In early March, more than 1.7 million doses of COVID-19 vaccine arrived at a warehouse in the Congolese capital of Kinshasa, a bustling city of 15 million people, in a colossal country of 100 million.
Shipped to the country through COVAX, a multi-organization global initiative aimed at equitable access to vaccines, the delivery was touted as “part of the largest vaccine procurement and supply operation in history … part of a first wave of supplies that will continue over the next few weeks.”
As of this writing, nearly two months later, some of those vaccines have finally begun being distributed. In fact, vaccines are sitting unused in docks and warehouses across the developing world — undelivered, and with fast-approaching expiration dates.
It’s clear, and it’s tragic: last-mile delivery of the best tool we have to end the pandemic is failing. Low- and middle-income countries (LMICs), some already facing a dearth of vaccine supply, are now contending with challenges related to human resources and training, mistrust and misinformation among citizens, logistics and cold chain capacity, and operating environments with security challenges.
In fact, a quarter billion people are at risk of being missed by government-led vaccination activities, including approximately 30 million frontline humanitarian responders, the majority of whom are women. These women face a significantly higher risk of severe disease or death from the virus.
At the same time, the World Health Organization’s Access to COVID-19 Tools Accelerator (ACT-A) — designed to accelerate global development, production and equitable access to COVID-19 tests, treatments and vaccines — remains chronically under-resourced. Only vaccine procurement for the first phase of inoculations has been mostly funded for now, which means money for vaccine delivery is mostly missing. Meanwhile, lethal variants of the virus continue to emerge. Every vaccine that goes undelivered or unused represents more time and opportunity for more deadly variants to emerge and spread.
So, while wealthy nations have spent billions to develop vaccines in record time, and trillions to blunt COVID’s impact on their economies and vaccinate their populations, all these investments and sacrifices could be rendered moot by the emergence of more infectious and deadly variants. Congress must prioritize additional funding for global vaccination efforts — specifically, those that use experienced, trusted institutions for distribution and help build sustainable health care infrastructure in countries that need it.
A joint analysis by our two organizations, CARE and Booz Allen Hamilton, looked specifically at the economic impact to the United States if we fail to achieve global herd immunity. We concluded that absent a significant U.S. investment in achieving global access to COVID-19 vaccines, the potential cost of a prolonged pandemic to the U.S. economy is at least $250 billion and could reach as high as $675 billion over the next five years. These investments must prioritize access to the vaccines for the parts of the world and the people in the world who would not get them otherwise due to geography, infrastructure, poverty, discrimination, misinformation, lack of security or any other reason.
A recent CARE study estimated that an “effective investment in a fast and fair global vaccine rollout must include $5 in preparation and delivery for every $1 in a vaccine.” An effective investment in vaccine delivery must consider costs like equipping, paying, training, and supporting frontline health workers, education and vaccine acceptance campaigns, childcare costs for frontline health workers, and infrastructure such as cold chains, vaccine tracking systems, power supplies and administrative costs. Experienced, trusted institutions must lead the global distribution of information, resources, and doses to avoid lengthening the pandemic and extending periods of economic costs and harm.
Building on this holistic view of needs and costs, Booz Allen and CARE estimated that a total global investment of approximately $190 billion would be needed to get LMICs to herd immunity. Further, drawing on a GDP insurance model as well as criteria for humanitarian cost-sharing from the Organisation for Economic Co-operation and Development, we estimated that America’s portion should be between $15 billion and $26 billion over the next 2-3 years — funding that Congress should approve in the coming budget cycles.
The return on such an investment? Protection of the $6 trillion the United States has already invested to fight and recover from the pandemic since it began, plus, even more importantly, protection of what is expected to be an economic turnaround in the U.S. and elsewhere as the crisis abates. In fact, we estimate that unilaterally bridging the ACT-Accelerators’ current funding gap would net the United States a domestic return on investment of over 30 times.
Vials of vaccines in a warehouse slowly spoiling with no one to deliver them, is not a strategy to end the biggest global crisis since World War II. A significant American investment — above and beyond the $4 billion already committed to COVAX and combined with contributions of other developed countries and the LMICs themselves — would be game changing, not just for the hundreds of millions of the poorest and most vulnerable, but for all of us.
We can do better, and it starts with American leadership. We know the true costs of vaccine delivery, and the benefits to all of us. Most of all, we also know the cost of inaction. We need to act now.
Horacio D. Rozanski is CEO of Booz Allen Hamilton and Michelle Nunn is CEO of CARE.