Pay, protect and respect women health workers on the frontlines of vaccine distribution

by 25th Mar 2021
Nurse Rugiatu at a Primary Health Unit in Sierra Leone (2018) Nurse Rugiatu at a Primary Health Unit in Sierra Leone (2018)

As the international debate rages around vaccine nationalism, the world is ignoring one of the most important investments we need to make to ensure fast and fair global vaccine distribution: fair pay and decent working conditions for those who deliver the vaccines, the majority of whom are women. No matter what we spend on vials of vaccines, it will all be worthless if those vaccines don’t make it into patients. Vaccines are useless without delivery systems.

Vaccine delivery systems are mostly made up of people. When I first started my career, I spent 2 weeks working on polio vaccination campaigns in rural Mali, literally walking house to house with a cooler full of vaccines, a clipboard, and a permanent marker to colour in the fingernail of every kid who got vaccinated so we didn’t give someone two doses by accident. I worked with two Malian community health workers, and every morning we went to a health centre staffed by four nurses to pick up our supplies. At the end of two weeks, we got $2 in “salary” to pay for our lunches and transportation.

For millions of people around the world, that’s what receiving the COVID-19 vaccine will look like. Maybe someone will knock on their door and administer the shot. Or maybe they will walk to the local health centre 10 miles away where a woman who gets at best a small per diem gives them a shot, with support from local volunteers who don’t get paid at all. That’s not good enough. We need to respect, protect, and pay the health workers who make vaccine delivery possible.

In a new report released today, CARE estimates that for every $1 a country or donor government invests in vaccine doses, they need to invest $5 to deliver the vaccine.(These are illustrative numbers based on triangulating 3 different possible models. Actual costs could range from $3 to $6 or higher, depending on local contexts. Any budgeting exercise should include local costing experts for health systems.)

Half of that cost must go to funding, training, equipping, and supporting health workers – predominantly women – who administer vaccines, run education campaigns, connect communities to health services, and build the trust required for patients to get vaccines.

Investing in fast and fair global vaccine distribution will save twice as many lives as maximising vaccine doses for the wealthiest countries in the world. Even better, investing in vaccine equality will speed up economic recoveries in every country in the world. Failing to make this investment could cost wealthy economies $4.5 trillion in economic losses.

Shots in arms are only part of the equation. That overlooks the millions of health volunteers who are holding the vaccine distribution system together. These women are:

  • Helping people trust health services enough to believe that they should get a vaccine at all
  • Making sure people show up for vaccines at the right time for their appointment
  • Providing information about vaccination campaigns, handwashing, and COVID-19 safety
  • Running logistics and safety and vaccination points
  • Keeping regular health services – like pre-natal visits – running.

These systems run on the more than 3.5 million semi-formal and informal health workers around the world who serve patients at the “last mile” of delivery. At least 70% of these health workers are women and they are risking their lives to get vaccines, services, and supplies to the most underserved and at risk populations in the world.

Appallingly, these women are getting little of the protection, recognition, equality, and pay that they deserve. Women health workers contribute $3 trillion to the global economy every year, but half of this work is unpaid and unrecognised. Where they do get paid, they make 28% less than their male counterparts. They aren’t getting access to the vaccines, either. WHO estimates that currently 30 million high-risk people are not included in any government vaccination plans, and many of them are community health workers.

To benefit globally from vaccines, we must pay, protect and respect women frontline health workers and their rights – a cost that is largely absent from recent WHO estimates on vaccine rollout costs. In fact, current cost estimates pay for per diems, but exclude salary costs or the real cost of running sustainable health systems. No current global conversations or guidance on vaccine costs includes the full cost of community health workers or long-term personnel costs.

As new and dangerous strains of COVID-19 emerge in countries that are struggling to access the vaccine and control the pandemic, every day that we wait for fair global vaccination allows for more contagious strains that spread around the world. The more chances the virus has to mutate in non-vaccinated populations, the higher the risk for everyone.

Comprehensive global vaccine delivery plans that make sure the vaccine gets to people who need it – and that those people are ready to get the vaccine when it arrives – are the only way to end this threat. No one is safe until everyone is safe.

Read the report: Our Best Shot: Women frontline health workers in other countries are keeping you safe from COVID-19

Emily Janoch

Emily Janoch is Senior Technical Advisor on Knowledge Management for the CARE USA Food and Nutrition Security team focusing on ways to better learn from and share practical experience on eradicating poverty through empowering women and girls. She focuses on learning from programming and using that learning to improve impact.

With four years of on-the-ground experience in West Africa, 10 years of development experience, and academic publications on community engagement and the human element in food security in Africa, Emily is especially interested in community-led development. She has experience in food security, nutrition, health, governance, and gender programming, and has a BA in International Studies from the University of Chicago, and a Masters' in Public Policy in International and Global Affairs from the Harvard Kennedy School.