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Nurses on motorcycles in a rural village in Sierra Leone
Photo: Michael Duff

Vaccine Delivery Initiative Expands in Sierra Leone

A new grant from The Mercury Project will allow a medical care and vaccine delivery project, co-led by Professor Mushfiq Mobarak, to expand into remote, rural parts of Sierra Leone.

A medical vaccine delivery initiative, co-led by Professor Mushfiq Mobarak, is expanding in rural Sierra Leone, thanks to a grant from The Mercury Project, a consortium of global researchers addressing affordable, scalable vaccine interventions.

The $673,000 grant was given to Wageningen University, where Mobarak serves as one of the principal investigators in the ongoing Sierra Leone initiative, alongside Niccolo Meriggi, country economist for the International Growth Center in Sierra Leone; and Maarten Voors, associate professor at Wageningen’s Development Economics Group.

In 2022, Mobarak’s team visited remote villages in Sierra Leone as part of a study to increase access to COVID-19 vaccines, published this week in Nature. The team demonstrated using a randomized controlled trial that this intervention induces over 50 people in each community to get vaccinated within 48-72 hours on average, compared to 5 people in the control group, at an average cost of $32 per person vaccinated. Solving the logistical complexities of travel to these remote villages was the largest component of the costs of vaccine delivery.

The new grant will explore an immediate implication of these results. Namely, once the fixed cost of reaching remote villages is paid, would bundling multiple vaccines along with other effective maternal and child health interventions on the same trip be feasible? If so, would it improve impact, cost-effectiveness, and scalability by reducing the cost of delivery per person treated?

In consultation with the research team, Sierra Leone’s Ministry of Health has prioritized a vaccine bundle comprising COVID-19 vaccination, HPV vaccination for girls aged 10-12, and routine immunizations for children aged zero to six for this project. The team is exploring with other public health and economics researchers and organizations whether yet more cost-effective interventions can be delivered on the same trip.

To maximize impact, the team conducts social mobilization and seeks endorsement from village authorities to disseminate accurate health information. This model leverages existing clinic infrastructure and (with electricity connections where vaccines can be stored) in a hub-and-spoke framework and networks of community health workers to provide mobile health services more cost-effectively to the most remote communities.

Mobarak also has ongoing research projects in Bangladesh and Nepal. His research centers on field experiments exploring ways to induce people in developing countries to adopt technologies or behaviors that can improve health and well-being, and the complexities of scaling up such interventions.

“In Bangladesh we were able to lower our infant mortality rate by 87% since 1971, partly by delivering the simplest health interventions—routine childhood immunizations, oral rehydration therapy to prevent diarrheal deaths—to all parts of the country,” says Mobarak. “Remote communities in sparsely populated West African countries have proved more difficult to reach. With this agenda, we are exploring whether a targeted mobile service delivery model can cost-effectively improve health. By experimenting with efforts to minimize the cost-per-person-treated, we hope to unlock larger scale development funds to address these problems at national or regional scales.”  

The expanded initiative’s piloting phase is ongoing.

Read more about the research in Yale Insights.

This work was generously supported by the Weiss Asset Management Foundation.