For wealthier nations that were able to mobilise resources to secure early access to COVID-19 vaccines, the first half of 2021 will mark the beginning of the end of the pandemic. Vaccine coverage across African countries has been off to a slow start, primarily because of fiscal constraints; only Guinea[1], Egypt, Mauritius, Morocco, Rwanda and Seychelles had begun rolling out their vaccination programmes by the middle of February 2021, with South Africa’s programme halted due to concerns around the AstraZeneca vaccine’s efficacy against the 501Y.V2 variant of the virus[2] (COVID-19 PF Response Monitor). Widespread distribution of the vaccine is not expected in Africa until 2022 or even 2023.

In Africa, even more than costing individual lives, the COVID-19 pandemic has caused economic devastation as countries were temporarily forced to shut down their economies resulting in a loss of income associated with taxes, foreign direct investment, remittances, and tourism. Vaccination against COVID-19 is consequently a critical measure, indeed the single most efficient measure, to mitigate against loss of lives and further economic disruption. However, purchasing and implementing the vaccine is a costly exercise and comes at a time when African governments have even less fiscal space than usual.

While the international community, particularly the World Bank and the Bill and Melinda Gates Foundation, have made significant contributions towards financing the vaccine, there remains a significant financing gap to be filled through domestic resource allocations and reallocations. However, fiscal constraints and inadequate planning mechanisms have meant that many African governments are relying exclusively on external partners to fund and provide the vaccine. Considering increasing health costs and financing constraints worldwide, traditional bilateral and multilateral development partners are unlikely to be able to fully finance vaccine programmes in African countries over the next two years or in outer years. It is consequently crucial that African governments consider ways in which to independently finance and distribute this new vaccine in both the short and medium term.

Throughout the crisis, countries have responded by reallocating programmed funds to the crisis response. We would expect this to also be the case for financing the vaccine; however, this is not what has been observed. The Government of Uganda has indicated it will purchase 18 million COVID-19 vaccines from the Serum Institute of India. Since the start of the pandemic, Uganda has passed two supplementary COVID-19 budgets and an annual budget, yet none of these make provision for vaccine financing. Kenya’s 2021 Draft Budget Policy Statement, released on 25 January 2021, does not mention financing for the vaccine. In Nigeria, the Ministry of Finance, Budget and National Planning released 10 billion naira (USD 26.27 million) to support domestic vaccine production, however Minister Zainab Ahmed, has said that there is no provision in the 2021 Budget to fund the purchase of COVID-19 vaccines. Somewhat reassuringly, the Nigerian Finance Minister expressed the commitment of the National Assembly to provide a supplementary budget for additional spending on COVID-19 vaccines, if needed. South Africa has also not disclosed how it will finance its vaccine purchases in either the emergency COVID-19 budget in June or in the adjusted budget in October; this information should be included in the February 2021 budget, only after the first (ill-fated) delivery of vaccines had been made. One country which has made clear provision in the budget for vaccine financing is Zimbabwe; George Guvamatanga, the Ministry of Finance Secretary said that the government would use funds from a 2020 budget surplus and reallocate some of this year's budget to buy the vaccines. The Government has set aside USD 100 million for the vaccines to procure 20 million vaccine doses to immunise 60 percent of the population (COVID-19 PF Response Monitor).

This trend is concerning given that governments have known since the beginning of the pandemic that they would need to allocate domestic resources to cover the costs associated with a vaccine; given limited avenues for increasing fiscal space for health, budget reallocations were inevitable. If governments do not approach the process of reprioritisation carefully and with foresight, other priority expenditure may suffer, including other health programmes. If approached carefully and with sufficient time, the reprioritisation exercise may benefit the economy as a whole. Governments could use this as an opportunity to re-evaluate spending decisions and direct funds away from non-priority areas or loss-making projects. Governments without a clear plan and budget may also be rushed into decisions about who should receive the vaccine rather than following evidence-based guidelines for equitable distribution. Ensuring early availability of funding would also have increased countries’ chances of receiving the vaccine early and at a reasonable price. Manufacturers are already struggling to supply in line with what has been requested by developed countries that signed purchasing arrangements in 2020. Furthermore, many of the existing agreements require manufacturers to supply the vaccine at their cost price; once the stock of the initial vaccines are depleted, it is likely that increased demand will result in a bidding war and higher prices.

A forthcoming CABRI paper, informed by data collected for CABRI’s COVID-19 Public Finance Response Monitor, offers an overview of the landscape of COVID-19 vaccine financing and how purchasing and distribution arrangements are being decided upon across the African continent. This should aid practitioners and policymakers faced with the challenge of how to pay for, procure and distribute the COVID-19 vaccine, and facilitate cross-country learning amongst PFM and health practitioners. This information will be useful for the many African countries who have not yet begun country-owned or direct procurement of the COVID-19 vaccine and for those who will require many more doses than they have already secured.

[1] Guinea is the only low-income country which has provided any vaccinations, administering doses of the Russian Sputnik vaccine to only 25 people, including its president (https://www.theguardian.com/so...)

[2] A recent decision by the South African government to donate its one million doses of the AstraZeneca vaccine to the African Union’s coordinated vaccine programme aligns well with the aims of the continental vaccine procurement programme. These can now be distributed to countries that do not have cases of the 501Y.V2 variant of the virus.