Interview with Doctor Raymond Brou, Technical Advisor to the Minister of Health and Public Hygiene of Côte d’Ivoire

Côte d’Ivoire’s response to the COVID-19 pandemic has made it a model for other middle-income countries. According to Gavi, the Vaccine Alliance, “In the face of a historic emergency, Côte d’Ivoire prioritized immunization at every level – making sure routine programs stayed on track alongside COVID-19 vaccination efforts. Championing integrated campaigns that were able to reach people with multiple lifesaving vaccines in one go, the country set an example that stability and recovery are achievable goals.”

Doctor Raymond Brou has played a key role in this response as Technical Advisor to the Minister of Health of Côte d’Ivoire. In 2018, he received support from the MSH-led Leadership, Management, and Governance (LMG) Project, which aimed to strengthen health systems to deliver more responsive services by developing inspiring leaders, establishing strong management systems, and promoting effective governance practices. We recently spoke with Dr. Brou about how he used some of those leadership principles in his country’s approach to the COVID-19 crisis.

How did you use the LMG training you received from MSH to respond to the COVID-19 pandemic?

When I was the Departmental Director of Health in Sakassou in the Gbeke region of Bouaké, I went through this training program. I learned that you can’t meet the needs of the population without having them at the table for the discussion. Whenever the central, regional, or departmental level makes plans to manage public health for population X, this population X must be informed. We need to be transparent with them.

I carried this principle with me when I became an advisor to the Minister of Health. I have regular meetings with department directors, and I encourage them to speak freely. Nothing is taboo and no one is left out.

For example, we recently made plans to intensify the campaign against COVID-19 over a 10-day period. Initially, we planned to target 21 districts with a coverage rate of less than 30%. One of the directors suggested that rather than just focusing on these districts, we should work with all districts with less than 50% coverage to target more people and get more people vaccinated. We immediately agreed.

The LMG training encouraged me to work with local government officials, nongovernmental organizations [NGOs], and religious groups. Public health activities aren’t just for a small group working in hospitals. They need to be open to everyone, including journalists, NGOs, women’s groups, and others so everyone can give their opinion. For vaccination activities in the markets, the merchants’ unions told us, “We don’t have time to get vaccinated. The Minister needs to find a way for us to be vaccinated.” We listened to what they were saying and this is how we came to launch an initiative to use mobile medical vehicles to get to them instead of asking them to come to us. These vehicles are now known and nicknamed “COVID trucks” by the population.

COVID vaccination shouldn’t be an administrative activity with burdensome protocols. It must be close to the people.

Doctor Raymond Brou, Technical Advisor to the Minister of Health, Côte d’Ivoire

What were the main challenges Côte d’Ivoire faced during its COVID-19 vaccination campaign?

There were many, from the logistical challenges of how to get vaccines into the country, since we don’t produce them, to how to distribute while keeping them cold. We also needed to educate our health workers on how COVID is linked to other health problems and help them understand the seriousness of COVID as a respiratory illness. In addition, we faced the challenge of paying our health workers for their continuous efforts on the ground administering vaccines. Plus, we had to find ways of communicating to the public and raising awareness about the importance of vaccines.

How did the LMG training help you address these challenges?

We were in contact with the African Vaccine Acquisition Trust and embassies of other countries that could donate vaccines to Côte d’Ivoire. Eighty percent of the 25 million doses of vaccine we received came from our allies in Europe, the United States, and India, as well as our neighboring countries who gave us unused doses that would otherwise have expired. We used cold chains that already exist for other vaccines (such as measles and polio) and transported COVID vaccines to regional storage warehouses once they left Abidjan. We moved the vaccines using pick-up trucks from each district to go as far as possible and finally motorcycles to get them to the more remote villages.

One example of how I incorporated the principle of making public health measures accessible was to use popular music and dance styles to get the message out. Youth groups helped by translating the messages from French into local languages and performing at night in restaurants to raise awareness and motivate people to get vaccinated. In San-Pédro, we vaccinated 100,000 people in just one week thanks to a musical tour.

COVID vaccination shouldn’t be an administrative activity with burdensome protocols. It must be close to the people. The district of Abobo is now the most vaccinated borough in Abidjan but how did we achieve this? The population has asked us to keep the COVID trucks on the busiest roads so that when they come back from work, they can line up to get vaccinated.

In addition, scrap metal dealers in Abobo organized themselves to ask the authorities to send them vaccines because they understood that COVID was hampering trade in their area. Thanks to these initiatives, 70% of people are now vaccinated in Abobo, although it is one of the most populous and vulnerable communities.

What lessons have you learned from this experience?

One thing I saw is the importance of solidarity between different countries and social classes in dealing with the pandemic. Côte d’Ivoire doesn’t produce vaccines, but we saw the support from allies who donated them. When USAID gives us one million doses of vaccine, those million doses save lives because we have the capacity to use the million doses they give us.

Another lesson: we need to grant authorization at the task force level to decentralize vaccination. The hotspot of the pandemic may be in Abidjan, but Abidjan is not isolated from the rest of the country. We vaccinated Abidjan and the rest of the country at the same time.

A third lesson is working with other sectors. Our efforts benefited from working with the technical education sector and the Ministry of Youth to reach young people. Because COVID was not as well-known as diseases like tuberculosis or HIV, awareness was very important. That way, people are not forced to comply with guidelines they do not understand.

How can we keep and institutionalize the lessons learned?

We have increased the number of professionals as well as the number of community health workers, and we are working to create more schools to train even more health workers. We also integrated COVID vaccination into routine immunization activities for children under 6 , school-aged children, pregnant women, and those with comorbidities. COVID vaccination should not be independent of other activities.

Communicating accurate facts will continue to be important, and the media (both national and international) can play a critical role in helping us raise awareness of the importance of vaccination and fighting misinformation. But we also have our own responsibility to respond to misinformation, and we are using social media to counter myths that can be harmful to people’s health.

Finally, we want to increase the production of vaccines and medicines in Côte d’Ivoire so that, in the next crisis, we can produce our own vaccines and medicines rather than waiting for donations.