The United States reports on its COVID-19 vaccination efforts
Article Number: 7
The vaccination rate falls short of that planned but lessons learned may help future vaccination efforts
On 27 September, the US Government Accountability Office (GAO) issued a statement concerning a new GAO report on COVID-19 vaccine delivery abroad, with insights on the United States’ efforts to help countries receive and distribute vaccines. It found that on average, countries assisted by the US Agency for International Development had achieved a 45% vaccination rate by July 2023 – short of the 70% global goal supported by the United States. The primary challenge in the early stages of the pandemic was supplying enough doses but now issues like vaccine hesitancy and “COVID fatigue” are slowing vaccination progress. USAID plans to use lessons learned from its efforts to prepare for future pandemics and emergencies.
The US Agency for International Development (USAID) supports COVID-19 vaccine country readiness and delivery abroad by assisting a country’s capacity to receive and administer vaccines. As of March 2023, USAID had committed an estimated $904 million to support its COVID-19 country readiness and delivery efforts in 125 countries. USAID’s obligations for these efforts covered eight areas of technical assistance, including promoting demand for vaccination and supporting supply chain logistics.
On 27 September, the US Government Accountability Office (GAO) issued a statement concerning a new GAO report on COVID-19 vaccine delivery abroad, with insights on the United States’ efforts to help countries receive and distribute vaccines. This article provides some highlights from that report.
The reason for this study
To attain high population immunity from COVID-19 during the pandemic, the US pledged to substantially contribute toward a 70% vaccination goal of the world’s population, initially by the end of 2022. USAID has partnered with other US agencies, multilateral organizations, and donor countries on country readiness and delivery efforts to significantly increase assistance to countries around the world to meet the vaccination goal.
The US Department of the Treasury’s Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 and the subsequent 2021 Coronavirus Response and Consolidated Appropriations Act include a provision for GAO to monitor the federal government’s response to the COVID-19 pandemic. The GAO report examines: (1) the assistance USAID has provided to support COVID-19 vaccine country readiness and delivery abroad; (2) progress made by USAID in its efforts to support COVID-19 vaccine country readiness and delivery abroad; and (3) any challenges USAID has faced and how these have been addressed.
GAO reviewed laws, funding, and guidance documents from the Centers for Disease Control and Prevention (CDC), the Department of State, USAID and the World Health Organization(WHO). GAO analyzed publicly available data to obtain global vaccination rates. GAO also interviewed USAID officials in Washington, D.C., and USAID officials and other local stakeholders in three countries: Guatemala, Malawi, and South Africa. GAO selected these countries based on factors such as the amount of estimated country readiness and delivery assistance USAID obligated for each country.
Together with other US agencies, host governments and other entities, USAID helped vaccinate an average of 45% of the population across assisted countries as of July 2023. This average was in comparison to the global goal of 70% vaccination in each country. Close to two-thirds of the assisted countries had vaccination rates below 50% and most of those rates have levelled off. Regional vaccination rates for countries that received USAID assistance ranged from an average of 28 to 63% (see Figure 1). USAID stated that it could not measure its direct contribution to countries’ vaccination progress because, among other things, the agency is only one of many entities involved in these efforts.
Figure 1. Average fully vaccinated rate by region for countries assisted by USAID as of 5 July 2023
Note: Vaccination rates reflect the efforts of USAID and other entities in assisted countries. USAID officials, citing WHO guidance, defined “fully vaccinated” as a complete primary series, which may be one or two doses depending on the vaccine manufacturer. USAID assisted 125 countries; no vaccination data existed for two small USAID-assisted countries in Asia. The most recent vaccination rate data for most countries are prior to July 2023.
USAID faced demand, supply, and other challenges in providing COVID-19 vaccine country readiness and delivery assistance. US agency officials in assisted countries reported that demand issues have overtaken supply issues as the greatest challenge to these efforts. Demand issues included, for example, vaccine hesitancy and barriers associated with people accessing vaccine sites. As vaccine demand diminished, USAID and other partners shifted priorities to vaccinating vulnerable groups and incorporating activities into countries’ primary healthcare systems on the way to reaching the global 70% vaccination goal. USAID initiated several efforts to learn from these challenges, and has plans to disseminate the lessons learned, in accordance with agency guidance.
These lessons learned will doubtless prove to be a valuable resource to countries moving forwards in developing applications to the Pandemic Fund and other sources for funding for COVID-19 and/or emerging pandemics.