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Access, not hesitancy, the barrier to COVID-19 vaccinations in Sierra Leone, study shows.

Press release14 March 2024
Concern vaccination team member records community members' information at a clinic
Concern vaccination team member, Baison Salone records community members' information at a clinic in a village, in Karene district. Photo: Conor O'Donovan/Concern Worldwide

The approach used by Irish humanitarian organisation Concern Worldwide to deliver COVID-19 vaccines to remote rural communities in Sierra Leone has been highlighted as a replicable, cost-effective and efficient way to increase vaccine uptake among similar communities in lower income countries.

Research, published in Nature, showed that by improving access, the number of people receiving the vaccine in 100 rural villages in the study increased by 400%. 

This was largely achieved through Concern, and the Sierra Leone Ministry of Health and Sanitation (MoHS Sierra Leone) building upon their regular vaccine support programme. It includes setting up temporary vaccination clinics where communities do not have an existing clinic, providing an opportunity for communities to ask questions and receive appropriate and accurate information about the vaccine. Alternative forms of transport such as motorbikes and boats were used to reach isolated and hard-to-reach communities.

The average cost of administering the vaccine was 81% cheaper than similar models, offering the potential for it to be replicated in countries with large rural populations, and similar infrastructure and community outreach.

“The research shows that once the vaccine is available to people, uptake is extremely high. This flies in the face of the common and much publicised narrative that vaccine hesitancy is a barrier towards vaccine uptake, not just in Sierra Leone but across many countries,” said Sarah Cundy, Health Programme co-ordinator with Concern in Sierra Leone.

“Our experience was exactly the opposite; that people were not resistant to getting the vaccine but the issue was that they could not access it. Although various countries supported COVID-19 vaccine availability through schemes such as COVAX, once vaccines arrived at the airport, there were no supports to deliver and administer them. There needs to be greater understanding among donors that access also includes public health information campaigns, transport and the human resources to deliver vaccines.”

The study entitled, ‘Last-Mile Delivery Increases Vaccine Uptake in Sierra Leone’ was conducted in 2022 by researchers Niccoló F. Meriggi, Mushfiq Mobarak, and Maarten Voors at the International Growth Centre (IGC), University of Oxford, Yale University and Wageningen University collaborating with Concern and the Sierra Leone Ministry of Health. 

The team conducted a randomised controlled trial involving almost 30,000 Sierra Leoneans aged over 12, living in rural towns and villages outside Sierra Leone’s national clinic network.

The research addressed why, one year into its COVID-19 vaccine roll-out, only 14% of the population – two thirds of whom live in rural areas, were immunised, and how to increase this number.

By December 2022, that percentage had increased to 70%, reaching the WHO’s global target, and in July 2023 over 9.1 million doses of the COVID-19 vaccine had been administered in Sierra Leone.

While the study focused on the COVID-19 vaccines, the Concern and MoHS Sierra Leone mobile and outreach approach has already evolved to provide integrated services combining vaccines and health checks into a single community visit. These focus on HPV vaccines, childhood immunisations, child health interventions, and pre and post-natal checks. 

There are mobile vaccination teams in each of the 16 districts of Sierra Leone, in addition to health workers from primary health facilities, who spend 10 days a month travelling to marginalised and hard-to reach groups. 

Lower income countries are still recovering from the economic and health shocks of COVID-19, which disrupted routine immunisation campaigns, increasing the risk of future pandemics, and disease outbreaks. 

The research team from IGC have been granted funding to expand the model studied in its 2022 paper to reflect these additional immunisation and medical interventions.

Concern has been working in Sierra Leone for 26 years, supporting and strengthening health systems, education, agriculture and livelihoods.

For further information contact Eilis Staunton, Media Relations Officer, Concern Worldwide, at or 085 872 0720.

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