Second Opinion: Refrigeration alone can’t solve the ‘last mile’ problem for COVID vaccines

The COVID-19 pandemic is far from over. The deadly Delta virus that decimated India has now spread to other parts of the world. If we don’t support campaigns in fragile countries like South Sudan or Yemen to get more people vaccined, the pandemic will not end.

But, vaccine availability doesn’t automatically translate into shots. However, vaccine availability does not automatically translate into shots in arms. Unexpected obstacles, such as extreme weather or displacement due to conflict and climate change can also present barriers.

Nongovernmental organizations, or NGOs, can ensure that vaccine doses make it from airports to arms — using some of the same infrastructure, knowledge and clinical staffers that the sector has used to help eradicate wild polio in Africa, provide cholera vaccinations in Haiti, treat malaria in Yemen and battle Ebola in Africa. The same foundation could also help deploy a newly authorized malaria vaccine and other new medicines. Last-mile delivery is more than logistics and cold chain support. It is also important to combat misinformation and vaccine hesitancy.

Communities themselves must embrace vaccination programs to reach the needed levels of immunity. Unfortunately, NGOs have seen that people in conflict zones and humanitarian assistance settings are not always willing to take preventive measures like vaccinations and masking. It won’t suffice to make vaccines available in these areas. It is essential to engage hearts and minds by focusing on the community and taking steps to address hesitancy about vaccinations and educate communities about preventive measures.

The humanitarian aid organization I manage, International Medical Corps, recruited volunteers from the community to help identify misinformation and counter it with accurate information. We established a hotline to allow community members to share their rumors with staff. We eventually got feedback from 5,625 people, many of whom asked about home remedies — for example, whether garlic or black pepper could cure or prevent COVID-19.

We also produced informational videos that played in health facility waiting areas, went door to door sharing COVID-19 information and supported a popular call-in radio program hosted by a doctor to answer COVID-related questions and correct misinformation about the disease. Since its launch in June 2020, this wide-ranging campaign has reached almost 850,000 people with accurate information about the virus and helped build confidence in the vaccines. A survey that we conducted in February showed that 89% of the target population could recall two or more protective measures against COVID-19.

In our global studies on vaccine hesitancy, we have found that hesitancy is higher among three groups: young people; refugees and other displaced persons; and women. These two groups, who feel excluded and disconnected from the health system, lack confidence in the safety and efficacy of the vaccine. These measures increase trust in vaccines as well as the healthcare system.

The main problem for younger age groups is complacency. They believe they are healthy and don’t need the vaccine to protect them. They’re not the only ones who are fed up with quarantines and masks, as well as the promise of vaccines that may never reach them. We don’t just give vaccines to the vaccination centers. This is a way to break free from complacency. These centers are easy to access.

A full-spectrum community-based approach to Azraq refugee camps in Jordan has resulted directly in more shots in arm. This includes registering people for vaccinations, transporting them to centers, education and dispensing vaccines. To overcome hesitancy we must instill confidence and combat complacency, as well as provide convenience. Cash is the second “C”. Donors must invest now in vaccine delivery in low- and middle-income countries to ensure that future campaigns are effective — and to discourage future variants. Additionally, it is important that humanitarian aid groups are included in the U.N.’s distribution strategy. A failure to include humanitarian aid groups in the distribution strategy with the U.N. and national governments could lead to vaccines becoming spoiled in storage, which could mean that the pandemic will continue indefinitely.

Nancy A. Aossey is president and chief executive of International Medical Corps.

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