key: cord-0704609-0ki73caz
authors: Emeka, Chisom; Edu, Betta; Ekpenyong, Janet; Getachew, Biniam; Chabo, Joy; Abdurhaman, Umar Pella; Ntui, Nyambu Bernard; Chukwu, Ephraim; Ekpenyong, Nsa
title: COVID-19 vaccine roll-out at the community level in developing countries: Lessons learnt from Cross River State, Nigeria
date: 2022-05-21
journal: Public Health Pract (Oxf)
DOI: 10.1016/j.puhip.2022.100273
sha: d2f8477b667efd314705f3c61a48a16525e9d3d7
doc_id: 704609
cord_uid: 0ki73caz

Since the first COVID-19 case was reported in Nigeria in February 2020, the Country’s effort to curb the surge in cases and protect people from the disease was undeniable, as does Cross River State (CRS). Using document revision, we illustrate the COVID-19 vaccine rollout in Cross River State, Nigeria. The State recorded its first COVID-19 cases on 29(th) June 2020. COVID-19 vaccination commenced in the State on 11(th) March 2021. The pandemic response was led by the COVID -19 taskforce constituted by the Government of CRS in March 2020 to ensure effective response to effective response to the pandemic. Intensified advocacy, communication and social mobilization activities, mainly community engagement, were conducted to minimize vaccine hesitancy. A chain of responsibilities was observed in vaccine management and logistics. The State carried out a successful rollout of the first phase of COVID-19 vaccination, including refugees’ vaccination and management of AEFI. This commentary aims to share the experience and lessons learned in rolling out the COVID-19 vaccine in Cross River State, Nigeria. This paper will guide policymakers in developing countries.

The first case of COVID-19 disease was reported in Nigeria on the 27 th of February, 2020. 20 Vaccination is one of the Country's strategies to curb the transmission of COVID-19 disease [1] . 21

Although the COVID-19 pandemic affected everybody, the burdens of the disease are not shared 22 equally by all people. The disease's rate of death and severity varies among different groups of 23 people [2] . A study in the USA reveals substantial racial and ethnic disparities in COVID-19 24 mortality, specifically among Black African Americans [3] . 25

Nigeria has planned four phases to vaccinate its population based on recommended prioritizations. plan was reviewed and validated by the LGA team for its feasibility. An existing structure of the 49 Expanded Program for Immunization (EPI), which includes trained healthcare providers, cold 50 chain supplies, coordination system, social mobilization, data management and monitoring system, 51 was the basis for the COVID-19 vaccine rollout. The CRS Government and partners provided 52 additional resources, mainly funds, to strengthen the existing structure. On monitoring, the LGA and State teams conducted daily evening review meetings (ERM) to 153 assess the daily activities, feedback from the supervisors, review the daily data and share it with 154 the State and National. Where serious gaps were identified, corrective interventions were carried 155 out and technical support was provided by the State team when necessary. One of the best practices 156 and innovations by Cross River State was the virtual weekly expanded review meeting of State 157 with the 18 LGA teams on zoom providing opportunities for learning among teams. 158

The vaccination data were captured using a paper-based register and an electronic-based data 160 collection system-the Electronic Management of Immunization Data (EMID) platform. The need 161 for both data capturing mechanisms was to make available vaccination history of vaccines readily 162 accessible from any location. Though, technological hitches were experienced in accessing the 163 electronic data capturing system at the beginning of the vaccination mainly due to network 164 challenges in certain areas and inadequate data bundles provided to recorders. 

• Inadequate Information, Education and Communication (IEC) materials to indicate the 192 location of vaccination sites

• Health workers were fatigued due to the extended vaccination period

• Delayed payment of the LGA and vaccination personnel from the National

• Challenges with electronic registration, such as heavy traffic on the server, inaccessibility 196 of internet in some LGAs, and lack of battery back-up (power bank) of smartphones for 197 recorders contribute to data variance between online registration and paper-based reports 198

• Continued high level of vaccine hesitancy among the populace

• Some persons who took the first dose migrated to other locations and were unable reached

• Government to continue mobilization of additional funding and human resources

• Intensify continuous ACSM engagement activities to dispel misinformation and 206 disinformation

• Intensify quality supportive supervision and take corrective actions on gaps identified

Reference 1. The Nigeria Centre for Disease Control (NCDC). COVID-19 Nigeria

World Health Organization. WHO SAGE values framework for the allocation and 251 prioritization of COVID-19 vaccination

Black-White Risk 255 Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the 256 United States: Translational Epidemiologic Perspective and Challenges

NPHCDA -National Primary Health Care Development Agency

Coalition for Epidemic Preparedness Innovations, GAVI, World Health Organization

COVAX vaccine roll-out | Gavi, the Vaccine Alliance

World Health Organization. Behavioural considerations for acceptance and uptake of 264 COVID-19 vaccines: WHO Technical Advisory Group on Behavioural Insights and Sciences 265 for Health, meeting report

COVID-19 immunization in refugees and migrants: principles 267 and key considerations: interim guidance