Equitable access to the COVID-19 vaccines in Africa (ECOVA) findings from a qualitative enquiry in Zimbabwe

Introduction: The COVID-19 pandemic exposed significant global disparities in vaccine distribution and access, prompting urgent calls to strengthen national delivery systems. In Zimbabwe and across the African continent, reliance on imports highlighted the need for both robust local distribution mechanisms and enhanced vaccine manufacturing capabilities. Africa's potential to produce vaccines, raw materials, and medical supplies exists, but its realization demands strategic investment and the promotion of public-private partnerships (PPPs). This study aims to analyze Zimbabwe's current COVID-19 vaccine distribution and delivery mechanisms, and explore the potential of PPPs to establish the necessary structures and processes to guarantee prompt access and administration of vaccines, particularly among vulnerable populations. Methods: We conducted qualitative in-depth interviews with twenty purposively sampled Key Informants, all possessing specialized knowledge of Zimbabwe's Expanded Programme on Immunization (EPI) and the COVID-19 vaccination program. A standardized template, shared across the study consortium, guided the participant selection process. Results: Our qualitative investigation reveals that equitable vaccine access was hindered by the lack of routine adult vaccination compared to the well-established immunization of children through the EPI program. While utilizing the EPI infrastructure for COVID-19 vaccine rollout was deemed successful and commendable by key informants, it also faced criticism for perceived disparities in rural outreach, favouring urban areas. The stationary vaccination sites posed challenges for vulnerable groups like the elderly and those living with disabilities in rural regions who faced difficulties traveling long distances, underscoring the urgent need for greater efforts to ensure equitable vaccine access across all population segments. Discussion: Participant perspectives on local vaccine production in Zimbabwe reflect a blend of optimism and apprehension. Many expressed a strong desire for domestic vaccine development, recognizing its potential public health benefits and self-sufficiency. However, a sizeable number doubted Zimbabwe's current capacity to produce vaccines, citing economic challenges. Instead, they suggested forging partnerships with other African nations to collectively establish a regional or continental hub of excellence, sharing costs and reaping mutual benefits. An essential takeaway from this pandemic is the stark revelation of systemic gaps within the healthcare infrastructure. It is crucial to seize this opportunity to fortify the health system, ensuring its resilience in preparation for future pandemics.