The COVID-19 Vaccination Rollout in Tanzania: The Role of Coordination in Its Success

<b>Background</b>: The national rollout of a vaccine is a complex and significant undertaking, made more challenging when the health system is experiencing shock, such as in a pandemic. Tanzania had relative success in its COVID-19 vaccination rollout compared to other African countries. <b>Objectives</b>: To better understand factors that contributed to this success, we examined the role of coordination (one of the six immunization system building blocks) on the outcomes of the national vaccine rollout. <b>Methods</b>: We obtained qualitative information from the published literature, COVID-19 vaccination program documents for Tanzania Mainland and Zanzibar, and reports from two documentation workshops with national, regional, and district stakeholders from the government, partners, academia, and civil society. Triangulating this information, we describe the COVID-19 vaccination coordination structure, the roles and responsibilities of its members, and the changes in their engagement and activities over the 18 months following the introduction of the COVID-19 vaccine. We also obtained quantitative data from the CHANJOCOVID system to analyze time trends in national COVID-19 vaccine coverage rates for the period August 2021 to December 2022. <b>Results</b>: We found that Tanzania had a multi-level, multi-partner integrated coordination mechanism that provided strategic direction, oversight, and guidance for the vaccination rollout. The coordination structure was initially weak but strengthened over time. Based on the level of coordination activities undertaken, we identified three periods marking different strengths of the coordination mechanisms, these corresponded with different trends in vaccination coverage in the mainland. In the first period (July-December 2021), the coordination mechanism was weak, and vaccine coverage was low, with only 3% of the target population vaccinated on the mainland. In the second period (January-May 2022), when stakeholder engagement was expanded and the coordination mechanism improved, there was a concurrent rise in vaccine coverage from 4% to 25%. In the third period (June-December 2022), coordination was further strengthened, and vaccination strategies were intensified; a corresponding increase in vaccine uptake was observed with coverage reaching 100% of the target population. <b>Conclusions</b>: Qualitative insights from the three time periods suggest a positive association between coordination strength and COVID-19 vaccine coverage. Coordination fostered collaboration, enhanced stakeholder engagement, and facilitated data-driven decision making. This enabled Tanzania to overcome complex challenges and achieve significant progress in vaccination coverage. Strong coordination and effective collaboration among stakeholders are essential mechanisms and processes to optimize vaccine delivery resources and ensure the equitable distribution and uptake of vaccines in Tanzania.