What does it take to deliver COVID-19 vaccines?

Ending the COVID-19 crisis hinges on all countries being able to vaccinate their people. A lot goes into getting ready.

13 April 2021
5 min read
by PATH

A health worker in Senegal pulls a vaccine vial out of a cold storage vaccine carrier. Ensuring that vaccines are kept at the right temperature is just one way that countries are preparing to immunize their populations against COVID-19. Photo: PATH.

For immunization to gain the upper hand on COVID-19, every country in the world must be able to vaccinate their populations quickly and equitably. This month, international collaboration is moving us closer to that goal, as the COVAX Facility – a global mechanism for distributing vaccines against COVID-19 – began sending doses to eligible low- and middle-income economies around the world.

Once a country receives doses, it must be ready to rapidly deploy the vaccine to priority populations. What does ready look like, and what will it take to get there? PATH is partnering with countries in Africa and Asia to help prepare for this moment, so we sat down with PATH Senegal senior technical advisor Dr. Cathy Ndiaye to learn more.

What has the COVID-19 experience been like in Senegal?

We had some time to prepare before COVID-19 arrived on our shores, so when it did come, our public health systems were ready. Initially, cases stayed low thanks to school and market closures, mask mandates, and curfews. Our government offered free diagnostic testing and same-day results, plus anyone who tested positive was required to quarantine – this all really helped control the spread.

But with the restrictions came hardship, especially for our large informal economy. For hair stylists, restaurant workers, and street sellers, who could no longer earn money, paying for food, basic necessities, and rent soon became more worrisome than getting COVID-19. Something had to give, so restrictions loosened.

Schools opened and people started attending naming ceremonies, weddings, and funerals. This allowed COVID-19 to finally solidify its grip. Cases spiked, hospitals filled up, and restrictions returned. It was a wake-up call, and it underscored the importance of vaccines to bring this relentless crisis cycle to an end.

How can a country prepare for vaccine delivery?

A big priority has been developing national COVID-19 vaccination plans – road maps for how health systems will get vaccines to the people they serve. In fact, delivery plans are required in order to receive donor-funded doses through Gavi’s COVAX Advance Market Commitment – the financing instrument supporting low- and middle-income countries. In Senegal, we’re rolling out COVID-19 vaccines obtained via COVAX as well as bilateral deals with manufacturers.

It was a wake-up call, and it underscored the importance of vaccines to bring this relentless crisis cycle to an end.

– Dr. Cathy Ndiaye, PATH senior technical advisor

These plans must detail which groups will be prioritized, when different groups will have access, and how people will access vaccinations, along with many other points. In Senegal, initial priority populations include health workers and people 60 years of age and older with comorbidities – aligning closely with the World Health Organization’s (WHO) allocation framework.

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Mapping out logistics is critical as well. We need an online platform for scheduling appointments, equipment for administering vaccinations, and cold chain storage, especially for remote areas. Other considerations include health worker training, education and awareness campaigns, strong safety protocols, systems for monitoring progress, and financing to make this all happen … the list goes on.

How is PATH helping?

PATH has decades of experience supporting and leading vaccine introductions, and I have supported human papillomavirus vaccine introduction in Senegal since 2014. When the time came to prepare for COVID-19 vaccine delivery, we had previous experience to inform our planning.

At the global level, PATH is supporting international efforts to finance and procure vaccines. We’re also assisting the COVAX Facility with program design and operationalization and advising on vaccine production capacity and scale-up. PATH staff, like myself, participate in WHO-led sub-regional committees, which are important for advising countries on introduction plans and strategies for overcoming gaps and challenges.

Working with national governments, PATH is a COVID-19 vaccine planning and/or response partner in Ethiopia, Ghana, Kenya, Senegal, Uganda, and other African countries. We’re also supporting COVID-19 vaccine trial site readiness in countries in Africa and Asia. PATH supports microplanning at the district and health facility levels in several countries, to ensure immunization services reach every community.

Beyond planning, PATH staff are supporting immunization implementation, including by helping train vaccinators, mobilize communities, and evaluate progress – among other things – in countries in Africa and Asia.

What does success look like – and what are the biggest obstacles?

Success will mean that countries achieve their vaccination coverage targets and interrupt community transmission enough to end the pandemic. However, it is a complicated process and a number of obstacles could stand in the way.

One major obstacle is information gaps, which can contribute to vaccine hesitancy. This is certainly a factor in Senegal and many other parts of Africa, and it must be addressed now. Community engagement through effective, consistent, and accurate communication is essential for addressing questions, correcting misinformation, and increasing vaccine confidence.

Success will mean that countries achieve their vaccination coverage targets and interrupt community transmission enough to end the pandemic.

– Dr. Cathy Ndiaye, PATH senior technical advisor

Another challenge is that COVID-19 has pulled staffing and resources from other public health problems that still need attention. In West Africa, for instance, cases of yellow fever and Ebola are starting to crop up again. Many routine immunization programs were already stretched thin prior to COVID-19. We can’t risk slowing or undoing progress during COVID-19.

The good news is we know how to introduce new vaccines – in Senegal and across Africa. The goal is to efficiently leverage existing vaccine distribution systems for COVID-19, while maintaining ongoing routine immunization programs.

But first, we need increased investment for more vaccine doses and more delivery support. COVAX needs more financing to continue securing and supplying vaccines to participating countries. Supply bottlenecks must be addressed to hasten access to allocated doses and reduce rollout delays. Government deals with vaccine manufacturers will also continue to play a role in advancing success. Gavi is working with COVAX partners, such as UNICEF and WHO, to support governments as they prepare for and execute COVID-19 vaccine roll out.

As our local campaign slogan goes, “vaccines are coming” to the continent, and with that, we will continue learning more and improving immunization processes.