Opinion: Why communities are essential to health security

More than 67 million children have missed at least one routine vaccination since the start of the COVID-19 pandemic — a distressing reality worsened by the reported decline in public opinion of childhood immunizations.

While reasons for falling vaccine confidence vary by community, the implications are clear: a higher risk for disease spread, more hospitalizations, and in some cases, death. For those of us working in health care, we know trust is essential in determining if and how people seek health services, whether they listen to health care providers, or accept medicines and vaccines.

Closing the global vaccination gap will require concerted efforts from partners around the world to build trust. It must be led by governments as a public good, driven by communities, and supported by resilient and inclusive health systems.

During the pandemic, we witnessed the successful development of multiple COVID-19 vaccines in under a year, but it takes more than a vaccine to fight a disease. We need partners with strong community connections, such as Amref Health Africa, to help better understand the local dynamics central to effective vaccination programs.

Through a multiyear collaboration, Amref and The Pfizer Foundation have been working to address critical barriers to equitable vaccination access across multiple African countries, building on years of successful global vaccination programs and health systems strengthening.

Building for one, scaling to all

One of the most important lessons is to create localized, scalable approaches that cater to country and community needs now and for the future.

Amref works closely with ministries of health across Africa, at local and subnational levels, to assess and bolster health systems by identifying gaps that impede routine health services and co-creating solutions that benefit the broader health system on the continent.

In Uganda and Malawi for example, through the partnership with The Pfizer Foundation, Amref worked with the governments to identify key needs and supported them to address challenges including strengthening cold chain infrastructure.

By supporting the procurement and maintenance of a temperature-controlled supply chain, the partnership is not only enabling the storage and transportation of COVID-19 vaccines from centralized facilities to communities but is also making sustainable improvements to a vital supply chain that can be scaled up for additional medicines and vaccines.

Human-centered programs

Due to the influx of misinformation on vaccination programs, it is critical to engage influential community members, including religious leaders, civil society organizations, and health care workers who can rebuild vaccine confidence. By creating spaces and platforms that are built on trust, communities can have open conversations around immunization and improve health-seeking behavior.

Through community dialogues, Amref and other local organizations are helping communities to prioritize their health needs, ranging from screening for noncommunicable diseases to childhood immunization, and reaching community members who have difficulty accessing health facilities due to health system gaps. They also act as their own advocates, asking questions and sharing concerns that help mitigate the spread of misinformation.

In Senegal, when the national government rolled out COVID-19 vaccination for adults, progress was slow in regions such as Diourbel where religious leaders with tremendous influence denied the existence of COVID-19. These leaders became the entry point in changing narratives on the COVID-19 vaccine in the region. Just as in Senegal, there is significant sociocultural and linguistic diversity in other regions, which has not been fully considered in vaccine messaging.

Without fully engaging communities — using local languages and culturally relevant strategies — vaccination programs will fall flat. The solution is in building human-centered programs that keep communities and their preferences at the core and then integrate services to address their unique health challenges.

Creating integrated, localized, and resilient systems

During the pandemic, numerous routine immunization programs had to reallocate resources to support the surge of COVID-19 infections — highlighting significantly understaffed and under-resourced vaccination programs. Now as we play catch up, countries are experiencing surges of other disease outbreaks, further stretching the health systems.

Without building more resilient health systems, we hamper attempts to address health inequities for emergency and routine health services. Rather than investing in single-issue crises, such as the COVID-19 pandemic, we can integrate response activities with primary health care services, such as routine immunization, and integrate training for our health care workforce.

In Zambia, Amref is combining COVID-19 vaccine outreach activities, which are based on community needs, with services for HIV and reproductive, maternal, newborn, child, and adolescent health, helping reduce the burden on overworked community health workers who would otherwise conduct multiple siloed outreaches.

Local civil society organizations, long recognized as health advocates, pivoted during the pandemic to provide health services, dispel misconceptions, and encourage vaccine uptake. Given the persistent threat of health emergencies in the region and the consequent need for sustainable response efforts, it is imperative to enhance civil society’s capacity to adequately engage communities during emergencies. Through this partnership, Amref is now working with such organizations to enhance their internal systems and capabilities and provide services — such as COVID-19 and childhood immunizations.

Strengthening health systems through a health security lens

Public health emergencies continue to be a threat on the continent, including recent cholera, Ebola, and Marburg outbreaks, presenting a tremendous burden on the region. Health security — the ability to lessen the impact of such emergencies — must remain a priority, even if it means stretching existing resources to address key health system pillars, including cold chain strengthening, people-centered care, and workforce training. These efforts will not only help increase equitable vaccine coverage but can help ensure resilience for when new epidemics inevitably occur.

Communities remain our first line of response in managing health emergencies, therefore, health system investments must also include a community mindset. By supporting localized responses and increasing ownership, we can close current vaccination gaps and prepare for the next health emergency.

The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions.