The Foot Soldiers Driving COVID-19 Vaccinations in Zambia
USAID-supported community health workers are changing local attitudes to stop the pandemic
As the rain falls hard and fast in the mining town of Chingola, Zambia, a dot of fluorescent orange can be seen in the distance, growing bigger as the figure moves forward. Albertina Mukuka isn’t going to let the weather get in the way of her work. She is a community health worker on a mission to get more people vaccinated against COVID-19. And she’s not alone.
The Initiative for Global Vaccine Access (Global VAX) worked through USAID’s DISCOVER-Health Project, implemented by JSI, to train tens of thousands of Zambian community health care workers. These community heroes are now walking and talking their way through neighborhoods, helping people get vaccinated. Albertina, a mother of four, is proud to be part of this army.
“I love working with people and taking care of them, safeguarding the community at large,” Albertina said. “It’s what drives me. This is my passion.”
These workers are the foot soldiers on the frontlines of Zambia’s national COVID-19 vaccination program. Their role is vital. They are trusted community figures, trained to provide accurate and timely information to encourage people to make the safe and smart choice for themselves and their families by getting vaccinated.
Vaccination teams are moving through markets, bus stations, schools, and places of worship, generating demand for COVID-19 vaccination and providing vaccines to those who opt in.
The Zambian Government started its COVID-19 vaccine rollout in April 2021, setting a national target of fully vaccinating 70 percent of the eligible population this year. As of July 12, more than 43 percent of eligible Zambians have been vaccinated.
Initially, there was low uptake of the vaccine due to supply challenges coupled with a lack of information and unfounded rumors. While safeguarding and continuing its routine health service delivery work, USAID quickly responded with a community-led strategy, focused on one-on-one interactions with people in their local area.
Bringing vaccines as close to the doorstep as possible
For many Zambians, a trip to the health facility to get vaccinated is out of the question; the journey is frequently expensive, long, and tiring — it’s often a choice between working to feed your family or getting vaccinated. So, Albertina and the vaccination team take the vaccine directly to people in the heart of the community.
“Visiting people in their community really works,” Albertina said. “It’s much better than asking them to come to the facility, as they often just won’t show up. They are happy we come to them, as we’re making life easier for them.”
USAID pairs community health workers with vaccine providers. This vaccination team moves as one. Once someone agrees to be vaccinated, the provider is on hand to immediately administer the vaccine. Albertina explains why this approach works.
“We create a buzz as we start to move about,” she said. “People get excited and interested to see what is happening. We explain we are providing COVID-19 vaccines, and some people are ready to say yes right away.
We can vaccinate a whole household in one go, if they’re eligible and willing. I ask to see everyone’s vaccination certificate, and I work hard to convince and encourage those who have reservations.”
Battling Misinformation
As in many countries including Zambia, misinformation surrounding the vaccine is still a barrier to acceptance. Ivy Kakungu and Pizza Chendaka are community health workers based in the busy town of Kitwe in Zambia’s Copperbelt Province. Full of hustle and bustle, they are tasked with sharing COVID-19 vaccine information in the downtown market place and bus station. Ivy and Pizza feel that rumors are the biggest barrier they face in encouraging people to get vaccinated.
“We are on the front line, meeting people. It’s a big responsibility,” said Ivy. “We share all the benefits of the vaccine with people, but still there are so many rumors and myths going around.”
Zambia has expanded vaccine eligibility to include youth ages 12–17 and rolled out its booster dose program. Since Zambia has a relatively young population, expanding age eligibility now means that millions more need to get vaccinated. So, community health workers focus on school-based vaccinations and start their work in the classroom.
“Coming directly into the schools definitely helps, rather than the parents bringing the children to the health facility,” said Melinda Fisulo, a community health worker in Kabwe.
However, just like for her colleagues working elsewhere, challenges–such as obtaining parental consent–arise for Melinda. Nonetheless, she and other vaccinators always secure informed consent in advance.
“Most of the pupils are happy to get vaccinated,” noted Melinda. “We reassure the children of the benefits of the vaccine for them to pass on. We ask the children if their parents or older siblings are vaccinated. This helps us guide the acceptance levels and where to focus our efforts.”
As Zambia makes progress towards its vaccination target, USAID’s community health workers are changing attitudes to help bring an end to the COVID-19 pandemic. Many of them share Albertina’s dedication.
“My job is so rewarding,” Albertina said. “I love knowing I have got through to someone with the right information. It makes me feel good to know we are making a difference.”
Global VAX, led by USAID, is a whole-of-U.S. Government effort to contribute to the global goal of vaccinating 70 percent of the population against COVID-19 in 2022.
By expanding assistance and enhancing international coordination, Global VAX is helping Zambia to identify and rapidly overcome vaccine access barriers to turn vaccines in vials into vaccinations in arms.
About the Authors
Sarah Hatchard is the Senior Communications and Knowledge Management Advisor with JSI for the USAID DISCOVER-Health Project. Margot Paulson is a Social and Behavior Change Advisor with the USAID Mission in Zambia.
