Emerging lessons from Africa's COVID-19 vaccine rollout show that planning and preparation, strong logistical systems, and effective communication strategies are key to successful vaccination programs. Countries like Ghana, Angola, and Rwanda that developed national vaccination plans in advance and leveraged existing healthcare infrastructure have been able to rapidly distribute vaccines. Effective communication approaches including engaging community leaders and disseminating factual information through multiple channels have helped boost confidence and manage expectations. Broad multi-sector partnerships at all levels of government and within communities have also proven crucial to the rollout. However, most African countries are now running out of vaccine doses and more supplies are urgently needed to sustain the momentum of their campaigns.

1. Emerginglessonsfrom Africa’s COVID-19 vaccine rollout
WHO Africastatement
With47 AfricancountriesnowrollingoutCOVID-19vaccinesandover17 milliondosesgivenonthe
continent,earlyinsightsfromAfrica’slargest-everimmunizationdriveofferhope,inspirationand
early,yetvital lessons.Here,we shine alightonkeylessonsemergingfromcountriesthathave
made strong progress,includingAngola,Ghana,MauritiusandRwanda.
Planningand preparation is crucial
Nearly40 Africancountriesdevelopednational vaccinationplansbefore COVID-19vaccinesbegan
arrivinginbulkonthe continent,manywithsupportandguidance fromWHO.
Thisearly,wide-rangingpreparationispaying-off,ascountrieswithgoodplansandlogistical
capacitiesalready inplace beganvaccinatingtheirprioritypopulationsthe fastest.
Ghana, the firstAfricancountryto receive vaccinesthroughthe COVAXfacility,reachedover470
000 people inareaswiththe highestnumberof COVID-19casesinjust20 days,includingover60%
of itsfirstphase targetpopulationandaround90% of all healthworkers.
‘Pre-listing’populationsincludesmappingpopulations,screeningpeopleandscheduling
appointmentsforvaccinationinadvance.Goodpre-listinghasbeenkeyelementinthe mostrapid
and well-targetedCOVID-19vaccine roll-outs.
Angola’selectronicpre-registrationsystemhelpedensure the rightpeople were vaccinatedandthat
theyknowwhere andwhentoget the vaccine.SMS messaging,emailconfirmationsandQRcodes
for on-site verificationhasalsoprovenuseful inpreparingtodeliverseconddoses,aswell as
collectingdatatomonitorthe safetyof vaccines.
“VaccinationstartedonMarch 10, andin twoweekswe hadvaccinatedover70 000 people from
prioritygroupsacrossthe country,includingover35000 healthworkers,”explainsDrAldade Souza,
Manager of Angola’sNational ExpandedProgramme onImmunization.
Angolahasalso investedheavilyincoldchainlogisticsandstorage facilitiestoensure thatall COVID-
19 vaccines,includingthose thatmustbe storedat ultra-coldtemperatures,canbe usedinthe
countryin the comingmonths.
Stronglogistical preparationsandcoordinationhave alsobeenkeytoreachingpeople inremote
areas.In Ghana, mobile vaccinationteamsbackedbycommunitymobilizersreachedelderlypeople
livinginfar-flungcommunities.
Mauritius,Rwandaandmany othercountriesheldwide-rangingvaccine rolloutsimulationexercises
inadvance,and countriesthatconductedthese have typicallyseensmootherrolloutsaswell as
havingstrongerregulatoryandsafetyproceduresputinplace.
For vaccinationteams,the provisionof personal protective equipment(PPE) alongwithtrainingand
supervisioniskeytoensuringthatvaccinationsare deliveredsafely.
“It’sveryimportantto note that infectionpreventionhasbeenakeypartof the vaccine roll-out,”
saysFred Osei-Sarpong,aWHO ImmunizationOfficerinGhana.“The vaccinatorsare wearingmasks,
observingregularhandhygieneandstickingtothe safetyprotocols.”

2. Existinghealth systemsgive a strong base
“In Rwanda,we builtourCOVID-19vaccinationprogramme onthe experience fromotherdiseases,”
saysDr SabinNsanzimana,DirectorGeneral of the RwandaBiomedical Centre.
“We pluggedintothe [existing]system,whichwaseasierandfaster,andwe had capacityto store
vaccinesthatrequire special conditions,includingfromfightingEbola.We hadteamsthatwere
trainedinrollingoutvaccinesatthe central,districtandcommunitylevels.”
Alongwithover40 countriesinthe WHO AfricanRegion,Rwandaalsomade use the WHO’sCOVID-
19 Vaccine CountryReadinessAssessmentTool toguide andmonitorpreparations.
The country isrollingoutthree differenttypesof vaccines –the Oxford/AstraZeneca,Pfizer-
BionTechandModerna vaccines - each withunique coldchainstorage andtransportneeds.
Buildingonitsexistinginfrastructure,Rwandaboosteditscapacitytostore and move Pfizervaccines
at ultra-coldtemperaturesandbeganvaccinatingwidely withinjusttwodaysof the firstvaccines
arriving.
The PfizerandModerna vaccinesare giveninhospitalsandthe AstraZenecavaccine isusedinhealth
centresacrossthe country.Target groupswere pre-listedforeachvaccine.
Angolaalsoleveragedits strongexistingsystemsandexperience,buildingit’sCOVID-19vaccination
drive onsystemssetupto deal witha deadlyoutbreakof yellow feverin2017.
For Ghana, the COVID-19vaccine roll-outbuildsonyearsof experience ineliminatingwildpoliovirus
and othermassand routine immunizationcampaigns.
Communicate early, strategicallyand persistently
Communicationsmuststartearlytoprepare communitiestoreceive the vaccine,andmustbe part
of wideroutreachplanstostopthe spreadof the disease.
Early evidencefromacrossAfricashowsthatmany are eagertoget the vaccine,despite verylimited
supplies.Yetbattlinghesitancyamongsome olderpeople,aswell asmanagingdemandand
eagernessamongthe younghasbeena challenge insome countries.
Ghana’scommunicationanddemandgenerationforCOVID-19vaccineshasbeenstrong,withclear
audiences,messagesandwell-plannedworkwithradio,TV,social mediaandthroughtrained
spokespeople,influencers,partnerorganizationsandamongcommunities.
Actionswere informedbypriorpublicassessmentsandanalysisthathelptrackopinionsandshift
approachesinline withpublicconcernsovertime.
Political leadershipiskeytofightingvaccine hesitancyandGhana’sPresidentreceivedcountry’s first
COVID-19vaccine live onnational televisionon1March.
He wasshortlyfollowed,alsoonlive TV,bythe Vice-President,andthe vaccinationdrivekickedoff
inearnestthe followingdaywithaformerPresident,politicians,judges,state councillors,royalsand
religiousleadersfromanumberof faithsall gettingthe jab.
“We reliedonfactsand figuresandwe gotinformationoutquickly,”notesFredOsei Sarpong.“We
decidedtoworkwithfacts,withtruth,so that helpedusbuildupconfidence.”

3. “Everythingwascommunicatedondifferentchannelsinadvance,”Osei-Sarpongcontinues.“Inrural
communities,informationcentresoftenhave PA systems,sowithourpartnerswe made use of them
to helpmake sure people knowwhere andwhentogetthe vaccine.”
Broad partnershipsare crucial
A huge national endeavourneedsawhole of societyapproach,bothbefore andduringthe rolloutof
COVID-19vaccines.
Withstrong leadershipandcoordinationfromthe Ministryof Health,partnershipsacrossand
beyondgovernmenthave provedcrucial incountriesthathave shownearlysuccesses.
Angola,Ghana,Mauritiusand Rwandahave all stressedthe needformulti-sectoral partnershipsto
be in place at the national,districtandlocal levels,includingwithinternational partnersand
business,especiallyif official resourcesare over-stretched.
“CoordinationinGhanaisexcellent,fromthe highestlevelsdowntoeachdistrict,”notesOsei-
Sarpong.“We’re gettinggooddata fromthe fieldtofeedintothe higherdecision-makingbodies,
and regional anddistrictleadersleadthe charge attheirownlevels.”
Partnershipsare alsoimportantingeneratingdemandforvaccinesandincommunicatingwith
communities,where religiousandcultural leadersare oftenrespectedandfollowed.
Risks and challenges
Despite apromisingstart,some Africancountriesare rapidlyrunningoutof COVID-19vaccines.
Othersface delaysthrougha lackof fundsor limitedplanning.
As of 12 April,lessthan2% of the 780 millionCOVID-19vaccine dosesgivengloballyhave been
administeredinAfrica.More dosesare urgentlyneededtokeepupthe momentumandtomeetthe
objectivesdetailedineachcountry’svaccine roll outplan.
“The onlyreal challenge we have isthatwe needmore dosestoreachour targetof vaccinating60%
of ourpopulationbynextyear,”explainsDrSabinNsanzimanainRwanda.
WHO Africahas made a strong appeal tothe international communitytoensure the continentisnot
leftbehindandthatthe worldcan endthe pandemictogether,asnocountry issafe until all
countriesare safe.
Throughthe ‘LessonsinCOVID-19vaccine rollout’webinarandpublicationseries,WHOisworkingto
collate,showcase andshare countryexperiencesinAfricaforpolicymakersandpublichealth
professionals.Researchonthe impactof COVID-19 vaccinesisalsounderway.