Our best shot to end COVID-19

“If not me and the many of like us reaching out, there are families who will not have one to help them during this crisis. Nothing can stop me."

Karunya Devi

Social Worker and Project Manager in India

In the global vaccine debate about who pays for doses, how much they cost, and how to ship them to lower income countries, the world is overlooking the most important factor: Who makes sure people get vaccines? Frontline health workers like Karunya and millions of women around the world. 70% of frontline health workers are women, and they’re running the education programs, building community trust, and helping people access vaccines. They do it for little or no pay, with little access to leadership, and in the face of gender inequality that is killing people.

Vaccines are useless without delivery systems, and until we pay, protect, and respect workers like Karunya, investments in doses of vaccines won’t have the benefits we’re hoping for.

CARE’s new report “Our Best Shot” shows the real cost of delivering vaccines is $5 of investment in rollout for every $1 invested in vaccines. It’s time to start thinking about vaccines beyond the vial.

This research is part of CARE’s commitment to fast and fair vaccine delivery. It builds on CARE’s decades of experience working with frontline health workers, supporting vaccine delivery, and strengthening health systems. Prior to COVID-19, CARE had 54 projects across 28 countries that included interventions and programming on frontline health workers.  Since the onset of the pandemic, several of these projects have adapted to COVID-19 and to date, CARE has reached 30M people in 69 countries through our broader COVID-19 response efforts.  CARE is also supporting over 1500 health facilities to provide adapted health services during the pandemic, and reaching a quarter of a million frontline health workers.

What did we learn?

  • No one is safe until everyone is safe. Investing in a fast and fair global vaccine distribution will save twice as many lives as maximizing vaccine doses for the wealthiest countries in the world.
  • No one recovers until everyone recovers. For every $1 invested in vaccines in less wealthy countries, wealthy countries will see $4.80 of economic benefit because economies can fully re-open sooner.  Failing to make this investment could cost wealthy economies $4.5 trillion in economic losses.
  • Half of women’s work in health is unpaid. Women health workers contribute $3 trillion dollars to the global economy every year, but HALF of this work is unpaid and unrecognized. Where they do get paid, they make 28% less than their male counterparts. 86% of health workers in sub-Saharan Africa get no pay at all.
  • Vaccine cost estimates are ignoring women health workers and their rights. Global cost projections for vaccine delivery systems ignore health workers salaries and exclude community health workers completely. Until we pay those workers for their services, we’re not going to get the benefits of vaccines.
  • Frontline health workers are essential to overcoming vaccine hesitancy. At least 28.5% of people globally are hesitant to take vaccines, and in some countries this numbers is as high as 60%., Without vaccine acceptance, we’ll never get enough people vaccinated to protect everyone. Investing in women health workers is the best way to overcome vaccine hesitancy.  People’s trust in health care workers is one of the most important factors in improving vaccine uptake, more than the opinions family, friends or other non-medical sources.

What do we need to do about it?

  • Invest global funding in a fast and fair global vaccine rollout. High-income countries, donors, development banks, and national governments need to invest in comprehensive vaccine delivery. This investment has to include not just the money invested per dose of vaccine, but also an average of $5.00 in preparation and delivery for every $1 in vaccine. COVAX and WHO need to include the full costs of delivering vaccines, including all health workers—formal and informal—as part of their costing models and advocacy asks.
  • Protect, pay, and value (women) frontline health workers. Out of the $5.00 in delivery costs, $2.50 has to go to equipping, paying, training, and supporting frontline health workers (at least 70% of whom are women). That includes ensuring they are first to receive the vaccine when available in their country and provided adequate personal protective equipment. It also includes ensuring equitable pay, and safe and supportive working conditions for women health workers on the frontline of COVID-19 response, including childcare, hazard pay, and funds for health-related expenses.
  • Invest in women leaders. Ensure women, especially women frontline health workers, have meaningful roles and voice in leadership in shaping vaccine roll out, policies and programs at all levels.
  • Start immediately to build national vaccine readiness and strengthen health systems so they are prepared to pivot quickly to fast and fair vaccine delivery, once doses are available.

What is CARE doing already?

  • Supporting vaccinations. CARE is aiming to help 100 million of the most marginalized and vulnerable people – including women, those living in extreme poverty, and nearly 275,000 healthcare workers – have access to the COVID vaccines over the coming year.
  • Coming up with creative financing mechanisms. In Bangladesh, CARE partnered with the government and the community, to develop a new cadre of private, community-based, skilled, women health entrepreneurs providers. These Skilled Health Entrepreneurs get paid through sustainable a fee-for service model, and are serving the people who need it most. They reach 61% of the poorest families in their districts. households from the lowest wealth quintiles. Khodeja, a Skilled Health Entrepreneur shares that “I have not only achieved improved healthcare and entrepreneur skills but also my work has earned me great deal of self-respect. Now, I know dreams do come true and I would like other girls and women to believe in their dreams too.”
  • Sharing information. Teams of health workers in Ghana have translated health messages into local language voice recordings so that illiterate people can hear messages in the language they understand. CARE has helped more than 178 million people access information about COVID-19 prevention and treatment. Those channels will help us get people information about vaccines.
  • Using multiple ways to communicate. In Afghanistan, health workers are using mobile phones and apps for awareness raising, reaching more than 60,000 people with text messages and 2,000 women with mobile phone voice messages.
  • Supporting health workers mental health. Countries like Colombia are providing psychosocial counseling to health workers via hotlines and other mobile applications to help them cope with the stress of COVID-19 and their increased workloads. Uganda has also rolled out psychological first aid to support frontline health workers and community members, and provides case management officers to follow up with people who need extra help.
  • Giving women health workers space to lead. In India, to strengthen teamwork and motivation between different groups of health workers, CARE created a collaborative system where the groups would come together as a team to set monthly goals and jointly track and monitor their progress. More coordinated efforts resulted in high quality home visits and improvements in community health.
  • Advocating for change. CARE is promoting vaccine access for 275,000 frontline health workers who might otherwise have been excluded. Advocacy on behalf of efficient and fair vaccine policy aims to support at least 40 million people in at least 10 countries.