The challenge 

Low- and middle-income countries are standing at the beginning of an incredibly challenging vaccine roll-out. COVID-19 vaccine delivery poses unprecedented challenges in terms of delivery volume, reaching new target populations, diversity of delivery strategies, and sometimes complex product profiles—elements which must all be managed at rapid speed if effective coverage is to be achieved.

Countries are considering many different delivery strategies designed to reach different priority target populations, which they have had to adapt to the uncertain influx of supply. These range from delivery at hospitals to reaching certain populations at their workplace, to mass delivery through large ad-hoc campaign sites to small, fixed sites in the community. In order to plan and budget for the roll-out in the most efficient manner possible, a better understanding of the costs and operational considerations associated with each of these delivery strategies is urgently needed.

The approach

ThinkWell is conducting costing studies of COVID-19 vaccine delivery in Bangladesh, Côte d’Ivoire, DRC, Mozambique, the Philippines, Uganda, and Vietnam to generate economic evidence to the support the sustainable roll-out of COVID-19 vaccines.

In each country, bottom-up ingredients-based costing studies are being conducted to estimate the cost of delivering COVID-19 vaccines through various delivery strategies, reaching different target populations, and using products with varying cold chain requirements. The studies are also mapping out the service delivery process and funding flows, and capturing the source and use of different types of paid and volunteer health workers mobilized to deliver COVID-19 vaccines. Semi structured interviews are being conducted with stakeholders to assess the roll-out and its challenges.

ThinkWell is working in partnership with local research institutions to strengthen capacity in each country. These are the Institute of Health Economics (Bangladesh), Université Félix Houphouët-Boigny (Côte d’Ivoire), the University of Kinshasa (DRC), Eduardo Mondlane University (Mozambique), Ateneo de Manila University School of Medicine and Public Health (the Philippines), Ndejje University (Uganda), and the Hanoi School of Public Health (Vietnam).

ThinkWell has developed a general research protocol for the country studies to describe the generalized approach, scope, methods, and expected outputs. While recognizing that the diverse range of vaccine roll-out modalities will require tailored research approaches in each of the countries, this general research protocol is aimed at ensuring comparability across countries and facilitating cross-country learnings.