Exploring America’s Achievable Last Mile Vaccinations through an African Lens

A Ghanian doctor studying Public Health in the United States considers how the country can successfully vaccinate the ‘final mile’ of hard to reach Americans — the solution could be closer than you think.

As a doctor from Ghana studying for a masters degree in public health at Columbia University, observing the vaccine rollout in the United States has reminded me of the stark differences in health systems compared to my home country, but also of common principles for delivering health services to vulnerable and hard to reach populations regardless of location. In this blog series created for the Project Finish Line campaign, I wish to expand on the stories of overlooked, unvaccinated groups here in the United States and portions of the population that want to be vaccinated or could easily be convinced to do so, but have not been adequately engaged with or do not have the means or accessibility.

Much like the adage of old, where all roads lead to Rome, there is optimism that all different vaccination routes lead to fulfilling the common goal — to ensure the safety of all persons in regards to the containment of this deadly virus. The latest developments in the medical management of the disease now firmly centre around the vaccination process and the need to achieve herd immunity (though this particular concept is now being deemed less urgent) in order to protect against the spread of the virus.

Contrary to the early days in the United States where the struggle was in getting a coveted vaccine appointment, in recent times the problem is that there are vaccines, and in some places more than enough, with not enough arms to put them in. Pointing the finger at the loud and provocative anti-vaxxer crowd is an easy target for the media, but due to a variety of reasons, including a lack of health insurance, lack of transportation to a vaccination site, distance from a vaccination site and many more, there are still people who want to be vaccinated and yet are unable to. As surprising as that may be in the US, this situation is a lot more commonplace in many other countries, especially African countries like Ghana.

Unlike in the US where these are problems arising during these last mile efforts, in Ghana, these are problems that we know very well and are always working on. There are large pockets of people whose health needs are unattended to and who require that healthcare workers go the extra mile to overcome language barriers, transportation issues and cultural innuendos. A system that has worked particularly well for us are community health nurses, who go into these communities to bring healthcare to the people. For people like marketwomen, who may not be able to take a day off work to go to a hospital or clinic, or even to get vaccinated, these community health nurses may be their only chance at access to healthcare or a vaccine.

In the US, a heavy burden seems to be placed on traditional healthcare systems (hospitals) to be the main provider of healthcare including vaccinations. However, this may not necessarily be the most efficient route or model for this pandemic. Although they are the most funded and receive plenty of government support, they cannot serve everyone. As we now know, in order to overcome the spread of this deadly disease we need to achieve generalized high vaccination rates where anywhere from 75–80% of the population is vaccinated. Using traditional healthcare with its barriers of health insurance and documentation leaves out a large population of people. This is where free and charitable clinics, which work in a manner similar to community health nurses in Ghana come in.

Aside from being an avenue for the uninsured, underinsured and undocumented to get their vaccinations, clinic staff are known to the community and are trusted much more than traditional hospital staff. Much like the community health workers in Ghana who are the backbone to healthcare access in rural areas especially, these free and charitable clinics may be the bridge required to help the US get closer to ending the pandemic.

Like the community health nurses, these clinic staff can go into the hard-to-reach communities and bring the vaccines to the people who for whatever reason may not be able to normally get access. Below are three principles to follow when dealing with healthcare on a community level which transcends location.

  1. Who is involved in the community outreach? — it should be people from the community or those who have already built trust with the people. This is one way to increase the chance of success.
  2. Where is the community outreach taking place? — it is important to provide healthcare to people where they are most comfortable and most likely to be receptive. This may be a person’s home, in a community center, or in church or a place of worship.
  3. What information is being given during the community outreach and how is it delivered? — a key step is to listen to the people and pay attention to their fears and concerns. Regardless of culture or language, address the people in a way such that they feel seen and heard. Tailor your message to your audience. In this case, one size may not fit all.

Taking into consideration the above, it is clear that the ruling resource is time and patience, and hospitals and traditional health setups do not have the luxury of this resource in the amounts required. This is why it is inherently important, especially now, to invest in these free and charitable clinics and community health nurses in both the United States and in Ghana who can get the work done and bring us all closer to the end of this pandemic.

Written by Dr. Emily Laura Aidoo. She is a Ghanaian trained physician and an MPH student at Columbia University.

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