Nearly three years on since the start of the Covid-19 pandemic and inequalities in vaccine coverage across the globe continue to be vastly apparent. The vaccination rate in Africa in particular is far slower than the world average, and many countries are struggling to up their immunisation levels. The country of South Sudan is currently only at 15%.

Vaccinating South Sudan was always going to be a challenge. The country has spent most of the last decade mired in civil war, its population is spread out across remote regions, the weather is volatile – from extreme heat to flooding – with 60% of the road network being inaccessible during rainy season. Yet, the Ministry of Health South Sudan set an ambitious target of attaining 40% Covid-19 vaccine coverage by the end of this year to protect the people of South Sudan against the COVID-19 virus.

Instrumental to achieving this goal is the Health Pooled Fund programme (HPF3), which is managed by Crown Agents and implemented across 8 out of 10 states of South Sudan through a network of 10 national and international implementing partners. This programme bolsters the Government’s capacity to meet basic medical needs in South Sudan, providing approximately 10 million people with life-saving health services and care. The programme is currently being funded by the Foreign, Commonwealth and Development Office, USAID and GAVI to roll-out a campaign to bring the Covid-19 vaccine closer to the population and boost vaccination efforts.

Our approach aims to reach at-risk populations and those who remain severely underserved. This includes individuals with comorbidities or disabilities, the elderly population, those who are internally displaced and refugees. Pastoral communities are also supported, as they transverse the country and run a high risk of contracting or transmitting Covid-19.

The first phase of the campaign has now been completed with huge successes – vaccinating 92.5% of the targeted population and at an extremely low cost of $3.2USD per dose. It contributed to 3.61% to the country’s fully vaccinated figures in just 7 days. Faith Okelo, HPF’s Covax Implementation Specialist takes a look at the lessons learned from working to vaccinate one of the world’s most difficult-to-reach populations.

Key takeaway lessons in rolling out a Covid-19 vaccination campaign in South Sudan

1. Early coordination is vital. The terrain of South Sudan can be challenging, and we understood the need for early logistical planning, coordination and transport to ensure vaccinators were in the right place at the right time. Should we face extreme weather conditions, our transport methods are flexible – even including using canoes to get the vaccines across flooded areas!
2. There needs to be early sensitization of the County Administrative leadership to instill confidence in the vaccine. Health staff and Government officials received their vaccinations first in our campaign which helped people feel safer in receiving it.
3. These campaigns are an opportunity to build capacity of the sub-national Ministry of Health on microplanning. This is a term used in immunization activities vaccination involving the development of a detailed roadmap for implementation, management of human resources, logistics, demand generation, service delivery and community engagement. Micro-planning for our campaign was done collaboratively in consultation with Ministry of Health government officials, local authorities, implementing partners and community leaders. There was also clear and transparent communication around the campaign budget with Country Health Departments.
4. Involvement of the community at various stages of planning is key to promote ownership. Demand generation and community mobilisation took place weeks ahead of the campaign and included large road shows with public address systems, house-to-house visits and advocacy from community leaders.
5. Community engagement, dialogue with the community and engagement of social leadership groups is critical to raise awareness and addressing concerns and rumours. Community workers, known as Boma Health Workers, were vital in travelling widely to educate communities on the vaccine. Trained by HPF and well informed, they were able to clearly explain the importance of vaccination. These workers addressed local hesitancies and provided key information such as the date and location of the vaccination sites. Popular local artists also composed informative and catchy songs, which educated communities on Covid-19 and the safety of the vaccines. They travelled from village to village to perform these songs and shows.

Crown Agents and HPF3 will be building on the successes and learnings of the Phase 1 as we currently finalise Phase 2 and 3 of the COVID-19 campaign rollout, which will cover a further 48 counties. We will continue to support the Ministry of Health to ensure the 40% vaccination coverage figures and beyond are reached in South Sudan.