Monrovia — As Liberia tackled rising COVID-19 cases in 2022, rapid diagnostic testing of everyone living within 100 metres of newly confirmed cases helped break transmission chains and significantly boosted the uptake of COVID-19 vaccines through reactive vaccination.

The community-based testing strategy to decentralize COVID-19 response allowed health workers to conduct door-to-door community sensitization to tackle COVID-19 misinformation, including myths about vaccination. The approach helped the country reach 81% vaccination coverage of the population by the end of 2022.

With financial and technical support from World Health Organization (WHO), mobile health teams administered tens of thousands of rapid tests in Nimba, Margibi and Montserrado counties, which are home to nearly half of Liberia’s total population.

With polymerase chain reaction (PCR) tests mostly no longer mandatory for cross-border travellers, the community-based response initiative enabled surveillance and monitoring of epidemiological trends to augment virus control measures.

The initiative, which uses rapid tests to counter the challenge of identifying COVID-19 cases outside health facilities, was launched in Liberia in July 2022. By the end of last year, 74 000 rapid tests had been administered.

“Expanding testing in communities using the antigen tests is helping provide a better way for the country to respond to the pandemic,” says Chea Sanford Wesseh, Assistant Minister for Vital Statistics in Liberia’s Ministry of Health, adding that there are plans to broaden their use beyond the three counties.

In practice, the mobile teams target everyone living within a 100-metre radius of new confirmed COVID-19 cases, administering rapid tests to identify other potential cases. The technology is simple, making it suitable for use in all settings.

Anyone who tests positive and requires treatment is linked to their nearest health facility. In cases where patients are either experiencing mild symptoms or asymptomatic, they are managed under home- based isolation and care, receiving infection prevention and control materials, including information on COVID-19 risk factors and prevention measures such as vaccination and handwashing. 

“With testing in communities, we are reaching both the asymptomatic and symptomatic cases. That way we are undertaking timely isolation of confirmed cases leading to a break in the chain of transmission,” explains Dr Monday Julius, the WHO team lead for health emergencies in Liberia.

The positive impact on vaccination uptake saw Liberia join Mauritius, Rwanda and Seychelles as the only four African countries to achieve the 70% global vaccination coverage target by December 2022.

Victoria Dekpah, a student at Nimba University in Liberia, was among those convinced to get vaccinated against COVID-19 when health workers visited her community.

“I didn’t think it was important to test. Many people were afraid of knowing their status and what would happen to them. But after listening to the health worker, I volunteered to take the test and it turned out positive. I isolated myself at home and the health worker visited me regularly until I tested negative again. I also got vaccinated thereafter,” she says.

Isaac Cole, County Surveillance Officer in Nimba, blames rampant misinformation surrounding COVID-19 for the reluctance among Liberians to accept testing and vaccination. But working with local leaders who are trusted by their communities, he says, is changing attitudes.

“The people now know that once they are tested and found to be positive, they will be taken care of either at the health facility or through the home-based care approach. When we go to communities, health workers also lead by example by being vaccinated first, as one of the ways of dispelling myths about vaccination and its effect on the body,” he adds.

WHO is supporting 18 other African countries to implement community-based COVID-19 response, with more than 400 000 rapid tests carried out to date. Across these countries, rapid testing currently accounts for at least 60% of all COVID-19 testing.