Accelerating vaccine rollouts to reach everyone

The inequities of global health have been starkly highlighted by unequal access to Covid-19 vaccines. In May, it was reported that 80% of the world’s vaccines have gone to high income countries leaving only 0.3% for low income countries. As the push continues to ensure equitable vaccine supply, the biggest challenge is reaching communities in low- and middle-income countries (LMICs) quickly.

Many LMIC populations live in remote rural regions far from health providers, with poor internet connectivity and where there is a lot of misinformation about health. This hinders the deployment of vaccination programmes.

In India’s rural districts, for example, many people aren’t aware of the government’s online vaccination registration system or are sceptical about vaccines. In the Philippines, health workers in rural areas have described to reach52 the arduous process of calling round to individually enrol rural residents by phone before manually entering their details in the government’s Vaccine Information Management System (VIMS). Tracking is also predominantly paper-based.

This rollout process is simply too slow and inefficient, and countries have had to destroy thousands of out-of-date vaccines as a result. Here are 3 ways public-private partnerships could accelerate Covid-19 vaccination rollouts in low-connectivity regions.

1. Establish digital vaccine systems for rural regions

Co-ordinating vaccine rollouts in LMICs requires a complex series of activities, involving multiple stakeholders. In our experience, one of the most difficult stages is between regional distribution hubs and last-mile delivery (that is, getting the vaccine from the final destination hub to the patient). Administration and monitoring can also be difficult in rural regions.

Digital vaccine systems (and the data driving them) can enable much faster, targeted vaccination rollouts in rural populations, but must be designed for these low-resource settings. This requires new ways of thinking about transportation and distribution, power sources and internet connectivity - or lack thereof.

To remain potent, current Covid-19 vaccines require regular refrigeration at least, if not a specialist cold-chain system to maintain temperatures for the entire vaccine transportation and storage process. Partnerships aiming to strengthen and extend cold-chain infrastructure are already happening in parts of Asia, but this requires time and investment.

Instead, tailoring the vaccine rollout to the setting can limit vaccine wastage. For example, the Rwanda government allocates vaccine types depending on local resources. Pfizer vaccines, which must be stored at lower temperatures, are supplied to urban areas with ultra-cold freezers. Since AstraZeneca vaccines only require normal refrigeration, these doses are sent to hard-to-reach rural regions.

In regions where electricity supply is unreliable, new power sources also need to be part of the solution. That’s why organisations including Unicef and public-private global health partnership Gavi are procuring solar refrigerators for last-mile vaccine delivery.

With 3.7 billion people in the world still lacking internet access, ‘offline-first’ tech platforms for enrolment, registration and monitoring are also essential. These apps are built with the potential for intermittent internet connectivity in mind. In partnership with the Asian Development Bank, reach52 has built a vaccine solution to help health workers manage rural vaccinations on an offline-first app. Patients receive mobile texts or Instant Messages with a unique ID, dosage details and booking reminders. Health workers can also track stocks and adverse event reporting through the platform.

2. Use community health workers to beat vaccine hesitancy

There can be a lot of vaccine hesitancy in communities where there is a lack of information and false rumours about vaccinations. Residents in rural parts of the Philippines, for example, expressed fears to our teams in June 2021 that the vaccine would actually give them COVID-19.

Community health workers are trusted members of these communities and need to be fully mobilized to address this type of false vaccine information. They should be placed front and centre of vaccine drives, and equipped to listen and explain through dialogue. Vaccinating community health workers is important too, for safety reasons of course, but also to build trust in the vaccine.

3. Deploy data to strengthen vaccination programmes

Data is the fuel for effective vaccine delivery systems. It enables local authorities to target priority groups, track and forecast supply, monitor adverse events, and rapidly address issues. Data and infrastructure are often not available in communities where paper-based systems are prevalent, however.

Rural population data needs to be rapidly collated and structured to support targeted vaccine rollouts. This could be done by engaging with community leaders to collect existing data. Community health workers (equipped with PPE) could also go door-to-door to collect basic demographic and health information using offline-first mobile applications.

Health data infrastructure, reporting and real-time tracking of supply chains also needs to be rapidly established. The technology is already available: non-profit Nexleaf Analytics has developed ColdTrace sensors to provide real-time data on the temperature and power of cold-chain systems for use by health professionals. Its Planning and Adapting for Vaccination Emergencies (PAVE) process can help governments use existing data to quickly establish a cold chain for emergency vaccine storage and distribution.

We know this global pandemic can only be stopped by a global vaccine. We know no one is safe until everyone is safe. To ensure COVID-19 vaccines reach everyone, the public and private sectors must work together to rapidly build and deploy vaccination solutions that work everywhere.