While some countries are struggling to roll out the COVID-19 vaccines they’ve received, Rwanda — which received 342,960 vaccine doses through the COVAX Facility — launched a blitz in early March to quickly get the vaccine to health clinics across the country and began rolling out vaccines only two days after receiving doses.
“Essentially, vaccines hit the tarmac. The next day was spent working on stock management and then, based on pre-prepared lists, [the government] got doses out to every health center in the country. And then the very next day, they were able to launch nationwide, and in health centers everywhere in Rwanda, an immunization campaign [started],” said Anstes Agnew, head of health systems at the Tony Blair Institute for Global Change.
Though the country was only given a few days’ notice before the doses arrived, it was able to react quickly because of advanced planning and smart data management.
Rwanda serves as an example of how other countries can manage data during COVID-19 vaccine rollouts, health experts said. A recent report from the Tony Blair Institute for Global Change found that many countries don’t have accurate, detailed demographic data at the community-level that includes occupation, age, and high-risk comorbidities and non-communicable disease.
But this information, as well as other data, is needed to improve the accuracy of demand and supply forecasting, monitoring of the vaccine rollouts, and help in monitoring side effects.
“Collecting this level of data for all communities is unprecedented in some countries,” according to the report.
Identifying, convincing people
Digitizing health systems helps countries with “timely decision-making, from early warning of pressure points to algorithmic optimization of rollouts,” the report stated.
“You can't manage what you can’t see. The role of data is really to make people see what is going on in their supply chains.”— Ruth Bechtel, Mozambique country director, VillageReach
In early 2020, Rwanda moved to a digital health registry to track routine childhood immunizations. It then ran pilots in January 2021 to include vaccinations for human papillomavirus, which targets school-aged girls, giving them a QR code and an immutable record of their vaccination. The government is now using this platform to roll out the COVID-19 vaccine, Agnew said.
In its plans for COVID-19 vaccinations, Rwanda prioritized front-line health workers, elderly individuals, and people with underlying chronic conditions — but it first needed to figure out where these people live. In the months leading up to receiving shipments of doses, the government conducted large-scale screenings of communities, working with community health workers and village leaders to identify high risk individuals.
But some groups are easier than others to identify — such as health workers, prisoners, refugees, front-line security workers — based on the buildings they work or live in and existing systems around these individuals, said Dr. Githinji Gitahi, CEO at Amref Health Africa. Identifying people with comorbidities is more challenging.
“Very few people know their status of whether they have hypertension or not, very few people know whether they're diabetic or not on the African continent,” he said, adding that this is where governments should lean on community health workers who know the households in their communities.
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Ahead of Rwanda’s campaign, community health workers also screened people for diabetes, Agnew said, and also worked to combat vaccine skepticism by sensitizing communities on the importance of vaccines.
Countries also need to map out where trained and available health workers are located so vaccines aren’t allocated to areas without the capacity to distribute them, according to the Tony Blair Institute. This also helps governments redirect staff to areas where priority groups are in high concentrations.
One method countries, such as Sierra Leone, are using is handing out electronic cards with unique identifying information for each individual to track their vaccinations and also helps the country monitor where it needs to intensify efforts, said Dr. Austin Demby, minister of health and sanitation, during a recent press conference.
Partnerships with mobile phone companies are also key, because these platforms can be used to remind people to return for a second dose, Gitahi said.
Moving vaccines and reporting data
Data systems also give decision makers at the national level information on where refrigeration systems are working properly, monitor vaccine expiration dates, and can help efforts to identify counterfeit vaccines.
“You can't manage what you can’t see. The role of data is really to make people see what is going on in their supply chains. Managers need to know where they need to put more stock and where they might have an imminent stockout,” said Ruth Bechtel, Mozambique country director at VillageReach.
Rwanda is using a tablet-based software that was developed locally as their stock management tool, Agnew said.
The logistics around ensuring that countries have enough vaccines for both first and second doses also requires strong data management because of global shortages of the vaccines, said health experts.
“There is this question of whether to give out all of the doses in your possession as first doses, what to hold back,” Agnew said. “Managing the uncertainty and the planning around when your next delivery will arrive.”
And a lot of this data also needs to be reported back globally. In the World Health Organization’s Africa region, only 29 countries have reported on efforts to vaccinate health workers, even though it's believed to be much higher than that, said Phionah Atuhebwe, vaccines introduction officer at WHO, during a press briefing last Thursday.
Only 25 have provided information on vaccination of people with pre-existing conditions and 28 have reported on vaccination of older adults. She added WHO has been told “countries are overwhelmed with the vaccination that is going on.”
“I must say this is really substandard reporting,” she said. “We urge all of our countries to give us information because we would want to know: What proportion of health workers on the continent are being vaccinated? What proportion of the older adults or people with pre-existing conditions have been vaccinated?”