Dolores de la Mata
Economista Principal, CAF -banco de desarrollo de América Latina-
This blog is written by Dolores de la Mata and Federico Pena.
The year 2020 will undoubtedly go down as one of the most difficult in recent history. In terms of health and social issues, the COVID-19 pandemic will have claimed the lives of nearly half a million Latin Americans. In economic terms, Latin American and the Caribbean countries will have fallen by more than 8 percent collectively. The good news is that, less than a year after the pandemic declaration, several vaccine patents have obtained emergency approvals from internationally recognized regulatory bodies such as the FDA (US), MHRA (United Kingdom) and EMA (European Union). Many countries have even started to apply the vaccine to their citizens.
In view of the above, a phase of new challenges to health policies begins. According to experts, as much as 60 to 80 percent of the population must get vaccinated in order to achieve herd immunity. This means that the effectiveness of the vaccine to definitively stop the spread of the virus will depend on the success of countries in achieving extensive coverage in the shortest possible period of time. This entry highlights some of the main challenges facing countries in achieving this goal, paying special attention to two essential elements to ensure broad coverage, namely the procurement of the vaccine by states and distribution among the population. The demand aspects are equally important, but we address it on another post.
The first challenge relates to the ability to purchase vaccines and close all necessary deals with major suppliers in order to have it available in a timely manner. To date, Latin American and Caribbean countries are lagging behind and have secured agreements to receive doses for 89 percent of their population (570 million doses) versus 323 percent (more than 4 billion) in a sample of OECD countries. Considering that all vaccines available on the market require not one but two doses to achieve optimal immunization, this first barrier is critical. If not resolved quickly, the situation can lead to major delays in the start of mass vaccination campaigns, as evidenced in countries of the region where less than one percent (3 million) of the promised doses have been received.
Once procurement is resolved, the second set of challenges has to do with the ability to offer the vaccine to the population at large. In particular, countries should strengthen their logistical capacity to be able to distribute the shot, as well as ensure sufficient resources to comply with protocols for its proper administration, and develop strategies to focus vaccination campaigns on the highest-risk population. The “focusing” part will be a central element in a context where dose availability is still limited. In logistical terms, just covering the most at-risk population will require a large effort. Considering that this group comprises citizens 60 years of age or older, diabetics between the ages of 20 and 60, and healthcare staff, the region must vaccinate approximately 126 million people, or about 19 percent of Latin America. Figure 1 shows some heterogeneity between countries as, while in some the at-risk population accounts for less than 15 percent of the total (Bolivia, Ecuador, Guatemala, Honduras, Haiti, Nicaragua and Paraguay), in some countries it exceeds a quarter of the population (Puerto Rico and Cuba). Incorporating primary and secondary school teachers would represent, on average, as much as one percent of the total covered population. To grasp the magnitude of the effort required to cover this group alone, it should be noted that annual influenza vaccination campaigns in OECD countries achieve an average 46-percent coverage on people over the age of 65 (equivalent to 8% of the total population).
Figure 1: Percentage and number of people to be prioritized for vaccination
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One way to measure the vaccination power in countries of the region is to calculate the coverage of routine immunization programs, which are usually mandatory. Figure 2 shows the average coverage achieved over the last five campaigns (2015–2019) of the DTP3 vaccine (third dose of the diphtheria vaccine). Two noteworthy patterns shed light on some pre-existing limitations in the ability to launch massive immunization campaigns. On the one hand, average coverage in countries of the region is below OECD countries (87 percent in Latin America versus 95 percent in OECD countries). On the other, it is evident that no individual country has coverage levels above the OECD average.
Figure 2. Immunization coverage against tetanus, diphtheria and whopping cough (DTP3) among 1-year-olds. Campaigns in 2015–2019.
Notes: Vertical lines represent simple regional averages.
Source: Authors, based on Global Health Observatory data. WHO/UNICEF. Updated July 2020
The fragmented nature of the region’s healthcare systems, which provide services to different segments of the population, can further hinder the supply of the vaccine to specific groups, especially the most vulnerable. The Economics and Development Report (EDR) 2020 shows evidence on the reduced access to preventive healthcare services by beneficiaries of non-contributory social security systems (regularly those with informal jobs) in relation to beneficiaries of contributory protection systems.
In short, the challenges facing Latin American countries in terms of achieving successful vaccination campaigns are considerable. Many structural deficits conditioning the responsiveness of the region's healthcare systems did not begin with the new coronavirus strain, nor will they end by developing proven vaccines to combat it. For this reason, the subcontinent’s nations must put into practice an ambitious policy complete with a set of tools that, on the one hand, debottleneck delivery of vaccines by suppliers in the very short term, while, on the other, ensuring their swift and wide-ranging supply every step of the way. The region must also implement vaccination campaigns that follow a smart targeting strategy by maximizing the benefits not only individually, but for society as a whole. Success in these tasks will depend on the speed with which the authorities act to overcome the social, health and economic crisis let loose by COVID-19.
