- Rural and ethnically diverse Xieng Khouang Province hosting the first post-pandemic National Games, combined with COVID-19 vaccine and booster coverage gaps among high-risk groups, required urgent action to protect health.
- A Ministry of Health and Ministry of Home Affairs vaccination campaign – Taloumbon – focused on enhanced community engagement via the WHO-supported CONNECT initiative. It ensured more than 39 000 people received a vaccine or booster.
- During this campaign, improvements in outreach through multi-sector collaboration and trust building saw a 246% increase in vaccination outreach uptake compared to previous efforts in high-risk communities.
“I never get injected in my life… but, after I heard clearly from the team about the possibility to contract COVID-19, and the vaccine benefits, I decided to get it. This is the first injection for me.”
- Village chief, Xieng Khouang Province
For many in Lao PDR, life is returning to normal following the COVID-19 pandemic.
One major step has been the December 2022 return of the National Games, back for the first time since 2014. This year, rural and ethnically diverse Xieng Khouang Province hosted the event, welcoming more than 10 000 athletes and spectators from across the country.
“The National Games provide an amazing opportunity to come together and see the best of Lao’s athletes,” said WHO’s health emergency specialist Satoko Otsu, “but also an opportunity for the spread of COVID-19 and other diseases. Reported cases were low, however, they are being detected in almost all provinces indicating community transmission was ongoing.”
While Lao PDR’s national primary series COVID-19 vaccination sits at a commendable 75%, booster coverage lags at 27%. The gap is prominent among the elderly, and rural and ethnic communities – regrettably, often the most at-risk.
“In November, Xieng Khouang booster uptake was 24% versus the national rate of 27%, with the elderly booster rate at 18% versus 26% nationally. The combination of low coverage and a mass influx of people required urgent action,” noted Dr Otsu.
Unfortunately, those most at-risk are often those least likely to seek health services or with limited faith in the health sector. Mistrust, limited knowledge, remoteness and other factors have all impacted the demand for COVID-19 vaccines and boosters in Xieng Khouang Province and other parts of Lao PDR.
Addressing this gap ahead of the influx of athletes and supporters, the Ministry of Health in collaboration with Ministry of Home Affairs launched a campaign targeting more than 100 communities (specifically those with low coverage of their first dose) across all districts in the province.
Having faced limited success in the past, officials decided to utilize the WHO-supported and Ministry of Health and Ministry of Home Affairs-delivered community engagement initiative: CONNECT.
Supported by the European Union (EU), Luxembourg, the Korea Foundation for International Healthcare (KOFIH) and the United States Agency for International Development (USAID), CONNECT focuses on building trust between healthcare providers and communities, and working closely with local leaders to improve communication with villagers, and demands for essential healthcare such as vaccination.
Working with provincial and national officials, CONNECT’s role was to plan and deploy rapid COVID-19 and routine vaccination outreach in November, ahead of the game’s launch. The focus was COVID-19 vaccination for at-risk groups – particularly the elderly, people with disabilities, and ethnic communities – and routine “catch-up” vaccination for children under the age of 1.
The results were significant. The campaign – Taloumbon – saw more than 39,000 people in the province receive a COVID-19 vaccine or a booster, with provincial booster coverage increasing from 24 to 32% within two weeks.
Importantly, from 29 targeted “high-risk” villages – communities where previous COVID-19 vaccination efforts had limited success in the province – improved community engagement resulted in a 246% increase in the number of people newly vaccinated (776 versus 316) during this campaign compared to previous traditional outreach.
“While this total number of people to newly receive a vaccine is small compared to the total number of people vaccinated overall, this figure represents a significant jump among some of the least reached groups,” said WHO’s community engagement team lead Shogo Kubota.
“Importantly, the things that seemed to be the most persuasive in changing people’s views, were simple - talking to them in a non-hierarchical way, spending time to discuss the vaccine and listen to concerns and views, and identify and persuade influencers – whether village representatives, religious leaders, or close neighbours and friends.”
While the visible side of the campaign was the vaccination outreach, equally crucial was planning involving people who have influence in the community – particularly, mobilizing organizations outside the health sector.
“The focus was on engaging non-health agencies and local leaders to support the effort,” said Dr Phonepaseuth Ounaphom, Director General of Department of Hygiene and Health Promotion, Ministry of Health.
“From provincial and district governors to Lao Front, Lao Women and Youth Unions, mother and child committees, information and cultural affairs colleagues, as well as community leaders – everyone has a role to play and is invited to join the planning and outreach efforts.”
Dr Ounaphom continued: “Joint planning and teambuilding provide a significant advantage in terms of ownership, working with the right people to build trust, and mobilizing the full strength of our institutions and teams to improve health – as well as reminding everyone health is everyone’s responsibility.”
For one village chief in Pek District, the change in approach was significant.
“I and my family decided not to get vaccinated because we only stay home and go to the rice field. So, we have no need for the vaccine. Besides, I never get injected in my life and I am still OK.
“But, after I heard clearly from the team about the possibility to contract COVID-19, and the vaccine benefits, I decided to get it. This is the first injection for me.”
The next day, he brought his wife to get vaccinated as well. The local health centre reported this was a significant breakthrough.
A 33-week pregnant woman in Mok District had a similar experience, at first refusing a vaccination or even to talk to the CONNECT team.
“I am afraid of the [COVID-19] vaccine because I am pregnant, but later I decided to get vaccinated since I saw more and more people in the village get vaccinated.”
She told a CONNECT team member that a supportive environment helped address her hesitancy, while home visits helped reach the elderly and people with disabilities.
Following the campaign’s success, the Ministry of Health is now exploring expanding similar efforts to additional provinces.
WHO’s efforts to support the Ministry of Health and Xieng Khouang Province officials around the National Games included COVID-19 vaccination outreach efforts, disease surveillance, food safety, risk communications, and infection prevention and control in health facilities. WHO’s technical assistance was made possible due to support from EU, USAID and DTRA, with CONNECT supported by the EU, KOFIH, USAID and Luxembourg.