Working with healthcare workers to improve vaccination uptake in Uganda
Over the last two years, more than ten billion doses of COVID-19 vaccines have been administered worldwide. However, global vaccine inequity has led to disproportionate vaccine distribution, with Africa, for example, receiving less than 6% of the worldwide share of vaccines. We believe that advocacy to bridge this disparity is urgently needed. Gaining ground on controlling the pandemic currently hinges on getting as many COVID-19 vaccines as possible to those susceptible, in order to reduce the death toll and avoid overwhelming essential services. Additionally, investment is needed to ensure doses are delivered to the last mile and address vaccine hesitancy. We present the current challenges to vaccine uptake in Uganda and suggest strategies for improvement.
Uganda has received 32 million vaccines, including AstraZeneca, Moderna, J&J, BioNTech, Sinovac, and Sinopharm. Until November 2021, the Ministry of Health prioritized the vaccination of essential workers (health care, teachers, security), people with comorbidities, and people over 50 years old. In preparation to open the economy, this scope was expanded to include all adults over 18. Then, with the surge in cases due to the omicron variant, boosters were recommended for individuals who had been fully vaccinated for a minimum of six months. The Government of Uganda has considered legislation against refusal to get vaccinated, although vaccination among healthcare workers was already high before this .
As of January 2022, 46% of all priority individuals in Uganda have been vaccinated, with healthcare workers accounting for the biggest share of those who have received at least one dose of the COVID-19 vaccine yet, 65% of all COVID-19 hospital admissions have been for the unvaccinated elderly .
So, how can we leverage the success achieved with healthcare workers for other groups (elderly and those with comorbidities) where coverage has lagged ? The rapid advances in science related to vaccine development and safety and access and government directives present a challenge. Until recently, myths relating to vaccine safety in pregnant women and lactating mothers–despite the data– were prevalent . Encouragingly, health workers are a trusted source of information for peers and community members, including for COVID-19 vaccines, and we believe that they are well positioned to provide accurate information about COVID vaccines during antenatal and postnatal visits.
Healthcare workers administer vaccines often in their workplace. However, most doses are currently in use in large scale community outreach efforts known as accelerated mass vaccination campaigns. These campaigns aim to reach large numbers of people within the community and aim to use up vaccine doses quickly, particularly vaccine doses with short expiry. Consequently, patients with comorbidities may attend their appointments at facilities which do not have vaccines and this is a missed opportunity for direct intervention from healthcare workers.
With the challenge of vaccines with a short shelf life, mass campaigns remain a relevant approach. However, health facilities can leverage existing staff and resources for routine childhood immunizations and ensure adequate local stocks of COVID-19 vaccines. Health workers must systematically screen vulnerable groups for vaccination status, must have the knowledge and skills to create demand for vaccines, and must link patients to locations where vaccines are administered. These approaches are not only targeted to maximize the benefits of vaccines for the most vulnerable, but they are also more sustainable and less costly than large scale community outreach. The robust vaccine distribution networks and vaccines with a long shelf life are essential for the success of this approach.
Additionally, the elderly may face challenges due to frailty, inadequate resources for transportation or to avoid crowds. Community health workers may be needed to ensure that elderly patients are counseled and mobilized for vaccination or linked to the nearest vaccination location points once vaccines are available.
The lifting of travel restrictions and the reopening of schools in Uganda presents an opportunity to collaborate with health workers to promote vaccine uptake among our most vulnerable populations. This intervention should be layered on other public health measures such as screening and testing, mask use, hand hygiene, and physical distancing to strengthen resilience to future waves.
We believe Uganda’s experience may be mirrored in other countries in the region and these experiences would have broader lessons for how COVID-19 vaccines are distributed on a global scale.
Dr. Rodgers R. Ayebare
CEID Scholar
Infectious Diseases Scientist, Infectious Diseases Institute, Makerere University, Kampala, Uganda
Dr. Mohammed Lamorde
Head of Global Health Security, Infectious Diseases Institute, Makerere University, Kampala, Uganda