In Cornwall, England this weekend, G7 leaders will need to strike an awkward balance: denouncing global vaccine inequity, while dodging their countries’ role in causing it and the lack of a clear plan to address it. Helpful is President Biden’s announcement this week that the US will purchase 500 million COVID-19 vaccine doses from Pfizer and BioNTech for global distribution to lower income countries. But while no single country is responsible for vaccinating the world, there is one global institution that could be doing more: the World Bank Group.
More than a year into a global pandemic, the leaders of the World Bank – an institution created, shaped, and capitalized for just such a moment – have too often been absent. As the vaccination gap between rich and poor countries yawns, the world’s leading anti-poverty institution is needed more than ever. But the recent 85-page evaluation of the COVID-19 response by the Independent Panel for Pandemic Preparedness and Response barely mentions the World Bank.
This is not to say the World Bank hasn’t done a great deal of good. Last year, it committed $108 billion to help countries address the health, economic, and social impacts of the pandemic – especially through its fund for low-income countries, the International Development Association (IDA). In October, it established a $12 billion financing window to help developing countries purchase vaccines. The organization’s effort to assess countries’ vaccine readiness is laudable. World Bank President David Malpass has helpfully urged rich countries to donate vaccines, advocated for transparency on vaccine deals, and flagged the need to address delivery challenges.
Many issues are also beyond the World Bank’s control. All the financing in the world could not solve the myriad supply chain bottlenecks hampering global production. Dose donations from rich countries would offer more immediate help, but are minuscule thus far. COVAX, the global alliance working to deliver 1.8 billion vaccines to low-income countries by early next year, has had real issues, including missteps on communication and engagement with key stakeholders like the Bank. Among developing countries, demand for World Bank loans to purchase vaccines has been surprisingly slow.
And it’s too soon to write off the global effort for vaccine equity – just last week, COVAX raised $2.4 billion in new commitments, and the IMF, World Bank, WTO, and WHO endorsed a $50 billion proposal to end the pandemic faster. This weekend may also see new G7 commitments as well.
But all that said, the World Bank has missed three major opportunities to lead:
For a year now, the World Bank Group has left COVAX hanging as it encounters challenge after challenge. COVAX – an entity set up at the start of the pandemic and co-led by Gavi, the WHO, and the Coalition for Epidemic Preparedness Innovations (CEPI) – has made several unforced errors on its own. But in retrospect, some challenges could have been avoided. For example, had the World Bank provided COVAX with the financing and financial tools to make its own up-front, at-risk investments in a diversified vaccine portfolio, by now those vaccines could have made their way into the arms of millions of people in developing countries. The World Bank also could have supported proposals to back COVAX’s indemnity insurance. While financial and legal hurdles complicate the Bank’s ability to support COVAX directly, the pandemic is an extraordinary challenge that requires extraordinary flexibility and leadership. Despite President Malpass’s eloquent calls for equity, the institution he heads has yet to take what could be the most impactful step for rapidly getting vaccines to developing countries.
Meanwhile, the World Bank’s $12 billion vaccine financing facility has largely languished since its creation. After 8 months, only about 20% of the facility has been committed. It was designed for speed, but not flexibility: like standard World Bank financing, it only gets disbursed to countries that request it, and it counts against countries' borrowing headroom as well as the Bank's own capital constraints. (The Bank also slapped the facility with regulatory requirements that were more onerous than COVAX’s, though these requirements have been relaxed.) Since it's not new money or new headroom, countries face the traditional tradeoffs: should they use their World Bank headroom to buy vaccines or for other development or COVID-19 needs? Uncertainty over the timing of COVAX distributions makes these tradeoffs even harder. A better facility might have enabled more aggregated, at-risk investments to secure vaccine doses sooner. Earlier and bigger investments in vaccine production capacity by the Bank’s private sector financing arm, the International Finance Corporation (IFC), would have helped too. But instead, as COVAX scrounges, the World Bank sits on $9 billion unused.
In the face of these challenges, the World Bank seems to lack the requisite commitment to lead. One would expect a major global health financing proposal during a pandemic to come from the World Bank; but last week’s $50 billion plan was based on an IMF paper from May, which ironically built off a joint research paper with the World Bank from April. Given COVAX and the World Bank’s shared aims and complementary capabilities, they should be working hand in hand to design a fair, equitable, well-financed, and fully functional global vaccine platform. If COVAX still has financing issues, it should work with the World Bank to overcome any legal or financial hurdles, or design guarantee instruments to help broker deals with manufacturers; if the problem is demand and delivery, they should together work with developing countries to shape the demand and delivery. Beyond COVAX, there are many worthwhile efforts that could benefit from the Bank’s financing and expertise – like the African Union and Vaccination Acquisition Task Team (AVATT) effort to procure and deploy vaccines across sub-Saharan Africa. But at the highest levels, these issues seem off the World Bank’s radar.
Outside the World Bank, its shareholder governments could exert more pressure on the institution to step up to the plate. Most of last year, rich countries were focused on themselves. But with half our populations vaccinated and countries like India dealing with horrific surges, that excuse no longer stands. Last week, G7 finance ministers urged the World Bank to do more; this is a step in the right direction. The Biden Administration – which joined COVAX on its second day, is now the alliance’s second-largest donor, and leads the world in dose donations – is saying the right things but is missing opportunities, too. The key US officials with primary responsibility for the World Bank, for example – an assistant-secretary and under-secretary at Treasury – have not yet been nominated.
But the good news? The global community has primed a lot of tools, and there’s still time to use them. First, leadership needs bolstering across institutions. The rest of the G7 should heed Malpass’s calls to donate doses at levels proportional to the recent US commitment, but they should also keep up pressure on the World Bank; and Biden should fast track the relevant appointments, so the Administration can fully engage. Second, the World Bank and COVAX must work together to urgently diagnose and begin to address the problems hampering vaccine access. Third, it is not too late to design better solutions. This includes improving current facilities, ensuring new ones do not encounter the same problems, and finding the investments and partnerships that can help end the pandemic sooner. Finally, the World Bank needs to lead the convening. Bar none, they are the best institution on earth to plan, coordinate, and finance the currently unclear, fragmented, and under-funded—but vitally needed—global effort to vaccinate the world.
We’ll be watching the G7 to see what happens.