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To optimize COVID-19 vaccine rollout, listen to health workers

February 25, 2021 by Jacqueline Deelstra

Health care workers in Kenya and Zambia are helping design vaccine preparedness and distribution plans.

Agnes Mulyata, a nurse at St. Joseph’s Hospice in Livingstone, Zambia, shows Lucy Daka, chief performance improvement officer in Zambia’s Ministry of Health, how she maintains vaccine cold storage.

Agnes Mulyata, a nurse at St. Joseph’s Hospice in Livingstone, Zambia, shows Lucy Daka, chief performance improvement officer in Zambia’s Ministry of Health, how she maintains vaccine cold storage. Photo: PATH/Brian Mushaukwa.

Mass vaccination campaigns involve many moving pieces, from vaccine doses and syringes to vaccination sites and patient tracking systems. But ultimately, you can’t get the vaccines into arms without one key piece of the puzzle: vaccinators.

Frontline immunization workers have been responsible for giving immunizations in communities for decades. This work comes with many challenges—and no one knows these challenges better than the health care workers themselves.

“COVID-19 immunization campaigns should be designed with health worker input, and health workers should be recognized for their role in this unprecedented campaign,” says Dr. Joseph Kayaya, lead product manager with PATH’s Living Labs Initiative. “We know from experience that when we listen to health workers, they identify challenges—and solutions—that no one else sees.”

Before the COVID-19 pandemic, PATH’s Living Labs Initiative was working with frontline immunization workers in Kenya and Zambia to better understand the day-to-day challenges that prevented them from achieving their immunization targets and professional goals.

Their feedback wasn’t surprising: health workers told Living Labs they were exhausted, stressed, and at times, under-appreciated. They are often up against ambitious immunization targets, with scarce resources to support them or recognize their achievements along the way.

In response, Living Labs staff and health care workers co-created solutions to help health care workers feel appreciated, supported, and able to achieve their goals. Living Labs staff continue to work with stakeholders to iterate on these solutions and integrate them into standard practice.

In addition, they are also working to prepare for the COVID-19 vaccine distribution.

With mass vaccination, small details have big repercussions

Nancy Otieno, a health care worker at the Kakamega Provisional General Hospital, analyzes a paper prototype of a COVID-19 vaccine vial label at a workshop in Kakamega County, Kenya.

Nancy Otieno, a health care worker at the Kakamega Provisional General Hospital, analyzes a paper prototype of a COVID-19 vaccine vial label at a workshop in Kakamega County, Kenya. Photo: PATH/Faith Mbai.

Frontline immunization workers in Kenya and Zambia are now helping to determine how the World Health Organization’s (WHO) model universal packaging and labeling for COVID-19 vaccines will vary from the standard operating procedures they currently use, and how to best accelerate vaccine distribution where they live.

“The vaccine label may seem like a small detail, but it’s a small detail that can make big waves in an immunization campaign,” said Dr. Kayaya. “We need to get it right, so we went straight to the people who know how to do it right, and we asked what they thought.”

First, health workers used an online survey to provide feedback on a sample label. Then, they participated in focus groups to discuss the prototype cartons and vials. Working through various immunization and supply scenarios, they analyzed the packaging to identify the label information and training they would need for proper storage, handling, and dosing.

For most participants, vaccine labels are more important than they might seem. In many cases, health care workers don’t have access to an informational leaflet or vaccine packaging, so the vial’s label is all they have.

“It is important the vial label is clear and distinct,” said one nurse in Kakamega County in Kenya. She said different vaccine vials often look very similar to each other, which can cause confusion.

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Many others agreed that effective labeling helps them feel confident in their ability to distribute vaccines safely and efficiently and can help manage patients’ concerns or skepticism.

For many in the focus groups, a clear, effective label should contain dosing information, handling instructions, a batch number, vaccine vial monitors to detect heat exposure, and an expiration date.

“Checking the vaccine vial monitor and expiry dates is a gold standard we cannot unlearn,” said a nurse in Kisumu County, Kenya. “These must be included on all vials so we are confident in the vaccine.”

Some said a barcode would be useful to authenticate the vaccine, and that a URL for the product website would be useful to access more information if needed. However, many of their facilities did not have software to scan barcodes or internet connectivity to get online.

“The health care workers were clear in their feedback: appropriate labels, based on their identified priority features, can help address concerns about vaccine distribution and boost community confidence in the vaccine,” said Oyugi Allela, creative designer with PATH’s Living Lab in Kenya.

Health worker insights lead to practical solutions

Livings Labs team members Wilkister Musau and Janet Muigai meet with Zippora Saitoti, the head maternity nurse at Kyuso District Hospital in Kitui County, Kenya.

Livings Labs team members Wilkister Musau and Janet Muigai meet with Zippora Saitoti, the head maternity nurse at Kyuso District Hospital in Kitui County, Kenya. Photo: PATH/Sue Wairimu.

The focus group’s insights will inform local adaptations to WHO’s training guidance for health workers on delivery and use of COVID-19 vaccines.

The health workers’ insights will also support the ministries of health in Kenya and Zambia as they develop road maps for vaccine preparedness. Their feedback will be particularly useful for supporting the governments’ efforts to build community trust in and demand for a new vaccination.

“This sector is, rightly so, led by hard science and technical rigor. But when we bring health care workers together, we’re leading with empathy and an open mind. We want to listen to them and understand their experiences,” said Oyugi Allela. “And it really works. Their feedback will improve systems for better COVID-19 vaccination and beyond.”

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