Left behind no more

^{A vaccination outreach team on the move in Tanzania. ©WHO, 2023}

The nomads who wander the arid Lake Chad Basin had heard about the COVID-19 pandemic but hoped they could avoid it. Medical services are scarce in the places they go.

Then clinics-on-wheels began to appear, bringing health information, state-of-the-art vaccines and health workers newly trained by the World Health Organization. Halima Abdrahim, 60, was camped with her group near the lakeside town of Baga Sola when one such clinic rolled in. The COVID-19 presentation made sense to her, and she was the first person to step forward and take the shot.

"This is the first time I have been approached for the COVID-19 vaccine,” she said. “I have heard a lot about this disease and when I was told about the benefits of the vaccine, I agreed to take it.”

Watching the nomads get their vaccinations was a victory for outreach worker Zoulé Youssouf. She knew the team might not encounter that group again.

“You can see them one day, then two or three days later they are already gone," Ms Youssouf said.

^{During the vaccination campaign in Chad. ©WHO 2023}

For the past two years, scenes like this have played out in some of Africa’s most hard-to-reach, most fragile communities, gradually bringing them more into line or even surpassing regional averages of COVID-19 vaccination rates.

A €16.6 million grant from the European Union has powered the project, which has been targeting 16 countries in Africa where protection against the virus was very low, and where there are large numbers of people living in unstable humanitarian settings.

The WHO-led project ends this month, and the numbers show its impact: 34 million people have been vaccinated. COVID-19 vaccination rates were, on average, less than 5% in the 16 countries when the project began in late 2021. Coverage is now almost 30% on average, closing in on Africa’s average of 30.5%. In some of the project countries coverage is considerably higher, ranging up to Liberia’s 80%.

The project placed a high priority on reaching people living in precarious situations; they set up vaccination stations in refugee camps and settlements of internally displaced people and migrants, went door to door in towns in search of older people, and travelled to people living in out-of-the-way places.

^{Tobiko E Ngobei greets vaccinators at his home in the Maasai village of Monduli Juu, Tanzania. ©WHO 2023}

Project legacy: stronger health workforce in countries

WHO’s training increased the number of health workers across the 16 countries from about 130 000 to almost 2 million. As the EU-funded project concludes, the countries keep that much-expanded workforce as a precious national asset, with a greater capacity for handling other health challenges.

Among the newly trained is Celio Marcelino, who learned data-management techniques that helped him track vaccinations as they were given in Mozambique. He used those skills at Malika, a camp for displaced people who had fled armed clashes in another province.

“I studied statistics, so good-quality data means a lot to me,” he said. “Thanks to the training, it’s easier to make sure we are reaching everyone on a campaign, even vulnerable groups. Our reporting has improved so much.”

^{COVID-19 vaccinators get to work in Niger. ©WHO 2022}

In Guinea, the project’s legacy is better protection against infectious diseases.

"With the COVID-19 vaccine being part of routine services, eleven vaccines are now available in the expanded immunization programme,” said Dr Gassim Cissé, National Coordinator for the country’s Expanded Immunization Programme. “This is particularly beneficial to vulnerable people.”

Newly trained teams, in turn, amplified their effectiveness by enlisting community leaders to encourage people to accept the shots. Suspicion of vaccines was often bubbling under the surface in communities.

Niger attributes its good results – including the vaccination of nearly a third of all refugees and internally displaced people – to the influence of local leaders in debunking falsehoods and getting vaccinated themselves.

"There were a lot of rumors going around about vaccines, that they make people sterile or cause anemia," said Sani Touraki, a community leader in the Maradi region. "We were the first to get vaccinated; nothing happened to us. This reassured the population and showed that the rumours were just lies.”

In the same town, school superintendent Malama Balki Rabiou neutralized rumors that the shots caused people’s faces to erupt in blisters.

"Whenever I get the chance, I explain that measles and meningitis have become rare thanks to vaccines,” she said. “We get vaccinated to protect ourselves, our families and everyone around us.”

^{Mariame Cisse holds her vaccination card in Conakry, Guinea. ©WHO 2023}

Liberia: once lagging, now leading

Liberia’s detailed planning helped push vaccination rates to 80% of the adult population and make the country one of the biggest project success stories.

Before getting under way, project teams studied the local cold chain and logistics to make sure vaccines would arrive on time and in good condition and made calculations so that the number of health workers assigned to an area would be right for the number of people who needed to be vaccinated.

They met with community and religious leaders; compiled a list of all towns, villages, and settlements to target, along with a list of places where people congregate -- markets, places of worship, riverside communities, and refugee areas.

“The vaccine is here (at the health centre), available free -- absolutely free!” health worker Thomas Suah said. “We go to campuses, to the village schools, in the community, house to house. That’s what we do.”

^{In Liberia, one of the project's biggest success stories. ©WHO 2022}

Country by country results

Every country that participated in the project made gains, notably among the vulnerable groups that were targeted.

Liberia pushed its overall coverage to 80%, which is well above the global average of about 66%. Mozambique reached 63%, Tanzania 52%, Somalia 44% and Central Africa Republic about 40%.

Some other countries achieved more modest results, still emerging from the project with better coverage than the continent’s 30% average. Those were Chad, Guinea, Nigeria, South Sudan, and Sudan.

Burundi, Cameroon, Democratic Republic of the Congo, Madagascar and Mali also participated in the project and made gains. Combined, those five countries fully vaccinated 23.7 million people.

Project data also shows that almost 26 million older people, group at high-risk for severe COVID-19 illness and death, received primary vaccinations. Among them was Makalé Camara, 70, of Conakry, Guinea.

“I ended up agreeing to be vaccinated to protect myself,” said Makalé Camara, 70, who lives in Conakry, the country’s capital. “The fact that I could do so right here in my local health centre was also a big factor in my decision, as it made it convenient and accessible.”

The work described in this story is made possible by a €16 million contribution to WHO from the European Commission’s Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO).