Knowledge Brief Health, Nutrition and Population Global Practice ENGAGING THE PRIVATE SECTOR FOR THE NATIONAL COVID-19 VACCINE ROLLOUT October 2021 KEY MESSAGES: • Very few (if any) countries will be able to organize a vaccination campaign covering the entire population, with public resources alone. Partnering with private sector actors is the obvious choice to increase speed and scale. • While some countries have experience in collaborating with private actors, others are less prepared and are starting from a position of limited mutual understanding, lack of knowledge about capabilities and resources, and lack of trust and experience in writing and executing contracts. • This knowledge brief provides practical guidance to address some of these challenges and to reduce the risks of collaboration with an unfamiliar partner. Which companies to approach as c. Critical infrastructure and service providers, such as partners utility companies, telecoms, data centers, transport and logistics companies Private companies to partner with in a vaccination campaign include a wide range of businesses both inside and outside the d. Companies attracting significant crowd traffic in central health sector. While it is obvious that private health service or peri-urban areas, such as shopping malls, sports providers could play a role in a vaccination campaign, there are venues, entertainment complexes, and trade fairs many non-health businesses that could also contribute in a meaningful way to the common objective (see below). e. Companies controlling large areas of land, with integration into rural communities, such as agribusiness This list of criteria can help to select companies to partner with, and mining companies toward achieving a specific goal, as further outlined in the next section: f. Health care companies such as hospitals, social franchise clinic networks, faith-based hospitals and a. Large national or multinational companies versus clinics, pharmacy chains, small individual clinics and smaller and medium-size businesses hospitals run by physicians and nurses, and single- owner pharmacies. b. Manufacturers and other companies with a large workforce versus smaller, knowledge-based service companies Page 1 HNPGP Knowledge Brief • Engaging private companies in supporting roles The list above can serve as a guide when considering collaboration with private companies for various facets of the vaccination campaign. Another important consideration is companies’ self-interest in achieving a fast recovery and a return to normal economic activity. Many companies are likely to offer a range of free contributions to achieve the common goal. Examples of how companies can be engaged include the following: a. Set up a coordination team for overall private sector engagement, reporting to the government coordinator of the vaccination campaign (for example, the local office of a global consulting firm). b. Provide logistics for setting up mass vaccination centers (shopping malls, entertainment complexes, and Engaging private companies to deliver sports venues with their own logistics teams or in vaccines coordination with event organizers). Many countries deliver vaccines in collaboration with private c. Provide support for developing and managing a central health service providers and pharmacies that have capacity to registry, data warehouse and dashboard for all vaccinate. They may allow private entities to provide vaccines at parties—public or private—involved in the vaccination their sites, or contract with providers to staff a public vaccination campaign (IT companies, telecoms). site. d. Provide logistics support for shipping and handling the A variation of this model is to work with large companies that vaccines and commodities for the campaign, including have a significant workforce to let them vaccinate their customs clearance, warehousing, cold chain, and employees through the company’s occupational medicine team inventory management systems to ensure availability or a contracted-in private provider, reducing the burden on the as needed (transport and logistics companies). local health care services. Mining or agriculture companies with a large rural footprint could possibly organize the vaccination of e. Provide communications support to inform the general entire rural communities in areas where they are the dominant public about the vaccination campaign and counter employer—many already run local clinics for their staff and disinformation (media companies, communications families. There are different scenarios for public-private interface agencies). and the sharing of responsibility, as shown below: PUBLIC FINANCING, PRIVATE PRIVATE FINANCING, PUBLIC PRIVATE FINANCING AND DELIVERY DELIVERY DELIVERY SOURCING Public Public or private Public or private INDEMNIFICATION/ National solution National solution National solution COMPENSATION PRICE Free for citizens Free for citizens Free or for fee, regulated or unregulated PRIORITIZATION Public guidelines Public guidelines or special Public guidelines or other solution agreement CERTIFICATE, REGISTRY National solution National solution National solution AEFI1 REPORTING National solution National solution National solution TRACK & TRACE National solution National solution National solution or private solution Page 2 HNPGP Knowledge Brief • This table is not exhaustive—other scenarios or choices may now purchasing power or capacity to deliver vaccines. As long make sense depending on the local context—but it offers some as governments can access only very limited supplies from the suggestions on how different issues can be addressed. The first COVAX facility, the public sector will have priority and only the scenario, public financing and private delivery, is a more first scenario (contracting with a private provider for delivery) is COMMUNITY common one in which the public sector procures vaccines and relevant. gives them to a private hospital, clinic, or pharmacy, which acts MIDWIFERY as a vaccination center for the general population. This service should be free for citizens; the government can require that all Principles for managing private partners rules and guidelines regarding prioritization, vaccine certificates, in the COVID-19 vaccine rollout EDUCATION reporting into a central database, and reporting of side effects (Adverse Events Following Immunization [AEFI]) are followed. Partnerships with private companies should be based on written PROGRAM IN contracts. In many countries there is a legal framework for The use of the vaccines would fall under the indemnification public-private collaboration. The World Health Organization clause and the standardized compensation mechanism for (WHO) issued a general guideline for engaging the private AFGHANISTA potential injuries governments are asked to sign before sector in the COVID-19 response2, including the following key manufacturers deliver vaccines to the country. recommendations3: N The second scenario speaks to a less common situation in Sameh which private El-Saharty businesses and Khalil buy vaccines and askMohmand government health services to deliver them. This could arise as an altruistic a. Set up a coordination mechanism with access to relevant information and ensure regular communication contribution by a 2014 May private business to accelerate vaccination of with private sector partners. the entire population. In this case the rules from Scenario 1 b. Conduct a rapid scoping exercise to identify private would apply—the vaccines would be used in the same way as sector resources that could be used to support the those procured by the government for public use. A similar vaccine rollout; assess gaps and funding needs. model has been chosen in Ghana—private companies buy vaccines for their own employees and make a 1:1 matching c. Define roles, responsibilities, and division of labor. donation to the government for the general campaign. The sourcing of vaccines in this model could be through a d. Identify legal and regulatory obstacles that can be government contract or as separate from the open market. In the addressed/waived, for example, through emergency latter case, there is a risk of buying fake products (see section orders. on risk management). A private business could also buy vaccines and give them to a public facility specifically to e. Develop a standard contracting template for private vaccinate the employees of the company and their families. A sector engagement. mining company may choose to finance the vaccination of an f. Develop guidelines and procedures for all steps of the entire village to reduce regional transmission and ensure the vaccination campaign and share with private sector safety of workers and their families. In such cases, general partners. public prioritization guidelines could be replaced by specifically negotiated rules for prioritization of certain populations. g. Ensure availability of supplies needed by private The third scenario is entirely private, although the private buyer partners to fulfill their role (personal protective could potentially use the government sourcing mechanism to equipment [PPE], syringes, needles, waste access cheaper vaccines. If legally possible, this approach management, and so forth—for all items that cannot be would be preferrable as it gives the government leverage to easily purchased on the local market). ensure that the private provider follows public guidelines for h. Ensure that the entire workforce, public and private, issuing vaccine certificates, reporting vaccinations and side has access to daily updates on information relevant for effects into a central database, and keeping vaccinations free or their role as frontline ambassadors of the national capping out-of-pocket costs at an agreed level. Examples for campaign. this scenario would be health care providers (for example, hospital chains or social franchising networks) buying vaccines i. If possible, work with one centralized system for and offering them to the population for a fee, or large companies procurement, distribution, regulatory clearance and buying vaccines to immunize their workforce and their families oversight, reporting of adverse effects, issuing through their occupational health service team. vaccination cards, and collecting vaccination data. The underlying assumption for these scenarios is that there is no longer a vaccine shortage in the global market; the bottleneck is Page 3 HNPGP Knowledge Brief • This list is meant to support a rapid response with mobilization of Manufacturers upload serialization data from their manufacturing private sector resources. It may need to be amended or adapted lines into this database, so, for instance, a vaccine package based on the local situation. received by a health worker in a village clinic can be instantly authenticated. If the authentication fails, the vaccine is probably a fake. Risk management in public-private Other than this verification system, countries can reduce the risk collaboration of fake vaccines by centralizing their procurement and buying In a pandemic, the speed of the response is critical for from official channels such as COVAX, or directly from major containing the spread of disease and to reduce mortality. manufacturers that have a marketing license or emergency use Decisions must be made and implemented quickly, which means authorization in the country. Every intermediary (importer, that errors and mistakes are inevitable. This might require wholesaler) increases the risk that fake products can be collaboration with new partners—with whom there is no smuggled into the supply chain. Limiting the number of such preexisting relationship of trust—which could cause friction. “middlemen” is therefore the way to reduce the risk. Some Countries have been more or less successful in managing this countries have national tracking systems for medicines and turbulent phase of “building the airplane while flying” through a vaccines; many have not. For the latter tranche of countries, the central coordination mechanism that interacts will all solution could be to contract with a major distributor who stakeholders and maintains regular two-way communication. handles the entire supply chain from import (shipped by the manufacturer) to delivery to the site where vaccines are used. A major external risk in a situation of vaccine shortage is the This distributor may have a tracking system that can feed a presence of fake vaccines. Fake and substandard drugs and dashboard at the control center, giving regulators and the public vaccines are an unresolved challenge in many countries that officials in charge full visibility of the supply situation for the have leaky borders and weak regulation and enforcement. The entire country. pandemic creates a huge illegal business opportunity for criminal networks. Another essential element of risk reduction could be a ban on all unauthorized sales of COVID-19 vaccines outside the official At global level, a verification system for COVID-19 vaccines is in channels controlled by the government and its contractors. The preparation and should be accessible to interested countries population should be informed about the places authorized for before the end of 2021. This system would allow verification of a vaccines and warned that all offers of nonauthorized providers shipment of vaccines by scanning a barcode and uploading it should be avoided and reported to a central hotline that is set up through a smartphone app into a central global database. with the responsible regulatory authority. 1 AEFI = Adverse Events Following Immunization 2 https://www.who.int/publications/m/item/an-action-plan-to-engage-the-private-health-service-delivery-sector-in-the-response-to-covid-19 3 Adapted from the long list in the original document The Health, Nutrition and Population Knowledge Briefs of the World Bank are a quick reference on the essentials of specific HNP-related topics summarizing new findings and information. These may highlight an issue and key interventions proven to be effective in improving health, or disseminate new findings and lessons learned from the regions. For more information on this topic, go to: www.worldbank.org/health. Page 4