Any global health researcher can tell you that solving one problem at a time is not enough. As the COVID-19 pandemic intensifies in Africa, securing access to vaccines is the dominant goal. But more needs to be done to ensure that citizens get them. The best option, in my opinion, is the cash incentives.
There is a debate around the world about how best to encourage vaccination. Parts of the United States offered entry to prize lotteries, and even US $ 100 savings bonds. Adoption is particularly important in Africa.
Only about 1.4% of the 1.3 billion Africans have been fully immunized. Since the start of the year, cases have more than doubled, with Botswana, Namibia, South Africa and Tunisia reporting their biggest increases in cases since the start of the pandemic. Right now the problem is the availability of vaccines. Rich countries have more vaccines than they need, and African countries ended up with just 2% of the total supply.
Outrage over this disparity (plus the potential for the evolution of more dangerous viral variants where infection rates are high) has prompted pledges of a billion doses to poorer countries, alongside others. initiatives and the acceleration of vaccine production.
Now you have to be careful to shoot your guns. Already, vaccine hesitation has cost Africa. Several African countries, including the Democratic Republic of the Congo, Malawi and South Sudan, had to destroy or return vaccines because the doses could not be used before their expiration date.
As Chief Economist at the African Development Bank in Abidjan, Côte d’Ivoire, and prior to that for the Middle East and North Africa region of the World Bank, I have evaluated numerous programs and studies on cash transfers. I know the idea is controversial. Some critics argue that all efforts should be focused on securing vaccines. Others argue that the capacity to implement a money transfer program on this scale does not exist. Still others argue that offering cash incentives to people for behaviors that benefit them is ethically problematic, coercive, or eroding trust.
When I first heard about cash transfers, as part of an employment program in 2008 in Liberia, I was skeptical. But I have seen them used with care and efficiency. For example, a program targeting women of reproductive age in Nigeria dramatically increased tetanus immunization. These programs encourage vaccine uptake even though logistical challenges such as keeping vaccines in cold storage and distributing them are managed.
This means that a cash transfer program would complement other “supply side” efforts, including logistics, communication and community engagement. (Of course, cash transfers need to be combined with other mechanisms, such as mobile clinics, to ensure that people who want vaccines can get them.)
Another example of their effectiveness, cash transfers to Indonesian families to get children to routine health care and enroll them in school has yielded significant results, reducing child stunting by up to 23%.
These programs are so well established that they are used to compare other interventions. Development banks and non-governmental organizations (NGOs) have developed best practices for designing and implementing these large-scale programs, including targeting them in vulnerable communities.
I am envisioning a program that would offer everyone eligible for vaccination in West African countries a payment to receive the vaccine, say 6,000 West African CFA (US $ 11). This amount is 10% of the guaranteed monthly minimum wage in Côte d’Ivoire.
In 2019, Africa received around $ 58 billion in foreign aid. I estimate that an actual cash payment would add some $ 9 billion to about $ 15 billion for the delivery and administration of COVID-19 vaccines across Africa. Most of the money would come after the second dose – or full payment would be made all at once in the case of single injection vaccines. Funding would come from the world’s wealthiest countries, foundations and companies, especially those with business interests on the continent. This program would reduce inequalities in immunization, save lives and strengthen hard-hit economies where the pandemic has pushed many people into poverty.
The infrastructure to carry out such a payment program is already in place: about half of Africans have cell phones, and programs designed around them have improved childhood immunization rates in Bangladesh. By transferring money directly through cell phones, authorities can better ensure that the funds go to the intended recipient. For those who did not have a phone, beneficiaries would receive a voucher with a unique identifier that could be redeemed for cash. Again, there is a precedent. During the Ebola crisis, a massive money transfer program used many delivery methods, including direct payments to people in the most remote areas without a cell phone.
The immunization incentive fund could be administered by development banks working with public health agencies, NGOs and telecommunications operators. Blockchain technology could record doses and payments, to ensure traceability and limit corruption. The technology to record doses has been implemented by UK airlines and hospitals.
This would be a huge benefit for Africa, and would be in the best interests of donors. Stopping the spread of the virus in Africa would both revive a major global market and reduce the chances of the virus mutating into more dangerous forms.
The author declares no competing interests.