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Principles of effective COVID-19 vaccination response in humanitarian contexts (August 2022)

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INTRODUCTION

Although the COVID-19 pandemic is still not over and the WHO continues to classify COVID-19 as a Public Health Emergency of International Concern, the world has largely moved on. While much has been achieved, including the rapid development of safe and effective vaccines, a resounding failure of the response has been the lack of timely and effective pandemic response to communities living in fragile and humanitarian contexts.

The impact of COVID-19 on populations in low income and fragile settings has been much worse than generally assumed:
WHO data highlights significantly more deaths occurred in countries with Humanitarian Response Plans (HRPs) between 1 January 2020 and 31 December 2021, with up to 2.2 million excess deaths attributable to COVID-19.

The WHO Africa region will likely experience 166 million COVID-19 infections in 2022, with severe implications for the elderly, health care workers, and people with comorbidities and underlying conditions.

Much remains to be done to ensure adequate vaccination coverage: As of April 2022, just two out of thirty countries,
Colombia and El Salvador, have met the WHO’s 70% COVID-19 vaccination coverage target. While dose availability has improved, delivering COVID-19 vaccinations is an immense logistical exercise and requires significant financing, technical expertise, coordination and outreach. On top of initial financing gaps, low income and fragile countries have limited healthcare and transport infrastructure, some of which is damaged by conflict, overburdened or curtailed by budget shortages and limited health care workforce.

Funding for COVID-19 vaccines delivery is now increasing, primarily through the World Bank and GAVI.
According to OCHA’s FTS, over USD 4.9 billion has been approved for covid vaccines, while the total funding approved for emergency health needs across all HRPs is just USD 761 million, 25.2% of requirements.

COVID vaccine financing comes at a time of enormous gaps in humanitarian funding, which have led to the reduction of health services, such as in South Sudan5 and major cuts in food and nutrition supplies in the midst of a global food crisis.

For many people living in fragile and conflict-affected states, COVID-19 is of low concern and while there were queues for vaccinations in 2021, in 2022 it is not considered a priority need. The international community now faces the challenge of how to effectively deliver a vaccine that is of low priority while also striving to put the needs and priorities of crisis affected people at the centre. On one hand, humanitarian and basic health needs are unmet due to financing shortfalls and COVID-19 vaccines are not perceived as a priority need by crisis-affected and marginalized populations; on the other hand, the virus remains a public health issue of concern and financing is available to deliver the necessary vaccines.

An effective response must grapple with these issues and leverage all available resources to ensure that COVID-19 vaccines are provided with or alongside humanitarian response and investments in health services.

This paper lays out six principles that will strengthen effective and timely pandemic response in humanitarian settings for both this pandemic and the next.

  1. Strengthen health services: Effective pandemic preparedness & response requires a functioning health system

  2. Leverage partnerships: Engage local, national and international NGOs

  3. Provide timely and sufficient financing and suitable financing mechanisms for vaccine delivery and outreach

  4. Streamline interventions: Ensure vaccine delivery, financing and demand move in tandem

  5. Respect & engage communities: Take a bottom-up approach to vaccine delivery

  6. Be inclusive: Tailor approaches to be gender responsive and inclusive of vulnerable or marginalised groups

The principles are not new; they largely underscore the lessons learned during the Ebola and HIV pandemics. NGOs will need to work together with communities, governments, donors, UN agencies, the World Bank, and the private sector at all levels from local to global to ensure that these principles are incorporated into the COVID-19 response and are the foundation of future response models in humanitarian and fragile contexts.