A Decade of Progress: Description of Ebola Vaccination Strategy and its Associated Factors in Sierra Leone

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Abstract Background The 2013-2016 Ebola virus disease outbreak in West Africa profoundly affected Sierra Leone’s health financing, health delivery, health governance, and health workforce. The country becomes the first among those most severely affected ten years ago by the West Africa Ebola outbreak, to launch nationwide preventive Ebola vaccination, targeting 20,000 frontline workers who received a single dose of the Ebola Vaccine. Methods A mixed-method study design that analysed administrative vaccination data, field supervision reports, and electronic records from all 16 districts in Sierra Leone was used. The following indicators were analysed: vaccination coverage and logistical regression. Qualitative information from stakeholder debriefings and community feedback complemented the findings from the quantitative analysis. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) version 27. Results A total of 17,454 (vaccine coverage= 84.5%) frontline workers and high-risk populations for EVD infection were vaccinated. Healthcare workers accounted for 35% of all vaccinations. Multivariate analysis showed that females had an AOR of 1.507 (95% CI: 1.293-1.756, P < 0.001) and individuals with tertiary education had an AOR of 1.900 (95% CI: 1.371-2.633, P < 0.001), were more likely to be vaccinated. Western and Southern regions achieved the highest coverage due to superior cold-chain readiness and community mobilisation. No serious adverse events following immunisation were reported. Conclusion Sierra Leone’s decade-long journey from outbreak response to preventive vaccination demonstrates the transformative impact of sustained investment, multisectoral coordination, and community trust. High coverage and operational success affirm the feasibility of nationwide Ebola immunisation in resource-limited settings.

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