As the world tries to move on from COVID-19, access to COVID-19 tools including rapid tests, novel antivirals, vaccines, and oxygen, remains inequitable in LMICs. For vaccines in particular, ‘hesitancy’ is often invoked as a key obstacle to vaccinating the world. A recent report by Matahari Global Solutions, International Treatment Preparedness Coalition, and the People’s Vaccine Alliance finds that the picture in lower- and middle-income countries is much more nuanced than a simple attribution to ‘hesitancy’.
We worked on Phase II of a mapping exercise to understand access to COVID-19 tools in 14 countries and territories (Bangladesh, Democratic Republic of the Congo, Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Perú, Senegal, Somalia (and de facto state Somaliland), Uganda, Ukraine), six months on from publication of results from Phase I of the project. Phase I findings indicated that there was no access to COVID-19 self-tests, that there was a lack of data on oxygen needs, and that vaccine access was impeded by poor operational support. In Phase II with an increased number of focus countries, Matahari collaborated with local consultants and organisations (Adeyemi Adeitan—Nigeria; Dr Elia Badjo COSAMED—DRC; and Katarzyna Bialous ANKIZY GASY—Madagascar) was able to gain insights from within communities (including rural communities) of what barriers continue to exist.
Overall, the work found that there are health systems failures exacerbate challenges of delivering COVID-19 tools, including the lack of professionalisation and remuneration of community health workers, that poor oxygen planning remains, that health workers in multiple countries have never heard of novel antivirals for COVID, that vaccine inequity persists, and that urgent planning is needed to ensure direct bank transfers for individuals in the informal economies across all countries during the next pandemic.