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421. Beyond the “Gavi-Eligible”: High-Leverage Opportunities for Gavi to Enhance Vaccine Access and Uptake in Ineligible Middle-Income Countries

Author:
Rachel Bonnifield, Morgan Pincombe, and Janeen Madan Keller
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The global locus of undervaccination is increasingly shifting from the poorest countries in the world—which are eligible for support from Gavi, the Vaccine Alliance (Gavi)—to middle-income countries (MICs) that do not qualify for traditional Gavi support. Given these growing challenges, Gavi must rethink its engagement with those MICs that are ineligible for traditional support. Although this engagement is intended to be “catalytic” and has been intentionally targeted to country needs, it also has been relatively small-scale and ad hoc. Gavi’s next five-year strategic period from 2026 to 2030, known as “Gavi 6.0,” offers a window of opportunity for its board and leadership to consider new and different ways for Gavi to engage with MICs to advance global vaccine access and improve vaccination outcomes. To have the greatest impact in this context, Gavi must lean into its comparative advantage in market shaping and demand consolidation to drive its contributions to global vaccination efforts with finite resources. We offer recommendations for Gavi to operationalize broader engagement with MICs, specifically by enabling an expanded cohort of MICs to access more affordable prices for both newer, costlier vaccines and future vaccines via opt-in framework agreements and by supporting a global coordinating hub to shape a forward-looking immunization innovation agenda.
Topic:
Public Health, Vaccine, Global Health, and Middle-Income Countries
Political Geography:
Global Focus

422. Disinvesting from Low-Value Health Technologies in Low- and Middle-Income Countries: Between a Solution to the Current Fiscal Crises and a Costly Mirage?

Author:
Adrian Gheorghe and Pete Baker
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
In this policy paper we summarise what is known about healthcare disinvestment and outline documented experiences in low- and middle-income countries (LMICs) to draw insights on what has worked, to what extent, and under what conditions. We reviewed the published literature on documented experiences of attempted healthcare disinvestment in LMICs. We identified two common scenarios when disinvestment initiatives were attempted, namely “one-off” and “systematic” initiatives, and characterised them in terms of objectives, resources and political will. We found four documented examples of one-off disinvestment initiatives—Iran, Malaysia, Romania, and Vietnam, two documented examples of systematic disinvestment initiatives by health technology assessment (HTA) agencies in LMICs—Brazil and China, as well as a range of countries like Thailand, India, and Ghana that carry out systematic disinvestment through routine HTA processes. We conclude that disinvestment is costly, time-consuming, and rarely as successful as policymakers intend. Key considerations to improve the chances of success include whether strong pre-existing health prioritisation systems exist (such as an HTA agency) and whether the design of initiatives are tightly matched to the level of political will, the policy objective, and available resources.
Topic:
Development, Science and Technology, Global Health, and Fiscal Crisis
Political Geography:
Global Focus

423. Why and How Multilateral Development Banks Support Improved Outcomes for Economic Migrants and Refugees

Author:
Helen Dempster, Martha Guerrero Ble, and Stephanie López Villamil
Publication Date:
05-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Economic migrants and refugees can bring both benefits and costs to their hosting countries. If well-integrated, they can support themselves, their families, and their hosting countries as producers and consumers. Both economic migration and forced displacement are therefore integrally linked with development outcomes. Recognizing this, multilateral development banks (MDBs) are supporting their beneficiary member countries to improve outcomes for economic migrants and refugees, in the form of billions of dollars in grants and loans, as well as technical assistance, policy dialogues, and knowledge exchanges. This paper provides an introductory snapshot of some of the financing instruments, projects, and strategies used; particularly innovative approaches; and challenges MDBs face in expanding their engagement. It is hoped this paper will be useful to anyone who engages with MDBs and wants to understand how they engage on economic migration and forced displacement, particularly as these issues continue to grow in importance.
Topic:
Development, Migration, World Bank, Refugees, and Banking
Political Geography:
Global Focus

424. ABCs of the IFIs: Understanding the World Bank’s IDA21 Replenishment

Author:
Erin Collinson, Clemence Landers, Justin Hurley, and Grace Miner
Publication Date:
06-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The International Development Association (IDA)—the World Bank’s arm that works in low- and lower-middle-income countries—is one of the largest sources of development assistance for the world’s poorest countries. It is also a crucial tool for resource-constrained governments to borrow on affordable terms compared to other creditors, including Chinese entities. IDA supports eligible countries whose annual per capita incomes fall below an established line (currently $1,315 in FY2024). Because IDA provides grants and highly subsidized loans to its client countries, its funds need to be replenished by donors every three years. Replenishments are year-long negotiations where the World Bank’s shareholding countries, of which the US is the largest, negotiate a policy and financing package for the next three-year cycle. This year, 2024, is an IDA replenishment year for the institution’s twenty-first round of funding (“IDA21”), culminating with a pledging session in December to finalize IDA21’s financing envelope.
Topic:
Development, World Bank, and International Development Association (IDA)
Political Geography:
Global Focus

425. Options for Green-Skilled Migration Partnerships: A Guide for Policymakers

Author:
Helen Dempster and Samuel Huckstep
Publication Date:
06-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The green transition is widely expected to lead to high levels of net job creation, with roles distributed across the pay and skill spectrum. To fill these roles, many countries of destination will need to use migration alongside their domestic labour supply. Yet few countries of origin have enough skilled workers to meet their own green transition targets. As a result, any green-skilled migration facilitated by countries of destination should be linked with investments in the training, recruitment, and retention of workers into ‘green’ jobs within countries of origin. This paper explores three models that link training and migration in a partnership framework—fixed-term migration; Global Skill Partnerships; and migration with parallel investments—to maximise both economic development and carbon reduction benefits. For each model, the paper outlines key considerations that should be taken into account along with a worked example. It also includes a "guide," walking policymakers through the different models to understand which would best meet the needs of countries of origin, countries of destination, and employers.
Topic:
Economics, Migration, Economic Development, and Green Transition
Political Geography:
Global Focus

426. The EU’s Global Role: A Third Node of Power

Author:
Mikaela Gavas and W. Gyude Moore
Publication Date:
07-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
In recent years, a quest for economic security and strategic autonomy have come to define the European Union (EU)’s politics. The need to compete globally for the finite resources required for the green and digital transitions, and rivalries between the US and China for global dominance, are all driving this agenda. And while the COVID-19 pandemic and the war in Ukraine highlighted countries’ global dependencies, deepening geopolitical tensions have brought national security considerations to the fore. At the same time, the rise of populist parties across Europe is fuelling calls for countries’ national interests to play the defining role in development cooperation. This presents a challenging environment for EU development cooperation. Caught up in this new paradigm, development cooperation is increasingly viewed as a lever of hard power and an instrument of influence which can be used to reinforce Europe’s strategic autonomy and economic security. With European interests central to EU development cooperation strategy, the climate of distrust between Europe and its partners is being heightened, given the not-so-distant memory of European vaccine “nationalism” during the COVID-19 pandemic, the different standards some Europeans apply with regards to fossil fuel exploration and the negative repercussions the Green Deal will have on African countries’ growth and development. However, shaping EU development policy in this fashion, with geostrategic interests at its forefront will be more detrimental than helpful for the EU in the medium to long-term, and carries the risk of fuelling conflicts of interest with partners. Geo-economic fragmentation and a trust deficit when it comes to governments and societal institutions are threatening our ability to address pressing global challenges. In Africa, this fracturing is evident in the plethora of Africa plus-one summits, for example, the first ever Korea-Africa summit. Instead of using multilateral vehicles to address development cooperation, this new environment has spawned a diversion of resources toward more bilateral initiatives, where the geopolitical returns are direct and attributable. In this piece, we propose a reset of the EU’s international relations narrative and “third way” for the EU to position itself as a global development player.
Topic:
International Relations, Development, European Union, and Green Transition
Political Geography:
Europe

427. Displacement as a Development Issue: Enabling Public Policy to Unlock Climate Finance in Asia and the Pacific

Author:
Steven Goldfinch
Publication Date:
07-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Internal displacement in the context of climate change and disasters is now recognized as a development issue with humanitarian consequences. As countries gain a greater understanding of the underlying drivers of displacement, and the corrosive effect it has on development outcomes, re-positioning public policy will be critical in prevention and solutions. To implement these responses, greater volumes of development financing is required. In the absence of dedicated instruments or resources to respond to displacement, utilizing existing sources of development finance, including climate adaptation finance, offers an important stream. This paper looks at the current public policy approaches to displacement across Asia and the Pacific, provides insights into selected country approaches, and explores the role of existing development finance, including the role of climate financial intermediary funds, in reducing the drivers of displacement.
Topic:
Climate Change, Development, Displacement, and Public Policy
Political Geography:
Asia-Pacific

428. Starting from the Source: Methods and Priorities for Explaining Lead Exposure

Author:
Rachel Bonnifield
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Lead is a dangerous neurotoxin, and lead poisoning remains one of the most serious and neglected public health challenges in the developing world, with major negative impacts on global health, education, and overall economic development. There is now growing international momentum to mitigate lead pollution, with the goal of dramatically reducing human lead exposure and consequent adverse effects. Yet before lead exposure can be effectively mitigated, it is essential to understand why humans are being exposed to lead in the first place and therefore how policymakers can intervene to stop further exposure. To date, such research into the major sources of lead exposure—broadly referred to as source assessment—in developing countries has been limited. Thus, there is limited information and no global scientific consensus about the most important causes of global lead exposure. Given growing global interest in addressing lead poisoning, there is an urgent need to better understand the major sources of lead exposure in different settings by increasing the volume and quality of related research. Tailored to a policy audience, this paper offers a state-of-the-science review of methods for doing so. First, it provides background for understanding lead exposure—that is, how and why lead enters the environment, how it behaves once there, and how environmental lead results in elevated blood lead levels for humans. Second, it outlines basic principles for source assessment, including a discussion of objectives and terminology. Third, it details the range of methods available for understanding the sources of lead exposure and describes how such methods can be used in combination to understand major sources of lead exposure in a given context. Finally, it considers major policy-relevant gaps in the literature base about sources of global exposure and offers suggestions for a research agenda in this space.
Topic:
Development, Public Health, Global Health, and Lead
Political Geography:
Global Focus

429. Financing the Pandemic Cycle: Prevention, Preparedness, Response, and Recovery and Reconstruction

Author:
Victoria Fan, Sun Kim, Diego Pineda, and Stefano Bertozzi
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The COVID-19 pandemic exposed critical gaps in the global response to health crises, particularly in the financing of pandemic prevention, preparedness, response, recovery, and reconstruction. This paper presents a comprehensive framework for pandemic financing that spans the entire pandemic cycle, emphasizing the need for timely, adequate, and effective financial resources. The framework is designed to support policymakers in both low- and middle-income countries (LMICs) and high-income nations, providing a guide to appropriate financing tools for each stage of a pandemic, from prevention and preparedness to response and recovery. Key economic concepts such as global public goods, time preference, and incentives are explored to underscore the complexities of pandemic financing. The paper also highlights the importance of timely, accessible, and sustainable financial instruments. The paper lists the pandemic financing instruments used for health during the COVID-19 pandemic, identifying 23 different tools. We also used the IHME 2024 Financing Global Health database to estimate that US$91.6 billion was spent for COVID-19 health support, primarily for response financing, over 2020 to 2023. The COVID-19 pandemic wrought significant economic impacts on the order of trillions of dollars, even as investments in pandemic preparedness to mitigate future risks is relatively small, on the order of $10 billion annually. The paper concludes with policy recommendations, calling for the establishment of a rapid-response financing mechanism, tailored to the unique challenges of pandemics, and a redesign of global health governance to better address these threats.
Topic:
Finance, Crisis Management, Public Health, Pandemic, and COVID-19
Political Geography:
Global Focus

430. A Win-Win: Migration Partnerships for an Aging EU Workforce

Author:
Helen Dempster, Pete Baker, and Samuel Huckstep
Publication Date:
09-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
European Union (EU) member states have ambitious green transition targets and healthcare strategies in place, requiring the relevant sectors to expand. Yet these sectors are already suffering from large workforce shortages. Expanding skilled migration from third countries to the EU to meet these shortages risks stripping countries of origin of the talent they need for their own goals. Any skilled migration therefore needs to be pursued within partnerships which prioritise meaningful benefits to the country of origin to combat “brain drain”, a “win-win” policy solution. This can be done through the Global Skill Partnership model, wherein the country of destination pays for the training of workers within the country of origin, some of whom migrate. While migration is a member state competence, there is real opportunity for the incoming European Commission to make a global difference in three ways: (1) expand funding for pilot projects; (2) support the development of new partnerships; and (3) be a positive voice for the role of skilled migration.
Topic:
Migration, European Union, Skilled Labor, European Commission, and Green Transition
Political Geography:
Global Focus

431. Transforming EU Climate Leadership through CBAM Reform

Author:
Ian Mitchell and Beata Cichocka
Publication Date:
09-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The EU’s Carbon Border Adjustment Mechanism (CBAM) incentivises key countries, including China and India, to assess their policies around industrial carbon emissions. But CBAM faced criticism from low-income countries at COP28, with evidence suggesting that its economic impact on Africa could be as much as three times the amount of EU aid to the continent. While major emerging economies should face the full incentives from CBAM, lower income countries require a different approach. The Commission must review CBAM's impact on least developed countries (LDCs) by 2025. We propose it collaborates with the Council and Parliament to reform CBAM in two ways: Implement a longer transition period for LDCs, following the principle of "Common but Differentiated Responsibilities" Revisit the European Parliament’s proposal to allocate additional finance to the most vulnerable countries, by proposing that CBAM revenues be used to finance climate-related loss and damage, amounting to around 1 percent of the Commission’s annual budget by 2030. These reforms would show the EU is listening to partner countries and provide a new and additional source of climate funding. This would transform its reputation and strengthen its international negotiating position.
Topic:
Climate Change, Development, European Union, Carbon Emissions, and Carbon Border Adjustment Mechanism (CBAM)
Political Geography:
China, Europe, and India

432. Making Migration Work for Adaptation: Classifying Remittances as Climate Finance

Author:
Samuel Huckstep and Jonathan Beynon
Publication Date:
10-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Labour migration programmes targeted towards climate-vulnerable populations can provide transformative finance, raising household incomes and allowing adaptation. Current flows of adaptation finance are highly insufficient. Mobilisation of private adaptation finance is very low, despite commitments to increase mobilisation. Targeted labour migration programmes can leverage private adaptation finance at a high level of efficiency. Incentivising the selection of migrant labour from communities most vulnerable to climate change by counting a portion of their remittance flows as mobilised private climate finance may therefore have significant benefits.
Topic:
Climate Change, Development, Migration, Adaptation, and Remittances
Political Geography:
Global Focus

433. Localization in Theory and Practice

Author:
Ranil Dissanayake
Publication Date:
10-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The movement for localization in foreign aid presents philosophical and practical challenges for providers of foreign aid. In the past, some level of localization (to at least state actors) of both decision-making and spending could be achieved through general and sector budget support, a logistically simple (though politically difficult) approach. Current practices, with more aid disbursed in the form of discrete projects, make localization more difficult to achieve. For development agencies to make progress they must confront conceptual, practical and strategic challenges. This paper suggests practical definitions of different kinds of localization and what they seek to achieve, points out trade-offs between them and sets out how they challenge current conceptions of how and what foreign aid seeks to do, as well as suggest limits to the optimal extent and type of localization. It then considers practical difficulties in implementing these different conceptions of localization given existing donor practices and capacities, and the strategic challenges of realizing the desired outcomes—specifically principal-agent problems within the organization and with contractors. It concludes with key lessons and messages for donors and funding agencies.
Topic:
Development, Humanitarian Aid, Reform, USAID, and Localization
Political Geography:
Global Focus

434. Climate and Development KPIs

Author:
Ian Mitchell and Edward Wickstead
Publication Date:
11-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
How committed are countries to tackling climate change at home and in developing countries? These tables provides nine key indicators on the world’s major economies spanning their climate contributions in three areas: emissions, policy, and international finance. Indicators are calculated to be comparable between countries with several expressed relative to population or economy size. Countries are ordered by the number of indicators on which they score in the best quartile, with indicators shaded for top quartile performance.
Topic:
Climate Change, Development, Climate Finance, and Economy
Political Geography:
Global Focus

435. Multilateral Development Banks in Fragile and Conflict-Affected Situations: Overview of Key Policy, Financial, and Operational Issues

Author:
Koldo Echebarria
Publication Date:
12-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
This paper presents an overview of significant policy, financial, and operational challenges encountered by multilateral development banks (MDBs) in fragile and conflict-affected situations (FCS). The data indicates that MDBs have increased their involvement in financing FCS compared to bilateral and other multilateral donors, with the World Bank playing the most significant role. This is explained by financial and operational comparative advantages inherent in the MDB business model, despite their implicit biases and constraints. The paper reviews the strategies and framework documents adopted by MDBs to address FCS as a distinct development challenge, highlighting the complexity of translating knowledge advancements and lessons learned into operational categories and clear priorities. It also examines how MDBs are placed regarding the recommendations of the "peace-humanitarian-development nexus," which is central to the international consensus for addressing FCS. The evolution of the financial capacities of MDBs and the criteria for resource allocation in response to the needs of FCS are analyzed. The paper concludes by posing a set of questions that MDBs and their shareholders should consider as they develop reforms to meet FCS-specific requirements and strengthen performance and outcomes.
Topic:
Development, World Bank, Banking, Multilateral Development Banks (MDBs), and Sustainable Development
Political Geography:
Global Focus

436. Childcare and Early Childhood Development Expenditures in Africa: Comparative Policy Insights for Advancing Women’s Economic Empowerment

Author:
Kelsey Harris, Kehinde Ajayi, and Astha Mainali
Publication Date:
12-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
This paper examines public expenditures on childcare and early childhood development in four African countries, providing comparative policy insights to advance gender equality and women's economic empowerment. It begins by addressing the methodological and data challenges involved in obtaining and analyzing public expenditure data in these critical areas. The analysis then focuses on Côte d'Ivoire, Kenya, Rwanda, and Senegal, examining government spending and national policies aimed at promoting accessible, affordable, and quality childcare. Findings indicate that these countries typically invest less than 0.2 percent of GDP and around 2 percent or less of their education budgets on pre-primary education, with less than 2 percent of foreign aid to education directed to early childhood education (with the recent exception of Côte d'Ivoire). These investment levels fall significantly short of international recommendations, though the precision of these figures is hindered by significant gaps and complexities in accessing and analyzing comprehensive expenditure data. The paper identifies key policies shaping public expenditures and explores the potential economic and social benefits of increasing childcare investments in these countries over time. The paper concludes with policy recommendations to enhance the transparency and accessibility of expenditure data, prioritize early childhood in public funding, and leverage international aid and policy frameworks to optimize childcare services in Africa. By doing so, these efforts can better facilitate gender equality, women’s economic empowerment, and economic development.
Topic:
Education, Economy, Childcare, and Gender Equality
Political Geography:
Africa

437. Education and Employment: Critical for Securing Peace for Gypsies in Iraq

Author:
Sarah Edgcumbe
Publication Date:
01-2024
Content Type:
Policy Brief
Institution:
Middle East Research Institute (MERI)
Abstract:
Gypsies have been living in both Iraq and the KRI for centuries, contributing to the country’s cultural diversity. Nonetheless, they have occupied a unique social positionality characterised by stigmatisation at all levels of society, including government institutions. Since 2003 in Mosul, and since 2008 in the KRI, there has been an evident reluctance on the part of both governments and NGOs to recognise, and respond to, the humanitarian, development, and protection needs of Gypsy populations. This has rendered Gypsies vulnerable during conflict, displacement, or state fragility. Stigmatisation has also marginalised Gypsy communities, excluding them from public services, support provision or peacebuilding initiatives. The widespread, insidious nature of anti-Gypsy racism and discrimination has enabled the Government of Iraq and the Kurdistan Regional Government (KRG) to neglect the needs of Gypsy communities in post-conflict Iraq without consequence. This policy paper and comparative analysis briefly examines experiences of conflict, displacement and post-conflict priorities, as narrated by Gypsy communities in Dohuk Municipality and Mosul. Foremost among these priorities are access to a safe environment, good healthcare, and quality education for their children – basic human rights that Gypsy children in neither location are currently able to enjoy adequately. This policy paper urges the Government of Iraq and the KRG to respond to the needs of their Gypsy populations – to facilitate intentional, considered, and long-term assistance and protection which will raise Gypsy communities out of a desperate cycle of poverty, and fully integrate them into society as equals.
Topic:
Education, Minorities, Employment, Peace, and Dom People
Political Geography:
Iraq and Middle East

438. Towards the end of AKP’s Hegemony in Turkey?

Author:
Hay Ertan Cohen Yanarocak
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Jerusalem Institute for Strategy and Security (JISS)
Abstract:
The Turkish opposition’s landslide victory in recent municipal elections indicate that with continued tacit Kurdish collaboration with the opposition and given the deteriorating economy and growing desire for change, the next general snap-elections may be far more challenging for President Erdoğan.
Topic:
Elections, Economy, Domestic Politics, Kurds, Recep Tayyip Erdoğan, and AKP
Political Geography:
Turkey and Middle East

439. Tehran’s Armenian weapons supply route

Author:
Alexander Grinberg
Publication Date:
02-2024
Content Type:
Policy Brief
Institution:
Jerusalem Institute for Strategy and Security (JISS)
Abstract:
Armenia is one of several routes used by Iran to smuggle arms to its regional proxies and clients. It also manufactures its own versions of Russian weapons that are used only by these groups and provides them with the knowledge to locally manufacture Iranian arms.
Topic:
Weapons, Proxy Groups, and Regional Security
Political Geography:
Iran, Middle East, and Armenia

440. Changes in the military deployment of the United States and their implications for Israel’s wars in the region

Author:
Eytan Gilboa
Publication Date:
01-2024
Content Type:
Policy Brief
Institution:
Jerusalem Institute for Strategy and Security (JISS)
Abstract:
At the start of the Gaza War, President Biden warned Iran and its proxies against launching an all-out attack on Israel and sent aircraft carriers to the region to clarify his intentions. The withdrawal of the Gerald R. Ford carrier from the Mediterranean could be interpreted as a sign of American weakness, diminish deterrence of Iran, and undermine US mediation efforts in Lebanon.
Topic:
Armed Forces, Military Affairs, Deterrence, Regional Security, and 2023 Gaza War
Political Geography:
Iran, Middle East, Israel, Palestine, Gaza, and United States of America