In low-resource environments like Sierra Leone, it is crucial to develop and evaluate efficient interventions that leverage every point of contact to support vaccine uptake. Prior to the COVID-19 pandemic, Sierra Leone was already facing a decline in immunization rates and the use of child health care services, with rates dropping by nearly 19%. However, through collaboration between the Sierra Leone Ministry of Health and Sanitation (MoHS), UNICEF, GAVI, and the World Health Organization, mobile vaccination teams were deployed to bring education and vaccine access to all 16 districts of Sierra Leone. These teams, composed of public health workers, vaccinators, data monitors, and social mobilizers, worked tirelessly to reverse the decline in immunization rates. Their efforts proved successful, with the rate of immunization for the third dose of the pentavalent vaccine reaching nearly 90% in most districts. Despite these successes, certain districts in the Northern province continue to show low overall life-course vaccine uptake, highlighting the need for a community-focused approach to further support vaccine uptake in these areas.
Dr. Desmond Maada Kangbai, a co-investigator for this project and the program manager of the Child Health and Expanded Program on Immunization, developed and implemented an integrated family-centered life-course approach to vaccine uptake, which has shown promising results. This approach goes beyond a singular focus on specific vaccines or demographics and instead assesses the entire household's vaccination needs. For example, the mobile teams are equipped to provide the pentavalent vaccine for children, HPV for youth, and COVID vaccines for youth and adults. The success of this integrated strategy has been evident, with a 70% increase in COVID-19 vaccine uptake and a 115% increase in HPV vaccine uptake when this method was employed. The expansion of this approach could potentially transform how point-of-contact opportunities are leveraged for life-course vaccinations, leading to widespread benefits for the population.
However, the deployment of mobile vaccine teams is not without challenges. Since the onset of the COVID-19 pandemic, health workers in Sierra Leone have faced significant physical and mental exhaustion due to the risks and pressures associated with their roles. In response to this identified need, Drs. Zephon Lister and Susanne Montgomery at Loma Linda University and the Sierra Leone CRM team adapted the Community Resiliency Model (CRM) with shared decision-making techniques (CRM+) to improve the resilience, mental health, and well-being of health care workers, enabling them to better serve their patients.
In this project we hope to evaluate whether embedding a wellness team member within the mobile vaccination units and providing training in resilience, vaccine knowledge, and shared decision-making, can enhance the effectiveness of the teams. This approach not only addresses the low vaccine uptake in isolated areas but also supports the mental health and well-being of both the mobile vaccine team members and the communities they serve. The findings from this project have the potential to inform policies and practices for life-course vaccination in Sierra Leone and other low- and middle-income countries, while also promoting the resilience and well-being of healthcare workers and the communities they engage with.
Written by Dr. Zephon Lister, Professor, Counseling and Family Sciences
