Bringing COVID-19 vaccination close to the most vulnerable

Increasing reach

Ensuring people at high risk of COVID-19 among population of concern are included in national vaccination plans is important to control the spread of this virus and is key for guaranteeing vaccine equity.​

In Bangladesh, the national COVID-19 vaccination campaign started in February 2021. In Cox’s Bazar Rohingya camps, one of the largest and most densely populated refugee camps in the world, the Government of Bangladesh campaign for people over 55 started in August 2021 and people over 18-year-old will be vaccinated as of December 2021. ​

The campaign overall is led by WHO, UNICEF and UNHCR. 30 partners of the Cox’s Bazar Health Sector have been directly involved in vaccinating vulnerable populations against COVID-19 in the camps with large scale community mobilization efforts supported by other sectors, including Nutrition, Protection, Site Management, WASH and others. ​

UNICEF and its implementing partners, such as Bangladesh Bita, a local NGO, has supported the roll-out of the national deployment and vaccination plan. Youth volunteers have been vital to address elderly's transportation needs to reach the vaccination centres. ​

Increasing reach

In North-West Syria, the COVID-19 vaccination campaign started in May 2021 and is currently being conducted from 21 fixed sites and 40 mobile teams. Vulnerable populations still face challenges to receive the vaccine, including not having the means to reach the vaccination centres.

The Syria Immunization Group, a vaccine program working under the umbrella of the Syrian Technical Committee (SIG), composed by several Health Cluster partners and led by WHO and UNICEF, is providing safe and reliable transportation to improve access to vaccination and support the equitable administration of vaccines in this region.

Migrants

Migrants may face multiple barriers to vaccination, such as stigma and limited access to health services including COVID-19 vaccination.​

In Libya, concerns exist for migrants and refugees, including those in detention centres. As partner of the Libya Health Sector, the International Organization for Migration (IOM) is a crucial provider of health care services for migrants both in communities and detention centres. ​

In October 2021, IOM started vaccinating migrants as part of the targeted national COVID-19 vaccination campaign for migrants led by the National Centre for Disease Control (NCDC). The national vaccination plan had begun in April 2021.​

Prior to vaccine administration, trained IOM community mobilizers, in collaboration with IOM medical teams, conducted intensive awareness raising campaign and provided migrants with critical information on COVID-19 vaccines.​

Migrants

Internally displaced people

Internally displaced people (IDPs) are often particularly vulnerable to the risks of COVID-19, as a result of living in crowded or shared housing, lacking access to water, sanitation and health services. Evidence suggests that they are likely to face significant challenges in accessing essential services, protection and are often last in line for vaccination.​

Burkina Faso was one of the first countries to undertake microplanning and was able to include IDPs and refugees in the operational plan for vaccination from the very beginning. The original plan aims to vaccinate 50% of the total population, including 462 252 IDPs and refugees.​

Health Cluster partners have been fully involved in supporting the Ministry of Health with the delivery of vaccine in conflict-affected areas by supporting key operational gaps based on specific regional and district needs: transport of vaccines, maintenance of the cold chain, community awareness campaign, community health workers trainings, monitoring and coordination of vaccination response. Here a vaccination outpost near an IDP camp in Pissila is set up to ease vaccine accessibility for this vulnerable group.​

Camps

As part of the Cox’s Bazar Health Sector, Medair and its partner World Concern are working in Kutupalong Refugee Camp to deliver and administer COVID-19 vaccines to Rohingya refugees. They also raise awareness about how the disease spreads, and the availability and importance of receiving COVID-19 vaccines. COVID-19 prevention and mitigation interventions have been at the core of both facility and outreach interventions.

Camps

Sudan hosts 1.1 million refugees from neighboring countries and 2.5 million internally displaced people (IDPs). The socio-political situation increases challenges to reach the population of concern.

UNHCR worked to ensure inclusion of refugees in the national COVID-19 vaccination plan throughout Darfur. UNHCR engaged with the Ministry of Health, WHO, UNICEF and other partners to develop the vaccine strategy and plan implementation. UNHCR advocated that refugees be included in the national quantification of vaccine needs and the national request.

Here a health worker from the Ministry of Health vaccinates a South Sudanese refugee in Dinka Camp in June 2021. 

Hard to reach areas

Lack of infrastructure, geographic dispersion, shortage of personnel and lack of vaccination materials are among the barriers faced by populations living in hard-to-reach areas. Executing strategies to vaccinate people outside of health facilities in non-urban areas increases access and ensures equitable vaccine distribution.  

In Colombia, the Ministry of Health with support from the Health Cluster, has set up a coordination mechanism along with “Mesas de Salud”, regional health groups managed by the Health Secretary, to conduct needs assessments, data management to monitor vaccine administration, capacity building trainings in vaccine administration and cold chain, logistical coordination and resource mobilization with various stakeholders and partners. This mechanism has the goal to reach geographically inaccessible areas to perform outreach vaccination campaigns, including door to door strategies,  ensuring the inclusion of the most vulnerable populations, such as indigenous groups, migrants and others in humanitarian situations.

Door to door outreach

Vaccine acceptance does not only involve making people aware of the benefits of vaccination. It also includes working with communities to understand and address the cultural, political and environmental factors that influence their behavior. Door to door outreach plays a vital role in the success to immunization programmes by allowing discussions on concerns and finding ways to address them in a participatory way. Ensuring continuous engagement with community networks and leaders, local governments and partners for a community driven response builds trust and acceptance of vaccines.​

As a partner of the South Sudan Health Cluster, World Vision has been supporting the COVID-19 vaccination scale up, by targeting vulnerable populations with door-to-door outreach visits from health promoters that included COVID-19 information as part of their routine home visits. ​

Frontline health care workers

Frontline healthcare workers have been prioritized as high-risk groups to be vaccinated due to their higher risk of COVID-19 exposure, especially when caring for patients. Globally, approximately 70% of the healthcare workforce are women. However, vaccine hesitancy even by health care workers exists and in humanitarian settings gender disparity is seen with low uptake by women. Health Cluster partners such as CARE are working to understand and address the concerns of their staff, to promote their well-being and safety and ensure COVID-19 vaccination uptake​.​

CARE has been working in Iraq supporting national vaccination roll out including establishing vaccination units, awareness programmes and training in Ninewah, Dohuk and Anbar governorates. CARE has also conducted Knowledge Attitude and Behavior surveys, including with IDPs, refugees and returnees, to understand barriers to COVID-19 vaccination. Results were critical to utilize and develop tailored solutions to increase uptake.​

Frontline health care workers

In Northeast Nigeria, the COVID-19 vaccination campaign started in March 2021. The Northeast Nigeria Health Sector led on state level coordination and planning with WHO and UNICEF, as well as other key humanitarian partners and the State Primary Health Care Development Agency, to deliver vaccination to all targeted people,  especially frontline health workers, humanitarian workers, people in the IDP camps and communities in fragile, conflict and vulnerable settings. This included management of vaccines cold chain logistics, resource and social mobilization and data management.

43 “hard-to-reach” teams operated by WHO and UNICEF were critical in providing supportive supervision to the vaccination teams through sensitization and training of trainers at local government area level.

Health facilities

Since the COVID-19 vaccine roll out started in March 2021, several Health Cluster partners have supported efforts to facilitate uptake of the vaccine by targeted populations facing access barriers.

With this support, Iraq national COVID-19 vaccination programme is now providing vaccines in over 1,300 primary health care centres all over the country, including in humanitarian contexts, to ensure the vaccines are available even for the most vulnerable people.

Health facilities

Supply chain

Strong supply chains are essential to improving COVID-19 vaccine uptake, especially in humanitarian settings. The World Food Programme facilitates cross-border delivery and leads the Logistics Cluster in North West Syria.

Thanks to this collaboration, WHO can provide Personal Protective Equipment (PPE) and other related supplies for infection prevention and control to ensure vaccination is implemented effectively, safely and in a timely manner.