U.S. CDC in Uganda and Partners Bring COVID-19 Vaccines to Local Populations

“Reach every community, reach every household, and reduce any vaccine uptake barriers. That is how we succeeded,” says Assay Ndizihiwe, MD, a technical expert with U.S. Centers for Disease Control and Prevention (CDC) in Uganda. Ndizihiwe, who works on health systems strengthening and vaccine programming, says the priorities of Uganda’s Ministry of Health (MOH) COVID-19 vaccination strategy were:

1. Provide vaccines in health facilities and other routine sites
2. Reach out to people as close to their homes as possible through intensive campaigns.

Supplies were limited when COVID-19 vaccines first arrived in Uganda in March 2021, forcing the Ugandan government to prioritize recipients. People aged 50 years and older and people with comorbidities – who are at higher risk for severe illness because they already have one or more diseases or conditions at the same time – were among the first groups eligible to get the COVID-19 vaccine.

However, people did not rush to get vaccinated. Five months after priority groups had access to the vaccines, fewer than one in ten people aged 50 and older got vaccinated, and fewer than one in 20 people under the age of 50 with comorbidities received a COVID-19 vaccine.

Ministry of Health, CDC, and Partners Engage Leaders of Priority Populations

CDC in Uganda works closely with the Infectious Diseases Institute (IDI). With CDC support, this local partner was able to reach each of the priority populations. IDI worked with the MOH to engage members of parliament as advocates and utilize stakeholders such as the Ministry of Labor, Gender, and Social Development.

IDI reached out to organizations that treat people with comorbidities, including the Uganda Cancer Institute, to get more people vaccinated. IDI also worked with patient advocacy groups, including the Community Health Advocacy and Information Network, to review education materials used to mobilize communities to get vaccinated for COVID-19.

Rumors about the safety of the COVID-19 vaccine were abundant in Uganda, including myths that claim the vaccine would kill people instead of prevent disease. This misinformation discouraged many people from getting vaccinated.

People who did want to get the vaccine often ran into obstacles. Some had to travel long distances to facilities, sometimes the vaccine was not readily available, or they had to wait in long lines.

Bringing Vaccines to the People Who Need Them Most

Getting more Ugandans vaccinated, especially those who are getting treatment for other illnesses, was a top priority for health officials. CDC, IDI, and the Ministry of Health looked for ways to bring COVID-19 vaccine to the people who need it most. IDI worked with local organizations Mildmay Uganda and others supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the AIDS Support Organization, and Rakai Health Sciences Program to increase vaccinations.

They set up outreach events at places of worship and at locations where people received their social security benefits. During one event held at a large Catholic parish, more than 1,200 people in priority groups got the COVID-19 vaccine in just two days.

To reach those with comorbidities, IDI held vaccination events at health centers where people were already getting care for chronic diseases such as cancer and HIV/AIDS. These vaccination clinics allowed patients to get the COVID-19 vaccine and also get treated for cancer or HIV, which they might otherwise avoid for fear of being stigmatized. In other cases, people were comfortable getting the vaccine because they already had known and trusted clinical caregivers providing the treatments. Being able to get the vaccine and treatment for their other illness in one trip was helpful for many patients.

Reaching the Masses

When more vaccines became available, MOH immediately rolled out campaigns to increase vaccinations by sending vaccination teams directly to people at their homes.

Alfred Driwale, MD, is the Program Manager of the MOH’s Uganda National Expanded Program on Immunization and in charge of leading Uganda’s COVID-19 vaccination effort. Driwale emphasized the importance that implementing partners had in sustaining the vaccine campaign. “We started with five teams per district because we couldn’t activate the entire structure. As vaccines started becoming more available, [IDI] started [expanding] training … to more teams. IDI, in particular, helped us in this area, working with the districts to provide technical assistance because we are far [from the districts].”

Combined Efforts Lead to More Vaccinated People

The U.S. government’s donation of more than 2.7 million vaccines to Uganda contributed to the success of Uganda’s COVID-19 vaccination campaigns. The strong relationships among the MOH, CDC and local partners bridged gaps between the government and the population by building the public’s trust in the COVID-19 vaccine.

With CDC’s support, IDI’s outreach to priority populations reached more than 75,000 people by March 2022. From the beginning to the end of the project, the percentage of vaccinated people over age 50 years increased eight-fold, and for those with comorbidities, it almost doubled. By the summer of 2022, 57% of Ugandans above the age of 18 years got their primary COVID-19 vaccinations.

This work supports CDC’s broader goals to increase global COVID-19 vaccination coverage – get shots in arms, prepare for COVID-19 surges, and prioritize healthcare workers and other priority populations based on public health data.