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Examining lessons learned from past pandemics about successful and less successful vaccine delivery.
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These lessons should aid national immunization program leaders in designing COVID-19 vaccine delivery systems that lead to an immune population.
To ensure that COVID-19 vaccines lead to widespread vaccination and that 60%–70% of the population has immunity, governments and public health leaders need to prepare transparent, evidence-based strategies to promote COVID-19 acceptance and implement equitable and effective vaccine delivery. This will require four interconnected strategies: generating demand for the vaccine, allocating the vaccine, distributing the vaccine, and verifying coverage. This paper outlines lessons learned from past pandemics and vaccine campaigns about the path to successful vaccine delivery.
- The complexity of generating demand for COVID-19 vaccines has increased with the rising tide of misinformation and vaccine hesitancy.
- Strategies to stimulate COVID-19 demand must be based on perceptions, attitudes, and public trust.
- The health care workforce also has an important role to play in promoting vaccine acceptance.
- Engaging grassroots and local leadership are also essential for demand generation.
- Decisions about how to allocate the limited initial supply of COVID-19 vaccine doses should leverage the expertise of the biological and social sciences, with the goals of interrupting transmission of the pathogen, minimizing disease burden, and maximizing societal functioning.
- COVAX—led by the WHO, Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness and Innovations (CEPI)—is a global mechanism under the ACT Accelerator to operationalize the “equitable access and allocation of COVID-19 health products,” including vaccines. Under COVAX, participating countries will receive COVID-19 vaccine doses as follows: In Phase 1, allocation is proportional to countries’ populations—covering up to 20% of the population including most of the at-risk groups. In phase 2, allocation is based on risk assessments of each country’s COVID-19 threat and health system/population vulnerability.
- Vaccine distribution must be responsive and efficient in order to successfully interrupt a pandemic. For COVID-19, it will require leveraging the know-how of manufacturing and supply-chain experts, organizations well versed in overcoming “last-mile distribution” challenges, and others with relevant experience to design, activate, and improve our distribution systems for vaccines.
- For a COVID-19 vaccine, the supply chain challenges—getting the right product at the right temperature to the right person at the right time—will be complicated by and must be responsive to allocation decisions.
- Verifying that the appropriate people and populations have received a COVID-19 vaccine will be critical in tracking global progress toward herd immunity, informing allocation, and tailoring strategies to generate demand among the appropriate people and populations.
- It will require a dedicated investment to build and implement a functional verification system for COVID-19 vaccines.