Last mile delivery of COVID-19 vaccination to populations aged 15 years and above in Nyeri County, Kenya, March 2021-June 2022

Background: The COVID-19 pandemic in 2019 wreaked havoc on global economies and nearly paralysed health systems in some areas. Though mortality was moderate in African countries, the pangs of the disease were felt through the disruption of economic activities. Experimenting for vaccines started by December 2019 and Pfizer and AstraZeneca vaccines were authorised for emergency use in the same month. Mass immunisation campaigns started immediately. Kenya received its first vaccine consignment, AstraZeneca, on March 6, 2021 and commenced the rollout campaigns. This paper aims to highlight strategies and interventions towards the successful implementation of COVID-19 vaccination in Nyeri County. Interventions: Nyeri established the COVID-19 Vaccine Deployment Committee (CVDC), mandated to provide technical leadership, planning and strategising on the implementation process. The vaccination roll-out strategies that were adopted included capacity building of healthcare workers and establishment of COVID-19 vaccination static sites, among others. There is a paucity of data in the county on how strategic interventions affected vaccination coverage, as a campaign of such magnitude has not been carried out previously. Additionally, there was a lot of system downtime in the initial phases of the vaccination exercise, leading to manual registration, which could have led to a loss of data. Nyeri county population is varied; some sub-counties have a good road network connectivity, which could contribute to better access to vaccination. Results: Nyeri County had a total of 791,910 persons and had targeted to vaccinate 510,023 persons aged 15 years and above, from March 2021 to June 2022. 67.7% (95% CI: 67.55% - 67.81%) of persons were given the first dose of Covid 19 vaccine, while 40.3% (95% CI: 40.2% - 40.4%) of persons were given at least two doses of the COVID-19 vaccine. Increase in vaccination static sites from 5 to 17 resulted in an upward trend in vaccine uptake between March 2021 and June 2022, where 27,263 people received the first dose. Outreaches conducted brought an additional 55,071 individuals to be vaccinated. Supplemental Immunisation Activities contributed to 85,149 persons on the COVID-19 vaccine first dose. More females, at 55.20% (95% CI: 55.04%, 55.37%), accepted the vaccine than males at 44.80% (95% CI: 44.63% - 44.96%). Persons above 50 years returned for the second dose in comparison to ages below 40 years. Lessons learnt: Aggressive roll-out campaigns, involving stakeholders at the onset of vaccine roll-out and targeted demand creation, placed the country at the forefront in the last-mile vaccine delivery. Conclusion and implications: More than two-thirds of the adult population in Nyeri County received at least 1 dose of the COVID-19 vaccine during that period. Documentation of best practices will help policymakers implement strategies that will deliver vaccines to the last mile. Counties struggling with low coverage can use some of the best practices to improve the uptake of vaccines.