How can early COVID-19 vaccine campaigns in the US-affiliated Pacific Islands inform future vaccine efforts: a cross-sectional analysis.

Introduction: The US-affiliated Pacific Islands (USAPI) are six geographically isolated and culturally distinct Pacific Island jurisdictions with special relationships with the USA; the USAPI were included in the US COVID-19 vaccination effort. This study documents the approaches and lessons learnt from the rollout of COVID-19 vaccination in the USAPI, including four COVID-19-free jurisdictions. Methods: Quantitative data regarding vaccination administration were obtained from each jurisdiction's immunisation information systems during 13 December 2020 and 11 March 2021. USAPI and US county-level vaccination administration rates by age group from the CDC were compared. Qualitative data regarding key components of the vaccination efforts were collected by survey from each USAPI lead immunisation manager. Results: A total of 90 870 individuals aged ≥16 years in the USAPI received at least one dose of vaccine during 17 December 2020 to 11 March 2021 (28.2% of the eligible population). Most jurisdictions observed rapid vaccine uptake after introducing COVID-19 vaccines and fully vaccinated >20% of their eligible populations in 3 months or less. During the study period, the USAPI region achieved higher coverage than the rest of the US once all USAPI had begun vaccination. All jurisdictions identified pre-campaign community messaging outreach as key to success and misinformation and rumours as the most common challenge. The lessons reported by USAPI immunisation managers included the need for quality risk communication and sustained involvement of interdisciplinary partners. Conclusion: Tailoring vaccine administration and communication strategies to each jurisdiction while maintaining system agility was critical for success, particularly considering the logistical challenges presented by the geographic remoteness of the USAPI. Maintenance of the jurisdictions' planning preparedness efforts, newly installed infrastructure and local partnerships can strengthen the resilience of the jurisdictions for a range of challenges beyond the COVID-19 response. Future immunisation strategies should build from the successful vaccination plans showcased here.