* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
I have managed immunization programs in the hardest-to-reach areas including displacement camps. We are in uncharted territory but a lot can be learned from previous efforts
By Mesfin Teklu Tessema, Senior Director of Health at the International Rescue Committee (IRC).
Within the last few weeks, the first delivery of COVID-19 vaccines provided by COVAX -- the mechanism set up to drive equitable access to the vaccine – arrived in low and lower-middle income countries including Kenya, the DRC, Colombia, the Ivory Coast and Nigeria, with more actively on their way to other countries every day.
The fact that we have several effective vaccines only one year into the pandemic is astounding. Yet, the scale of this crisis and the task of vaccinating nearly 8 billion people at the same time is unprecedented and demands urgent action.
Never before have we tried to vaccinate an entire global population at the same time. We aren’t just talking about the need to manufacture 15 billion doses – recognizing most of the current vaccines require two doses -- but consider the syringes, the glass vials to hold the vaccines, the pallet shipments, and the refrigerators. Science has gotten us a very long way, but vaccines don’t deliver themselves.
Even in the wealthiest countries with the strongest health systems we are seeing huge challenges from production and distribution to vaccine hesitancy. Now, as low-income countries begin receiving their first doses, the global community faces increased challenges. If the pressure wasn’t high enough, the emergence of new and more transmissible strains of the virus is increasing urgency and putting the world at more risk.
In my more than two decades of experience in humanitarian work, including my current role as the head of the health unit for the International Rescue Committee (IRC), I have helped plan and manage routine immunization programs in the hardest-to-reach areas and executed mass vaccination campaigns to tackle infectious disease outbreaks like measles and cholera, which often plague overcrowded displacement camps. While we are now in uncharted territory, a lot can be learned from previous vaccine efforts to strengthen COVID-19 vaccine distribution in every country – including those affected by conflict.
Plan for vaccine storage and distribution: Vaccines require the financial resources to ensure doses actually reach people, regardless of where they live. For any vaccine campaign, this means hiring additional health workers and investing in local transportation to deliver vaccines to rural areas. It also means expanding cold chain equipment – like refrigeration and cold boxes – to ensure doses are properly stored and transported. Recognizing it will be difficult for low-income countries to fund distribution –especially given the economic impact of the pandemic – the COVAX Facility now estimates at least USD 2 billion is needed to deliver vaccines to just the first 20% of people living across the 92 low- and lower-middle income countries they’re working with.
Invest in frontline and community health workers (CHWs): Vaccination efforts in crisis-affected contexts often rely on overstretched health workers to inoculate people both at health facilities as well as in more remote and underserved areas. CHWs – a cadre of dedicated individuals providing a critical link between communities and the public health system -- are increasingly being tapped to support these providers. When a measles outbreak struck the Hagadera refugee camp in Kenya in 2009, CHWs were trained to go house-to-house to identity cases and provide information about the disease and treatment, and to refer people to vaccination sites. As part of COVID-19 vaccine efforts, frontline health workers – including CHWs – need to be supported with adequate training, supervision, and protective supplies to safely deliver vaccines to the last mile.
Don’t underestimate the importance of community engagement: During the Ebola outbreak, communities were largely kept in the dark with minimal access to information about the disease. Coupled with existing mistrust of the government and institutions, misinformation was rampant and allowed the disease to spread further. Effective and localized community engagement strategies can ensure demand meets supply. This includes mobilizing local champions – religious leaders, elders, and trusted individuals -- as key voices to dispel misinformation; hosting outreach sessions at convenient locations like churches and markets; and using local media to share health messages.
Leverage digital tools: Digital tools can support the planning, delivery, and monitoring of vaccine programs, especially for people living far from facilities. In Uganda and Somalia, mReach – a mobile platform – has been helpful to health workers monitoring and following up with children that missed one or more of their routine vaccinations. Introducing geo-coding and maps made it even easier to track and trace people when due for inoculation. Tools like this can be utilized for COVID-19 vaccine distribution, particularly for people receiving two doses.
Coordinate across borders: With porous borders in many countries, it’s important that national governments develop vaccine plans that include cross-border strategies and are inclusive of refugees, migrants, and other displaced populations – regardless of documentation. Polio campaigns in East Africa, have shown that coordinating with cross-border actors is critical for surveillance, information and resource sharing, joint planning, and tracking cases.
There is no one-size-fits-all approach to ending this pandemic, but these strategies can help provide a pathway to more equitable vaccine access, including within the most hard-to-reach areas. Alongside this, the international community must continue to apply pressure on high-income countries and pharmaceutical companies to provide funding and share excess doses of the vaccines with the COVAX Facility. No one is safe until everyone is safe.