Maldives: Responsive COVID-19 Vaccination for Recovery Project under the Asia Pacific Vaccine Access Facility

Health / Disease control of communicable disease

The project will provide Maldives with needed financing to sustain and upgrade its national coronavirus disease (COVID-19) vaccination program, within its overall expanded program of immunization (EPI), through the project investment component (PIC) modality of the Asia Pacific Vaccine Access Facility (APVAX) of the Asian Development Bank (ADB). The PIC grant will support investments for the storage, distribution, delivery, and administration of COVID-19 vaccines, along with related investments in capacity building, which will help ensure the success of the government's COVID-19 vaccine booster program.

The project is aligned with five of the operational priorities of ADB's Strategy 2030: (i) addressing remaining poverty and reducing inequalities; (ii) accelerating progress in gender equality; (iii) tackling climate change, building climate and disaster resilience, and enhancing environmental sustainability; (iv) strengthening governance and institutional capacity; and (v) fostering regional cooperation and integration. It is consistent with ADB's country partnership strategy, 2020-2024 for Maldives, which prioritizes the strengthening of Maldives' health system.

The Pandemic. The first confirmed COVID-19 case in Maldives was recorded on 7 March 2020 while the first local transmission was confirmed on 15 April 2020. Since then, the country has experienced several waves of COVID-19. The latest and the biggest wave thus far was attributable to the Omicron variant, and occurred from December 2021 to March 2022, increasing the recorded confirmed cases to 179,979, with 299 deaths as of 15 June 2022.

Costs to the economy. Maldives' real gross domestic product (GDP) contracted by 33% in the first 9 months of 2020 and by 28% in 2020. Tourism contracted significantly immediately following the COVID-19 pandemic, with only around 555,000 tourists visiting Maldives in 2020, 67% lower than the 2019 record high of 1.7 million tourists. The construction and civil works activities also decreased drastically. This was mainly due to illness among workers and the breakdown in the supply chain and logistics systems. Maldives reopened borders to all travelers from all countries on 15 July 2020. In 2021, tourist arrivals rebounded strongly to 1.3 million, or 76% of the 2019 level, because increased vaccination rates both globally and domestically made it possible to ease travel restrictions. Although the tourism sector is reviving, it remains below pre-pandemic levels, and the risk that the recovery could be compromised due to the emergence of future new COVID-19 variants remains.

Impact on poor and vulnerable groups. The COVID-19 pandemic, and containment measures undertaken by the government to curtail it, considerably affected the economic and health status of the poorer and more vulnerable persons in Maldives. The pandemic had a major impact on the general population's ability to meet financial obligations. Around 90% of business owners, people working in tourism and food-related employment reported being extremely or very affected by the pandemic or having lost all their income, and with nearly 50% having lost employment. People with disabilities could not avail essential health services as home visit services were suspended. The populations in the outer atolls and islands were particularly affected due to the challenges of providing quality health care and other services in a geographically dispersed territory.

Impact on women. The Ministry of Economic Development estimated that around 12% of women in the workforce lost their jobs. The National Job Center data showed that unemployment and complete loss of income was higher for women than men. Additionally, women continue to be more vulnerable to the ongoing COVID-19 waves, as approximately 44% of women (compared to 36% of men) are in the informal sector with no job security. 32% of women are also likely to earn less than their partners and 21% of women even have no earnings at all. Unpaid care work has also increased for women since the onset of the pandemic, particularly for female single parents. Restrictions in mobility constrained women's access to essential health care services needs such as surgery, maternal care, and contraceptives and obstetrics care. Around 68% of women reported mental and emotional health deterioration as they faced economic strains and gender-based violence increased during the pandemic.

Impact on the health system. The direct impact of COVID-19 in Maldives has been substantial with more than 30% of the population requiring COVID-19 care during the period March 2020 to May 2022. As Maldives' health system is dispersed across many islands across a large sea area and with the high density of the population living in the Greater Male' area, the health system was stretched to meet the demands of increased testing for COVID-19 and in providing care to the affected. As approximately 50% of doctors and nurses are expatriate staff, the government was also faced with human resource constraints when managing the increased COVID-19 cases burden.

Resilience and responsiveness of health systems to COVID-19 enhanced, and uninterrupted supply of quality COVID-19-related vaccines ensured.

The deployment of COVID-19 vaccines and other vaccines under the Expanded Program on Immunization (EPI) effectively managed

Capacity of vaccine storage and transport system increased

Information management of the Expanded Program on Immunization strengthened for COVID-19 vaccination and

routine immunization

Human resource capacity of the Expanded Program on Immunization enhanced.