Q&A: The World Bank's COVID-19 vaccine finance plans

BURLINGTON, Vt. — On Tuesday the World Bank’s board of executive directors approved a $12 billion funding proposal to help countries purchase and distribute COVID-19 vaccines, tests, and treatments.

The announcement was met with questions about what role the bank intends to play in the COVID-19 vaccine arena — particularly given the existence of other efforts, such as COVAX, the vaccine access initiative co-led by the World Health Organization, Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations.

Devex spoke to Axel van Trotsenberg, the World Bank’s managing director of operations, about what the bank hopes to achieve with $12 billion as countries around the world jostle for position in hopes of securing a COVID-19 vaccine when it becomes available.

“What we would like to indicate is that financing should not be an obstacle for countries to get these vaccines. And secondly, with COVAX and others, we want to make sure that we can get those doses for the countries,” van Trotsenberg said.

This conversation has been edited for length and clarity.

Is this funding announcement formally part of the COVAX initiative, which aims to spur vaccine access for lower- and middle-income countries?

This is a joint effort that needs to be done, and it is in that spirit in that we need to move, and that has been our organizing principle — that you keep your focus on the people that matter … particularly the people in the developing countries and particularly in the poorest countries. That remains our focus. Whatever it takes in terms of coordination, cooperation, we will do it so that we can actually deliver.

It is a strong signal to the world that the developing countries matter, because to date the industrialized countries have, through their portfolio approaches, secured billions of doses. We need to make sure that also the developing countries will have access.

The experience of the swine flu was not a positive one for developing countries, because everything was reserved by the industrialized countries and very little for the developing countries. What we are arguing is we want to have an indication that there will be money made available so that countries will be in a position to buy and that in coordination with all the agencies … that actually all the poorest countries are getting that access to those vaccines.

How would you articulate the World Bank's unique value when it comes to ensuring vaccines get to low-income countries?

We have to have a sharp focus on two things. One, that you have the infrastructure in place to deploy and deliver, because unfortunately, compared to a lot of countries — industrialized countries — many countries don't have the infrastructure to deliver effectively these vaccines, which require cold chain technology. How do you do that when there is no electricity in a rural area? ... That is, I think, one of the number one priorities. And again, this is not only a World Bank task, it is a task of countries, health ministries, airports. There is a whole logistical chain that has to be fulfilled. And there, again, you need to work across the spectrum of partners.

We are probably the largest multilateral financier for the poorest countries and certainly when it comes to the fragile countries. So what we would like to indicate is that financing should not be an obstacle for countries to get these vaccines.

And secondly, with COVAX and others, we want to make sure that we can get those doses for the countries. And it is important, when a big player like the World Bank comes in as well, because thus far the game has been played for the industrialized countries, and it is time to make sure that we have the necessary doses also set aside for the developing world.

Have you already determined how much of this $12 billion will be spent on building up that vaccine infrastructure versus making vaccine purchases specifically?

No … We have an envelope announcement, and then comes the individual projects. So there we will work with the individual countries. It is the way the World Bank works, and I think we work best, on the basis of country programs. We want to clearly always be part of a country effort, and then one can identify what we can best do. It may well be that there are already efforts — in Latin America maybe PAHO is already [working] or the WHO or UNICEF. How can you identify complementarity, rather than descending on a country and say, look, I want to do this, this, this … I’ve created a task force within the bank to look at this — with the country directors in consultation with governments — so that we can actually see where we can best compliment.

Are you signaling to pharmaceutical companies that they have a market in low- and middle-income countries? Or, are you signaling to other potential donors that the World Bank is putting forward funding, and therefore, so should they?

I think it's a little bit of [both] because basically, the signaling is that you have to stand by developing countries that are already struggling with incredible adversity — and now another wave of new charges are coming in terms of how do you finance these vaccines. Some countries are in a better space. Other countries, they are struggling.

What you want to indicate is that the international community wants to stand by them in solidarity and provide the necessary financing, and that can come through different forms. Particularly for the poorest countries, if that is available in doses that COVAX has, that will be great. The fear is [that] it's not. So one needs to see how one can tap into additional resources.

The second thing is that it's a good reminder that the majority of mankind is living in developing countries. [About 1.7 billion people live] in the IDA countries … compared to a billion people in the OECD. In the lower-middle-income countries, there are another 2 billion people. That's twice the OECD. So with only the lower-middle-income and the IDA countries, you are looking at 3.7 billion …

If you were to say, just as an initial coverage ratio of 20%, you would look at 750 million people only in the lower-middle-income countries and the IDA countries. If you have two doses necessary, you're looking at 1.5 billion doses, and that is at the lower end. So I think it is important that we are looking at this, and I think this is where we want to indicate this support.

COVAX is making it very clear that a lot of support is needed. I think it is good that it is being reinforced by WHO, by PAHO, by the bank. I know that the IDB is talking about this. I think it is good that we all say that this is an important topic and an important area where we need all to act together.

What is your position on the argument that this should be a “people’s vaccine,” and that pharmaceutical companies should forego intellectual property in order to ensure free access to a vaccine for the most vulnerable and most marginalized people?

It's not like we have been in this market for a long time. We have, at times, been supporting [with] Ebola or TB or [others]. We have never been in this business at this scale ... We have been today basically working within the established routes, and if you look at Gavi, they have been working with the pharmaceutical industry directly. We have never challenged that ... If countries want to engage, or people want to engage with pharmaceutical [companies] or others about other debates on how to do it — we have not engaged on that.

I think what we have been focused on, and I would say laser-sharp on, is delivery. And I think that is what is most needed right now.

The $12 billion envelope that the bank has announced — is that in the form of loans or grants or some combination?

It's a combination. We have announced $6 billion IBRD — IBRD is on loan terms — and the IDA depends where a country qualifies, and can get grants [or] highly concessional finance. So that is the combination.