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 semiconductor industry gives it a strategic advantage, but that advantage would be threatened as the US seeks to end Taiwan’s monopoly in the industry and as China grows more assertive, analysts said at a security dialogue last week. While the semiconductor industry is Taiwan’s “silicon shield,” its dominance has been seen by some in the US as “a monopoly,” South Korea’s Sungkyunkwan University academic Kwon Seok-joon said at an event held by the Center for Strategic and International Studies. In addition, Taiwan lacks sufficient energy sources and is vulnerable to natural disasters and geopolitical threats from China, he said.
After reading the article by Hideki Nagayama [English version on same page] published in the Liberty Times (sister newspaper of the Taipei Times) on Wednesday, I decided to write this article in hopes of ever so slightly easing my depression. In August, I visited the National Museum of Ethnology in Osaka, Japan, to attend a seminar. While there, I had the chance to look at the museum’s collections. I felt extreme annoyance at seeing that the museum had classified Taiwanese indigenous peoples as part of China’s ethnic minorities. I kept thinking about how I could make this known, but after returning
What value does the Chinese Nationalist Party (KMT) hold in Taiwan? One might say that it is to defend — or at the very least, maintain — truly “blue” qualities. To be truly “blue” — without impurities, rejecting any “red” influence — is to uphold the ideology consistent with that on which the Republic of China (ROC) was established. The KMT would likely not object to this notion. However, if the current generation of KMT political elites do not understand what it means to be “blue” — or even light blue — their knowledge and bravery are far too lacking
Taipei’s population is estimated to drop below 2.5 million by the end of this month — the only city among the nation’s six special municipalities that has more people moving out than moving in this year. A city that is classified as a special municipality can have three deputy mayors if it has a population of more than 2.5 million people, Article 55 of the Local Government Act (地方制度法) states. To counter the capital’s shrinking population, Taipei Mayor Chiang Wan-an (蔣萬安) held a cross-departmental population policy committee meeting on Wednesday last week to discuss possible solutions. According to Taipei City Government data, Taipei’s