In the race to protect people from COVID-19, nearly 6 billion vaccines have been administered, enough to fully vaccinate 38% of the world’s population. But the doses haven’t been equally distributed, leaving 65 countries with less than 10% of people fully vaccinated, while countries like Singapore and Qatar have 79% coverage and, the UK and Canada roughly 70%, and the US and most European Union countries around 60%, according to the Bloomberg COVID-19 Vaccine Tracker.

In low- and middle- income regions like West Africa, the rates are extremely low, with many countries hovering around 1% coverage and the highest, Mauritania, only at 10%. Nigeria, the most populated country in Africa, has been able to provide just 1.5% vaccination coverage. 

These low rates not only keep people at risk and slow the end of the pandemic, but increase the possibility for stronger virus variants and further economic strain in countries that are already among the poorest in the world.

While the WHO and  the COVAX initiative work to ensure an adequate and equitable supply of vaccines, The Task Force’s COVID-19 Vaccine Implementation Program (CoVIP) works  with low- and middle-income countries to implement vaccination systems so doses can be administered once received.

Epidemiologist Aminu Muhammad leads CoVIP’s work in West Africa, with countries such as Ghana, Liberia, Nigeria and Sierra Leone.

“Although there has been a little bit of a spike in terms of another wave of COVID-19 cases coming up, governments in these countries and citizens themselves have been very diligent in preventing it from getting too bad because they know they can’t rely on protection from treatments like vaccines yet,” said Muhammad, based in Kano, Nigeria where he supports West African ministeries of health with the roll-out. “For example, in Nigeria, the government has enforced measures like widespread mask use to prevent this spike from blowing up.”

With the doses received so far, Nigeria has vaccinated some health care workers and elderly. At the end of August, Nigeria received a new shipment of Moderna, AstraZeneca, and Johnson & Johnson vaccines to start the next phase of vaccinations which will reach additional  healthcare workers and the elderly and some of the general population.

“All of the countries are at various stages of updating or developing their vaccine deployment systems, so I support each country in different ways depending on the stage they are at,” said Muhammad. “In June and July for example, I was based in Sierra Leone to help update their policy and deployment plan in anticipation of receiving a new shipment of J&J/Janssen vaccines. In Liberia, we’ve been working to develop an electronic reporting system for adverse events following immunization so that there is an established reporting process should events arise.”

During pauses in vaccination campaigns due to insufficient supply, CoVIP has helped these countries monitor and evaluate their initial vaccine roll out. 

“We reviewed what were the challenges observed in implementation during the first round of doses and what were the best practices and, from that review, worked on updating and reinforcing the vaccine system so that they will be more prepared for the next round of doses received,” said Muhammad.

Vaccinating entire countries quickly with a new vaccine presents multiple challenges.

“In addition to the global challenge of producing and delivering enough of this new vaccine to every place, funding for the required vaccine infrastructure, plans for implementation, and a skilled workforce are some of the many challenges that countries like Nigeria, Sierra Leone and Liberia face,” said Muhammad.

Few countries have ever implemented such a large and complex program of vaccinations so quickly, so CoVIP regional leads  like Muhammad work with each country to provide the types of assistance that best addresses their needs. Countries that have previously vaccinated health workers and adults for influenza generally have greater capacity for COVID vaccination, based on the experience and planning used for influenza vaccination programs. Countries without such experience may need greater support to get their citizens vaccinated and reach their 2021 goals once they receive vaccine doses.

While the immediate goal is to enable all countries to fight COVID-19, these efforts will also strengthen national health systems for future vaccine-preventable outbreaks, epidemics, and pandemics.

In addition to West Africa, CoVIP is working with countries in East Africa, Central Asia, and Latin American and the Caribbean, including Haiti. In July, Haiti received its first shipment of 500,000 doses from a U.S. pledge of 12 million doses to increase its 0.1% vaccination coverage. With the country’s infrastructure severely devastated  by  the August earthquake that killed more than 2,000 people , CoVIP and partners like UNICEF continue to support the Haitian Ministry of Health in rapidly training health workers to deliver COVID-19 vaccines.