Covid-19: What went wrong after initial success in Laos?

Silver, Andrew

doi:10.1136/bmj.o994

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…The South-East Asia region saw a wide disparity in health-system capacities and consequent outcomes for COVID-19 management, spread, and mortality. Several countries (eg, Sri Lanka, 190 Thailand, 191 Lao PDR, 192 and Cambodia 193 ) were able to contain the spread of COVID-19 in the first year of the pandemic as a result of effective contact tracing, wearing of face masks, and physical distancing. Other countries (eg, Pakistan, Bangladesh, Malaysia, and India) saw sharp rises in infections, but death rates remained relatively low.…”

Section: Section 2: a Review Of The Global Regional And National Resp...mentioning

confidence: 99%

The Lancet Commission on lessons for the future from the COVID-19 pandemic

et al. 2022

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Section: Section 2: a Review Of The Global Regional And National Resp...mentioning

confidence: 99%

The Lancet Commission on lessons for the future from the COVID-19 pandemic

et al. 2022

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“… 9 Logistical constraints such as transportation and staff shortages and difficult road conditions impeded access to remote communities. 10 …”

Section: Introductionmentioning

confidence: 99%

Reaching the unreached through building trust: a mixed-method study on COVID-19 vaccination in rural Lao PDR

Phrasisombath,

Kubota,

Elliott

et al. 2024

BMJ Glob Health

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IntroductionThe global COVID-19 vaccine rollout has been impacted by socioeconomic disparities and vaccine hesitancy, but few studies examine reasons for changed attitudes. In Lao People’s Democratic Republic (Lao PDR), a nationwide government-led initiative was developed in response to COVID-19, focused on community health ownership and trust in primary healthcare. The intervention team including health and governance sectors conducted capacity-building workshops with local staff and community representatives and visited villages for vaccination outreach. This study investigates the impact of this intervention on COVID-19 vaccine acceptance in rural communities.MethodsConducted in Xiengkhuang province, Lao PDR, from December 2022 to February 2023, the study employed a sequential mixed-methods research design. Data on vaccinated individuals from 25 villages were collected from 11 primary healthcare units; pre-post analysis was applied. Qualitative data, gathered through interviews and focus group discussions with villagers, village authorities, health staff and local government (n=102) in six villages, underwent inductive thematic analysis.ResultsFirst-dose vaccine uptake after the intervention increased significantly (6.9 times). Qualitative analysis identified key reasons for vaccination hesitancy: (1) mistrust due to rumours and past experiences; (2) poor communication and inconsistent messaging and (3) challenges in access for priority groups. Influencing factors during the intervention included (1) effective local-context communication; (2) leveraging existing community structures and influential individuals in a multisectoral approach and (3) increased community motivation through improved satisfaction, ownership and relationships.ConclusionThis study highlights the impact and methods of building trust with unreached populations in health interventions, emphasising locally led solutions. Successful reversal of vaccine hesitancy was achieved by addressing root causes and fostering ownership at community and local government levels through a ‘positive approach’. This diverges from conventional supplemental immunisation activities and holds potential for systematically building trust between unreached populations and health systems. Further research could explore the impacts of routine vaccination for sustained improvements in health equity.

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“…Hong Kong had low numbers of SARS-CoV-2 cases through strict border control, quarantine and NPIs, but did not vaccinate abundantly, which exposed the population to severe disease outcomes when the Omicron variant emerged ( Ma and Parry, 2022 ). The feasibility of an elimination strategy may depend on variant characteristics and jurisdictional geographic and social characteristics ( Silver, 2022 , Martignoni and Hurford, 2022 , Department of Health and Community Services, N.L., 2022 ). In early 2022, following the establishment of the Omicron variant, NL shifted from a containment to a mitigation approach ( Department of Health and Community Services, N.L., 2022 ), with many of the jurisdictions that had implemented an elimination strategy responding similarly (a notable exception is China who continued to pursue an elimination strategy).…”

Section: Introductionmentioning

confidence: 99%