Last-mile delivery increases vaccine uptake in Sierra Leone

Less than 30% of Africans received a dose of the COVID-19 vaccine even 18 months after vaccine development. Motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties, we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities shows that this intervention with mobile vaccination teams increases the vaccination rate by about 26 percentage points within just 48-72 hours. Moreover, auxiliary populations visited our community vaccination points, more than doubling the number of shots administered. The additional people vaccinated per intervention site translates to an implementation cost of US$ 33 per person vaccinated. Transportation to reach remote villages accounts for a large share of total intervention costs, so bundling multiple maternal and child health interventions on the same trip would lower costs per person treated even further. Current scholarship on vaccine delivery maintains a large focus on individual behavioral issues like hesitancy, but this research demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate larger returns in terms of uptake of health services

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.Publisher PDFPeer reviewe