Post-introduction evaluation of COVID-19 vaccine deployment in Ghana: lessons learnt to inform future new vaccine introductions and strengthen public health readiness, 2023

Abstract

On March 2nd, 2021, Ghana, the first country to receive vaccines from the COVAX facility, began its COVID-19 vaccination using a complex multi-phased approach, to reach target populations. We evaluated the vaccine deployment to document best practices challenges and lessons for future new vaccine introductions and public health emergency readiness. We conducted a mixed methods post-introduction evaluation, purposively sampling 36 facilities from 12 districts in six regions. Adapting the World Health Organization’s COVID-19 Post-Introduction Evaluation tool, we conducted a cross-sectional survey using a structured questionnaire, reviewed programme records, observed practices, and interviewed purposively selected health workers, immunization managers and partners who supported vaccine deployment. We performed summary descriptive statistics on quantitative data, thematic analysis on qualitative data, and triangulated the results. As of March 2023, more than 70% of the target population (15 years and older) had received at least one dose, while more than 50% had completed the primary series. Vaccine deployment was built on the existing immunisation programme and functional coordinating bodies. Cold chain capacity was revamped with ultra-low-temperature freezers, while 33.3% of surveyed districts adjusted waste disposal systems to accommodate COVID-19 vaccine introduction. Door-to-door delivery and demand generation through varied risk communication and community engagement strategies improved vaccine access. Electronic data platforms were established, surge capacity improved, and healthcare and community workers were trained. Initial unpredictable vaccine supplies limited vaccination efforts. Changing vaccine information affected health workers’ ability to engage communities with up-to-date guidance. While vaccine safety monitoring systems were in place, reporting knowledge varied among health workers, and 36% of surveyed facilities had ever documented and reported COVID-19 vaccine-related adverse events following immunisation. Challenges with electronic data systems limited timely access to and use of granular service-delivery data for decision-making. Ghana leveraged existing immunisation and emergency-response systems to make substantial progress in COVID-19 vaccine deployment. Coordination, cold chain expansion, flexible service delivery, demand generation and workforce mobilisation supported implementation. Irregular vaccine supply, data system challenges, variable adverse event reporting, waste management pressure and misinformation challenged deployment. These findings provide lessons for adult immunisation, life-course vaccination and future public health emergency readiness.