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Tanzania has taken an unusual route in the COVID-19 pandemic response. In early 2021, Tanzania was reported to have refused COVID-19 vaccines.1 In response, the Tanzanian Government explained the country's position, arguing there were concerns with initial vaccine safety but pointing out that the country was ready to work with the international community in the fight against COVID-19.2 After the appointment of a presidential task force in April, 2021, to establish the country's direction on COVID-19 response, as initially recommended by an expert committee,3 Tanzania joined COVID-19 Vaccines Global Access (COVAX), and the first batch of US-donated Janssen (Johnson & Johnson) COVID-19 vaccines arrived on July 24, 2021. By then, many countries in Africa were on their third round of COVAX consignments. The Tanzanian Government quickly undertook the task of mass vaccinations by starting with priority populations and thereafter resumed sharing COVID-19 epidemiological data with WHO. However, initial vaccine uptake was extremely low due to scepticism. Some assessment studies reported COVID-19 vaccine hesitancy of up to 65% in the general population4 and low vaccine confidence, especially in health-care workers. Another study reported hesitancy of 62% in western Tanzania.5

emiological data with WHO. However, initial vaccine uptake was extremely low due to scepticism. Some assessment studies reported COVID-19 vaccine hesitancy of up to 65% in the general population4 and low vaccine confidence, especially in health-care workers. Another study reported hesitancy of 62% in western Tanzania.5 Faced with very low vaccine uptake, the Government appealed to local and international partners for COVID-19 vaccination assistance. The renewed engagement led to numerous partners mobilising resources for vaccine deployment, including US Government agencies (eg, the US Centers for Disease Control and Prevention, the US Department of Defense, and the US Agency for International Development); WHO; UNICEF; Gavi, the Vaccine Alliance; Africa Centres for Disease Control and Prevention; development partners; and local non-governmental organisations. In September, 2021, after the completion of the logistic arrangement, Tanzania began an intensive campaign to vaccinate all eligible adults older than 18 years. Multipronged strategies were applied to combat vaccine hesitancy and build confidence, especially among health-care workers. When required, one-on-one engagements with stakeholders were arranged to address concerns, which helped to convince many hitherto sceptics of the utility and effectiveness of vaccines. Concerted efforts ensured that vaccine supplies, logistics, and surge staffing were available to maximise the effect of vaccination drives. These drives were implemented through various intense local operations at health facilities, mobile units, temporarily fixed sites, and events-based vaccinations in communities. The US Government agencies leveraged existing HIV, tuberculosis, and other service delivery infrastructures to surge mass vaccinations nationwide.

e drives were implemented through various intense local operations at health facilities, mobile units, temporarily fixed sites, and events-based vaccinations in communities. The US Government agencies leveraged existing HIV, tuberculosis, and other service delivery infrastructures to surge mass vaccinations nationwide. By Dec 30, 2022, Tanzania had received more than 46·8 million COVID-19 vaccine doses. After initially targeting populations at high risk, the country extended vaccinations to adults older than 18 years for a complete dose, in line with manufacturers’ instructions. The vaccines provided full-dose coverage for more than 37·7 million people, representing 62% of the total population (61 million people according to 2022 census data) and close to 100% of all eligible adults older than 18 years. The coverage far exceeds the national target to fully vaccinate 70% of eligible individuals by December, 2022. The coverage places Tanzania only behind Rwanda in eastern Africa, exceeding many countries in Africa, according to data available on the WHO Coronavirus (COVID-19) Dashboard. Challenges remain, including approving and deploying booster doses and vaccinating children and adolescents younger than 18 years. However, considering the COVID-19 pandemic scenario, Tanzania's efforts serve as a successful example of in-country re-evaluation and leverage of effective partnerships to tackle the COVID-19 pandemic. For more on COVID-19 and vaccine data for Tanzania see https://covid19.who.int/region/afro/country/tz

By Dec 30, 2022, Tanzania had received more than 46·8 million COVID-19 vaccine doses. After initially targeting populations at high risk, the country extended vaccinations to adults older than 18 years for a complete dose, in line with manufacturers’ instructions. The vaccines provided full-dose coverage for more than 37·7 million people, representing 62% of the total population (61 million people according to 2022 census data) and close to 100% of all eligible adults older than 18 years. The coverage far exceeds the national target to fully vaccinate 70% of eligible individuals by December, 2022. The coverage places Tanzania only behind Rwanda in eastern Africa, exceeding many countries in Africa, according to data available on the WHO Coronavirus (COVID-19) Dashboard. Challenges remain, including approving and deploying booster doses and vaccinating children and adolescents younger than 18 years. However, considering the COVID-19 pandemic scenario, Tanzania's efforts serve as a successful example of in-country re-evaluation and leverage of effective partnerships to tackle the COVID-19 pandemic. For more on COVID-19 and vaccine data for Tanzania see https://covid19.who.int/region/afro/country/tz For more on COVID-19 and vaccine data for Tanzania see https://covid19.who.int/region/afro/country/tz