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Many countries, prepared for the kind of childhood immunization campaigns they run on a regular basis, have been surprised to find that they can’t rely on people just to show up for a coronavirus vaccine.

“Many vaccine hesitancy issues could be resolved, but not all, with timely operational funding in place,” said Benjamin Schreiber, the Covid-19 vaccine coordinator at UNICEF, who is leading the distribution efforts of Covax.

In the midst of a race to fund vaccine purchases, however, the money to get them into people’s arms has been slipped. Of the 92 poorest countries provided by Covax, eight have cut their health budgets due to economic losses from viruses, and several others are struggling to fund their health systems in part because they do not qualify for grants or more generous loans, said Mr. Dit Schreiber.

The World Bank has pledged $ 12 billion for vaccine deployment, but has so far approved $ 2 billion in projects. In mid-March, the bank found that less than a third of low- and middle-income countries said they intended to train enough vaccinators or conduct campaigns to tackle vaccine reluctance, a said Mamta Murthi, vice president of the bank for human development.

The needs of many countries are even simpler. Some cannot pay to print vaccination cards. Malawi, which plans to destroy 16,000 doses that arrived shortly before their expiration date, has struggled to cover meal allowances for health workers traveling from facility to facility to administer vaccines.

The outlook is uncertain. More doses will engender greater confidence in the vaccines, said Freddy Nkosi, country director in the Democratic Republic of Congo for VillageReach, a non-profit health organization. But if India’s epidemic continues to increase, the CEO of the Serum Institute of India recently said, “We’re going to have to keep supplying India, and not elsewhere.”

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