Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach
Abstract Background The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s13012-024-01412-5 |
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| author | Viola Pavoncello Irina Kislaya Diavolana Koecher Andrianarimanana Valentina Marchese Rivo Rakotomalala Tahinamandranto Rasamoelina Simon Veilleux Ariane Guth Alexina Olivasoa Tsiky Zafinimampera Sonya Ratefiarisoa Olivette Totofotsy Cheick Oumar Doumbia Rivomalala Rakotonavalona Holinirina Ramananjanahary Zely Arivelo Randriamanantany Jürgen May Rivo Andry Rakotoarivelo Dewi Ismajani Puradiredja Daniela Fusco |
| author_facet | Viola Pavoncello Irina Kislaya Diavolana Koecher Andrianarimanana Valentina Marchese Rivo Rakotomalala Tahinamandranto Rasamoelina Simon Veilleux Ariane Guth Alexina Olivasoa Tsiky Zafinimampera Sonya Ratefiarisoa Olivette Totofotsy Cheick Oumar Doumbia Rivomalala Rakotonavalona Holinirina Ramananjanahary Zely Arivelo Randriamanantany Jürgen May Rivo Andry Rakotoarivelo Dewi Ismajani Puradiredja Daniela Fusco |
| author_sort | Viola Pavoncello |
| collection | DOAJ |
| description | Abstract Background The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine uptake in the Boeny region of Madagascar. Methods Guided by the Dynamic Sustainability Framework (DSF), the VC implementation was regularly reviewed through multi-sectoral stakeholder feedback, key informant interviews, problem-solving meetings, and weekly monitoring of outcome indicators to identify and apply key adaptations. Qualitative data on processes were collected and analysed using a rapid assessment approach. Outcome indicators, including pre- and post-VC vaccine hesitancy and trends in vaccine doses administered, were analysed using generalized linear models. Additionally, vaccination coverage, geographic reach, and target population characteristics, and sustainability indicators, such as staff trained, facilities equipped, and degree of integration of operational and educational materials were also tracked. Results Key strategy adaptations included using a proactive campaign approach, community-led awareness and outreach, particularly in remote areas, and addressing cold chain, waste management, vaccine transport, and information technology (IT) equipment gaps. Over six months, 24,888 COVID-19 vaccines were administered. The adapted strategy led to an 8% increase in doses administered weekly (RR = 1.08, CI 95%: 1.01-1.15). However, vaccine hesitancy among the unvaccinated population remained unchanged (∆ = 0.02, CI 95%: -0.04-0.08). In terms of sustainability, 340 staff were trained, and 10 primary healthcare facilities were equipped and refurbished. Conclusions Implementing collaborative, multi-sectoral vaccination strategies that integrate healthcare services with proactive outreach and community-driven campaigns are effective in increasing vaccine coverage in resource-limited settings. It demonstrates how theory-based adaptive strategies can enhance vaccination rates, even if they do not significantly impact COVID-19 vaccine hesitancy within the community. More generally, this initiative has important implications for adult vaccination programmes other than those related to COVID-19. |
| format | Article |
| id | doaj-art-49ea41e8eeb44310ab85e2ef48d14178 |
| institution | Kabale University |
| issn | 1748-5908 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Implementation Science |
| spelling | doaj-art-49ea41e8eeb44310ab85e2ef48d141782025-01-12T12:33:50ZengBMCImplementation Science1748-59082025-01-0120111610.1186/s13012-024-01412-5Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approachViola Pavoncello0Irina Kislaya1Diavolana Koecher Andrianarimanana2Valentina Marchese3Rivo Rakotomalala4Tahinamandranto Rasamoelina5Simon Veilleux6Ariane Guth7Alexina Olivasoa Tsiky Zafinimampera8Sonya Ratefiarisoa9Olivette Totofotsy10Cheick Oumar Doumbia11Rivomalala Rakotonavalona12Holinirina Ramananjanahary13Zely Arivelo Randriamanantany14Jürgen May15Rivo Andry Rakotoarivelo16Dewi Ismajani Puradiredja17Daniela Fusco18Research group: Implementation Research, Bernhard Nocht Institute for Tropical MedicineGerman Centre for Infection Research (DZIF)Centre Hospitalier Universitaire (CHU) AndrovaResearch group: Implementation Research, Bernhard Nocht Institute for Tropical MedicineCentre Hospitalier Universitaire (CHU) AndrovaCentre d’ Infectiologie Charles Mérieux (CICM), University of AntananarivoResearch group: Implementation Research, Bernhard Nocht Institute for Tropical MedicineResearch group: Implementation Research, Bernhard Nocht Institute for Tropical MedicineCentre Hospitalier Universitaire (CHU) AndrovaCentre Hospitalier Universitaire (CHU) AndrovaCentre Hospitalier Universitaire (CHU) AndrovaDepartment of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical MedicineVaccination Program, Ministry of Public HealthUnit for the Coordination of the Covid-19 Vaccination, Ministry of Public HealthMinistry of Public HealthGerman Centre for Infection Research (DZIF)Department of Infectious Diseases, University of Fianarantsoa AndrainjatoDepartment of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical MedicineResearch group: Implementation Research, Bernhard Nocht Institute for Tropical MedicineAbstract Background The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine uptake in the Boeny region of Madagascar. Methods Guided by the Dynamic Sustainability Framework (DSF), the VC implementation was regularly reviewed through multi-sectoral stakeholder feedback, key informant interviews, problem-solving meetings, and weekly monitoring of outcome indicators to identify and apply key adaptations. Qualitative data on processes were collected and analysed using a rapid assessment approach. Outcome indicators, including pre- and post-VC vaccine hesitancy and trends in vaccine doses administered, were analysed using generalized linear models. Additionally, vaccination coverage, geographic reach, and target population characteristics, and sustainability indicators, such as staff trained, facilities equipped, and degree of integration of operational and educational materials were also tracked. Results Key strategy adaptations included using a proactive campaign approach, community-led awareness and outreach, particularly in remote areas, and addressing cold chain, waste management, vaccine transport, and information technology (IT) equipment gaps. Over six months, 24,888 COVID-19 vaccines were administered. The adapted strategy led to an 8% increase in doses administered weekly (RR = 1.08, CI 95%: 1.01-1.15). However, vaccine hesitancy among the unvaccinated population remained unchanged (∆ = 0.02, CI 95%: -0.04-0.08). In terms of sustainability, 340 staff were trained, and 10 primary healthcare facilities were equipped and refurbished. Conclusions Implementing collaborative, multi-sectoral vaccination strategies that integrate healthcare services with proactive outreach and community-driven campaigns are effective in increasing vaccine coverage in resource-limited settings. It demonstrates how theory-based adaptive strategies can enhance vaccination rates, even if they do not significantly impact COVID-19 vaccine hesitancy within the community. More generally, this initiative has important implications for adult vaccination programmes other than those related to COVID-19.https://doi.org/10.1186/s13012-024-01412-5Dynamic Sustainability FrameworkVaccination campaignsVaccine uptakeCapacity strengtheningResource-limited settingsCOVID-19 |
| spellingShingle | Viola Pavoncello Irina Kislaya Diavolana Koecher Andrianarimanana Valentina Marchese Rivo Rakotomalala Tahinamandranto Rasamoelina Simon Veilleux Ariane Guth Alexina Olivasoa Tsiky Zafinimampera Sonya Ratefiarisoa Olivette Totofotsy Cheick Oumar Doumbia Rivomalala Rakotonavalona Holinirina Ramananjanahary Zely Arivelo Randriamanantany Jürgen May Rivo Andry Rakotoarivelo Dewi Ismajani Puradiredja Daniela Fusco Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach Implementation Science Dynamic Sustainability Framework Vaccination campaigns Vaccine uptake Capacity strengthening Resource-limited settings COVID-19 |
| title | Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach |
| title_full | Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach |
| title_fullStr | Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach |
| title_full_unstemmed | Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach |
| title_short | Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach |
| title_sort | optimizing vaccine uptake in sub saharan africa a collaborative covid 19 vaccination campaign in madagascar using an adaptive approach |
| topic | Dynamic Sustainability Framework Vaccination campaigns Vaccine uptake Capacity strengthening Resource-limited settings COVID-19 |
| url | https://doi.org/10.1186/s13012-024-01412-5 |
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