Global inequity creates local insufficiency: A qualitative study of COVID-19 vaccine implementation challenges in low-and-middle-income countries

IntroductionThe COVID-19 pandemic has amplified pre-existing challenges to health promotion and care across the world, and particularly in low- and middle-income countries (LMICs). This qualitative study draws on data from a panel of immunisation experts and uses a novel framework of vaccine delivery domains to explore perspectives from those who live and work in these settings on the challenges to implementing COVID-19 vaccine programs in LMICs. MethodsWe conducted a thematic content analysis of 96 participant free text replies to questions from Round I of a three-round Delphi consensus study amongst global experts on COVID-19 vaccine implementation. ResultsParticipant responses highlighted challenges to vaccine program implementation including issues related to equity; governance, decision-making, and financing; regulatory structures, planning, and coordination; prioritisation, demand generation, and communication; vaccine, cold chain, logistics, and infrastructure; service delivery, human resources, and supplies; and surveillance, monitoring, and evaluation. ConclusionWe reflect on our findings in light of global efforts to address vaccine inequity and emphasise three key areas salient to improving vaccination efforts during novel infectious disease outbreaks: 1) Ensuring safe and sustainable service delivery in communities and at points of care; 2) Strengthening systems for end-to-end delivery of vaccines, therapeutics, diagnostics, and essential supplies; 3) Transforming structural paradigms towards vaccine equity.

Automated summary

The COVID-19 pandemic has posed challenges to health promotion and care worldwide, especially in low- and middle-income countries (LMICs). This qualitative study examines perspectives from individuals living and working in LMICs on the challenges of implementing COVID-19 vaccine programs. Through thematic content analysis, the study identifies various challenges in vaccine program implementation, including issues related to equity, governance, regulation, logistics, and service delivery. The findings emphasize the importance of focusing on safe and sustainable service delivery, strengthening end-to-end vaccine delivery systems, and promoting vaccine equity during novel infectious disease outbreaks.