Journal Article

Integrating COVID-19 vaccination into health systems: qualitative findings from seven countries

Ewald, Leah Hughey, Sigauque, Betuel, Cherinet, Mebratu Massebo, Voss De Lima, Yara, Hatt, Laurel, Jain, Manish, Selvavinayagam, Thirumalaichiry Sivaprakasam, Kaucley, Landry, Okeke, Chinyere, Chee, Grace, Soni, Gopal Krishna, Kokebie, Melkamu Ayalew, Kumar, Vinay, Moore, Melvin B, Kanagat, Natasha, Gupta, Anil, Matsinhe, Graça, Oduro, Abraham R, Kotebagilu Guddemane, Deepak, Ashagre, Aschalew Worku, Kudrati, Sakina, Houngnihin, Roch, Kolawole, Adejoke, Touré, Cheickna, Amoussou, Audrey Semevo Eunice, Yeboah, Isaac, Almiñana, Adriana, Makinen, Marty, Hatau, Israel Mitiku, Tamire, Mulugeta, Fields, Rebecca, Alemayehu, Tewodros

2025

Overview

IntroductionIn May 2023, when the WHO declared that COVID-19 was no longer a public health emergency of international concern, countries began considering transitioning from the emergency phase to routine provision of COVID-19 vaccination. This paper presents the experience of seven countries with integrating COVID-19 vaccination into other health services and health system functions.MethodsData collection took place between August 2023 and April 2024 in Benin, Ethiopia, Ghana, India (Tamil Nadu State), Liberia, Mozambique and Nigeria using key informant interviews and focus group discussions. Interviewees included national and subnational representatives from across the Ministry of Health, COVID-19 task forces, civil society organisations and partners. Focus group discussions were conducted with health workers.ResultsWhile demand for vaccination was low at the time of data collection, six of seven countries had started integrating or planned to integrate COVID-19 vaccination with other health services. Relatively high integration was reported for certain health system functions such as supply chain, while others such as information systems were less integrated. The immunisation programme served as lead on integrating COVID-19 vaccination, but coordinating across other health programmes was a major challenge. Nearly all assessment countries relied on external funding for COVID-19 vaccines; none had plans to self-procure COVID-19 vaccines when external funding ends.ConclusionThis article highlights challenges such as a lack of cross-programmatic coordination with clear roles and accountability mechanisms, absence of a clear strategy for sustainable procurement of COVID-19 vaccines, infodemics, as well as considerations countries face in transitioning from emergency response to a more routine approach to COVID-19 vaccination. Opportunities exist to focus COVID-19 vaccination integration efforts in a way that sets the stage for a strengthened life course approach to immunisation; lessons for future emergencies include designing for integration earlier to ensure systems and processes built are leveraged postemergency.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 vaccines / COVID-19 Vaccines - administration & dosage / Data collection / Delivery of Health Care - organization & administration / Emergency preparedness / Ethiopia / Focus Groups / Ghana / Green procurement / Health services / Health services research / Health systems / Humans / Immunisation / Immunization / Immunization Programs - organization & administration / India / Mozambique / Nigeria / Original Research / Public health / Qualitative Research / SARS-CoV-2 / Vaccines