About Programs Fellowship News Calendar
Examining economic solutions for equitable vaccine access in the Middle East and North Africa
Health, economics, and equity are inextricably linked in a post-pandemic world. Amr Elshawarby, an economist with the World Bank based in Cairo, Egypt, shared his opinions on the economics that underlie equitable health systems and vaccine availability.
Addressing the challenges faced by countries in the Middle East and North Africa (MENA) region, Amr noted that “one of the biggest challenges, particularly in low- and middle-income countries, is how they finance their health systems, whether it is tax-funded or whether it is through social insurance schemes, to reduce out-of-pocket expenditure on health, while improving health outcomes”. As the MENA region represents diverse economic backgrounds, ranging from low- to high-income countries, “Every country has a different type of challenge," explained Amr. He emphasized that a financial response to these challenges must be “country-specific”.
Proper health financing is a crucial component of the economics behind equitable health systems. Amr pointed out that Egypt had begun reforming its health financing at the time of the pandemic outbreak. Its prevalent public health system was largely tax-funded, with a low utilization rate that could benefit from improved service delivery mechanisms, and was characterized by significant out-of-pocket spending. To expand healthcare coverage and provide protection for the most vulnerable groups, the country embarked on an ambitious program to roll out a “universal health insurance system” that drew on multiple sources of funding, such as premium collection and government funding as well as earmarked contribution from tobacco taxes and road tolls, while also subsidizing premium contributions for their most vulnerable groups. “They are trying to diversify the sources of financing to be able to develop stronger, more resilient, and a more responsive health care system that is able to better engage in pandemic situations,” described Amr.
The COVID-19 pandemic highlighted the inequity between countries, particularly regarding vaccine access and distribution. According to the United Nations Development Program, high-income countries could vaccinate their citizens two months earlier on average than low-income countries. Amr highlighted the role of differential income in contributing to this inequity. He explained that wealthier countries have more indigenous investments in pharmaceutical research and development that help them get earlier access. “How [then] can we economically support low- and middle-income countries to get early access to vaccines?” asked Amr rhetorically.
The answer lies, at least partially, within economics. Vaccine production, Amr noted, “needs financial innovation to be able to provide a global public good, such as vaccines, to everyone equitably”. However, if done incorrectly, it may have its pitfalls. Amr added that “multi-lane procurement” presented a huge challenge during the COVID-19 pandemic. In a bid to maximize vaccine delivery, countries pursued any available avenues. This, however, led to an “operational nightmare”, he remarked, as multiple vaccines were operational in a single country, with different vaccines having different requirements in terms of dose administration, syringe type, and cold chain requirement, all the while competing for storage space.
Amr likened the issue of inequity in vaccine procurement to climate change, stating that it “is a global issue that requires getting together and trying to find a collective solution”. Drawing inspiration from this week, he commented, “this [program] brings [together] people from various backgrounds, from the private sector, people working in the pharmaceutical industry, people working in donor foundations, development partners, academia, governments, health sector, [and] lawyers in the health field. Understanding all these moving variables in one place was extremely helpful.” He concluded, “It is important for us to find ways to better address pandemics in the future”.
Amr Elshawarby attended the Salzburg Global Health and Health Care Innovation program "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-income Countries" from March 11 to 16, 2024. This program convened nearly thirty Fellows, including healthcare practitioners, policymakers, researchers, and representatives from health ministries in several African countries, for crucial discussions on access to suitable and affordable vaccines in low- and middle-income countries (LMICs). Central to the discussions was a focus on understanding end-user needs and constraints to inform the design of a new model for multilateral vaccine procurement.