Monrovia ‒ On 16 March 2020, Liberia registered its first case of COVID-19. Like other countries, it grappled with the pandemic, prompting the government to implement various strategies to respond and contain the outbreak.

At the same time, the country struggled with the interruption of health services and immunization was among the key strategies implemented by the government in the response. The initial rollout of COVID-19 vaccines faced obstacles, including community resistance, misinformation and general mistrust, resulting in slow uptake of COVID-19 vaccines. 

To address these challenges, the Government of Liberia partnered with various stakeholders, including World Health Organization (WHO), to enhance coordination and support vaccine uptake. 

In response, WHO proposed assigning counties to different partners for comprehensive support and accountability, a proposal that was adopted for implementation. WHO took responsibility for six counties, including five which are most densely populated nationally, accounting for a total 70% of the total population. After witnessing the successes achieved in these counties, the government requested WHO's support for Margibi county, which is also heavily populated and which was lagging behind. This brought to seven the total number of counties receiving WHO's support as at December 2022.

Interventions undertaken by the country with WHO's support

Robust planning and enhanced implementation

Working with county health teams, WHO and its field teams guided the development of strategies and set performance targets for vaccination activities. The approach involved employing fixed/static sites, temporary outreach, and mobile vaccination services. WHO provided extensive support, including vaccine pre-positioning and distribution, demand creation, social mobilization, personnel training, supervision, coordination, monitoring, data management and logistical support. 

Bi-monthly meetings between field teams and the WHO country office ensured that implementation issues were addressed promptly. Through these approaches, Liberia became one of the three countries in Africa with the highest COVID-19 vaccination coverage rates, at 81% as of December 2022.

Integration of COVID-19 vaccines into routine immunization.

In April 2023, WHO supported the six originally assigned counties to kickstart the integration of COVID-19 vaccines into routine immunization and primary health care services, to ensure sustainable availability of COVID-19 vaccines to priority groups such as the elderly, refugees, pregnant women, and those with comorbidities. 

This integration is aligned with the new global strategy and SAGE recommendations, and the global move on immunization under “The Big Catch-Up” global campaign, where the Ministry of Health, with support from WHO and other partners, is striving to get routine immunization back on track.

The support to integrate COVID-19 vaccination into existing routine immunization approaches of fixed, mobile, outreach and Periodic Intensification of Routine Immunization (PIRI), involved several key initiatives. These included expanding the cold chain system; providing integration tools such as ledgers and microplanning booklets to health facilities; offering logistical support for vaccine transportation to and within counties; supplying printers, cartridges and generators for on-site printing of vaccination certificates; and paying stipends to vaccinators. 

Expanded support for integration efforts

Following the declassification of COVID-19 as a Public Health Emergency of International Concern (PHEIC), and the change in priority target groups, WHO, with funding from USAID, extended comprehensive support to 14 of the 15 counties for integration of COVID-19 vaccines into routine immunization and primary health care services, starting in July 2023. The process commenced with micro-planning in all 14 counties, with WHO field presence. 

"We are proud of the significant progress Liberia has made in integrating COVID-19 vaccines into routine immunization. Through strategic planning, enhanced coordination and comprehensive support, we achieved a remarkable vaccination coverage rate, and now the integration,” said Adolphus Clarke, Expanded Programme on Immunization manager in Liberia’s Ministry of Health. 

He added: “Our collaboration with the partners, including WHO, has allowed us to prioritize target groups and ensure equitable access to vaccines.”

Results

Through the coordinated efforts and support provided by WHO, Liberia made significant progress. By December 2022, 4 474 600 eligible people had received at least one COVID-19 vaccine. Of those, 3 749 044 people were fully vaccinated, representing 81% of the total population. The seven counties with WHO presence achieved coverage rates of 90% and above. Currently, with the ongoing integration, it is anticipated that over 80% of the target population will be reached. 

“In the face of the COVID-19 pandemic, Liberia's success in introducing new vaccines and recently integrating COVID-19 vaccination into routine immunization, reflects a nation that rises above its challenges to secure a brighter future for its people. Thanks go to our health partners, including WHO, that have always supported us through and through,” says Hon Dr Wilhelmina Jallah, Liberia’s Minister of Health. 

Dr Clement Peter, WHO Country Representative in Liberia, emphasized that the ongoing integration efforts, and the expansion of COVID-19 vaccine integration support, demonstrates WHO's commitment to support the government of Liberia to reach its target populations.

 “This COVID-19 vaccination integration success showcases the value and effectiveness of the model, serving as an example for other countries. By restoring essential immunization coverage and strengthening primary health care, we can protect vulnerable populations from vaccine-preventable diseases, enabling them to lead happier and healthier lives,” he says.