How to pull off a mass vaccination campaign

The team had to account for a wide diversity of backgrounds and vaccination histories to make sure everyone got the shots they needed to protect themselves and others. For example, some children who came from countries like Iraq and Syria—whose once robust immunization programs were disrupted by war—might be partially vaccinated. But children born after their families fled home might not have received any vaccines at all. In September 2020, when COVID-19 rates began to rise in Greece, the camps went on partial lockdown and the vaccination campaign temporarily paused. MSF teams resumed as quickly as possible, hoping not to miss the opportunity to immunize people who would be transferred out of the camps.

Plans were complicated once again in October, when an earthquake struck the island. By then, because people living in the camp had become familiar with the routines, MSF was able to keep vaccinations going. “Continuing our operations through the emergency brought calm to an already awful camp situation where people are in upheaval all the time,” said Molenaar. “Anything that can remain consistent, that shows that we are still here, is helpful.” Though the mass vaccination campaign ended in November, MSF continues to vaccinate new children arriving at the camp.

A team effort

The goal of a mass vaccination campaign is straightforward: vaccinate thousands of people over a relatively short period to prevent or respond to a disease outbreak. But just as no two emergencies are alike, there is no onesize-fits-all way to organize a mass vaccination campaign. Instead, each response must be carefully planned and tailored to reach the most people possible with lifesaving vaccines, sometimes in the most challenging settings imaginable—often amid a slew of complicating variables. 

“[Mass vaccination campaigns] are quite challenging to execute, but beautiful to see,” said Dr. Northan Hurtado, MSF deputy medical advisor. “It’s like a ballet, where a team works in unison to accomplish something incredible.” In addition to thorough pre-planning, substantial human, material, and financial resources are required. Medics, logisticians, community health promoters, human resources managers, and more must collaborate closely, combining their respective skills to make it happen.

First, teams investigate an outbreak to identify priority communities and age groups in need of protection. Then, while coordinators secure permissions from local health authorities, medical, logistics, and human resources teams carry out a series of critical calculations that provide a framework for the campaign. Priority age groups and areas are used to estimate the total number of people to be vaccinated. Then, the team calculates how many different vaccination sites must be set up in order to reach those people, and how many health workers are required to staff them.

With locations identified, health promoters begin circulating information to surrounding communities, ensuring that families know when and where they can receive free immunization. Health promoters rely on different communication methods depending on the context. In remote places, for instance, teams travel in advance to homes and meet with local leaders for support in informing rural communities. In urban areas, MSF publicizes vaccination campaigns through local radio announcements, text message alerts, or simply by driving through a city with megaphones to broadcast information far and wide.

As colleagues spread the word, human resources managers assess how many new staff members must be recruited. Every vaccination site operates like an assembly line, with each team member managing one specific responsibility in order to improve efficiency and maintain proper protocol. New hires are assigned clearly defined roles and trained in MSF guidelines for vaccine preparation and administration, aseptic measures, waste management, crowd control, and emergency procedures, like managing accidental exposure to blood. 

Logistics experts also play a critical role. Because many vaccines must be stored at specific low temperatures to remain viable, each vial must be kept cold from the time it leaves an MSF storage facility in Europe to the moment a patient is vaccinated thousands of miles away. This requires a “cold chain,” a system of refrigeration, portable cooling, and temperature monitoring. In some places, weak local infrastructure combined with a warm climate make maintaining the cold chain a major challenge. 

Tackling an outbreak

The logistical challenges are immense in Democratic Republic of Congo (DRC), where a deadly measles outbreak declared in June 2019 has infected more than 460,000 people and killed nearly 8,000 children. Although the government declared an end to the outbreak in August 2020, the epidemic rages on. MSF teams have provided patient care, surveillance to track the epidemic, and mass vaccination campaigns, immunizing millions of children.

In this vast country communities are often separated by great distances and unpaved, poorly maintained roads. MSF teams must travel for hours or even days over rugged terrain by car and motorbike, or navigate rivers by boat. Vaccine vials are packed securely in portable coolers, using ice packs and insulating materials to keep the doses cold without freezing them.

MSF has long experience carrying out such campaigns in DRC and other places. “I’ll never forget working on measles vaccinations in DRC in 2010,” said Dr. Hurtado. “The sheer number of freezers we had to keep running, and the dozens of coolers we had to pack and carry six hours away, without the vaccines getting too warm or too cold, made me understand how complicated this work is.” 

MSF team members typically wake well before dawn to pack their supplies and travel—sometimes for hours—to the vaccination sites. Upon arrival they set up fencing to direct lines of people and set up stations for patient registration, the vaccinations themselves, and supplementary services as needed.

During the latest measles vaccination campaign in DRC, triage staff worked the entrance, checking the ages of children in line and managing crowd control. Children and their guardians filed through registration, where they received a stamped vaccination card. At the following station, children were given vitamin A, which can become depleted by measles infection. Next was the vaccination station, where a team member loaded syringes before handing them to a vaccinator, who administered the shots. Nearby, another staff member was responsible for tallying each vaccination performed.

Each night, team members met to report on vaccination figures for the day before finally going to bed—only to wake up before dawn to do it all again. “It’s a very long day and they’re exhausted, but teams return at night feeling energized,” said Dr. Hurtado. “They’re excited to know they’ve reached thousands of people with lifesaving protection.”