How can early COVID-19 vaccine campaigns in the US-affiliated Pacific Islands inform future vaccine efforts: a cross-sectional analysis

Abstract

Introduction: The US-affiliated Pacific Islands (USAPI) are six geographically isolated and culturally distinct Pacific Island jurisdictions with special relationships with the USA; the USAPI were included in the US COVID-19 vaccination effort. This study documents the approaches and lessons learnt from the rollout of COVID-19 vaccination in the USAPI, including four COVID-19-free jurisdictions.

Methods: Quantitative data regarding vaccination administration were obtained from each jurisdiction's immunisation information systems during 13 December 2020 and 11 March 2021. USAPI and US county-level vaccination administration rates by age group from the CDC were compared. Qualitative data regarding key components of the vaccination efforts were collected by survey from each USAPI lead immunisation manager.

Results: A total of 90 870 individuals aged ≥16 years in the USAPI received at least one dose of vaccine during 17 December 2020 to 11 March 2021 (28.2% of the eligible population). Most jurisdictions observed rapid vaccine uptake after introducing COVID-19 vaccines and fully vaccinated >20% of their eligible populations in 3 months or less. During the study period, the USAPI region achieved higher coverage than the rest of the US once all USAPI had begun vaccination. All jurisdictions identified pre-campaign community messaging outreach as key to success and misinformation and rumours as the most common challenge. The lessons reported by USAPI immunisation managers included the need for quality risk communication and sustained involvement of interdisciplinary partners.

Conclusion: Tailoring vaccine administration and communication strategies to each jurisdiction while maintaining system agility was critical for success, particularly considering the logistical challenges presented by the geographic remoteness of the USAPI. Maintenance of the jurisdictions' planning preparedness efforts, newly installed infrastructure and local partnerships can strengthen the resilience of the jurisdictions for a range of challenges beyond the COVID-19 response. Future immunisation strategies should build from the successful vaccination plans showcased here.

Keywords: COVID-19; SARS-CoV-2; public health; public health practice.

Figure 1. Prioritisation of COVID-19 vaccine doses† by jurisdiction in the US-affiliated Pacific Islands (USAPI) from 17 December 2020 to 11 March 2021. Phases: 1a—Healthcare workers and long-term care facility residents; 1b—75 years of age and older, first responders and frontline essential workers; 1c—65 years of age and older, 16–64 years with high-risk conditions and other essential workers; 2—40 years of age and older; 3—18/16 years of age and older. †COVID-19 vaccine products available in each jurisdiction during the period: Moderna product only (FSM, Palau and RMI); both Moderna and Pfizer-BioNTech products (American Samoa, CNMI and Guam). *Not actively vaccinating.

Figure 2. Daily count of first and second doses of COVID-19 vaccine administered in the US-affiliated Pacific Islands (USAPI) from 13 December 2020 to 11 March 2021.

Figure 3. COVID-19 vaccine coverage among those aged 65 years and older and the overall population by dose in the US-affiliated Pacific Islands (USAPI) and the USA from 13 December 2020 to 11 March 2021.