Home Medizin Auswirkungen der intensiven Lieferinitiative

Auswirkungen der intensiven Lieferinitiative

von NFI Redaktion

The response to the 2019 Coronavirus Pandemic (COVID-19) saw several vaccines developed and brought to market at an unprecedented pace, but access and cost issues limited vaccine delivery in many developing countries.

A new study in the journal Nature reports on the success of the Sierra Leone COVID-19 vaccination program, which is based on a simple, cost-effective, and scalable intervention that improves vaccine access.

Study: Last-mile delivery increases vaccine uptake in Sierra Leone. Image source: Media Lens King / Shutterstock.com

Inequality in COVID-19 Vaccination

COVID-19 vaccines were first introduced in December 2020, but by March 2022, only 15% of the population in low-income countries (LICs) had received at least one dose, compared to 80% in high-income countries (HICs).

The risks associated with low vaccination rates include the potential for new spikes and subsequent lockdowns, unemployment, income loss, food insecurity, and the emergence of dangerous new variants and subvariants.

By March 2022, only a third of the African population had received a single dose of the COVID-19 vaccine. Previous studies in Sierra Leone showed that, on average, a person had to travel seven hours to access a vaccine dose, with the cost of accessing the vaccine equivalent to a week’s wages.

The Intervention

In collaboration with the Sierra Leone Ministry of Health and Sanitation (MoHS) and the international non-governmental organization (NGO) Concern Worldwide, the authors of the current study designed and implemented an intervention aimed at distributing vaccines to remote villages. The first step involved obtaining permission from the local community, followed by efforts to mobilize the community for the vaccination initiative.

The current intervention was a randomized controlled trial (RCT) in rural Sierra Leone involving 150 villages. All of these villages were located outside the five-kilometer radius of primary health units (PHUs) offering COVID-19 vaccines in the region. Of these, 100 villages were included in the intervention, and 50 served as control villages.

The villages were small, with about 200 people per village, totaling just over 20,000 participants. The average age of these individuals was 22 years, with approximately 75% of households led by men. Agriculture was the main occupation of the household head in 86% of cases.

The first day of the intervention involved community mobilization with all village elders, political, youth, and religious leaders, along with health ministry volunteers. That evening, a community meeting was held to educate people about the vaccine, its safety, efficacy, and importance, and to address any questions.

The following day was dedicated to setting up the temporary vaccination site with vaccine deliverers, health ministry staff for data collection, and dispensing vaccine doses. For the next two to three days, from sunrise to sunset, vaccines were available, and community mobilization continued. Individual, door-to-door, small group, or randomly selected houses were some of the outreach strategies tested.

The Results

The daily vaccination rate increased from nine to 55 people within two to three days, with a 26 percentage point increase in vaccination rates. The initiative attracted numerous people from surrounding areas and passersby, resulting in approximately 5,000 people getting vaccinated.

Initially, the average vaccination rate in the control and treatment villages was 6% and 9%, respectively. After the intervention, the treatment villages reported a vaccination rate of 30%, which rose to over 70% by December 2022, with nearly eight million doses administered by March 2023.

Approximately 65% of those who attended the meetings received the vaccine, compared to 40% of non-participants. Conversely, about 53% of participants who were initially hesitant to get vaccinated did so after attending the meetings, compared to only 14% of non-participants.

The cost per administered vaccine dose was approximately $33. If repeated with the same trained volunteers, these costs would reduce to about $23 per person, facilitating large-scale or nationwide efforts.

Compared to over 200 similar interventions offered in the context of 144 RCTs, including financial and other incentives, social motivation, and community engagement, the intervention discussed in the current study achieved a more significant effect size than 95% of others at lower costs.

These results suggest that low vaccination rates are linked to lack of access and that a cost-effective intervention can address this deficiency.

Implications for the Future

The approach used in the current study could have significant public health impacts globally by promoting immunization delivery programs to remote communities when individuals cannot reach vaccine delivery centers. In Bangladesh, similar efforts increased infant vaccination rates from 1% in the early 1980s to over 70% in the 1990s.

By bundling measures to improve maternal and child health, healthcare costs could also be reduced, as transportation to remote locations accounted for a significant portion of associated costs. Therefore, providing access to remote areas in LICs is crucial for promoting vaccination of the first 50% of the population.

Prominent behavioral scientists have recently acknowledged our excessive focus on individual behavior peculiarities („i-frame“) at the expense of systemic solutions („s-frame“).

The current study demonstrates the remarkable efficiency and cost-effectiveness of a community-based vaccination intervention that benefited the local community as well as neighboring and migrant populations. Future applications of the approach used in this study have the potential to improve vaccine uptake rates and ensure near-universal coverage, ultimately enhancing vaccine equity.

Journal Reference:

  • Meriggi, NF, Voors, M., Levine, M. et al. (2024). Last-mile delivery increases vaccine uptake in Sierra Leone. Nature. doi:10.1038/s41586-024-07158-w.

Related Posts

Adblock Detected

Please support us by disabling your AdBlocker extension from your browsers for our website.