Abstract
The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccines.
Highlights
The development of multiple effective COVID-19 vaccines in less than a year is a remarkable achievement, but successful protection of populations globally will rely on the availability of vaccine doses and the campaigns countries run to immunise their populations
Barriers encountered in previous vaccination—including governments’ limited funds to buy vaccines, vaccine shortages, few trained service providers, suboptimal cold-chain systems, fear of adverse events, complacency, and rumours of vaccine inefficacy—remain issues for COVID-19 vaccination as low- and middle-income countries (LMICs) build on their Expanded Programme on Immunisation (EPI) to deliver COVID-19 vaccines
LMICs have learned a lot from EPI vaccination
Summary
The development of multiple effective COVID-19 vaccines in less than a year is a remarkable achievement, but successful protection of populations globally will rely on the availability of vaccine doses and the campaigns countries run to immunise their populations. “vaccines do not save lives; vaccination does.”. Several high-income countries (HICs) have made significant headway, with Israel leading the way, vaccinating 50% of its population by the end of February [1]. Many low- and middle-income countries (LMICs) are relying on support through the COVAX (COVID-19 Vaccines Global Access) Facility, which is led by the World Health Organisation (WHO), Gavi, and the Coalition for Epidemic Preparedness Innovations. COVAX has been utilising donor funds in its Advance Market Commitments as it aims to ensure equitable access to COVID-19 vaccines. Vaccination campaigns have begun in a few of these LMICs
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