Even before recording its first case of COVID-19 in March 2020, the government of Sierra Leone put in motion a rapid response to control the spread of the virus. Drawing on experiences of an Ebola epidemic that had ended only four years before, response measures were, initially at least, prompt and stringent, including a return to military-led coordination structures seen during the previous outbreak. Soon however, it became clear to the population that the devastation seen in the West and predicted for Africa did not materialise, and the pandemic was experienced primarily as mild and asymptomatic. Nonetheless, in 2021, as vaccines became available, the Ministry of Health rolled out an extensive vaccination programme with demanding targets were placed on District Health Management Teams to achieve the expected 70% coverage set by the World Health Organisation. Based on ethnographic fieldwork embedded within the Kambia District Health Management Team as well as in the wider Kambia community, this paper explores how this mass vaccination drive in the context of localised experiences of COVID-19 opened up the space for much broader conversations within the health system and between health workers and citizens. Firstly, the paper discusses how memories of Ebola were contrasted with COVID-19 during vaccination encounters to debate the meaning of crisis, the nature of epidemic preparedness at community and district level. These moments of encounter provided fora for citizens to articulate expectations of care. Secondly, contrasting the COVID-19 vaccination drive with a concurrent measles response, I show how vaccine deployment requirements served as a window into daily challenges of making the health system work. Tensions around prioritisation, redirection of resources and struggles to achieve targets in the midst of everyday crises, highlight the often invisible social lives of global health agendas as they intersect with local political and moral economies.
