Achieving a Better COVID-19 Vaccine Rollout

It is vital to ensure equitable access to vaccines within and across all economies. Photo: Hakan Nural
It is vital to ensure equitable access to vaccines within and across all economies. Photo: Hakan Nural

By Cyn-Young Park (朴信永), Kijin Kim, Matthias Helble

Ensuring equitable access to vaccines is crucial for developing countries in Asia to reopen their economies and recover. Well-designed policies will speed the rebound of Asian economies and have impacts that span the globe.

To fight COVID-19, vaccines have been developed at an unprecedented speed. As of March 2021, 12 vaccines were authorized for use by at least one country with 90 candidates currently in clinical trials. In Asia, the People’s Republic of China  and  India have developed their own vaccines while a few other countries have their own candidates under clinical trials. Vaccination campaigns have also started in 21 economies in the region.

The speedy rollout of vaccines is critical for full economic reopening and recovery. Yet, delays in the vaccine rollout are significant. Asia and the Pacific has currently around 2 doses administered per 100 people compared to more than 20 doses per 100 in the leading countries, such as the United States. Vaccine availability remains an issue, particularly for low- and middle-income countries, although COVAX has stepped up vaccine acquisition for those economies.

A large COVID-19 vaccination campaign is challenging for many developing countries in Asia and the Pacific. The COVID-19 vaccines are new while some need to be kept in ultra-low temperature freezers for storage and distribution. Many countries’ existing immunization programs may not be ready for these new vaccines and require new guidance, including the adaptation of the current programs to allow large vaccination programs for adults and elderly people.

A successful campaign also requires transport, storage, and logistics infrastructure; capacity in health facilities; sufficient medical personnel; safety monitoring; and strong public awareness and advocacy campaigns.

What can be done for better vaccine rollout in developing economies?

National vaccination strategies and policies should be in place. Well-designed policies will ensure proper regulatory decision-making to authorize, distribute, and create a safe marketplace for vaccines. Countries will need to decide who should be vaccinated first and how to distribute vaccines in a timely and fair manner, with close attention to protecting the most vulnerable populations.

The role of national regulatory systems is critical in facilitating vaccine procurement and access. Weak and fragmented regulatory systems may cause delays in vaccine authorization. Harmonized policies, regulations, and guidelines for institutions and personnel are needed for effective vaccination.

Efforts should also be made to address vaccine hesitancy and raise vaccine uptake. This includes targeted, clear, and credible communication from trusted sources as well as safe, familiar, and convenient locations for vaccine access. In low-income developing countries, financial and nonfinancial incentives coupled with regular delivery of services can be more cost efficient and effective in improving the immunization rate.

Regional and international approaches can help accelerate new vaccine introduction. The COVAX Facility aims to roll at least 2 billion doses of COVID-19 vaccines globally by the end of 2021. But even when its target has been met, it wouldn’t get many economies to reach the level of immunity necessary to slow the transmissions. Expansion of vaccination coverage continues to be challenged by a funding gap, risks of delays in deployment due to varying country readiness in addition to short-term supply shortages.


A regional approach can help address such challenges through financing, health policy support and capacity-building. For example, ADB launched the Asia Pacific Vaccine Access Facility (APVAX) amounting to $9 billion in December 2020 to assist in vaccine procurement and distribution for its developing members, in addition to its private sector support and assistance through subregional programs.

Regulatory authorities should also collaborate across borders. For example, there have been efforts to harmonize the pharmaceutical regulatory landscape in the ASEAN region.

Further efforts to strengthen data sharing, mutual acceptance and recognition of manufacturing practices, drug registration, inspection and evaluation would improve the efficiency and transparency of regulatory decision making.

Logistics support and proper handling of vaccines are integral to successful immunization. The World Health Organization reports that more than 50% of vaccines are wasted globally every year due to temperature control, logistics, and shipment-related issues. Many developing countries in Asia and the Pacific are not ready for the enormous logistical challenges to distribute COVID-19 vaccines rapidly and safely under the stringent temperature requirements.

The success of vaccination campaigns also depends on how to effectively reach to disadvantaged groups of people who are poor, socially excluded, and/or residing in rural areas which often face poor transport and energy infrastructure. More than a half of the population in Asia live in remote and rural areas.

Since much of wastage is also caused by mishandling of vaccines, having well-trained personnel is a must along with properly designed cold-chain management policies and procedures. Personnel in charge of new vaccines should be trained for different handling requirements.

Digital immunization information and vaccine certificates can help effectively monitor and implement vaccination campaigns. Common standards for vaccination documentation and digital tools for verifying test results and vaccination certificates can facilitate monitoring and implementation of vaccination programs. Digitally-verified health status can help economies to reopen and manage the potential risks of cross-border transmission. The international community should also leverage digital technology to improve information exchange through better interoperability of digital immunization information systems.

Ensuring equitable access to vaccines within and across all economies is crucial. The current challenge faced by developing Asian countries to vaccinate a large share of the population in a short amount of time is enormous. However, the rewards will be even greater to both Asia and the world.

Economic reopening and recovery crucially depend on the success of vaccination programs by substantially lowering the risk of new outbreaks. The gains extend far beyond economic sectors as it can also put an end to disruptions in education and health systems.

International collaboration is critical to ensure fair and equitable access for all people and countries, rich or poor, to deliver effective immunization and minimize the risk of prolonged and recurrent pandemics.

This article draws from the ADB Policy Brief “Getting Ready for the COVID-19 Vaccine Rollout