New case studies from the U.S. Agency for International Development (USAID) show recent targeted efforts to accelerate COVID-19 vaccinations in sub-Saharan Africa are making significant progress. In Côte d'Ivoire, Uganda, and Zambia, United States support contributed to a steady rise in vaccinations–with the most notable increase in Uganda, which in just 6 weeks experienced a 33 percent increase in first-dose shots among the eligible population.
The case studies detail several efforts to increase vaccinations in countries, including targeted interventions under the Initiative for Global Vaccine Access, or Global VAX, an initiative that encompasses the U.S. Government’s work in more than 100 countries to increase access to COVID-19 vaccines. Even as U.S.-donated vaccine supplies continue to increase to meet demand, many countries face significant challenges in turning vaccines in vials into shots in arms. Some don’t have enough ultra-cold chain freezers to stop doses from spoiling, others have large rural populations living miles from the nearest health facilities, and many struggle to combat widespread misinformation and increase vaccine confidence.
USAID is working to address the specific needs of these communities, coordinating in lockstep with local governments, nonprofits and health care partners, and investing resources to accelerate vaccinations. Here are some of the results:
Côte d’Ivoire: Fighting COVID-19 misinformation and increasing vaccine access drives first-dose rates from 22 percent to 36 percent in December
Facing low national vaccination rates–around 22 percent–the government of Côte d’Ivoire set an ambitious goal to administer 2.5 million vaccinations over one month in December 2021. Recognizing that vaccine hesitancy was a major barrier to uptake, the U.S. Government and other partners have focused efforts on education campaigns and fighting misinformation. Since March 2020, USAID’s Breakthrough ACTION project has been collecting, analyzing, and addressing harmful COVID-19 rumors in real time through a Rumor-tracking Management System (RMS). The U.S. and other partners also supported a December vaccination campaign led by Côte d’Ivoire’s government that used targeted national radio messaging to dispel COVID-19 rumors and misinformation and educate residents about the benefits of getting vaccinated. By the end of the month, the government had reached 93 percent of its goal–and more than 2 million Ivoirians had received at least one dose. That bumped the national first-dose vaccination rate from 22 percent to 36 percent among the eligible population, compared to the average 14 percent across the African continent.
Uganda: Eight million vaccine doses accelerate vaccination coverage from 14 percent to 47 percent in just six weeks
Though Uganda received its first historic arrival of COVID-19 vaccine doses in March 2021, shortages in supplies and overwhelmed health systems meant the country fell behind in vaccinations. By November 2021, only 14 percent of Uganda’s population of 44 million had received their first dose.
The U.S. Government worked with the Government of Uganda closely to prepare the country to receive several large vaccine shipments in the fall–including eight million Pfizer doses donated by the U.S. Government in partnership with COVAX. The influx of vaccines, coupled with the support to help with distribution efforts, increased the percentage of eligible Ugandans that had received at least their first dose of COVID-19 vaccine from 14 percent to 47 percent in just six weeks.
The U.S. Government–including USAID and the CDC– supported the Government of Uganda to develop a comprehensive “Accelerated Mass Vaccination Campaign” that allowed the country to quickly pivot to open access to vaccines to all adults–while still focusing on high-risk populations. USAID supported critical project management to help logistics and community mobilization get vaccines to communities as quickly as possible. The U.S. Government also set up a new management team that included USAID and the CDC to track data across the country using a critical tool developed by the World Health Organization to capture data needed to track vaccine roll-out. By working together and training local workers to monitor the systems, Uganda’s government can now track and respond to gaps in their vaccination coverage. Now, five of nine regions in the country have exceeded 55 percent coverage for at least one dose of vaccine–just within that six weeks period.
Zambia: Leveraging existing health care and vaccine programs nearly doubles COVID-19 vaccination rates in densely populated region
As Zambia experienced its third wave of COVID-19 cases and began to anticipate a fourth wave last fall, the President of the Republic of Zambia requested support from the U.S. Government to expand and accelerate vaccination efforts across the country. In response, the Government of Zambia, in partnership with USAID and the CDC, kicked off a national COVID-19 vaccination campaign on World AIDS Day, December 1, 2021. This launch leveraged the World AIDS Day slogan of “Ending Inequalities. Ending AIDS. Ending Pandemics” and added a second focus with the theme: “Fight COVID-19! Take the Vaccine! Protect Zambia: Two Million Doses in Arms By Christmas.” By pairing these two events and messages, more Zambians were reached than ever before.
To get shots into arms, USAID engaged local leaders and prioritized delivering COVID-19 vaccines and messages directly to places where people gather–such as markets, stadiums, bus-stations, schools, universities, places of worship, businesses–and provided door-to-door vaccination services to reach eligible people in their homes. In addition, the campaign used local media and national and community radio programs in local languages to deliver key messages directly to people, reaching population groups that might not have been contacted otherwise.
This joint campaign achieved exceptional results, especially in the Copperbelt Province, Zambia’s second most populated region, where USAID supported vaccination efforts alongside Zambia’s Ministry of Health. The percentage of the eligible population fully vaccinated in the province nearly doubled, with rates jumping from 12 to 22 percent in just one month, the most striking increase since COVID-19 vaccines first arrived in-country.
Strategic efforts in Zambia have relied on leveraging support from existing successful health systems and building on that infrastructure. For example, USAID has been able to work with partners including the United States President's Emergency Plan for AIDS Relief (PEPFAR), the CDC and Zambia’s Ministry of Health to integrate COVID-19 vaccinations into existing HIV treatment centers. By building on previous public health successes and long-standing U.S. support in Zambia, USAID has helped expand vaccine access to vulnerable groups, including people living with HIV.
Background on Global VAX:
Global VAX is a whole-of-government effort to get COVID-19 shots into arms around the world by strengthening international coordination and rapidly overcoming barriers to vaccine access. It builds upon President Biden’s commitment to share more than 1.2 billion vaccine doses with more than 100 countries by the end of 2022. To date, the U.S. has already committed $1.7 billion to support vaccine readiness work.
USAID worked in partnership with the Centers for Disease Control and Prevention, the State Department–including the Office of the Global AIDS Coordinator–Department of Defense, Department of Health and Human Services, Peace Corps, the U.S. International Development Finance Corporation, Department of Treasury and other interagency partners to leverage a range of existing global health programs and resources. The effort, officially launched in December, will also include a surge of financial, technical, and diplomatic engagement in an initial group of countries that have both significant need and significant potential for rapid vaccination progress.