Last-mile delivery increases vaccine uptake in Sierra Leone

Niccolò F. Meriggi (), Maarten Voors, Madison Levine, Vasudha Ramakrishna, Desmond Maada Kangbai, Michael Rozelle, Ella Tyler, Sellu Kallon, Junisa Nabieu, Sarah Cundy and Ahmed Mushfiq Mobarak ()
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Niccolò F. Meriggi: International Growth Centre
Maarten Voors: Wageningen University and Research
Madison Levine: University of Illinois
Vasudha Ramakrishna: Boston University
Desmond Maada Kangbai: Ministry of Health and Sanitation
Michael Rozelle: Wageningen University and Research
Ella Tyler: Wageningen University and Research
Sellu Kallon: Wageningen University and Research
Junisa Nabieu: Wageningen University and Research
Sarah Cundy: Concern Worldwide
Ahmed Mushfiq Mobarak: Yale University and Y-RISE

Nature, 2024, vol. 627, issue 8004, 612-619

Abstract: Abstract 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.

Date: 2024
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DOI: 10.1038/s41586-024-07158-w

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