There was a global sigh of relief when the WHO declared in May last year that COVID-19 was no longer a public-health emergency of international concern. However, there is no room for complacency. The COVID-19 pandemic has represented an urgent warning about weak health systems and has served as an impetus to strengthen them ahead of a possible new variant or the emergence of a new pathogen.
The challenges of vaccine delivery, in particular, offered insights into what makes a successful health campaign. Specifically, lower-income countries demonstrated how to reach people where they are by using innovative and tailored approaches that often required collaboration among national governments, local organizations and vulnerable communities. Their experience provides crucial lessons as the world prepares for the next pandemic.
Like their wealthier counterparts, lower-income countries had to vaccinate their adult populations against COVID-19 as quickly as possible. That meant reaching broader population groups than their existing childhood-vaccination programs could serve, while also targeting those in the greatest need: healthcare workers, immunocompromised people and the elderly.
However, lower-income countries faced unique challenges. Owing to vaccine nationalism and other obstacles, many of them only accessed consequential amounts of doses much later than high-income countries, delaying their immunization campaigns. A dearth of financial resources, together with the weaknesses of national health systems, also hindered vaccine uptake. For example, countries with limited cold-chain capacity often lacked the ultra-cold storage facilities required for certain COVID-19 vaccines. Many countries’ reporting systems could not provide decisionmakers with up-to-date, in-depth data to adjust rollout strategies based on what was working and what was not.
Despite these challenges, lower-income countries found ways to meet the needs of their communities. These initiatives included door-to-door outreach to vaccinate older people at home; female vaccination teams to encourage uptake by women; coordination between professional organizations and the private sector to reach people at the highest risk of getting very sick from COVID-19; mobile vaccination teams — on buses, motorbikes, camels, donkeys, and boats — to access remote or underserved areas; and vaccination sites in markets, along nomadic routes, and at major transit points, including bus stations.
Somalia is a good example of how to reach people where they are. The vaccine rollout occurred in the context of multiple overlapping challenges: years-long political instability and conflict, severe hunger caused by the worst drought in decades, and the displacement of several hundred thousand people by historic floods. However, the country’s polio vaccination program had pioneered the use of locally informed “micro-planning” to find unvaccinated people, and these tailored strategies ensured that Somalia’s nine mass COVID-19 vaccination campaigns reached underserved populations, such as women and nomadic communities. In September and October 2022, for example, a phased campaign led by the Somalian government reached 3.2 million people, achieving a 37 percent primary series vaccination rate. Equally important was Somalia’s investment in cold-chain infrastructure and vaccine-delivery logistics, made possible with financial support from partner organizations.
The Solomon Islands, the South Pacific’s third-largest archipelago, also struggled to vaccinate people living in remote areas, given that most of the country’s resources are concentrated on Guadalcanal, the largest island. Government health workers responded by creating pop-up and informal clinics on outer islands, making it easier for isolated communities to receive the vaccine and health services.
Meanwhile, in Sierra Leone, a country covered by grassland, savannah and dense forest, many villages can be reached only by bike or on foot — a journey made even harder during the rainy season. However, the country’s health workforce, together with community mobilizers, conducted mobile vaccination clinics in rural villages. Moreover, to address fears about the vaccine, local leaders took the jab and then promoted their vaccinated status within the community.
In Mali, access to information similarly posed a major challenge, as many people were not aware of the availability or effectiveness of the COVID-19 vaccine. To engage communities and raise awareness, trucks carrying entertainers and influencers alongside vaccinators traveled through busy markets to answer questions and encourage passers-by to get the shot; loud music and dancing created a buoyant atmosphere. Over the course of 12 days, the caravan reached more than 21,000 people and vaccinated more than 3,000 men, women and adolescents.
These innovative strategies can serve as models for the global community. However, they also highlight the importance of developing tailored immunization programs, which in turn require trust, clear communication, equitable access to vaccines, data-driven decisionmaking, and collaboration among governments, health organizations, grassroots groups and volunteers.
In the wake of the COVID-19 pandemic, we know that miraculous vaccines can be developed quickly and delivered to hard-to-reach communities. The key is to focus on meeting people where they are.
The-delivery.org is a digital time capsule developed by CEPI, Gavi, UNICEF and the WHO to ensure that official findings and stories of the COVID-19 vaccine rollout are safely stored and easily accessible for future generations. Benjamin Schreiber is senior manager at UNICEF Center for Health Emergency Strategy and Partnerships. Richard Mihigo is director of COVID-19 Vaccine Delivery, Coordination and Integration at Gavi, the Vaccine Alliance. Ann Lindstrand is head of the Essential Programme on Immunization Unit at the WHO.
Copyright: Project Syndicate
Taiwan’s victory in the World Baseball Softball Confederation Premier12 championship is an historic achievement. Yet once again this achievement is marred by the indignity of the imposed moniker “Chinese Taipei.” The absurdity is compounded by the fact that none of the players are even from Taipei, and some, such as Paiwan catcher Giljegiljaw Kungkuan, are not even ethnically Chinese. The issue garnered attention around the Paris Olympics, yet fell off the agenda as Olympic memories retreated. “Chinese Taipei” persists, and the baseball championship serves as a reminder that fighting “Chinese Taipei” must be a continuous campaign, not merely resurfacing around international
Taiwan Semiconductor Manufacturing Co (TSMC) appears to be encountering some culture shock and safety issues at its new fab in Arizona. On Nov. 7, Arizona state authorities cited TSMC for worker safety violations, fining the company US$16,131, after a man died in May. The Arizona Division of Occupational Safety and Health released its six-month investigation into the fatality and cited TSMC for failing to keep the workplace free from hazards likely to cause death or serious harm. At about the same time, the chip giant was also sued for alleged discriminatory hiring practices favoring Asians, prompting a flurry of debate on whether TSMC’s
This month, the National Health Insurance (NHI) is to implement a major policy change by eliminating the suspension-and-resumption mechanism for Taiwanese residing abroad. With more than 210,000 Taiwanese living overseas — many with greater financial means than those in Taiwan — this reform, catalyzed by a 2022 Constitutional Court ruling, underscores the importance of fairness, sustainability and shared responsibility in one of the world’s most admired public healthcare systems. Beyond legal obligations, expatriates have a compelling moral duty to contribute, recognizing their stake in a system that embodies the principle of health as a human right. The ruling declared the prior
US president-elect Donald Trump is inheriting from President Joe Biden a challenging situation for American policy in the Indo-Pacific region, with an expansionist China on the march and threatening to incorporate Taiwan, by force if necessary. US policy choices have become increasingly difficult, in part because Biden’s policy of engagement with China, including investing in personal diplomacy with President Xi Jinping (習近平), has not only yielded little but also allowed the Chinese military to gain a stronger footing in the South China Sea and the Taiwan Strait. In Xi’s Nov. 16 Lima meeting with a diminished Biden, the Chinese strongman signaled little
RSS