Generating Resource Estimates for the National Deployment and Vaccination Plan for COVID-19 Vaccines in Sudan DECEMBER 31, 2021 1 Outline • NDVP Technical Committee – vaccination priority groups and target • Assumptions for population estimates • Deployment stages • Vaccine demand and supply by deployment stages • Delivery modalities for vaccine groups • Costing Process • CVIC Tool • Scenarios • NDVP program components • Resource needs estimates, distribution by program area and key points • Resource mobilization – comparing estimated cost to funding sources to identify resource gap. • Discussion 2 Sudan’s National Deployment and Vaccination Plan for COVID-19 Vaccines 3 3 NDVP Technical Committee - Priority groups and target parameters • Priority groups, as defined by NDVP Committee (in order of priority). Representing ~ 11.45M (25.5%) of total population • All Health workers • 45yrs and above with comorbidities • 16-44yrs with comorbidities • Essential workers • All other 45yrs and above. • Refugees living in camps • National coverage target (apart from priority groups) • 15.4M (35.5%) of remaining general population to reach 40% vaccination coverage target by the end of 2022 and 60% vaccination coverage target by the end of 2023. • Delivery modalities group • Modality 1 – Fixed sites with cold storage • Modality 2 – Vaccination campaigns through lowest level health facility or other public facilities (community halls, schools, police stations) that do not have cold storage. • Modality 3 – Long-term residential facilities such as nursing homes, refugee camps etc. • Modality 4 – Outreach or mobile sites. 1. Adult population (15yrs and above) are approximately 61% of total population Assumptions for population estimates Population Groups Estimated Number Data sources Healthcare workers 700,000 Sub-committee estimate Older adults (>45yrs) with ~1,412,000 19.5% prevalence of severe raised blood pressure comorbidities (RBP)1 in 45-69yrs2 16-44yrs with comorbidities ~ 844,000 4% prevalence of diabetes1 in 18-44yrs2 Remaining Older adults (>45yrs) ~5,810,000 Age based data from UNDP – World Population Projection estimate for 2021 Essential Workers ~2,300,000 Sub-committee estimate of 5% of total population >18yrs living in refugee camps ~ 498,0003 Based on estimated 1,100,000 refugees living in 21 camps. General Population ~15,440,0004 Estimated number needed to reach national (in addition to above) vaccination target 1. Sudan STEPwise Survey for Non-Communicable Diseases Risk Factors 2016 2. Based on WPP age group estimates from UNDP 2019 projections. 3. Assumes 45.3% of 1.1M refugee population (498,000) are 18-44 based on WPP age group population estimates for Sudan. 4. Assumes coverage target of 60%. Deployment stages Using the NDVP prioritization list in conjunction with current supply vaccine doses, Sudan’s vaccine rollout followed WHO vaccine deployment guidance (SAGE1) stages 2021 • Stage 1- Health workers at high to very high risk of becoming infected and transmitting SARS-CoV-2 All health workers in Sudan • Stage 2 - Sociodemographic groups at significantly higher risk of severe disease or death. Defined in Sudan as 16years and above with comorbidities 2022 - 2023 • Stage 3 - Social/employment and other groups at elevated risk of acquiring and transmitting infection. In order of Sudan NDVP prioritization - 3.1 - Essential workers 3.2 - All 45years and above (regardless of comorbidity) 3.3 - General population needed to reach target coverage 1. Strategic Advisory Group of Experts on Immunization Vaccine distribution by year and stage Population Group 2021 2021 2022 2022 2023 2023 Stage 1 Stage 2 Stage 3.1 Stage 3.2 Stage 3.3 Stage 3.4 Healthcare Workers 100% Older Adults (>45yrs) with Comorbidities 18% 82% 18-44yrs with Comorbidities 18% 82% Essential Workers 42% 58% Remaining Older Adults (>45yrs) 70% 30% 15.4 Million from General Population 48% 52% Delivery modalities by population group Population Group Fixed Vaccine Residential Outreach Site Campaign Facility Healthcare workers 100% Older adults (>45yrs) with comorbidities 70% 15% 2.5% 12.5% 18-44yrs with comorbidities 70% 15% 15% Remaining older adults (>45yrs) 70% 15% 15% Essential workers 90% 10% >18yrs living in refugee camps 100% General Population 70% 15% 15% Total Population Intended for 71% 14% 2% 13% Vaccination Provides a structured and comprehensive estimation of: � Incremental operational and selected capital costs of introducing and deploying COVID-19 vaccines � For resource mobilization, budgeting, requests for external funding, strategy refinement, etc. � Compiles Sudan specific NDVP and cost inputs WHO CVIC Tool Is in alignment with: � Guidance on developing a NDVP for COVID 19 vaccines � Guidance for prioritization and allocation: WHO SAGE values framework and prioritization roadmap � Readiness assessment tool (VIRAT VRAF 2.0) � Gavi COVAX Readiness and Preparation TA Plan 9 9 Limitations • As with any tool, the results are only as good as the data that are used. • It is an iterative process that requires revising data inputs and validation to ensure accuracy. In other words, we need to check assumptions with preliminary analysis. • Is not meant to be the final step in planning process but part of the decision-making process to finalize what is eventually adopted into the plan NDVP Cost Categories NDVP Cost Categories Description Vaccinators Vaccinator compensation, training and per diem (for mobile teams) Cold Chain Materials (carrier, ice packs), fuel, electricity etc. related to cold chain and storage. Data Management + Monitoring Local data management and monitoring, pharmacovigilance Vaccination Delivery Domestic travel for personnel, waste management, last-mile transport, PPE (face masks/respirators, face shields, gloves etc.) and security for vaccine and related commodities. Demand Generation & Communications Social behavioral awareness and change campaigns Vaccine Safety Surveillance Surveillance and safety activities for adverse events following immunization (AEFI) and/or adverse events of special interest (AESI). Cross-cutting Technical Assistance Planning and coordination activities Scenario Analysis • Scenario assumptions1 to reach 60% coverage by the end of 2023 • A: Donations from Denmark, France and Germany are part of COVAX 20% (approximately 28.5M people vaccinated by 2023) • B: Donations from Denmark, France and Germany are not part of COVAX 20 (approximately 28.92M people vaccinated by 2023) 1. Scenario analysis were developed as a result of challenges with securing definitive vaccine procurement data which were further compounded by the October 2021 coup. Resource Needs Estimates by Scenario 13 13 A: Preliminary cost outputs Estimated Cost per person NDVP Categories 2021 2022 2023 Total vaccinated1 Vaccinators $10,521,000 $15,632,000 $19,820,000 $45,973,000 $1.61 Cold Chain $26,333,000 $8,685,000 $6,995,000 $42,014,000 $1.47 Data Management, Monitoring & Oversight $9,945,000 $1,119,000 $13,755,000 $24,819,000 $0.87 Vaccination Delivery $3,051,000 $2,995,000 $12,052,000 $18,098,000 $0.64 Demand Generation & Comm. $4,095,000 $41,000 $78,000 $4,214,000 $0.15 Vaccine Safety & Surveillance $71,000 $406,000 $1,497,000 $1,973,000 $0.07 Cross-cutting TA for Planning, Coordination and Delivery $401,000 $- $- $401,000 $0.01 Sub-Total (Excl Vaccine) $54,418,000 $28,877,000 $54,197,000 $137,492,000 $4.82 Vaccine Cost (Only) $99,369,000 $83,812,000 $216,759,000 $399,941,0002 $14.03 Grand Total $153,787,000 $112,690,000 $270,956,000 $537,432,0002 $18.86 1. Cost per person who has received the current full course of vaccine doses. 2. Total cost of confirmed and projected vaccine demand includes donated vaccines estimated cost of ~$315M for approximately 21.1% of the Sudanese population and ~$74M in financing from the World Bank Group for an additional 18% of the population of Sudan. Note: The global average estimated cost per vaccine dose is $14.70 and the estimated cost in this analysis is lower as a result of the inclusion of J&J vaccine in Sudan’s vaccine country mix. A: Cost drivers (with and without vaccines) NDVP Components Share of Total Cost Excluding Cost of Vaccine Doses Vaccine Safety & Vaccine Cost (Only) 74.5% Demand Generation & Surveillance Comm. Vaccinators Cross-cutting TA 8.6% Cold Chain 7.8% Vaccination Delivery Data Management, Monitoring & Oversight 4.6% Vaccinators Vaccination Delivery 3.4% Data Management, Monitoring & Oversight Demand Generation & Comm. 0.8% Vaccine Safety & Surveillance 0.4% Cross-cutting TA for Planning, Coordination and Delivery 0.1% Cold Chain Sub-Total (Excl Vaccine) 25.6% A: Financing requirements increasing / phased over time 650 600 550 $135M 500 450 $136M 400 350 300 $72M $537M 250 200 $40M $89M 150 100 $64M 50 0 2021 Stage 2: 2021 Stage 1: 2022 Stage 3.1: 2023 Stage 3.3 : 2023 Stage 3.4: 82% of population 2022 Stage 3.2 : All healthcare workers 58% of essential workers, 26% of general 28% of general with comorbidities & 30% of all other 45+ & 18% of population 70% of all other 45+ population population 42% of essential population with comorbidities1 population workers B: Preliminary cost outputs Estimated Cost per person NDVP Categories 2021 2022 2023 Total vaccinated1 Vaccinators $10,521,000 $15,263,000 $20,814,000 $46,598,000 $1.61 Cold Chain $26,374,000 $8,726,000 $7,039,000 $42,139,000 $1.46 Data Management, Monitoring & Oversight $9,945,000 $1,323,000 $13,771,000 $25,039,000 $0.87 Vaccination Delivery $2,953,000 $3,132,000 $12,190,000 $18,275,000 $0.63 Demand Generation & Comm. $4,120,000 $29,000 $67,000 $4,216,000 $0.15 Vaccine Safety & Surveillance $842,000 $529,000 $1,415,000 $2,786,000 $0.10 Cross-cutting TA for Planning, Coordination and Delivery $401,000 $- $- $401,000 $0.01 Sub-Total (Excl Vaccine) $55,156,000 $29,003,000 $55,296,000 $139,455,000 $4.82 Vaccine Cost (Only) $99,369,000 $86,314,000 $220,594,000 $406,277,0002 $14.05 Grand Total $154,525,000 $115,317,000 $275,890,000 $545,732,0002 $18.87 1. Cost per person who has received the current full course of vaccine doses. 2. Total cost of confirmed and projected vaccine demand includes donated vaccines estimated cost of ~$315M for approximately 21.1% of the Sudanese population and ~$74M in financing from the World Bank Group for an additional 18% of the population of Sudan. Note: The global average estimated cost per vaccine dose is $14.70 and the estimated cost in this analysis is lower as a result of the inclusion of J&J vaccine in Sudan’s vaccine country mix. B: Cost drivers (with and without vaccines) NDVP Components Share of Excluding Cost of Vaccine Doses Total Cost Vaccine Safety & Vaccine Cost (Only) 74.4% Demand Surveillance Generation & Cross-cutting TA Comm. Vaccinators 9.6% Cold Chain 5.3% Vaccination Delivery Data Management, Monitoring & Oversight 5.4% Vaccinators Vaccination Delivery 4.0% Data Management, Demand Generation & Comm. 0.7% Monitoring & Oversight Vaccine Safety & Surveillance 0.4% Cross-cutting TA for Planning, Coordination and Delivery 0.1% Cold Chain Sub-Total (Excl Vaccine) 25.5% B: Financing requirements increasing / phased over time 650 600 550 $138M 500 450 $138M 400 350 300 $73.5M $546M 250 $41.7M 200 $89.9M 150 100 $64M 50 0 2021 Stage 2: 2021 Stage 1: 2022 Stage 3.1: 2023 Stage 3.3 : 2023 Stage 3.4: 82% of population 2022 Stage 3.2 : All healthcare workers 58% of essential workers, 26% of general 28% of general with comorbidities & 30% of all other 45+ & 18% of population 70% of all other 45+ population population 42% of essential population with comorbidities1 population workers Scenario Comparison Costs Scenario A Scenario B Total Cost $537,432,000 $545,732,000 Number of people vaccinated 28,500,000 28,922,000 Cost per person who has received a full course of vaccine dose(s) $18.86 $18.87 Negligible cost difference between scenario assumptions as volume of donated vaccine accounts almost 0.5% of the population. The added volume of donated vaccines improves cost-effectiveness of the deployment process, contributes to fewer infections, decreases chances of new variants/mutations in circulation and moves Sudan closer to herd immunity. Resource Needs Estimates- Key points Fiscal space: As in most countries, the cost of the COVID-19 vaccination rollout (excluding cost of donated vaccines) represents a high fiscal burden for Sudan Total Cost of Vaccination Vaccination as share of GDP Vaccination as share of Government Health Expenditure Scenario A Scenario B Scenario A Scenario B Scenario A Scenario B $223M $214M 1% 0.9% 21.5% 20.9% GDP and Government Health Expenditure data were sourced from World Economic Outlook Data from IMF for 2020. Resource Mapping To Resource Mobilization 22 22 Mapping resources for vaccine rollout Starting with the resource estimates required to vaccinate 60% of the population, the next key step will be identifying funding sources available to support scale-up vaccination efforts. To that end the resource mapping process • Provides estimates by cost categories which government and partners can then align with available funding streams • Identifies gaps between resource needs and available funding. • Starting point to discuss and develop possible strategies to mobilize additional funding to fill the resource gap. Scenario A: Estimates and Finance Sources – Cumulative 2021-2023 NDVP Total Ministry COVAX World UNICEF US Govt Chinese Others Gap Gap Categories Resource of (Denmark, Bank Govt (Emirates) ($) (Proportion Estimates Finance France & Group of total that Germany is NOT funded) Vaccinators $45,973,000 $3,200,000 $13,494,000 $29,279,000 64% Cold Chain $42,014,000 $42,014,000 100% Data Management, Monitoring & Oversight $24,819,000 $7,500,000 $6,000,000 $11,319,000 46% Vaccination Delivery $18,098,000 $4,357,000 $25,000,000 $11,259,000 62% Demand Generation & Comm. $4,214,000 $2,053,000 $2,161,000 51% Vaccine Safety & Surveillance $1,973,000 $597,000 $1,376,000 70% Cross-cutting TA $401,000 $2,100,000 $1,699,000 424% Vaccine Cost (Only) $399,941,000 $298,384,000 1 $73,692,000 $5,707,0001 $10,179,0001 $470,0001 $11,509,000 3% GRAND TOTAL $537,433,000 $3,200,000 $300,484,000 $101,693,000 $31,000,000 $5,707,000 $10,179,000 $470,000 $84,700,000 16% 1. Provided in the form of donated vaccine doses. 2. Funding resources in Gap ($)- numbers in red represent gap while numbers in black represent surplus. Scenario A: Distribution of Donor/Partner Funding Funding Sources Total Estimate US Govt Ministry of Others Chinese Govt 1% Finance (including 2% 1% Emirates) Gavi via COVAX (including Denmark, 0.10% France & Germany) $300,484,000 UNICEF 7% World Bank Group $101,693,000 UNICEF $31,000,000 World Bank Group Chinese Govt $10,179,000 23% COVAX (including Denmark, France & United States Govt $5,707,000 Germany) 66% Ministry of Finance $3,200,000 Others (Including Emirates) $470,000 GRAND TOTAL $452,733,000 Scenario B: Estimates and Finance Sources – Cumulative 2021-2023 NDVP Total Ministry COVAX World UNICEF US Govt Chinese Others Gap Gap Categories Resource of Bank Govt (Denmark, ($) (Proportion Estimates Finance Group Emirates, of total that France & is NOT Germany) funded) Vaccinators $46,598,000 $3,200,000 $13,494,000 $29,904,000 64% Cold Chain $42,139,000 $42,139,000 100% Data Management, Monitoring & Oversight $25,039,000 $7,500,000 $6,000,000 $11,539,000 46% Vaccination Delivery $18,275,000 $4,357,000 $25,000,000 $11,082,000 61% Demand Generation & Comm. $4,216,000 $2,053,000 $2,163,000 51% Vaccine Safety & Surveillance $2,786,000 $597,000 $2,189,000 79% Cross-cutting TA $401,000 $2,100,000 $1,699,000 424% Vaccine Cost (Only) $406,277,000 $304,066,0001 $73,692,000 $5,707,0001 $10,179,0001 $12,102,0001 $531,000 0.1% GRAND TOTAL $545,731,000 $3,200,000 $306,166,000 $101,693,000 $31,000,000 $5,707,000 $10,179,000 $12,102,000 $75,684,000 14% 1. Provided in the form of donated vaccine doses. 2. Funding resources in Gap ($)- numbers in red represent gap while numbers in black represent surplus. Scenario B: Distribution of Donor/Partner Funding Funding Sources Total Estimate Others (including US Govt Denmark, Chinese Govt 1% Ministry of Emirates, France 2% Finance Gavi via COVAX $306,166,000 and Germany) 0.7% 2% World Bank Group $101,693,000 UNICEF 7% UNICEF $31,000,000 Others (including Denmark, Emirates, France and Germany) $12,102,000 World Bank Group Chinese Govt $10,179,000 22% COVAX 65% United States Govt $5,707,000 Ministry of Finance $3,200,000 GRAND TOTAL $470,047,000 Take-away on Resource Mapping Given the total cost of ~$537M-$546M, approximately $452M-$470M (84%-86% of vaccine rollout) will been funded. This means the resource gap ranges between $76M-$85M (14%-16%) • Funding across key program areas are not equitable: Funding for vaccine delivery, cross- cutting TA exceed estimated needs, while the funding gap for vaccine doses is $5M or less. However, funding gap for demand generation, vaccinators, vaccine safety and surveillance are 50% or more. Most importantly, no funding has yet been identified for cold chain. Uneven funding could affect efficiency of vaccine deployment, if key parts of the roll-out are not available when vaccine doses are made available but cold chain storage systems are not in place. • Funding data: Access to full spectrum of expected donors has been limited. Discussion Questions, comments?