Delivery
What made Mozambique's Covid vaccination drive so successful?
By Mauro Cuna, Antonio Sambo, Kate Brownlow & Ahmed Razzak
Mozambique’s strong performance is gaining recognition regionally and internationally, despite initial constraints of vaccine supply, in-country delivery, and local acceptance.

 

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Figure 1: Mozambique’s rapid vaccination scale-up compared to Africa and other low-income countries; Source: Our World in Data

 

Dramatic progress

In April 2021, only 2% of the target population aged 18 and over had received one or more doses. Almost a year later, 95% of those over 18 years have received at least one dose, and 88% are fully vaccinated. Sufficient vaccines have been secured through COVAX, bilateral donations and government resources to cover the remaining population over 18 and to administer boosters. Booster coverage of targeted groups is 99%. Later in 2022, with international support (COVAX, USAID, UNICEF), the country will acquire the cold chain necessary to allow vaccination of 12–17-year-olds.

Five elements stand out among the many contributing factors and stakeholders:

  1. High-level leadership and governance at all levels: the President and Council of Ministers approved the National Covid-19 Vaccination Plan and had weekly progress updates; the Minister of Health led daily health team meetings to review progress, resolve issues and identify actions; provincial leadership was actively involved at the subnational level. In addition to governance, this engagement was critical to mobilising resources.
  2. Strong coordination structure: the Immunisation Department led the vaccination drive; as vaccine supply increased, a campaign director was appointed to lead mass vaccination efforts. While internal coordination was strong, there remain opportunities to strengthen the flow of information with health partners as this has been constrained by the pace of activities and pressures on those involved.
  3. Covid-19 planning & data and monitoring task force: responsible for continual review of plans and (re) prioritisation of priority populations – with an eye on equity, vulnerability, vaccine quantities, and expiry. Data packs were produced for the Minister’s daily reviews with health teams as well as information for the website.
  4. Commitment and active involvement of health partners: in addition to the efforts of Gavi and COVAX, Mozambique’s health partners were active advocates, donating vaccines, providing critical resources, and promoting open discussion around data.
  5. Communication task force: the task force met evolving communication demands for different phases of the vaccination drive. Rapid assessments informed the design of innovative approaches to swiftly combat rumours and misinformation.

Mozambique is now focused on scaling-up access and further reducing subnational inequities.

 

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Figure 2: Map of national coverage of target groups (taken from the national vaccine tracker tool developed with OCG and Gavi support)

 

Until recently, Mozambique’s Covid-19 vaccination rollout was challenged by the irregular availability of vaccines, compounded by short expiry dates, multiple types of vaccine, and little forward guidance. While these issues placed pressure on already limited resources, improvements in vaccine supply eased the path to a successful rollout.

In the coming months, the system is shifting focus to tackle two new challenges:

1. Sustaining access: strategic actions to safeguard routine immunisation whilst integrating Covid-19 vaccinations into the national schedule; delivering booster shots; vaccinating under 18s; forecasting needs; and tackling Covid-19 fatigue.

2. Reducing inequities at subnational level: there remains disparity among districts in both low and high-performing provinces.

Mozambique’s experience demonstrates that even in challenging environments good management, leadership and coordination can ensure rapid rollouts and high quality.

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