Equitable vaccine delivery will fuel better global health processes 

SpaceX, founded in 2002 by Elon Musk with the goal of reducing space transportation costs to enable the colonisation of Mars, once had an epiphany: if its team were to build a reusable rocket, they could simultaneously decrease costs and increase speed, innovation and quality.

Hence the birth of Falcon 9. Reusability allows SpaceX to refly the most expensive parts of the rocket, which in turn drives down the cost of space access.

It was visionary, and it worked. In fact, Falcon 9 was the most launched rocket of 2020.

The reusable rocket of global health

In global health circles, we talk a lot about the need to strengthen health systems. What we really mean by this is that we too need a reusable “rocket”— a global health one. It would combine technology, people and process to launch intervention after intervention.

The danger is that we could miss a golden opportunity to create this foundation if we don't capitalise on investments currently being made in order to roll out COVID-19 vaccines. By leveraging modern technology platforms for community health workers, community-based organisations and frontline providers, we could build a reusable rocket to reach new health outcomes.

GAVI, the Global AIDS Vaccine Initiative, has created global mechanisms to try to ensure that the vaccine can be purchased by everyone. The new Biden administration announced a $4 billion contribution to GAVI. The World Bank’s $12 billion program suggests planning for roughly $5 per dose and $1 for the delivery of each.

This $1 for delivery is key: if we are smart about it, it can be a vital downpayment on our reusable rocket. The most immediate mission for a global health rocket is ensuring vaccine delivery is equitable and fair.

The power of community for health

Community-based organizations play a critical role in forming trust with underserved communities and will be essential in ensuring the adoption of and access to the vaccine among key populations.

By investing money directly into community-based organizations, rather than taking the indirect approach of paying for expensive consultants who will then connect with the organizations for their ideas, we can create the infrastructure to fight this public health crisis. And this is also how to build strong community and public health infrastructure for the future.

Not only are these teams and systems critical elements of delivering COVID-19 vaccines, but they are also essential for successful outcomes in all other health interventions of the future. Routine immunisations for children – one of the best investments in global health – has dropped dramatically due to COVID-19.

Empowering communities to build this foundation will require sophisticated planning, technology, verification and follow-up. Various digital health platforms have been purposely built to work offline, provide verification and multi-dose tracking, enable portable records and follow up. These systems have proven successful in many low- and middle-income countries.

Ensuring that patients have a longitudinal digital record that goes down to the community level and that is also available at the vaccination site, will be critical for both COVID-19 vaccines' equitable distribution and for future use cases.

We are hearing a concerning sense of fatalism that we may have missed the only window to build a strong foundation for our global health rocket. This is simply not true.

Yes, perhaps the best time to plant a tree was 20 years ago. But the second best time is now.

Many stories about vaccine rollout efforts have come to the fore, including challenges scaling new, expensive technology systems. But there are also positive stories of governments testing new, effective approaches to procuring digital technology, and saving millions of dollars.

There is still time to create our rocket, and while there is immense time pressure, we can meet the need.

Let's build a reusable rocket that equitably delivers vaccines today and can take off again tomorrow to reach those most in need.

Procurement innovation and rapid systems change is incredibly hard. Vaccine scientists have generated a moonshot by developing a set of vaccines quickly and effectively.

Our public health community should be bold and build in they was that SpaceX did. Our product will be a reusable platform, and in turn we will bin any future plans for one-off, overpriced missions.