How to increase COVID-19 vaccination among a population with persistently suboptimal vaccine uptake? Evidence from the North Macedonia mobile vaccination and public health advice caravan.
Manuel Serrano-Alarcón, Martin Mckee, Leonardo Palumbo, Cristiana Salvi, Anne Johansen, David Stuckler
Author Information
Manuel Serrano-Alarcón: European Commission, Joint Research Centre (JRC), Ispra, Italy; Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy. Electronic address: manuel.serrano-alarcon@ec.europa.eu.
Martin Mckee: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.
Leonardo Palumbo: World Health Organization, Geneva, Switzerland.
Cristiana Salvi: World Health Organization, Geneva, Switzerland.
Anne Johansen: World Health Organization, Geneva, Switzerland.
David Stuckler: Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy; Department of Social & Political Sciences, Bocconi University, Milano, Italy.
Over three years since the first COVID-19 vaccine was approved, many countries still have suboptimal vaccination rates despite holding great amounts of vaccines. Overall, there is little evidence on which policies are more effective to encourage vaccination, particularly in countries where a large share of the population remains unvaccinated. In this study, we examine the effectiveness of a community-based intervention carried out in March 2022 in North Macedonia, a country with a large and persistent share of the population that remains unvaccinated. The intervention, spearheaded by the Ministry of Health and supported by the World Health Organization and UNICEF, consisted of a mobile caravan offering vaccination and public health advice to different locations across the country on different days. Results from our staggered difference-in-difference model show that the mobile vaccination caravan increased daily vaccination rates by 7.7 vaccines per 100,000 inhabitants during the three weeks after the day of the caravan visit. This corresponds to a 35 % increase with respect to pre-intervention vaccination rates. We estimate a cost-effectiveness of 25.4 US dollars (USD) per additional vaccination induced. These results point to mobile caravan vaccines as an effective and cost-effective strategy to increase COVID-19 vaccination rates, even in a context of persistently suboptimal uptake.
