• Liberia is among African countries that faced challenges in rolling out the COVID-19 vaccines. In the initial stages of the vaccines roll-out, there was a great hesitancy due to infodemic and miscommunication regarding the vaccines. The country also had operational and human resource challenges such as inadequate cold chain storage facilities, improper stock management and insecure transport system for the vaccines. Additionally, there was inadequate surge capacity, sub-optimal training of staff on COVID-19 vaccines and delayed payments leading to demoralization of staff, among other challenges. The challenges compounded into a slow start to the roll-out of vaccines and low coverage. Due to low uptakes, the country’s ministry of health with the support of WHO convened an inter-agency coordinating committee meeting for all partners involved in the COVID-19 vaccines roll-out and response. The meeting aimed at agreeing and setting modalities on the response mechanisms among partners. To this end, WHO took a steering role in coordinating the partners, setting out workplans and providing funds to spearhead the campaigns. In order to change from the “business as usual” mantra like was in the past, an inter- and multi-partners approach was agreed upon including incorporating local leaders and influencers at the grass root levels. The local leaders and influencers at the grass root levels were tasked with mobilizing their people as well as providing relevant information to increase uptake. The partners then agreed to sub-divide the regions and take full responsibility for the regions assigned to them for a holistic operation and implementation of the campaign. The regional division was to ensure interoperability while at the same time to increase efficiency and effectiveness within the limited timeframe. WHO took up six counties with 70% of the country’s population, USAID took two counties, UNICEF and John Hopkins took a county each. To ensure seamless operations, WHO country office field staff (coordinators) were tasked with the full mandate of managing and handling the finances as opposed to channeling the funds to the ministry of health. WHO, through the country representative, conducted weekly review meetings with the coordinators and other partners to discuss progress, identify challenges and provide way forward during the campaigns. WHO catered for the hiring of vehicles, bought generators and provided funds for fueling of the generators, provided transport to all the field staff involved in the campaign and ensured additional staff welfare while on duty. Moreover, WHO worked with the local community leaders and influential people at the grass root levels who were themselves tasked to mobilize their people and provide important information necessary to increase vaccine uptake. The approach created huge impact compared to the initial modalities of working with the community health workers to do outreaches. WHO also provided additional incentives to vaccinators who were then able to provide the services for extended periods of time including the weekends and late hours. Mobile clinics were also provided to reach out to people in their places of work and other hard-to-reach populations. In the previous campaign, people who received vaccines complained that they did not receive a card as evidence of being vaccinated, which they needed as a proof while traveling. This had demoralized most of them. The printing of cards was initially outsourced to an individual service provider who had failed to deliver despite resources and time spent. WHO therefore took up this mandate and procured fully functional printing system. In the end it managed to print 600000 cards enabling people who received the vaccination to be issued with cards and certificates right at the vaccination centers leading to a high influx of people for vaccination. WHO also provided transport to people who were willing to get vaccinated but were far from the vaccination sites or were unreachable via the mobile clinics. Finally, WHO permitted field coordinators to do local recruitments of the personnel and influencers who were all critical for driving forward the vaccine coverage. And to allow for rapid response and reimbursement, the country office made payments via mobile money transfer. Lastly, the country office set targets for the coordinators and fully backed them up with the resources they needed to implement their initiatives to achieve the targets.

• The ministry of health adopted the WHO target of 70% vaccine coverage for African countries by June 2022. The local leaders (church and administrative unit staff) and local influencers were tasked to mobilize their people and provide critical information necessary to increase vaccine uptake for all partners responsible for the COVID-19 vaccines roll-out. Because of this initiative, there was an appreciable uptake of vaccines in the counties, especially in those that received direct WHO support through the field offices and coordinators. Two out of the six counties achieved an exemplary 70% vaccine coverage compared to the national average of 32% during the same period. This campaign was carried out in select counties, and it proved vital in driving further the coverage. There is need to escalate the approach to the rest of the counties (regions). As it has pushed up the coverage, this is a potential approach that is replicable in other contexts and countries too.

• Multi-partners and inter-sectorial approach is an effective way of collaborating to achieve maximum outputs from the existing resources and constrained timelines. The approach however requires close supervision and increased level of accountability among all the partners involved. Additionally, local leaders and grassroot influencers carry the weight of a localized approach, it may suffer from lack of originality and little impact due to familiarity with the locals. It needs innovativeness from time to time to create a “wow effect” among the locals

Combined approach of multi-partners and use of local leaders and influencers are appropriate for efficiency in use of resources and effectiveness in maximizing outputs in a limited period to increase vaccine uptake