The COVID-19 Vaccination Journey: Five Critical Considerations for Governments

Early in my career, I served as a US Peace Corps volunteer where I travelled with a satellite community health clinic as part of a maternal and child health campaign. Each month, our small team visited 21 villages to support community health through vaccines, family planning, nutrition, and basic health treatment.

Administering vaccines in this context was no small feat. With villages up to four hours apart by boat, dry season made small communities nearly unreachable as creeks dried up while rainy season made the trip very physically taxing with a small hand-held tarp the only respite from the rain pelting our faces. In some cases, women would pull up beside our wooden boat in their dugout canoes carrying several children. Holding the tarp in one hand to shelter everyone from the rain, a cooler with vaccines in the other to maintain a semblance of cold storage, we worked together to ensure children received the vaccines they needed. We worked diligently to record each dosage in a handwritten logbook, though often mothers didn’t name their children for the first several months of live in case the worst happened. 

Vaccines requiring multiple doses were exponentially more difficult. In some instances, we were not able to make it back to a village at the designated time due to inclement weather. In other cases, stock outs made vaccinations on time impossible. And finally, some women could not make the trek, often a several hour journey, to the clinic at the appointed date. 

This may sound like an extreme circumstance, but for many countries, similar scenarios exist today. No matter the strength of the health infrastructure, every country in the world will need to navigate significant challenges on the road to COVID-19 vaccination. Government leadership and support will be critical to accelerate progress toward achieving the vaccination rates required for community protection. At a minimum, the following five principles must be considered:

• Combine global standards with a local approach. 
• Develop a strategic communications plan.
• Consider the possibilities for a digital infrastructure.
• Develop a deployment plan considering priorities, capacity, and resources.
• Remove barriers to access for all citizens.

Combine global standards with a local approach.

A careful balance must be struck between global standards required for vaccine efficacy and localized distribution approaches to maximize adoption. Governments should play a key role in defining and driving each. 

Globally consistent quality control in vaccine distribution will be critical, including cold chain requirements, method of administration, and dosage timing. Depending on the local regulatory environment, Government Ministries or Agencies are expected to play a critical role in distributing the vaccines or in certifying medical providers for distribution, enforcing quality measures, and monitoring and overseeing processes to ensure specifications are met.

At the same time, the approach to addressing pandemics, including vaccination efforts, must be localized to be effective. I worked closely with our in-country teams throughout the Ebola crisis response and recovery efforts in West Africa where we supported several health and development organizations. When performing a sentiment analysis of the response efforts, citizens applauded the Africa Against Ebola Solidarity Trust and African Union in their efforts to deploy regional doctors who went into the most impacted regions. They understood the cultural norms and were able to break through the trust barrier, a key requirement to changing behaviors related to transmission.   

Local citizens must feel comfortable with all elements of vaccine distribution including location, approach, and data storage. Door to door vaccination techniques may be appropriate in some countries, for example, and increase the rate and speed of adoption; in others, it may be viewed as an invasion of privacy and an infringement on personal rights. Similar challenges exist with the maintenance and storage of health data. 

Employing a culturally accepted approach will be a determining factor in gaining acceptance among a critical mass of citizens in many countries. Governments must work closely across Ministries and Agencies and with private sector providers to ensure this is appropriately considered.

Develop a strategic communications plan to build trust across all segments of society, including those who have ‘vaccine hesitancy.’ 

Pharmaceutical companies and regulatory bodies have been working to develop and approve vaccines to address the COVID-19 pandemic in record time. The pace of progress has created skepticism among citizens in many countries. Significant concerns exist around the safety and efficacy. However, without sufficient levels of trust, the likelihood of achieving herd immunity for eradication is low.

Communications planning, like the distribution approach, must be tailored. Citizens in some countries will require Government endorsement and encouragement before considering a vaccination. This is not the case, however, in other countries. A recent study of American attitudes toward a COVID-19 vaccine, for example, indicated that trust on the topic was placed in scientists and public health officials but was likely to decline as political involvement increases.  

Governments must be aware of public sentiment and take a data-driven approach to communications. A multi-channel approach will be required to maximize reach to citizens which may include televised press conferences and advertisements, written press releases, traditional promotional materials (e.g. billboards, brochures), social media (e.g. tweets, Instagram posts), and direct outreach at a community level.

I recently worked with a national Government to develop a COVID-19 communication plan, and we opted to message through each of these channels with the understanding that different stakeholder groups are likely to ingest information in different forms. Even within channels, we tailored messages for different segments of the population – a short video story may catch the eye of younger Instagram audience while an informational tweet through a trusted news source may help to grab a business reader or an older demographic. 

To aid in overcoming resistance, governments may consider engaging local, trusted champions who can publicly campaign for and support the vaccine movement. This approach can be effective at the national, state, and local levels. 

Consider the possibilities for digital infrastructure at the local, national, and global level. 

The COVID-19 pandemic has served to accelerate digital transformation across all elements of life, with healthcare no exception. Traditionally, management of vaccine records has varied dramatically by country. Approaches are diverse and include national digital databases, decentralized digital records maintained by private health facilities, and paper-based systems at public or private health facilities. Vaccine records used for travel are almost exclusively paper-based and documented on yellow World Health Organization vaccine cards.

Governments have an opportunity to support a coordinated, digital records management approach for the COVID-19 vaccination effort. The development of a consistent approach to capture, store, and safeguard data will aid in the efforts to aggregate information at the national and global levels, a critical requirement to track progress. Additional benefits may include increased completeness and accuracy of data, enhanced ability for citizens to access health records online, and an improved ability for authorities to validate the authenticity of information at border entry. Finally, it may serve to pave the path for increased broad-scale health digitization increasing access to records and critical care for all citizens.

Develop a deployment plan with explicit prioritization, human capacity requirements, and detailed demand planning. 

Vaccines will not be available for entire populations on day one. With that in mind, public and private sector providers, along with civil society, must collaborate to determine the optimal approach to maximize coverage, manage risk, and ensure continuity of stock. 

In some countries, cross-sector collaboration is institutionalized, such as those supported by GAVI a long-standing public-private partnership for vaccine distribution across 73 countries. In other markets, COVID-19 has created a new mandate which has been embraced. Recognizing unprecedented need, the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership was established in April and includes more than a dozen leading biopharmaceutical companies and national health authorities. 

Similar models must continue from vaccine development into vaccination efforts. Governments must play a role in helping consortiums to:

• Develop objective criteria for prioritizations of vaccine efforts which may include those in at-risk professions, age, underlying conditions, vulnerable communities, anticipated adoption levels.
• Assess human resource requirements for vaccine distribution at early and peak stages, map against current resources, and increase resourcing as required.
• Determine anticipated demand considering dosage requirements, and lock-in secure and stable supplies.

Preventing delivery interruptions and stock outs will be critical. If someone makes the effort to visit a health facility for the vaccine and it is not available, they may not return. We have seen this often in low-income or rural communities, particularly prevalent with vaccines requiring multiple doses. The barriers were simply too high for many to try once, much less to make repeated attempts. 

Remove barriers to access for all citizens. 

Recognizing those barriers that exist, and trying to remove them, will help. Common impediments, in addition to those described above, include cost (direct and secondary such as transportation), time, childcare, and inconvenient or hard to reach facilities. 

Government must play a role in helping to break down barriers, making it simple for those who want to be vaccinated to do so. Stimulus funds, for example, can be used to defray financial costs to citizens and to companies who allow paid leave for vaccination appointments. Childcare can be provided at health facilities providing vaccines. Tax incentives can be provided to private-sector providers who place vaccination centers in high-cost, high-traffic locations for convenience. Government health agencies can be deployed in door-to-door or community health center campaigns where such techniques are appropriate. 

Reducing the level of effort or hardship required for vaccination will be a crucial element to achieving adoption and herd immunity. 

Summary

There are many challenges in the move from vaccine development to vaccination, but adoption must reach critical mass to recover from the global health, economic, and education crises. The factors described above will be critical for governments, the business community, civil society and citizens to consider when coming together in a collaborative effort to overcome this crisis.  

In my work, I have seen too many people die, young and old, because they could not access required medical facilities, did not believe in or trust medical treatment, or felt stigmatized. Learning lessons from previous pandemic response and vaccine efforts can fuel a different approach, one that safeguard one of the world’s most crucial assets – our people. 

Note: For a detailed analysis of COVID-19 distribution challenges, please see the following PwC publication: https://www.pwc.com/us/en/industries/health-industries/library/covid-19-vaccine-supply-distribution-challenges.html