Management of the World Bank thanks the Independent Evaluation Group (IEG) for the opportunity to respond to the IEG report The World Bank’s Early Support to Addressing COVID-19: Health and Social Response—An Early-Stage Evaluation. Management appreciates IEG for supporting the World Bank’s COVID-19 response by offering just-in-time lessons and evaluative evidence to inform management’s choices. Management recognizes the usefulness of this evaluation for informing the World Bank’s efforts to support countries to prevent, prepare for, and respond to present and future crises.

Global Leadership, Partnerships, and Learning

Management welcomes the report’s recognition of the World Bank’s global leadership in the delivery of an unprecedented crisis response. The report underscores the importance of prior World Bank country engagement and the mix of instruments that enabled a swift response comprising new lending and repurposed projects.1 The World Bank’s COVID-19 response has been, from multiple angles, an extraordinary one. The World Bank responded at speed and at scale in an unprecedented fashion.

The World Bank

• Completed pathbreaking analytical work to help understand how an unknown pandemic was evolving and impacting social and economic circumstances, globally and at the country level;
• Provided affected countries with a sharp increase in financing tailored to their circumstances, including by accelerating an International Development Association Replenishment by a full year;
• Innovated on instruments, especially the health Multiphase Programmatic Approach (MPA), which was the initial Fast Track COVID-19 Facility of $6 billion;2
• Achieved record commitments and disbursements;
• Made more financing for vaccines available than any multilateral development bank or international organization—this is especially true once the vaccine donations provided by countries that are members of the Organisation for Economic Co-operation and Development are excluded from the calculation; and
• Built on lessons from past crises, including the need to employ a variety of instruments like the Contingency Emergency Response Component; repurposed projects, including regional projects, trust funds, and grants; and guidelines on a variety of topics for projects in emergency situations.

Management acknowledges IEG’s recognition that the flexibility of the World Bank’s processes for project financing improved in COVID-19 from past crises and allowed an agile and swift response that shortened time to disbursement by half compared with previous crises. Procurement plans for vaccine projects also disbursed nearly 10 times faster than other investment project financing health projects. Moreover, the World Bank continued to be a full-service development bank, addressing all key aspects of the pandemic and its impacts while maintaining a focus on its corporate commitments, including a large increase in climate financing and on preserving the basis for a resumption of progress toward long-term development outcomes.

Management believes that the World Bank’s early coordination with global and regional partners on interventions in relation to vaccines were instrumental for the effectiveness of the response. From the beginning, the World Bank’s COVID-19 response recognized the centrality of vaccination for containing the pandemic—once an effective vaccine was available—but prior to vaccines becoming available in 2021, the interim emphasis of the response was on prevention, testing, treatment, and surveillance. Management notes the strength of its partnership with external partners, including with COVID-19 Vaccines Global Access (COVAX)3on the following areas: (i) assessing countries’ readiness to deliver vaccines (World Bank 2021a) through the Vaccine Introduction Readiness Assessment Tool and Vaccine Readiness Assessment Framework (VRAF); (ii) streamlining the vaccine acquisition process by setting up a cost-sharing mechanism (World Bank 2021b) with COVAX that supported countries willing to procure doses in addition to free doses through COVAX; and (iii) monitoring countries’ capacity to deliver vaccines by monitoring, sharing, and coordinating information, data, and activity regarding vaccine availability and countries’ readiness through the Multilateral Leaders’ Task Force, which included the World Bank, World Health Organization (WHO), the International Monetary Fund, and the World Trade Organization. Management also appreciates the report’s acknowledgment in relation to the challenges of having a global instrument to support advanced market commitments for vaccines, but notes that the Gavi Alliance and World Bank do have a long track record of financial innovation at the global level, most notably through the International Finance Facility for Immunization, for which the World Bank serves as Treasury Manager. This frontloading tool, which creates vaccine bonds through raising finance on capital markets backed by long-term donor pledges, meant that a global mechanism was in place to raise additional funds through COVAX, and several donor countries made their contributions to the COVAX Advanced Market Commitment through this mechanism. The World Bank, through its cost-sharing mechanism developed with COVAX, allowed COVAX to make advance purchases from vaccine manufacturers based on aggregated demand across countries, using financing from the World Bank. Additionally, the World Bank’s efforts to strengthen regional capacity was one of the most notable highlights of the vaccine response, particularly the support offered to the African Union to make use of the African Vaccine Acquisition Task Team (AVATT) initiative. By the time the announcement was made, many of the 36 countries with approved vaccine operations had already formalized plans to procure vaccines through AVATT. Both COVAX and AVATT financing arrangements were part of the World Bank’s effort to ensure countries had flexibility in financing in alignment with country preferences. The World Bank, as a country-based model, demonstrated the ability to complement the other mechanisms, and specifically, to take advantage of the centralized procurement capacity of COVAX and AVATT. To date, 630 million vaccine doses have been purchased with World Bank financing ($6.5 billion) through a variety of procurement channels.

Management believes that the efforts made pre-COVID-19 in helping strengthen regional capacity, especially in Africa, yielded results during the COVID-19 pandemic. Regional projects facilitated knowledge sharing and were particularly helpful for countries with limited capacity to respond independently to COVID-19. They also supported technical cooperation (such as for planning and reporting on the response) among ministries and public health institutes, encouraged leadership, developed human capacity, and coordinated technical sharing and financing for COVID-19 responses in countries. World Bank operations have also helped strengthen institutional capacity of Africa Center for Disease Control, and regional projects such as the World Bank project Regional Disease Surveillance Systems Enhancement have improved prevention, preparedness, and response (PPR) capacity using a One Health approach. The World Bank is building on these partnerships through its global PPR program, including the PPR Financial Intermediary Funds.

Adaptive Management and Internal Coordination

Management emphasizes its adaptive response in a context characterized by deep uncertainty and fluidity. As the crisis evolved and as new information became available, the World Bank’s response remained flexible and adapted continuously as country and regional needs evolved throughout the 15-month period of this review. The World Bank remained relevant by analyzing the evolution of the virus, enhancing its understanding of it, and calibrating its response to the changing external environment. As a global institution working across all regions in a context of high uncertainty and shifting landscape of vaccine development and regulatory approvals, management had to recalibrate safeguards carefully and continuously in relation to financing for vaccines. The early use of a waiver for the first vaccine project in Lebanon (as mentioned by the report), was critical for upholding both speed and safety. When more data became available, the World Bank aligned with WHO regulatory approvals, and the focus shifted to helping countries to navigate the severe supply constraints at the global level and working with countries to match supply and demand in a context where donation timelines were highly uncertain. Adaptive management is an essential element of the World Bank’s outcome orientation. There was sufficient flexibility built into the World Bank’s operational policies and approaches, building on lessons learned from earlier crises, and the speed and agility with which these were triggered (allowing substantial additional commitments to be made within months of the WHO declaration that COVID-19 constituted a pandemic).

Management highlights the contribution of the Social Protection and Jobs (SPJ) Global Practice as one of the most dynamic aspects of the World Bank’s COVID-19 response. During the period covered by the report, SPJ had the highest lending volume (in fiscal year [FY]21 $8,837 million, almost four times that of the Health, Nutrition, Population [HNP] Global Practice). In addition, significant effort was devoted to adapting existing operations and safety net programs, topping-up benefits to existing beneficiaries, or expanding the beneficiary pool without new lending. These efforts led to securing financial support to households to face health-related restrictions. As businesses closed and movement was restricted to essential services only, social protection (through new or repurposed SPJ-led projects) provided essential intermediate income that allowed people to stay home instead of continuing to work and mingle, risking disease transmission. It should be noted that over 40 evaluations have demonstrated the effectiveness of SPJ programs in saving lives and protecting or enhancing well-being across a range of dimensions. A new “lessons learned” paper, recently released by SPJ, includes an overview of those evaluations (Gentilini 2022). Similarly, the upcoming Poverty and Shared Prosperity Report shows evidence from microsimulations for low- and middle-income countries showing that poverty would have been significantly higher without safety net responses, and that countries with better social protection systems were able to mitigate the impact of the pandemic more effectively.

Management took unprecedented steps for an effective internal coordination to help manage its engagement globally and will reflect on ways to further improve for future crises. Management established coordination arrangements that permitted the delivery of the MPA in just three weeks—the fastest and largest response in the history of the World Bank. The success of the effort was a combination of top-down and bottom-up creativity of many teams across the institution that found innovative ways to quickly resolve challenges. Among the many actions taken, management highlights the adoption of streamlined processes and efforts for cross-fertilization; regular coordination meetings starting in February 2020 within the Human Development practice; and design of the global blueprint for the MPA Program, with close coordination of headquarters and field offices. Management also compiled operational updates from countries about restructuring ongoing projects and reallocating funds to support initial national responses. Moreover, management established the Emergency Operations Center as the engine of internal coordination. The Emergency Operations Center was established quickly with experienced staff; it shared information, held weekly cross-functional coordination meetings, resolved queries with a daily turnaround, and maintained regular communication between headquarters and country offices for the health sector.4,5 It was instrumental in coordinating operational responses and facilitating problem solving. Management also notes that the World Bank gained considerable experience engaging stakeholders and built on this experience over time, including using electronic platforms, stronger engagement with civil society networks to ensure governments’ accountability to citizens, and strengthening opportunities for citizen engagement through the World Bank’s Global Partnership for Social Accountability.

Gender and Targeted Beneficiaries

Management points out that the World Bank projects continued to focus on women, as teams were given the flexibility to waive the gender tag requirements in the early stages of the COVID-19 response. While reviewing the FY20 MPAs as they were approved, based on the gender priorities detailed in the Gender HNP Guidance Note, management observed that a good share of the MPA projects did consider gender issues to the extent possible, even if not all of them were able to specify project interventions due to the limited scope and time frame. Although the early response projects did not adopt entry points of gender that would have been used under “normal” circumstances (such as psychosocial support or sexual and reproductive health), HNP’s COVID-19 projects acknowledged and responded to gender-based gaps directly related to the pandemic response, such as ensuring women received critical health information, training of female service providers, supporting countries in providing compensation packages to frontline workers (mostly women) who were at high risk, and psychosocial support for frontline workers. By April 2021, HNP, in collaboration with the Gender Group, also produced a second set of guidelines on reducing gender gaps in vaccine delivery for COVID-19, which includes recommendations for continuation of essential health services including sexual and reproductive health services, community engagement, and provision of psychosocial support. These recommendations are reflected in subsequent COVID-19 projects. The subsequent additional financing operations covered cross-sectoral issues more systematically, based on the learnings and lessons of the initial MPA operations along with a growing body of global evidence and data showing the impact of the pandemic on health, education, and social protection.6 By phase II of the pandemic response, the gender tag was resumed. From the early stages of the response, management provided multiple trainings to staff on identifying and addressing gender gaps in their pandemic response. Key guidelines from this training have also been incorporated into the HNP Flagship Course (aimed at client countries) as part of the gender and health training module. Currently, as part of the gender strategy update, HNP is developing its action plan, which covers pandemic preparedness and ensuring continuity of health services including sexual and reproductive health and psychosocial services along with community engagement.

Management clarifies that the World Bank’s COVID-19 response targeted vulnerable populations from the onset. Although in health, vulnerability is a broad concept (it includes women, children, adolescent girls, poor people, farmers, and so on), the wider World Bank COVID-19 response targeted vulnerable populations as more narrowly defined based on their risk of COVID-19 mortality and morbidity. This prioritization process was aided by the WHO Strategic Advisory Group of Experts Road map for prioritizing use of COVID-19 vaccines, which was referenced in project documents and which countries then adapted to their specific country needs. Key vulnerable groups were defined as people most at risk of COVID-19 infection, (severe) illness, and death, including health workers, and adults over 60, and people with comorbidities. Children were not prioritized, given their lower risk and lack of approval for COVID-19 vaccines early in the pandemic. Still, the SPJ projects succeeded in reaching 92 percent of the vulnerable population they intended to reach at design, including 95 percent of the intended women and children. These projects also reached the ”last mile” of vulnerable and marginalized beneficiaries from the outset, using existing platforms for behavior change communication (that usually accompanies cash transfers) to deliver COVID-19 messages. Given the broad impact of the crisis, universal programs have a greater likelihood of reaching most, if not all, vulnerable populations. That said, the decision regarding whether a program should be universal or targeted requires consideration of the trade-offs in coverage, cost, and efficiency.

Management underscores that essential service delivery to meet human capital needs was supported by the ongoing Human Development portfolio (not tagged as COVID-19 response) and through COVID-19 response operations. At the global level, the World Bank was one of the first large-scale development organizations to point to the risk and impact of disruptions in essential health services resulting from COVID-19. The report correctly notes that beyond its immediate impact on health outcomes (mortality and morbidity), the pandemic also had a dramatic impact through disruptions in essential health services, especially for maternal and child health and gender-related services.7 The World Bank’s ongoing portfolio of projects complemented the emergency response: the long-term investment portfolio in health systems amounted to $30 billion in more than 200 countries. The World Bank has been supporting countries to strengthen the resilience of essential health services, expand reach of telemedicine, strengthen data to inform decision-making, and strengthen citizen engagement.8 To mitigate drops in coverage rates of childhood immunization, the World Bank continues to work closely with Gavi Alliance partners to find ways to protect financing of routine vaccines in the highest risk countries, drawing on World Bank financing to complement domestic financing through existing health projects when necessary. Furthermore, health systems strengthening, including preparedness planning for delivery of essential health services, was represented in about one-third of all MPA commitments. Some of the COVID-19 response investments under the MPA project had positive spillovers for the delivery of essential public health services for dealing with comorbidities that increased the risk of severe COVID-19 disease, hospitalization, and death.9 Examples include the Essential Health Services Recipient Executed Trust Fund grant program and the Global Financing Facility, launched toward the end of calendar year (CY)2020 to help incorporate support for essential health services into COVID-19 operations.

Recommendations

Management welcomes the report’s recommendations as the World Bank continues to scale-up its engagement in crises preparedness and response in a world affected by compounding crises, not just COVID-19. As stated in the Management Action Record FY22, management has observed that the effects of IEG’s evaluations often start long before the issuance of the formal report, as evaluation processes highlight key issues, spark new ways of thinking, and trigger real-time learning and adaptation. This is particularly true for this evaluation given IEG’s effective collaboration with management in building the knowledge base to confront the crises. Most of the recommendations are therefore being internalized in existing engagements and the report will only help advance their implementation.

Management agrees with the first recommendation to use the World Bank’s crisis recovery efforts to strengthen the resilience of essential health and education services to ensure that human capital is protected in a crisis. The World Bank is already working toward strengthening resilience of essential health and education services, including through operational design that better addresses the intersection of primary health care and pandemic preparedness and response, and through the sharing of experiences on mechanisms to strengthen telehealth and other relevant platforms for use in emergencies, and for education through evidence and innovations and an expanding portfolio in addressing learning losses and accelerating long-term learning.

Management agrees with the second recommendation to apply a gender equality lens to health and social crisis response actions across sectors. The World Bank’s gender strategy and guidelines will continue to provide support and capacity building to country teams to implement these recommendations, making the report’s findings operational. However, there is scope to do more, and HNP will leverage new opportunities to ensure a gender lens in its analytical and operational work, for example, through capacity building and knowledge exchanges to encourage more gender focused analytics; through support for the collection of gender-disaggregated data; by documenting lessons learned; and by developing a thematic paper to feed into the update of the gender strategy in 2023. The World Bank will also apply a gender lens to its strategic priorities (Global Solutions).

Management agrees with the third recommendation to help countries strengthen regional cooperation and crisis response capacities for public health preparedness. The World Bank’s work to strengthen regional cooperation is articulated in both the position paper on pandemic prevention, preparedness, and response (which will be launched soon), and PPR Financial Intermediary Fund communications.10 The 20th Replenishment of International Development Association regional window would continue to support countries in this regard. The World Bank recognizes the need to find new ways to better engage civil society and increase stakeholder engagement, and it is also looking for opportunities to further strengthen platforms for coordination and to be more inclusive of civil society organizations.

Management also agrees with the fourth recommendation to build on the COVID-19 experience to strengthen the World Bank’s internal crisis preparedness so that it has the tools and procedures ready to respond in future emergencies. Applying the lessons from COVID-19 and other crises, the World Bank will build on the experience of developing guidance notes for World Bank teams to operate more efficiently and effectively as it supports countries to strengthen capacities for pandemic PPR (including through PPR Financial Intermediary Funds), for example, by providing hands-on support for Environmental and Social Framework, promoting cross-country learning, and strengthening the monitoring and use of data on World Bank portfolios. Additionally, the World Bank has a long history of involvement working on global innovative financing mechanisms (for example, Treasury Manager for International Finance Facility for Immunization, and pneumococcal Advance Market Commitment), and is actively involved in dialogue with other partners. World Bank will explore further to shape and redesign global and regional financing instruments to be more “fit-for-purpose” during crises.

Reference

World Bank. 2021. “COVAX and World Bank to Accelerate Vaccine Access for Developing Countries” Press release no. 2022/006/HNP, July 26, 2021. https://www.worldbank.org/en/news/press-release/2021/07/26/covax-and-world-bank-to-accelerate-vaccine-access-for-developing-countries.