COVID-19 vaccine rollout: Lessons from Tanzania

In the past year, Tanzania has scaled up its health care infrastructure to distribute millions of COVID-19 vaccination doses. Programs to offer COVID-19 vaccination began in August 2021, but a long road lies ahead in getting to the country’s goal of 70% coverage, with current coverage at 32.1%.

As part of any new vaccine rollout, the World Health Organization recommends an intra-action review to assess the COVID-19 vaccine implementation plan and look for areas where the program can be strengthened. Tanzania conducted an initial IAR in November 2021 and held another IAR meeting in February 2022, supported by the Data for Implementation (Data.FI) project and funded by USAID. These meetings culminated with a report on Tanzania’s progress which outlined successes, challenges, and recommendations moving forward.

Many of the successes in the vaccination campaign, which initially targeted high-priority groups, have resulted from local community engagement and mobilization efforts. Examples include the following:

• Outreach immunization services were intensified through a campaign using the slogan “Timua vumbi” (Erupt the Dust) in the Ruvuma region. This campaign led to vaccination coverage that is twice the national average (12% vs. 5%).
• Students from the University of Dodoma were involved in supporting vaccination activities on weekends in the Chamwino District. Vaccination rates usually drop during weekends, but the participation of students helped bring daily vaccinations from 20 to more than 500 people per day.
• The integration of COVID-19 vaccination in routine HIV/AIDS care and treatment clinics in the Dar es Salaam region allowed increased vaccinations among attendees at those clinics.
• Vaccine champions in the Ukerewe District helped to address misconceptions, rumors and misinformation about COVID-19; this contributed to an increase in COVID-19 vaccine uptake from 2% to 11%.

The IAR report also highlighted key challenges:

• There was a high dropout rate between the first and second dose, with up to 40% of Pfizer first-dose recipients not returning for their second dose within the recommended time.
• There was a shortage of insulated vaccine carriers at health facilities, which are necessary for COVID-19 outreach sessions in remote areas and for continuing routine childhood vaccination.
• Fewer than half of community health workers have been trained to support COVID-19 vaccine awareness, sensitization and defaulter tracking.
• Some health workers need additional training on COVID-19 vaccine storage, delivery, administration, reporting and use of systems.

Importantly the report offered a few recommendations, namely that the health sector should:

• Intensify outreach and mobile immunization services to target high-priority groups and people working in special job categories, such as students, teachers, members of the security forces, nomadic pastoralists, farmers, taxi drivers and others.
• Train additional community health workers, along with village and ward health committees, on COVID-19 vaccines to increase advocacy and sensitization and to implement other activities at the community level.
• Conduct comprehensive training of health care workers on new vaccines before distribution, including information about vaccine storage, delivery, administration and reporting.

WHO’s IAR process offers a chance to celebrate successes, delve into challenges and chart new paths forward. The review process revealed specific actions that can be taken over the next few months and offered ways for the Tanzanian government to benchmark their progress. Some of these actions are already being undertaken, as Tanzania begins subnational campaigns to incentivize vaccination and decrease hesitancy. Overall, Tanzania is continuing to make progress and will hope to continue in the efforts to protect people from COVID-19.

Florian Tinuga, MD, MPH, is the program manager for the Immunization and Vaccine Development Unit at the Ministry of Health Tanzania. Matiko Machagge, MSc, BPharm, is the country team lead for inSupply Health and JSI in Tanzania. Ruben Conner, MPH, is a technical advisor to the Data.FI project at Palladium. Data.FI is a global project that helps countries strengthen and sustain access to key, high-quality data to accelerate and maintain HIV and COVID-19 epidemic control. The Data.FI team, with support from USAID, continues to support the Tanzanian government in executing and achieving their National COVID-19 Response Plan.