Key Considerations: Effective Vaccine Rollout and Uptake in Sierra Leone

Sierra Leone received its first shipment of 550,000 malaria vaccines in December 2023, marking a milestone for public health in a country that sees over two million hospital visits for malaria annually.1 Over the last 20 years, routine childhood vaccination in Sierra Leone has increased significantly; DTP (diphtheria, tetanus and pertussis) coverage went from 64% in 2004 to 91% in 2022, while measles went from 60% in 2015 to 73% in 2022.2 Sierra Leone has also implemented emergency vaccination programmes, such as experimental Ebola vaccines and the more recent COVID-19 vaccines. However, major crises – such as the 1991-2002 civil war and the Ebola epidemic – have resulted in significant drops in vaccine coverage. This brief draws on evidence from academic and grey literature, proposing key considerations for ongoing vaccination efforts – including the hepatitis vaccine and the new malaria vaccine (RTS,S/AS01 (RTS,S)). It offers insights on how best to address these considerations when planning equitable vaccine campaigns for new infections. This will enable UNICEF and health system stakeholders including the Expanded Program on Immunization, the Directorate of Primary Healthcare, and the District Health Management Teams to plan inclusive and equitable vaccine programming.