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  • Writer's pictureMuso

Mobile teams meet patients in their homes with life-saving COVID-19 vaccine

Muso works with our public sector partners in Mali and Côte d’Ivoire to cure delays and remove barriers to care – whether that care is malaria treatment, prenatal check-ups, or COVID-19 vaccination. In December 2021, with the generous support of the Government of Canada and the Primate’s World Relief and Development Fund (PWRDF), Muso and our public sector partners launched a concerted campaign to improve access and uptake across Bamako’s 6th administrative commune, one of the most populated areas in Mali’s capital and home to at least 700,000 residents. Since the start of the campaign, mobile teams have deployed from 12 of the commune’s community health centers (CSCOMs) several days a week to reach residents with vaccines in their daily lives: at the market, at the mosque, and at home.

A mobile vaccination team in the Missabougou neighborhood of Bamako.

This campaign was critical given the ongoing disparities in vaccine and therapeutic access experienced by Mali and numerous other low-income countries since the start of the COVID-19 pandemic. In early February, the Center for Global Development heralded the COVID-19 vaccination roll-out as the fastest in global history – reaching farther in one year than comparable vaccine campaigns have reached in three. Yet the availability of these COVID-19 vaccines has been far from equitable. Throughout 2021, as hundreds of millions of people in the highest-income countries received their first, second, and sometimes third doses of the COVID-19 vaccine, ultimately reaching full vaccination coverage for 70% of their populations, the lowest income countries waited for sufficient vaccine supply and by the end of the year were unable to achieve even 4% national coverage. Despite significant mobilization for global vaccine partnerships, including through the COVAX facility and the African Union’s African Vaccine Acquisition Trust (AVATT), by March 2022, sub-Saharan Africa has been able to fully vaccinate just 15% of its population against the worst effects of the virus.

While some have blamed low coverage rates in Africa on higher levels of vaccine hesitancy among the population, research found that those in low and middle-income countries (LMIC) were in fact often more willing to take the COVID-19 vaccine than those in the United States. In reality, the gap in uptake was a result of much larger systemic barriers - a global health system failing by design. COVAX’s shortage of doses led to inconsistent shipments, smaller quantities than planned, and delays that frequently resulted in doses arriving just a few weeks before expiration. Poor cold chain access excluded the temperature-sensitive mRNA vaccines made by Pfizer and Moderna from being distributed outside of centralized facilities. Global announcements on rare dangerous side-effects from Johnson & Johnson and AstraZeneca shots sowed doubt and mistrust among communities who quickly became wary that they might be receiving second-class vaccines. Remote clinics and low-resource campaigns have not been able to keep up with constantly changing global guidelines on the numbers of doses required for target groups. Finally, as the Omicron variant swept across the globe at the end 2021, usable doses that did arrive in Africa were shipped to health systems that still faced a $1.3 billion funding gap in operational and logistics costs needed to get shots into arms.

Muso’s campaign has sought to address this glaring gap in equitable delivery and logistics. On a Wednesday morning in January 2022, a team of three mobile outreach workers walked from their place of work at the CSCOM in the eastern Bamako neighborhood of Missabougou, across a major highway, to set up a vaccination station near a parking area used by long-haul shipping trucks. They carried doses of Johnson & Johnson, Sinovac, and AstraZeneca in a handheld cooler with an ice pack, along with a bag of syringes, gloves, and cotton swabs, and a sharps container for medical waste disposal. When speaking to community members at the site, the outreach team provided information on the advantages and disadvantages of each vaccine type, and potential side effects. Johnson & Johnson, as the single-dose option, was the overwhelming favorite, as it meant recipients would receive their proof-of-vaccination card that day, rather than waiting to receive it after a second dose.

Over the course of their first 30 minutes at the site, the mobile team vaccinated a quick succession of people, the majority of whom were men in their 40s. One member of the team recorded recipient information in a register book, which will eventually be transitioned into the national DHIS2 database and be used to develop digital proof of vaccination for all those who have been inoculated. Muso’s grant with the government of Canada has provided support for training for health officials on this new digital system.

Muso is also leading a push in our peri-urban Bamako site of Yirimadio to reach residents for vaccination through the door-to-door case detection conducted daily by our Community Health Workers (CHWs). CHWs screen patients for COVID-19 risk factors, prioritizing those at high risk due to elevated exposure or underlying conditions and linking them to vaccination. As most Muso CHWs are vaccinated themselves, they often share their own experiences, demystifying the process for their patients.

Vaccination teams from our partner CSCOMs periodically join CHWs on their door-to-door visits and are able to provide doses directly in the home when patients are interested, ensuring that access to this essential service does not interrupt daily life. During one of these outreach efforts in March, a woman received her vaccination while preparing dinner for her family, briefly putting down the vegetables she was peeling and squeezing her eyes shut as a vaccinator gave her the shot. Then she turned right back to her peppers.

As a result of Muso’s community-level efforts to improve access and bring the vaccine to residents where they live and work, more than 200,000 people are now fully vaccinated in Bamako’s 6th Commune, 57,000 of these in Yirimadio. As of the end of March, 58% of the eligible population is now fully vaccinated, up from 26% in early December 2021.

Yet these successful vaccination efforts in Mali are not exempt from the challenges and inequities of the global vaccine roll-out. According to the African Union, Mali has still only received 9% of the doses needed to fully vaccinate its whole population, and is only administering doses of AstraZeneca, Johnson & Johnson, and Sinopharm/Sinovac, all vaccines that last longer outside the cold chain. Inconsistent and dwindling supply of two-dose regimens like AstraZeneca has meant that those who received one dose already have to wait extended periods or go without for their second, a poor formula for reaching full vaccination. Moreover, until very recently, protocols advising against COVID-19 vaccination for pregnant and breastfeeding women, limited access for major portions of Mali’s adult population. As of late March, national recommendations have been updated and this limitation has been removed.

The World Health Organization set a target to fully vaccinate 70% of the world by mid-2022, a deadline that is fast approaching. Yet as the pandemic drags into its third year, and new, more contagious variants of the virus continue to emerge, institutional momentum to vaccinate the world seems to be waning. US senators have proposed cutting funding for global vaccination from the latest COVID-19 relief package, and as of early April, COVAX has been able to mobilize less than 600 million USD, a fraction of the 5.2 billion USD it needs to continue its work in 2022.

Adequate supply is a critical piece of the global vaccination effort, but it is not the whole puzzle. Ending the pandemic will require ongoing investments in health workers, protective equipment, transport, cold chains, and visible and trust-generating collaborations with Ministries of Health. Muso’s work with Mali’s public sector on the COVID-19 vaccine campaign in Bamako has shown the potential impact of a supported, community-focused vaccine drive - the challenge going forward will be ensuring initiatives like these are embedded and expanded through reinforced systems that support health for all.


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