{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:11:16Z","timestamp":1788786676695,"version":"build-2803163510"},"reference-count":47,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: The 100 Days Mission has reorganised preparedness around vaccine development speed. Modelling suggests that meeting its target during the COVID\u201119 pandemic could have averted more than eight million deaths, conditional on equitable distribution. Distribution depends on a national pathway from authorisation through financing, cold chain, targeting, delivery, monitoring and community trust. The Mission measures speed at only one end of this system.Objective: To develop and apply a country\u2011anchored framework for the deployment\u2011readiness layer of preparedness.Methods: We conducted a comparative documentary analysis of three vaccine deployment events in Sierra Leone: COVID\u201119 vaccination in 2021, preventive Ebola vaccination in 2024 and mpox clade IIb vaccination in 2025. Sources included regulatory records, government and partner reports, national plans and aggregate programme records. We organised 11 established immunisation and emergency vaccination functions into a Deployment Readiness Chain. We traced constraints, handoffs, time to vaccination start and dated reach.Findings: COVID\u201119 vaccination began 45 days after European Medicines Agency authorisation. Full coverage among people aged 12 years or older reached 73.2% by December 2022 and a reported 86.7% by October 2023. More than 84% of doses were delivered through surge campaigns or periodic intensification of routine immunisation. Nationwide preventive Ebola vaccination reached 17,454 of the 20,621 targeted workers, or 84.6%, in three weeks. It began 1851 days after authorisation, although a global stockpile had been in operation since 2021. Mpox vaccination began 106 days after outbreak confirmation and reached 186,053 people by 14 December through capabilities built during earlier emergencies.Conclusions: For Ebola, the 1851\u2011day interval spanned product authorisation, global preventive policy, financing and national activation. Product availability alone was not sufficient. Preparedness frameworks should evaluate deployment readiness alongside development speed. They should treat the global\u2011to\u2011national deployment pathway as one fundable category. Deployment readiness is built between emergencies, not during them.<\/jats:p>","DOI":"10.5334\/aogh.5326","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:45:42Z","timestamp":1788785142000},"page":"91","source":"Crossref","is-referenced-by-count":0,"title":["From Product Availability to Population Protection: Vaccine Deployment Readiness in Sierra Leone"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0594-2956","authenticated-orcid":false,"given":"Lucy","family":"Namulemo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Ikoona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Kaluya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Alex","family":"Vandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foday","family":"Sahr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3402-1961","authenticated-orcid":false,"given":"Eric Nzirakaindi","family":"Ikoona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"1","unstructured":"Coalition for Epidemic Preparedness Innovations. The 100 Days Mission. Oslo: Coalition for Epidemic Preparedness Innovations; 2022. Accessed July 30, 2026. https:\/\/cepi.net\/100-days-mission."},{"key":"2","doi-asserted-by":"crossref","unstructured":"Saville M, Cramer JP, Downham M, et al. Delivering pandemic vaccines in 100 days: What will it take? N Engl J Med. 2022;387:e3. doi:10.1056\/NEJMp2202669.","DOI":"10.1056\/NEJMp2202669"},{"key":"3","doi-asserted-by":"crossref","unstructured":"Barnsley G, Olivera Mesa D, Hogan AB, et al. Impact of the 100 Days Mission for vaccines on COVID\u201119: A mathematical modelling study. Lancet Glob Health. 2024;12:e1764\u2013e1774. doi:10.1016\/S2214-109X(24)00286-9.","DOI":"10.1016\/S2214-109X(24)00286-9"},{"key":"4","doi-asserted-by":"crossref","unstructured":"Gouglas D, Christodoulou M, Hatchett R. The 100 Days Mission\u20142022 Global Pandemic Preparedness Summit. Emerg Infect Dis. 2023;29:e221142. https:\/\/wwwnc.cdc.gov\/eid\/article\/29\/3\/22-1142_article.","DOI":"10.3201\/eid2903.221142"},{"key":"5","doi-asserted-by":"crossref","unstructured":"Wouters OJ, Shadlen KC, Salcher\u2011Konrad M, et al. Challenges in ensuring global access to COVID\u201119 vaccines: Production, affordability, allocation and deployment. Lancet. 2021;397:1023\u20131034. doi:10.1016\/S0140-6736(21)00306-8.","DOI":"10.1016\/S0140-6736(21)00306-8"},{"key":"6","unstructured":"World Health Organization. World Health Assembly adopts historic Pandemic Agreement to make the world more equitable and safer from future pandemics. Geneva: WHO; 2025. Accessed July 30, 2026. https:\/\/www.who.int\/news\/item\/20-05-2025-world-health-assembly-adopts-historic-pandemic-agreement-to-make-the-world-more-equitable-and-safer-from-future-pandemics."},{"key":"7","unstructured":"World Health Organization. COVAX calls for urgent action to close vaccine equity gap. Geneva: WHO; 2022. Accessed August 1, 2026. https:\/\/www.who.int\/news\/item\/20-05-2022-covax-calls-for-urgent-action-to-close-vaccine-equity-gap."},{"key":"8","unstructured":"World Health Organization Regional Office for Africa. A decade after the deadliest Ebola outbreak in history, Sierra Leone begins a new chapter with nationwide preventive vaccination of frontline workers. Brazzaville\/Freetown: WHO AFRO; 2024. Accessed August 2, 2026. https:\/\/www.afro.who.int\/countries\/sierra-leone\/news\/decade-after-deadliest-ebola-outbreak-history-sierra-leone-begins-new-chapter-nationwide-preventive."},{"key":"9","unstructured":"Gavi, the Vaccine Alliance. Gavi announces launch of preventive Ebola, routine multivalent meningitis, human rabies, and hepatitis B birth dose vaccination programmes. Published June 13, 2024. Accessed August 2, 2026. https:\/\/www.gavi.org\/news\/media-room\/gavi-announces-launch-preventive-ebola-routine-multivalent-meningitis-human-rabies-hep-b-vaccination-programmes."},{"key":"10","unstructured":"World Health Organization. Extraordinary meeting of the Strategic Advisory Group of Experts on Immunization on Ebola vaccination, May 2024: conclusions and recommendations. Wkly Epidemiol Rec. 2024;99(27):355\u2013362. Accessed August 2, 2026. https:\/\/www.who.int\/publications\/i\/item\/WER-9927-355-362."},{"key":"11","unstructured":"European Medicines Agency. First vaccine to protect against Ebola. Amsterdam: European Medicines Agency; 2019. Published October 18, 2019. Accessed August 2, 2026. https:\/\/www.ema.europa.eu\/en\/news\/first-vaccine-protect-against-ebola."},{"key":"12","unstructured":"US Food and Drug Administration. First FDA\u2011approved vaccine for the prevention of Ebola virus disease. Silver Spring, MD: FDA; 2019."},{"key":"13","unstructured":"Ikoona EN, Gebru GN, Faye M, et al. Early epidemiologic and genomic insights from Sierra Leone\u2019s first mpox cases, 2025. Pan Afr Med J. 2026;53:177. https:\/\/www.panafrican-med-journal.com\/content\/article\/53\/177\/full\/."},{"key":"14","doi-asserted-by":"crossref","unstructured":"Samai M, Seward JF, Goldstein ST, et al. The Sierra Leone trial to introduce a vaccine against Ebola: Tolerability and safety of rVSV\u0394G\u2011ZEBOV\u2011GP. J Infect Dis. 2018;217(Suppl 1):S6\u2013S15. doi:10.1093\/infdis\/jiy020.","DOI":"10.1093\/infdis\/jiy020"},{"key":"15","doi-asserted-by":"crossref","unstructured":"Kangbai DM, Sesay EN, Clemens\u2011Kangbai N, et al. A decade of progress: Ebola vaccination strategy and associated factors in Sierra Leone. medRxiv. 2026 [preprint]. doi:10.64898\/2026.01.28.26345081.","DOI":"10.2139\/ssrn.6040638"},{"key":"16","doi-asserted-by":"crossref","unstructured":"Kallay R, Muhoza P, Tchoualeu DD, et al. Use of Ebola vaccines worldwide, 2021\u20112023. MMWR Morb Mortal Wkly Rep. 2024;73(16):360\u2013364. doi:10.15585\/mmwr.mm7316a1.","DOI":"10.15585\/mmwr.mm7316a1"},{"key":"17","unstructured":"World Health Organization. COVID\u201119 vaccine introduction readiness assessment tool: VIRAT\/VRAF 2.0. Geneva: WHO; 2020. Accessed July 30, 2026. https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccine-introduction-RA-Tool-2020.1."},{"key":"18","unstructured":"World Health Organization. Guidance on Developing a National Deployment and Vaccination Plan for COVID\u201119 Vaccines. 2nd Version. Geneva: WHO; 2021. Accessed July 30, 2026. https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccine_deployment-2021.1."},{"key":"19","unstructured":"Republic of Sierra Leone, Ministry of Health and Sanitation. COVID\u201119 National Vaccine Deployment Plan. Freetown: Ministry of Health and Sanitation; 2022."},{"key":"20","unstructured":"World Health Organization. Joint External Evaluation of IHR Core Capacities of Sierra Leone: Mission Report, 27 February to 3 March 2023. Geneva: WHO; 2023. Accessed July 30, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240081376."},{"key":"#cr-split#-21.1","unstructured":"World Health Organization. International Health Regulations (2005): States Parties self\u2011assessment annual reporting tool. 2nd ed. Geneva: World Health Organization"},{"key":"#cr-split#-21.2","unstructured":"2021. Accessed July 30, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240040120."},{"key":"#cr-split#-22.1","unstructured":"World Health Organization Regional Office for Africa. Sierra Leone Advances Health Security with Development of Second National Action Plan (NAPHS 2025\u20112029). Freetown: WHO AFRO"},{"key":"#cr-split#-22.2","unstructured":"2025. Accessed July 30, 2026. https:\/\/www.afro.who.int\/countries\/sierra-leone\/news\/sierra-leone-advances-health-security-development-second-national-action-plan-naphs-2025-2029."},{"key":"23","unstructured":"World Health Organization Regional Office for Africa. COVID\u201119 vaccines shipped by COVAX arrive in Sierra Leone. Brazzaville\/Freetown: World Health Organization Regional Office for Africa; 2021. Published March 8, 2021. Accessed July 30, 2026. https:\/\/www.afro.who.int\/news\/covid-19-vaccines-shipped-covax-arrive-sierra-leone."},{"key":"24","unstructured":"World Health Organization Regional Office for Africa. Sierra Leone steps up countrywide COVID\u201119 vaccination. Brazzaville\/Freetown: World Health Organization Regional Office for Africa; 2021. Published August 26, 2021. Accessed July 30, 2026. https:\/\/www.afro.who.int\/news\/sierra-leone-steps-countrywide-covid-19-vaccination."},{"key":"25","doi-asserted-by":"crossref","unstructured":"Kangbai DM, Mutebi RR, Shen AK, et al. Informing Life\u2011Course Immunization and Pandemic Preparedness: A COVID\u201119 Vaccine Evaluation and HPV Introduction Experience in Sierra Leone. BMC Public Health. doi:10.1186\/s12889-026-27139-0. Published online 27 May 2026.","DOI":"10.1186\/s12889-026-27139-0"},{"key":"26","unstructured":"Government of Sierra Leone. The Public Health Act, 2022 (Act No. 17 of 2023). Freetown: Government Printing Department; 2023. Accessed July 30, 2026. https:\/\/faolex.fao.org\/docs\/pdf\/sie223891.pdf."},{"key":"27","unstructured":"World Health Organization Regional Office for Africa. Sierra Leone launches National Public Health Agency to strengthen healthcare infrastructure. Brazzaville\/Freetown: World Health Organization Regional Office for Africa; 2023. Published December 21, 2023. Accessed July 30, 2026. https:\/\/www.afro.who.int\/countries\/sierra-leone\/news\/sierra-leone-launches-national-public-health-agency-strengthen-healthcare-infrastructure."},{"key":"28","doi-asserted-by":"crossref","unstructured":"Kim J, Sabet\u2011Azad R, Patel D, Malin G, Askary SH, S\u00e4rnef\u00e4lt A. Fast\u2011tracking vaccine manufacturing: CEPI\u2019s rapid response framework for the 100 Days Mission. Vaccines. 2025;13:849. doi:10.3390\/vaccines13080849.","DOI":"10.3390\/vaccines13080849"},{"key":"29","doi-asserted-by":"crossref","unstructured":"Moon S, Sridhar D, Pate MA, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. Lancet. 2015;386:2204\u20132221. doi:10.1016\/S0140-6736(15)00946-0.","DOI":"10.1016\/S0140-6736(15)00946-0"},{"key":"30","doi-asserted-by":"crossref","unstructured":"Njuguna C, Jambai A, Chimbaru A, et al. Revitalization of integrated disease surveillance and response in Sierra Leone post Ebola virus disease outbreak. BMC Public Health. 2019;19:364. doi:10.1186\/s12889-019-6636-1.","DOI":"10.1186\/s12889-019-6636-1"},{"key":"31","doi-asserted-by":"crossref","unstructured":"Jones\u2011Konneh TEC, Kaikai AI, Bah IB, et al. Impact of health systems reform on COVID\u201119 control in Sierra Leone: A case study. Trop Med Health. 2023;51:28. doi:10.1186\/s41182-023-00521-z.","DOI":"10.1186\/s41182-023-00521-z"},{"key":"32","unstructured":"Ministry of Health, Sierra Leone. In a Defining Moment for Public Health Response in Sierra Leone, Health Minister Declares the Mpox Outbreak Over. Freetown: Ministry of Health; 2025. Accessed July 30, 2026. https:\/\/mohs.gov.sl\/in-a-defining-moment-for-public-health-response-in-sierra-leone-health-minister-declares-the-mpox-outbreak-over\/."},{"key":"33","unstructured":"World Health Organization Regional Office for Africa. Sierra Leone Launches Mpox Vaccination Campaign to Curb Rising Cases. Freetown: WHO AFRO; 2025. Accessed July 30, 2026. https:\/\/www.afro.who.int\/countries\/sierra-leone\/news\/sierra-leone-launches-mpox-vaccination-campaign-curb-rising-cases."},{"key":"34","unstructured":"Bah S. Sierra Leone\u2019s mpox case\u2011count is plummeting. Can the country get to zero new infections? VaccinesWork. 2025. Accessed July 30, 2026. https:\/\/www.gavi.org\/vaccineswork\/sierra-leones-mpox-case-count-plummeting-can-country-get-zero-new-infections."},{"key":"35","unstructured":"National Public Health Agency, Sierra Leone. Mpox Outbreak Situation Report 203. Freetown: NPHA; 2025. 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Internal aggregate programme report."},{"key":"39","unstructured":"World Health Organization. Behavioural and Social Drivers of Vaccination: Tools and Practical Guidance for Achieving High Uptake. Geneva: WHO; 2022. Accessed August 1, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240049680."},{"key":"40","doi-asserted-by":"crossref","unstructured":"Meriggi NF, Voors M, Levine M, et al. Last\u2011mile delivery increases vaccine uptake in Sierra Leone. Nature. 2024;627:612\u2013619. doi:10.1038\/s41586-024-07158-w.","DOI":"10.1038\/s41586-024-07158-w"},{"key":"41","unstructured":"World Bank. Pandemic Fund allocates first grants to help countries be better prepared for future pandemics. Washington, DC: World Bank; 2023. Published July 20, 2023. Accessed July 30, 2026. https:\/\/www.worldbank.org\/en\/news\/press-release\/2023\/07\/20\/pandemic-fund-allocates-first-grants-to-help-countries-be-better-prepared-for-future-pandemics."},{"key":"42","doi-asserted-by":"crossref","unstructured":"Bollyky TJ, Hulland EN, Barber RM, et al. Pandemic preparedness and COVID\u201119: An exploratory analysis of infection and fatality rates and contextual factors in 177 countries. Lancet. 2022;399:1489\u20131512. doi:10.1016\/S0140-6736(22)00172-6.","DOI":"10.1016\/S0140-6736(22)00172-6"},{"key":"43","doi-asserted-by":"crossref","unstructured":"Alakija A. Leveraging lessons from the COVID\u201119 pandemic to strengthen low\u2011income and middle\u2011income country preparedness for future global health threats. Lancet Infect Dis. 2023;23:e310\u2013e317. doi:10.1016\/S1473-3099(23)00279-7.","DOI":"10.1016\/S1473-3099(23)00279-7"},{"key":"44","doi-asserted-by":"crossref","unstructured":"Lal A, Abdalla SM, Chattu VK, et al. Pandemic preparedness and response: Exploring the role of universal health coverage within the global health security architecture. Lancet Glob Health. 2022;10:e1675\u2013e1683. doi:10.1016\/S2214-109X(22)00341-2.","DOI":"10.1016\/S2214-109X(22)00341-2"},{"key":"45","doi-asserted-by":"crossref","unstructured":"Sirleaf EJ, Clark H. Report of the Independent Panel for Pandemic Preparedness and Response: Making COVID\u201119 the last pandemic. Lancet. 2021;398:101\u2013103. doi:10.1016\/S0140-6736(21)01095-3.","DOI":"10.1016\/S0140-6736(21)01095-3"}],"container-title":["Annals of Global Health"],"original-title":[],"link":[{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5326\/files\/6a9ea32fe1361.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5326\/files\/6a9ea34b0e35d.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5326\/files\/6a9ea32fe1361.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:51:12Z","timestamp":1788785472000},"score":1,"resource":{"primary":{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/10.5334\/aogh.5326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.5334\/aogh.5326","relation":{},"ISSN":["2214-9996"],"issn-type":[{"value":"2214-9996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}