Last-mile delivery increases vaccine uptake in Sierra Leone

• 成果类型: Article
• 署名作者: Meriggi, Niccolo F.; Voors, Maarten; Levine, Madison; Ramakrishna, Vasudha; Kangbai, Desmond Maada; Rozelle, Michael; Tyler, Ella; Kallon, Sellu; Nabieu, Junisa; Cundy, Sarah; Mobarak, Ahmed Mushfiq
• 署名单位: Wageningen University & Research; University of Oxford; University of Illinois System; University of Illinois Urbana-Champaign; Boston University; Ministry of Health & Sanitation Sierra Leone; Yale University
• 刊物名称: Nature
• ISSN/ISSBN: 0028-6513
• DOI: 10.1038/s41586-024-07158-w
• 发表日期: 2024-03-21
• 关键词: centralized reminder/recall; immunization rates; care; influenza; community; intervention; inference; program; visits; HEALTH

摘要

Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development1. Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties2, we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48-72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services3. A cluster randomized controlled trial in Sierra Leone shows that targeting access to vaccines in remote areas increases uptake, an approach that can be used to improve vaccine equity in developing countries.