Study: CDC’s International COVID-19 Vaccine Implementation and Evaluation Program and lessons from previous vaccine introductions. Image credit: Viacheslav Lopatin/Shutterstock A team of CDC scientists recently published an article in the journal Emerging Infectious Diseases to discuss CDC’s role in managing COVID-19 vaccination programs.
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The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overwhelmed the global healthcare system. Many vaccines have been developed worldwide to break the chain of infection and control the pandemic. The World Health Organization (WHO) has issued an emergency use list (EUL) and policy recommendations for these vaccines. A total of 10 COVID-19 vaccines have been included in the EUL. COVID-19 Vaccines Global Access (COVAX) is a global initiative to accelerate vaccine development and ensure equitable global distribution of vaccines. A total of 145 countries participate in COVAX, with the US government being the largest contributor.
CIVIE program
The CIVIE program was established by the US CDC to work with country ministries of health to support the planning, implementation, and evaluation of COVID-19 vaccination programs. A total of 55 countries have been supported by CIVIE, comprising 27% of the world’s population. CIVIE has set 7 priority areas, including vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety and evaluation.
Challenges in implementing the COVID-19 vaccine
The implementation of vaccines against COVID-19 globally has faced many challenges. The main challenge was the delivery and distribution of vaccines within and within the country. During the initial phase of vaccination campaigns, there was a significant imbalance between vaccine production and supply and demand. In addition, there were other factors such as uneven distribution of vaccines, multi-dose vaccination schedule, lack of data on some vaccines, lack of human resources, exhausted health care system, inadequate vaccine safety monitoring process and spread of misinformation, which collectively made the initial availability of vaccines difficult.
Achievements in the COVID-19 vaccination program
Despite initial obstacles, the global vaccination program against COVID-19 has provided a tremendous opportunity to manage the spread of the pandemic and restore global health systems and economies. The support provided by CIVIE to country ministries of health has provided many benefits, including strengthening partnerships and creating new collaboration. In addition, evidence gathered from clinical trials and real-world settings has greatly helped to improve immunization systems. These improvements could have long-term benefits, including the development of a new vaccination platform, strengthening national vaccination programs, establishing new strategies to address future public health emergencies, and introducing non-COVID vaccines that had been put on hold by during the pandemic.
Experience from previous vaccination programs
Many lessons were learned from the vaccination programs implemented during the large 2014–2016 Ebola outbreak in West Africa. These programs faced similar challenges to the COVID-19 vaccination programs, including lack of production and supply and uneven distribution and access to vaccines.
Since the Ebola outbreak occurred mainly in rural areas, locating traditional healers and community health workers was difficult. This challenge highlighted the need for robust microdesign and the development of a health worker registry to ensure effective immunization.
Ebola vaccination programs have highlighted the importance of public communication in building trust and willingness to vaccinate. These experiences have helped CIVIE develop effective strategies to improve the uptake of COVID-19 vaccines.
To expand seasonal influenza vaccination programs in low- to middle-income countries, CDC launched the Partnership for Influenza Vaccine Introduction (PIVI) with the Task Force on Global Health (TFGH) and WHO in 2013. This combined initiative significantly helped develop invaluable skills, including policy development, micro-planning, communication and staff training, which in turn accelerated the distribution of COVID-19 vaccines.
Meningococcal serogroup conjugate vaccine (MACV) developed to prevent meningitis epidemics in Africa. Lessons learned from MACV programs include strategies for rapidly launching mass vaccination campaigns in low-resource settings, introducing public outreach services, and developing sustainable vaccination programs.
