Equitable Vaccine Delivery: What Our Obstacles Are and How to Overcome Them

December 21, 2020

The COVID-19 vaccine campaign promises to be one of the most ambitious public health undertakings ever.

Yet the triumphant development of the vaccine by biopharmaceutical groups like Pfizer and Moderna is only half the battle.

Those familiar with global health know that the crux of the field is that delivery of solutions matter just as much as the solutions themselves. With ‘distribution’ now the dominant headline, discussions around equity and identity have become the subtext underneath general decisions on vaccine supply and global demand. These themes present themselves clearly in low-to-middle income countries (LMICs). Even though wealthier nations have less than 15% of the world’s population, they already account for more than half of the available vaccines, with a majority of the incoming supply following suit.

A successful campaign means every government ensuring that adverse barriers are reported and addressed quickly; that strategies can shift in real time as new evidence emerges; and that administrators have the data they need to plan, deliver, and carefully monitor doses. 

The Challenges We Face

The sheer complexity of the undertaking presents itself through the geographical and social nuances associated with each country. For example, for countries with intense heat waves like India, Pfizer’s vaccine may be a trickier selection due it requiring storage at -70ºC. In these situations, the Moderna vaccine may be a more viable choice, as it can be transported at higher temperatures. Some companies are also exploring how a vaccine may be transported in a more resilient form, such as tablets, which could survive at 70ºC, or powders, projected to survive at upwards of 100ºC.

Unfortunately, the general scarcity of medical staff in LMICs is an even bigger issue, with extensive training and logistical oversight required. In these cases, a foundation of available support and easily-accessible reference materials can go a long way. 

When it comes to social complications, we are more fortunate, as vaccine confidence is fairly high in LMICs. The challenges deal more with identity, particularly around low-literate, under-represented populations. These groups, who are focused in rural, sparsely populated areas, run the risk of not being counted in governmental regulatory systems and excluded when it comes to the administration of healthcare more broadly. In these circumstances, an effective community health worker program can ensure that these otherwise overlooked and undersupported populations receive the care they deserve.

Overcoming These Obstacles

If our goal is to get enough doses to all countries such that at least 20% of their population can be vaccinated, the approach will involve many actors. First, facilities like COVAX, which attempt to maximize participation through economic research and manufacturing investment, can help LMICs receive enough doses. Then, the World Health Organization’s Fair Allocation Framework will provide countries with a model outlining which demographics should receive the vaccine first, beginning with frontline health workers, followed by senior citizens and those with comorbidities.

With regard to implementation, the management of these nationwide campaigns needs to rely on a flexible, data-driven infrastructure that can support on-the-ground initiatives. Technologies like GIS can significantly help tackle spatial issues, and biometric tools can support secure identification of vaccine recipients. 

Knowing the time and capacity pressures that our frontline workers face, we also need an easy-to-use platform that can effectively take advantage of all of these solutions, that prioritizes privacy and thorough data analysis, and is flexible to the specific nuances of vaccine delivery in LMICs. Most importantly, this platform must be able to support existing health-care systems in LMICs and amplify existing local efforts in distribution.

Developing a Solution

Dimagi is developing an open-source digital solution that can serve as a frontline tool in the upcoming campaign to vaccinate billions of people in LMICs.

The platform is built on protocols and guidance from COVAX, WHO, CDC, and other sources and will track and support every vaccine recipient before, during, and after their vaccination. It provides direct digital support to health providers administering vaccines with a job aid to guide them through the screening, registration, and vaccination process.

People receiving the vaccine can be reminded of their appointments, receive confirmation of their vaccination, and self-report adverse events. Along with reminders directly to recipients, the solution helps administrators follow up with those who have missed appointments in order to ensure course completion. Integrations with existing reporting tools can also provide officials with analytics and visualizations to monitor the progression of the vaccination campaign. Biometric tools and screening workflows help to ensure the equitable delivery of vaccines based on occupation, age, and existing comorbidities.

Developing an effective and safe COVID-19 vaccine – let alone four – in less than a year is an unquestionable success. But the challenges associated with the delivery of those vaccines still exist. If countries and their partners can continue to leverage the global partnerships and innovative tools at their disposal, not only can they ensure the equitable distribution of this vaccine, but in doing so, strengthen their approach to health care delivery overall.


To learn more about Dimagi’s approach to equitable vaccine delivery, click here.

Written by
Dimagi

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