Rwanda’s success in rolling out its covid-19 vaccination campaign is a lesson to us all

The discovery and approval of effective and safe covid-19 vaccines has provided a glimmer of hope during a seemingly intractable crisis. The vaccines were rapidly distributed across the globe, with priority given to the most at-risk populations in many rich countries.1 While many have called for the equitable distribution of vaccines across the globe through COVAX, and continue to do so, this continues to be far from the reality. As of 1 April 2022, 64.5% of the world’s population has received at least one dose of the vaccine; yet, this proportion is only 14.5% in low-income countries.2 It is in this context of vast vaccine inequity that we discuss Rwanda’s vaccination strategy and milestones over the past year.

Today, Rwanda has fully vaccinated over 60% of its population.2 In a continent that is a covid-19 vaccine desert, this result is due to the hard work and early preparation of those in charge of the vaccine programme. Months before receiving covid-19 vaccines in the country, the Scientific Advisory Group and National Task Force for covid-19 vaccination met weekly to devise a vaccination strategy, identify gaps, and strengthen cold chain capacity.3 Following these deliberations, Rwanda bought 437 new refrigerators, refrigerated vehicles, passive containers for transportation and 5 ultra-low temperature freezers to ensure readiness for the Pfizer vaccine which at that time needed be stored at −70°C.34 By the time of arrival on 3 March 2021, the country was ready with the capacity to store over 5 million vaccines.

Following scientific advice aligned to the World Health Organisation’s (WHO) guidelines, Rwanda developed a vaccine priority list that included the most at-risk—medical professionals and community health workers, older populations, individuals with underlying conditions—including those in prisons and refugees—and all essential workers.4 As more people were vaccinated in the country, the priority list was expanded to all individuals over 60 and over time, this age limit was reduced to 18 years old.5 This national priority list was conceived rapidly and accurately using a nationwide demographic screening programme up to the community level and an up-to-date registry of non-communicable diseases at the facility level. This list is also currently being applied to the rollout of booster shots.6

To make this equitable and effective distribution a reality, Rwanda adopted a coordinated and organised plan. Every single individual, both within the ministry of health and in implementing partner institutions, knew what to do. More than a month before vaccination started, at least two vaccination teams were appointed at each health facility across the country to ensure that healthcare workers had the capacity to vaccinate, manage, and electronically track the vaccinated.3 Moreover, the location of vaccine delivery was adapted to reach communities that are most at-risk and hard-to-reach. For instance, door-to-door vaccination was adopted for those above 60 and those living with disabilities.7 When the Ministry of Health expanded the eligibility list to include those above 18, the campaign was first focused in Kigali which is the most densely populated region and carries the highest covid-19 burden.5 Afterwards, the delivery was done across the country following these criteria.

While many have claimed vaccine hesitancy to be the major hurdle to covid-19 vaccination in Africa, this is largely inaccurate. According to a 2018 Wellcome Trust study, the Rwandan population has the highest trust in the public health system, which explains the country’s high childhood vaccination rate.89 This high level of trust was further reinforced by the government’s open communication. The Ministry of Health worked alongside various partners such as faith-based organizations, NGOs, local authorities, and the media to provide more information on the vaccines and dispel any misinformation. Examples of public engagement channels used include a one-page fact sheet and radio and TV channels.10

One example of the vaccine rollout is on the night of 3 March 2021, 340 000 vaccines from COVAX – from Pfizer BioNTech and Oxford/AstraZeneca—arrived in Rwanda.11 They were kept overnight at the central storage facility and recorded in an electronic registry. By noon of 4 March, the vaccines were distributed to all district hospitals that in turn distributed them to all health centers the same afternoon, using health sector trucks and other modes of safe transport available including military helicopters. The quantity of vaccines allocatedto each district and health facility was based on a list created during the preparatory phase.3 On the morning of 5 March, Rwanda had started vaccinating healthcare workers across the country and within three weeks, Rwanda had vaccinated 348 000 people, including doses donated by China at that time.

Rwanda has surpassed the 30% target it had set for the end of 2021 and is well on its way to achieving the 60% target for June 2022, having already vaccinated nearly 60% of its population. It is because of this efficiency and success that Rwanda Biomedical Center was named one of the covid-19 Vaccination Centers of Excellence by Africa Centers for Disease Control and Prevention (CDC).12