Table 3. Ranked consensus statements on the most important challenges and solutions for implementation of COVID-19 vaccination programs in low- and middle-income countries (n = 39).
| Consensus Ranking | ||
|---|---|---|
| Theme | Challenge | |
| Infrastructure, and human and material resources | Insufficient health system capacity to simultaneously deliver routine primary care and COVID-19 vaccines at the required scale and speed. | A (94.9) |
| Structural factors | Insufficient operational funding within countries to create infrastructure and mobilize human resources for vaccine distribution and administration. | A (92.3) |
| Infrastructure, and human and material resources | Inadequate cold chain and storage infrastructure, including insufficient and insecure facilities, unreliable power supply, and absent or poorly maintained equipment. | B (86.8) |
| Theme | Solution | |
| Planning, processes, and operations | Develop flexible plans at the national level in anticipation of multiple scenarios to ensure effective response to changing situations such as supply availability, public perceptions, and the epidemiological situation. | U (100.0) |
| Communication, community engagement, and access | Develop communication strategies through the collaboration of multiple partners (e.g., academia, public health agencies, regulators, media) to counter misinformation, disinformation, and vaccine hesitancy. | A (94.9) |
| Communication, community engagement, and access | Collaborate with local traditional, civil, and religious leaders to address concerns such as vaccine hesitancy. | A (94.5) |
| Infrastructure, and human and material resources | Provide dedicated training for health care workers focusing on interpersonal communication skills that can facilitate addressing concerns and doubts about the vaccines and the vaccination programmes. | A (92.3) |
| Infrastructure, and human and material resources | Strengthen cold chain capacity through improved transportation, enhanced storage space, temperature monitoring, etc. | A (92.3) |
| Planning, processes, and operations | Develop centralized surveillance systems and digital tools that allow for continuous monitoring and evaluation of key vaccine indicators such as doses distributed, vaccine coverage, adverse events following immunization (AEFIs). | A (92.1) |
| Communication, community engagement, and access | Design strategic, context-sensitive risk communication materials and awareness campaigns tailored to different communities, including campaigns targeted at health care workers. | B (89.5) |
| Communication, community engagement, and access | Prioritize the vaccination of populations involved in the maintenance of essential services such as health care, education, and food industry workers. | B (87.2) |
| Structural factors | Create a new or reformed global mechanism and binding agreement, with clear accountability, to better regulate and ensure equitable access to, and supply of, vaccines to LMICs regardless of their purchasing power. | B (82.1) |
| Infrastructure, and human and material resources | Deploy mobile units to vaccinate remote or hard-to-reach populations. | B (81.1) |
Note: LMICs, low- and middle-income countries
Grade Unanimous (U) is 100% agreement, A is 90–99% agreement, B is 80–89% agreement. We defined consensus as agreement among more than 80% of the panelists.