Why PFM is Key for the Effective Roll Out of COVID-19 Vaccines

Budget Covid-19

Posted by Hélène Barroy[1], Federica Margini[1], Triin Habicht[2], Tomas Roubal[3], Peter Cowley[3], and Joseph Kutzin[1]

As COVID-19 vaccines are rolled out globally, the number one question for many countries is how much it is going to cost to procure and deploy the vaccines. Currently, COVAX only covers 20% of the vaccine purchase price for 92 eligible low- and middle-income countries. While the question “how much?” is a legitimate one to consider, especially given the fiscally constrained environment, another key question— “how to?”—requires careful attention as well. Figuring out how to channel necessary funds towards the vaccine roll-out is as important as determining the cost of the roll-out itself. For this, PFM becomes highly relevant as it is what supports the last mile distribution of a predominantly publicly funded and managed public good.

Preliminary country evidence indicates that PFM bottlenecks, regularly encountered in the health sector during normal times, are also affecting COVID-19 vaccination plans. Some of the key issues include: How are vaccine procurement and delivery costs formulated in budget structures? How will funds flow to health service providers to cover costs associated with implementation? What are the rules for hiring and contracting temporary vaccinators? How will providers be incentivized for vaccination services? How can reporting mechanisms ensure financial accountability for vaccine-related expenditures?

This article describes PFM “stress points” in each phase of the budget cycle that may arise throughout the vaccine roll-out. The article also uses country examples to illustrate possible ways to overcome these barriers.

Budget planning and formulation

Budget execution and spending modalities

Expenditure reporting and accountability

A more detailed mapping of these challenges and possible solutions is available here.

This article is part of a series related to the Coronavirus Crisis. All of our articles covering the topic can be found on our PFM Blog Coronavirus Articles page.


[1] Health Systems Governance and Financing, World Health Organization

[2] Barcelona Office for Health Systems Financing, World Health Organization

[3] Regional Office for the Western Pacific, World Health Organization

Note: The posts on the IMF PFM Blog should not be reported as representing the views of the IMF. The views expressed are those of the authors and do not necessarily represent those of the IMF or IMF policy.