies, are indeed safe. Recent Ebola outbreaks highlighted the importance of building trust in immunisation. In the Democratic Republic of Congo, this involved hiring local staff, engaging with community and religious leaders, and conducting campaigns in local languages to counter rumors and misinformation.
Over the next 100 days, the World Bank aims to help at least 100 countries get ready to deploy Covid-19 tests, treatments, and vaccines. We are coordinating closely with Gavi, UNICEF, WHO, CEPI, and the Global Fund and offering financial and technical support. We’ll start by helping countries assess their readiness, quantify cost gaps, and boost health systems to implement vaccination.