Impact Series

Vaccine skilled on U.S. missteps and what we are able to study from profitable inoculations in Africa

An immunization campaign in Mozambique. (Denis Onyodi / VillageReach Photo)

While scientists were able to create and test COVID-19 vaccines in nearly unimaginable, record-breaking time, the administration of vaccines across the U.S. has been bumpy, slow and inequitable.

What’s to blame for the messy rollout?

“The classic trap that the U.S. fell into … is we did not put the same energy into how we were going to deliver the vaccine that we put into the science of creating the vaccine,” said Emily Bancroft, president of VillageReach, a Seattle-based global health nonprofit founded in 2000 that helps with vaccine delivery in underserved communities.

In the 11 weeks since the first vaccines were shot into American arms, the vaccination campaign has made marked improvements. Some 55.5 million Americans — or nearly 17% of the population — has received one or more doses of the vaccine produced by Pfizer or Moderna. Nearly 9% are fully inoculated. In Washington state, nearly 15% of the population has had at least one dose, and 8.4% have received two shots.

Emily Bancroft, president of VillageReach. (VillageReach Photo)

But the U.S. made missteps in all three key components of a successful program, Bancroft said. That includes creating centralized and local plans for administration, prepping a sufficient supply of healthcare workers to deliver the shots, and developing the data infrastructure to track the vaccine doses and who is receiving them.

Now President Biden has said that the country is on track to have enough COVID vaccine  “for every adult in America by the end of May.” The question is will we be ready to deliver them.

Massive vaccination programs are tricky — but not impossible. In recent years numerous African countries have launched campaigns to curb cholera, polio and measles, delivering millions of doses over a few days or weeks. Those efforts provide lessons that Americans could learn from.

When it came to the U.S. COVID vaccination program, “we were building the car as we were driving it,” Bancroft said, “as opposed to stepping back a year ago and saying, ‘OK, this vaccine is coming. What are the pieces that are going to be in place and how do we learn from mass vaccination campaigns in other countries?’”

VillageReach has a seat with technical working groups in five African countries in preparation for their COVID vaccination rollout, which was delayed given the shortage of vaccines worldwide and the fact that richer countries snapped up initial doses. The vaccine rollout in Mozambique is starting any day. In the meantime, two employees from the nonprofit are assisting with the campaign in the Seattle area, helping out at two mass vaccination sites run by King County.

Here are some additional takeaways from Bancroft on the U.S. vaccination efforts:

  • Many African countries have community health workers, who are less skilled than doctors, trained in administering vaccines. More recently, U.S. health organizations have been training nursing and pharmacy students and providing refresher instructions to retired healthcare providers to boost the number of vaccinators.
  • Often in lower-income countries, healthcare systems use simple software for managing campaigns, but even that has been lacking in the U.S. A VillageReach employee developed a tool to track vaccine supplies in King County based on experience managing vaccine inventory in Africa. It predicts how many doses would be needed the following day based on previous usage, helping streamline operations.
  • The U.S. generally is without robust community networks found in Africa that can be activated to bring people to vaccination sites and to share factual information about vaccines and counter misinformation. That lack of human infrastructure has added to the challenge of vaccine inequities: racially diverse communities that have been hardest hit by COVID are also lagging in vaccination rates.
A vaccination campaign in Mozambique. (Paul Joseph Brown / VillageReach Photo)

The U.S. inoculated nearly half the population for flu in 2019, so why has COVID shots been so difficult to provide? There are many reasons, including the need to keep the first two approved mRNA vaccines at very low temperatures, the challenges of tracking people for the required two doses, and because the vaccines aren’t available to everyone, but rather prioritized recipients according to risk.

Vaccine doses are being administered much more quickly and now the greater hurdle is the limited supply of vaccines. The U.S. Food and Drug Administration last week gave emergency use authorization for a third vaccine from Johnson & Johnson that requires only one dose and should become available in coming days.

But there will be another pandemic, experts warn, and long-term improvements to our healthcare system are needed to wage a better response.

“We’ve been under-investing in our public health infrastructure in the U.S. for a long time,” Bancroft said. “And so you’re going to see that when you try to surge, to do something as massive as this.”

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