It is not vaccine hesitancy; it is lack of access: increasing access accelerates COVID-19 vaccination in a Zambian district

Title

It is not vaccine hesitancy; it is lack of access: increasing access accelerates COVID-19 vaccination in a Zambian district

Presenter

Lackeby Kawanga

Authors

L. Kawanga * (1), N. Chibesakunda (1), T. Zimba (1), M. Chikaka (1), D. Tindi (1), D. Mumba (1), K. Mwanda (1), M. Chikuba-McLeod (1), M. Njelesani (1), M. Musonda (2)

Institutions

(1) JSI Research and Training Institute, Clinical Services, Lusaka, Zambia, (2) United States Agency for International Development (USAID) Zambian Mission, Clinical Services, Lusaka, Zambia

BACKGROUND: COVID-19 vaccine hesitancy has been blamed for low vaccination rates in Zambia, a credible assumption given the high prevalence of misinformation/myths. In December 2021, the USAID DISCOVER-Health Project, implemented by JSI, supported the Ministry of Health (MOH) to increase demand for and uptake of COVID-19 vaccination through the national COVID-19 Vaccination Drive. The nation planned to vaccinate 2 million people and each district was assigned a target according to its population. The Project opted to provide full cascade support to 22 districts, including Kalulushi District.
DESCRIPTION: The Project's support to Kalulushi district included:

Entire cascade support, from micro-plans to service delivery.
Pairing community sensitisation with vaccination service delivery, missing no opportunity to vaccinate.
Taking vaccination into communities, door-to-door, in markets, schools and churches, taking services where people are.
Implementing a full in-facility coverage model, from the highest to the lowest level facilities, integrating into existing service delivery.
Hiring out-of-work healthcare workers to undertake supervised vaccination outreach.

As a result of the Project's support to the Kalulushi District COVID-19 Drive, the district achieved 116% of its December vaccination target compared to the 21% average district achievement, out-performing all the other 115 districts. Overall from the beginning of vaccination (April 2021), the December Drive contributed 55% of the people ever vaccinated in Kalulushi in one month.
LESSONS LEARNED:

Supporting the full-service delivery cascade ensures optimum effectiveness with no missed vaccination opportunities.
District ownership from leading planning meetings to coordinating rollout is key to success.
Orientation of leaders (traditional, civic and religious) ensured buy-in, consistent messaging and showcased them leading by example encouraging constituents to get vaccinated.
Hiring extra out-of-work staff safeguarded other ongoing health services, such as the HIV programme, and ensured quality provision of all health services.

CONCLUSIONS: Vaccine hesitancy does not fully account for the low vaccination rates in Zambia. When the full vaccination cascade is supported and outreach is facilitated, people will get vaccinated in order to protect themselves and their loved ones. Success in Kalulushi was achieved through MOH, Project staff and others working together at every stage, building on their collective strengths.

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