At a recent Wilson Center event, hosted in partnership with USAID’s MOMENTUM Routine Immunization Transformation and Equity Project, Dr. Folake Olayinka, Immunization Technical Lead of the Global Health Bureau at USAID, described a recent two year period as “the largest sustained backsliding of childhood vaccination,” citing the fact that “between 2019 and 2021, approximately 67 million children missed out on essential lifesaving vaccines.”

The recent event—Advancing Local Solutions and Innovations for Lasting Impact: Applying Strategies from COVID-19 Vaccination to Routine Immunization—provided an opportunity for participants to share successful strategies for achieving high equitable COVID-19 vaccination coverage, particularly for hard-to-reach priority populations, with a focus on their application to routine immunization. “As we brought our attention back to routine immunization this year, we realized that so much of what is needed for immunization is exactly what we did for COVID-19 vaccination,” said Grace Chee, Project Director of MOMENTUM Routine Immunization Transformation and Equity Project.

The introduction of new vaccines in early 2021 also brought about several new uncertainties. The use of novel technologies and specific cold chain requirements, coupled with limited global vaccine supply, posed significant challenges. The complex landscape of multiple vaccines, new variants, evolving evidence, and changing health recommendations also made public communication difficult. The result was a decrease in both vaccine demand and confidence in various regions, which was accompanied by a surge in rumors and misconceptions.

“Successful vaccination not only entails managing logistics of vaccine delivery, but also building widespread trust in vaccination, including among the health personnel prioritized for vaccination and tasked with providing the service,” said Dr. Olayinka. 

The MOMENTUM Routine Immunization Transformation and Equity Project brings a unique perspective to these questions. It works in 18 countries to enhance vaccination programs, address emerging challenges, and prepare them for COVID-19 vaccine introduction. The project focuses on identifying priority populations, designing effective service delivery strategies, and leveraging expertise in areas like microplanning, healthcare staff training, demand generation, communication, community partnerships, and supply chain strengthening.

Best practices and innovative approaches

In early 2022, the Imo state in Nigeria had less than 6% COVID-19 vaccination coverage, ranking third to last nationally. Despite strong political will, insufficient partner support was one of the key reasons. So, initiation of the MOMENTUM Routine Immunization Transformation and Equity Project in Imo strengthened the strategic coordination forum in the state, which enabled regular stakeholder meetings and facilitated awareness campaigns across media platforms. The expansion of mobile teams also proved instrumental in ensuring comprehensive coverage.

“For hard-to-reach areas and security compromised areas, we employed vaccinating teams and monitors from those areas because they know the terrain,” said Dr. Maria Joannes Uzoma, Executive Secretary of Imo State Primary Health Care Development Agency in Nigeria.

These vaccination outreach efforts in Imo were also supplemented by providing routine drugs, including over-the-counter and antimalarial medications. Within a mere five months of the project’s initiation, Imo state witnessed a remarkable surge in vaccination coverage, soaring to an impressive 70% coverage, observed Dr. Uzoma.

Reliable data forms the basis for informed decision making by healthcare professionals and policymakers. But in the Democratic Republic of the Congo (DRC), creating a new data system for COVID-19 vaccines posed challenges in terms of technology access and training.

“As more people were getting vaccinated, it was becoming clearer that it was really difficult for health workers to keep up with the number of people’s data they needed to enter,” said Constant Kingongo, Monitoring and Evaluation Lead of the MOMENTUM Routine Immunization Transformation and Equity Project in the DRC. So instead of proposing a “band-aid solution”, the Project used the pandemic as an opportunity to strengthen the DRC’s overall digital health system by reverting to the system used for routine immunization.

Health workers in Kinshasa found it easier to enter data into the familiar routine immunization system, reducing their workload and improving data completeness, said Kingongo. He added that “New technologies should be adapted to each country’s reality. Make sure the solution fits the context, is designed around end user needs, and builds on existing systems and skills.”

In Nigeria, new initiatives included mapping through the use of Geographic Information Systems (GIS) to create a microplan and identify hard to reach communities. “COVID-19 resources were available for us to go beyond the cardboard paper mapping to identify settlements, taking their geocoordinates, assessing the distance between the serving health facility and the settlements, and identifying natural barriers and obstacles,” said Dr. Joel Yakubu Cherima, Nigeria Country Lead, MOMENTUM Routine Immunization Transformation and Equity Project at JSI.

Reaching priority groups for vaccination

When COVID-19 vaccination was rolled out in Karnataka, India, the state achieved high vaccine coverage rates of nearly 92% for the first dose and 87% for the second dose. Yet Dr. Rajani B.N, Deputy Director and State Immunization Officer of the Karnataka government noted that the persistent challenge in this region is covering the last mile to bring vaccinations to particularly vulnerable and traditionally unreached populations, such as tribal people, migrant laborers, and the elderly. She added that in collaboration with local NGOs already well-rooted in these communities, the state devised culturally tailored strategies and mapping of vulnerable populations to improve the reach to and uptake of vaccinations in these areas.

In Kenya, the Project partnered with the Aging Concern Foundation (ACF), a community organization that advocates for the welfare of elderly people, said Dr. Isaac Mugoya, Kenya Country Lead of MOMENTUM Routine Immunization Transformation and Equity Project at JSI. Since elderly people in Kenya are supported by the government through a monthly welfare stipend, Dr. Mugoya described an initiative to facilitate the vaccination of this demographic in which ACF successfully collaborated with local banks to provide a tent where elderly individuals could collect their stipends and also get vaccinated.

“The vaccine has been characterized by a narrative that shows distrust in relation to the safety and efficacy of [COVID-19] vaccines,” said Dr. Betuel Sigauque, Mozambique Country Lead of the MOMENTUM Routine Immunization Transformation and Equity Project at JSI. To address the issue comprehensively, the Project utilized social mobilization initiatives and engaged leaders at community and national levels. By combining strategic messaging with support from influential figures, the project aimed to build trust and convey the importance of COVID-19 vaccination in a manner that resonated with diverse communities.

In India, similar efforts identified faith-based leaders who could disseminate correct messaging about COVID-19 vaccination and combat the spread of misinformation among religious communities, said Dr. Gopal Krishna Soni, India Country Lead of the MOMENTUM Routine Immunization Transformation and Equity Project at JSI.

In Ethiopia, the MOMENTUM Routine Immunization Transformation and Equity Project worked with the Ministry of Health in Addis Ababa City Health Bureau to integrate COVID-19 vaccination with a mass measles vaccination campaign. “In one of the vaccination sites, we helped the vaccination team to rearrange the service station so that the COVID-19 information and vaccination was stationed in the middle of the vaccination post,” said Tewodros Alemayehu, Ethiopia Immunization Project Director of the MOMENTUM Routine Immunization Transformation and Equity Project at JSI. “This rearrangement helped each vaccination team to provide clear information to every client on COVID-19 vaccination.”

New programs and initiatives from the COVID-19 era – especially those that build on existing best practices – will play a pivotal role in helping navigate a growing vaccination crisis. Nida Parks, COVID-19 Response Coordinator of Global Health Bureau at USAID, noted that not only can these innovations “support our primary health care systems now,” but that they might also prepare global health systems for the next major crisis.

Written by Rhea Kartha, edited by Richard Byrne.