Contributed by Stephanie Palmer, Act | West Program Trachoma Lead, FHI 360
Friday, December 11, 2020, is one of those dates that I’m not likely to forget anytime soon. That was when the Pfizer-BioNTech COVID-19 vaccine was authorized. It was the first time I’d felt hope in nearly a year. My mother, who is nearly 80, has a number of risk factors that make her more susceptible to severe illness from COVID-19, and she lives in a senior apartment complex where COVID-19 cases and deaths had been reported, over 1,000 miles away. With the announcement of the new COVID-19 vaccines, I finally felt that my mother might make it through the SARs-CoV-2 pandemic, unlike one of her brothers, who passed away from complications due to COVID-19 just a couple of weeks before the announcement.
National vaccination campaigns have seen regional and other disparities in coverage, however, due to misinformation (among other reasons), even in countries considered to have had successful rollouts. Observing countries’ vaccine rollout efforts, especially their strategies to inform the public and earn the public’s trust, has been both fascinating and frustrating.
In my job, I work on a USAID-funded program called Act to End Neglected Tropical Diseases (NTDs) | West that helps 11 countries in West Africa to control and eliminate neglected tropical diseases (NTDs) through a strategy known as mass drug administration (MDA). Although the medicines distributed through MDA are mainly tablets, not injections that require a cold chain, the challenges aren’t all that different: community-wide distribution of medicine—or several medicines, in the case of NTDs—to large numbers of people as the primary intervention.
Reflecting on the similarities got me thinking about how some of the lessons learned from MDA for NTDs could be applied to the COVID-19 vaccine response. Here are a few strategies used by Ministries of Health in the 11 West African countries that my program supports that are worth considering in the context of COVID-19 vaccine rollout campaigns:
Social mobilization via accessible information channels. While in some countries, state and local health departments have web pages and social media detailing who can get vaccinated, this information may only be available almost exclusively on the internet. However, not everyone has Internet access and knows how to use it. For example, there is an inverse relationship between age and internet and social media usage, while there is a direct relationship between age and risk for severe COVID-19 disease (https://www.pewresearch.org/internet/fact-sheet/internet-broadband/, https://www.pewresearch.org/internet/fact-sheet/social-media/).
Social mobilization strategies for NTDs are generally multipronged: public service announcements (PSAs) on TV, local radio shows, and via town criers, among others. While enlisting people to run through neighborhoods with bullhorns, telling people where to get vaccinated may not work in every country, broadcasting PSAs on TV and the radio in addition to social media could help people find out who can get vaccinated, where to go for a vaccine, and how to make an appointment.
Don’t assume the community knows why they should participate. Communicating effectively about NTDs means communicating clear information year after year, even when the presence of NTDs is no longer apparent to communities. While some may assume that after three to five years of receiving treatment, communities would know why they should participate in MDAs, people may forget that medicines, whether NTD tablets or vaccines, only work for a certain period time. Also, certain community members or sub-populations may be hesitant to participate for a number of reasons, such as fear of side effects. Clear, consistent communication is essential for reminding people to participate, providing trustworthy information from trusted sources, and addressing misinformation and rumors head-on to avoid participation hesitancy. This is highly relevant for COVID-19 vaccine campaigns, which are struggling with vaccine hesitancy in certain settings.
Advocacy to respected community, religious and cultural leaders. Regardless of geography, communities respond to and will follow the advice of their own leaders. In Senegal, for example, Islamic Sufi brotherhoods have an enormous influence and are a primary audience for MDA advocacy efforts. Those who agree with the party or administration in power may tend to rely on information from government authorities such as the Ministry of Health; however, those who are mistrustful of the government or who have strict religious beliefs would be better served with messaging from those they consider leaders. Any health campaign aiming to reach the widest possible segment of the population needs to reach out to leaders across the political, cultural, and religious spectrums and help them understand the issues, the solutions, and their role. For example, in Senegal, this might be through meetings led by influential religious family leaders with conservative media and community religious leaders in their respective Islamic Sufi brotherhoods, with the goal of getting them to speak directly to their communities.
Bringing the intervention to the community. MDA would not be successful if people were asked to come to an urban center for NTD treatment. Instead, the intervention needs to be brought to the community. In West Africa, national NTD programs and partners like my program make every effort to provide MDA to even the hardest-to-reach communities. This is generally done via a network of community drug distributors (CDDs) who are selected in nearly every community to go house-to-house to provide their neighbors with the medicines. These men and women often must walk for hours over several days in severe heat or over rough terrain.
In my mother’s community, there are numerous locations where people can get vaccinated—pharmacies, healthcare providers, and large-scale vaccination events, to name a few. However, there is no centralized system for appointment booking. So, to make an appointment for my mother, I had to click on the individual location of every pharmacy in her area to see if vaccine appointments were available.
After weeks of trying, I eventually found one and I am happy to say that soon, my mother will receive her second dose of the vaccine. Now, my hope is that greater efforts will be made to reach out to those who are still not sure they can, should, or want to be vaccinated and that these lessons learned from NTD programs might help improve efforts to distribute the COVID-19 vaccines.