Vaccination team member Baison Salone facilitates a vaccination clinic in Kafugumbah village, Karene district.Credit: Conor O'Donovan/Concern Worldwide
With pop-up clinics and dispatching vaccinators to remote locations on motorcycles and by boat, a new study showed that vaccination rates could be trebled in as little as three days in highly remote parts of Sierra Leone.
Although focused on bolstering uptake of COVID-19 vaccines, the authors are now investigating how their simple, cost-effective last-mile intervention can be expanded to deliver other priority vaccinations including routine immunisations for measles and polio, and vaccination against human papilloma virus (HPV).
“The largest expense was the transport cost of reaching remote communities; therefore, an obvious implication is that we should bundle COVID-19 vaccines with other necessary mother, infant and child health interventions that can be simultaneously delivered on the same trip,” says principal investigator Niccolo Meriggi, an applied microeconomist with a regional focus on sub-Saharan Africa.
Their model, he and his colleagues argue, is easily replicable across parts of Africa where vaccination rates are severely lagging among rural populations: “Access, among other approaches like communication, is crucial to achieving vaccine equity in developing countries, and will likely be relevant to new malaria vaccine rollout, and (of) other health products and services,” he adds.
Published in Nature, the study was conducted among residents of 150 rural towns outside of Sierra Leone’s national clinic network in 2022, one year into the COVID-19 vaccine rollout. The model not only proved to be 76% cheaper than the average cost of similar interventions, but also successfully trebled vaccination rates within just 48 to 72 hours.
“The vaccine doses and staff often travelled on motorbikes or on boats, given the difficult terrain they had to traverse to reach these remote communities,” the study reported, adding that vaccines were administered either during door-to-door visits, or at mobile vaccination sites that were open from sunrise to sunset. Engagements with community leaders, followed by bigger community meetings, proved critical.
Sierra Leone reached the World Health Organization (WHO) global target of vaccinating 70% of its adult population against COVID-19 in December 2022, with the organisation confirming in a website article that accessing people in remote villages had been the biggest challenge, especially during the rainy season.
Thanks to significant financial grants from organisations in the United States and the United Kingdom, the researchers are now working with Sierra Leone’s Ministry of Health to further explore the feasibility and cost-effectiveness of their model. The first bundle of services and health products for delivery include the COVID-19 vaccine, the HPV vaccine for girls aged 10 to 12, and routine immunisations for children younger than six.
The authors stressed that their study moved beyond the current research focus which focused largely on individual behavioural challenges, such as hesitancy. “Our study demonstrates that prioritising mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services,” they say.
