July 16, 2021

How can LMIC countries prepare to receive and efficiently administer large numbers of COVID-19 vaccine doses?

Weekly COVID Vaccine Research Update

Friday, July 16, 2021

Original post can be found on the Duke Global Health Innovation Center's Launch and Scale Speedometer website.

High-income country confirmed dose total: 6.1 billion
Upper-middle-income country total: 2.1 billion
Lower-middle-income country total: 2.8 billion
Low-income country total: 270.2 million
COVAX total: 2.5 billion
Total worldwide confirmed purchases of Covid-19 vaccines:

12.9 billion doses


How can LMIC countries prepare to receive and efficiently administer large numbers of COVID-19 vaccine doses?

Author: Andrea Taylor

Of the 3.5 billion COVID-19 vaccine doses that have been administered globally, only about 69 percent of the doses have been administered in low and middle income countries (LMICs) with 84 percent of the world’s population. Wealthy nations’ over-purchasing of the limited vaccine supply left LMIC nations without access to COVID-19 vaccine doses. However, as these nations start to vaccinate their populations and curb the pandemic within their borders, we are seeing increased donations from over-supplied countries to poorer nations. Combined with improvements in the supply landscape, COVAX forecasts a large supply of vaccine doses to be available to LMICs by the end of 2021.

The next challenge is to ensure efficient in-country dissemination and administration of the vaccine doses. This is especially concerning as many LMIC countries have reported using only a portion of the vaccines they received due to poor logistical capacity in administering doses, requiring some nations to destroy expired COVID-19 vaccines. African nations have destroyed a total of 450,000 expired doses; Malawi, for one, destroyed 20,000 expired AstraZeneca doses despite only having vaccinated around 2 percent of its population in May 2021.

To prevent further vaccine wastage and ensure efficient distribution of COVID-19 vaccine doses, countries should take the following preparatory measures.

Greater Data Transparency

Vaccine hesitancy, inadequate country readiness for massive vaccination campaigns, and poor financing are critical barriers to administering vaccinations in countries. However, data on the scope and extent of these issues in LMICs is fragmented and inconsistently reported. Systematic tracking of these data points, with increased sharing of this information in the public domain, will allow country leaders to better assess and prepare for vaccination challenges.

Combatting vaccine hesitancy

Existing data indicates that there is relatively high acceptance of the COVID-19 vaccine across LMICs. Between June 2020 and January 2021, about 80 percent of individuals across LMIC countries indicated a willingness to take the COVID-19 vaccine—acceptance rates ranged from 97 percent in Nepal to 67 percent in the Burkina Faso. (Comparatively, the COVID-19 vaccine acceptance rate in the United States is at 65 percent.) While these numbers are promising, misinformation in media combined with mistrust of outsiders, rooted in historical experiences, is raising doubts on the safety of vaccines and increasing vaccine hesitancy in these countries. Moreover, vaccine confidence in LMICs was further damaged as wealthy nations suspended AstraZeneca and Janssen (J&J) rollouts due to safety concerns.

LMIC countries should tackle these emerging vaccine confidence crises sooner rather than later. Through effective and targeted community engagement, governments should provide reliable information on the pandemic and on getting vaccinated. In the past, healthcare workers or community health workers traveling door to door and providing reliable information has been proven successful. Rwanda, for example, found that coupling a vaccination campaign with targeted information on the need for and benefit of the vaccine boosted vaccination rates in earlier campaigns.

Preparing for national vaccination campaigns

Countries must be prepared for a large-scale rollout of COVID-19 vaccine doses to reach the majority of their populations. While a World Bank readiness assessment of low and middle income countries indicates that 85 percent of LMIC countries have national vaccination plans on paper, these do not always successfully translate into action. All key stakeholder groups must buy in to the plan and the logistics be rehearsed.

The World Bank assessment found major gaps in the training of health workers to administer vaccines and social engagement strategies to encourage vaccinations. Countries need to increase the health workforce available to vaccinate their people and community health workers who can engage with individuals about vaccination.

Additionally, countries must start identifying methods to reach marginalized communities across the country, including informal, rural, and transient populations. A lack of infrastructure often makes these points of entry difficult in LMICs, and this becomes even more relevant as countries finish vaccinating their health workers and start vaccinating their broader populations. Morocco provides an example of what can be achieved; mobilizing just over 3,000 vaccination centers (with more than half in rural areas) and 700 mobile vaccination units to target the most remote populations, the lower-middle income country has achieved impressive vaccination rates with 30 percent of its population receiving at least one dose by mid-July. A report from McKinsey further recommends setting up a “command center” to manage all vaccination activities and making use of innovative data sources such as mobile data or household geotagging to facilitate in the administration of doses.

Finally, in order to achieve a successful vaccination campaign, it is imperative that we see a strong and unified political commitment towards achieving high vaccination rates and effective governance in coordinating the massive vaccination campaigns.

Invest in infrastructure for delivery and administration of doses     

A recent International Monetary Fund analysis calls for a $50 billion investment in manufacturing capacity, supply, and delivery for COVID-19 related treatments, including vaccines, to tackle the pandemic. According to a CARE Analysis, for every dollar invested in the vaccine dose itself, an additional five dollars needs to be invested in the delivery of the dose. The World Bank is currently providing $12 billion in loans to finance the purchasing and distributions of COVID-19 vaccines, which countries could perhaps make use of in supporting the distribution of vaccines—such as investing in data and IT systems to track vaccinations and book appointments and training health workers.

Without these investments, the costs will inevitably be placed upon the most vulnerable populations as indirect costs of receiving the vaccination, further increasing inequities in vaccine distribution. Moreover, countries can use this as an opportunity to plan and invest in the long-term growth of their health system.

Delivering vaccine doses to countries is only part of the challenge in fighting the COVID-19 pandemic. We need to ensure that countries have what they need to distribute these vaccine doses and efficiently administer them equitably to curb the pandemic.


Significant updates, news, and trends we saw last week:

  • Cuba becomes the first Latin American country to issue an emergency approval of its own Abdala vaccine.
  • China makes its first donation of 550million Sinopharm and Sinovax vaccines to COVAX, the alliance dedicated to ensuring equitable global vaccine distribution.
  • US officials are resisting a push by Pfizer to provide booster shots for vaccinated Americans, saying more data is still needed.
  • Israel, on the other hand, is allowing those with weakened immune systems to get a third Pfizer-BioNTech shot.
  • The EU has excluded the SII version of the AstraZeneca vaccine from its vaccine travel certificate, though the Europe-produced version is included.
  • Malaysia announced it will use its remaining supply of Sinovac’s Coronavac and for second doses and then stop use of the vaccine. The country plans to pivot to Pfizer-BioNTech for the majority of its national supply.  

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.