New pneumococcal conjugate vaccine introductions in four sub-Saharan African countries: a cross-country analysis of health systems’ impacts

Abstract

Background: Pneumonia is a main cause of under-five mortality in low-income settings. The pneumococcal conjugate vaccine (PCV) has been introduced in many countries as a tool in the disease's prevention. Although PCV's effectiveness has been established, less is known about the effects of introducing additional injectable vaccines into routine immunisation programmes, particularly in the context of resource-constrained settings. Objectives: To explore the effects of PCV introduction on the immunisation programmes and health systems in four low-income countries. Methods: This study was carried out in Cameroon, Ethiopia, Kenya and Mali. Three to four regions and nine to 10 districts were selected within each country. Semi-structured interviews were carried out at national, regional and district levels (n=173). Researcher-administered questionnaires were completed with facility staff (n=124). Routine data on monthly vaccination activities were collected at district and facility levels. Results: PCV was generally well integrated into existing routine immunisation. Little or no impact was found in most areas of the health systems. Some minor effects were found on immunisation programmes, particularly in areas with either planning activities or investments e.g. staff skills were strengthened and there were limited improvements in surveillance. Although health sector workers perceived increases in the coverage of other vaccines following the introduction of PCV, routine service data did not confirm this claim. No substantial impacts were seen in health system management, service delivery or performance. Conclusions: The introduction of PCV had marginal impacts on the Expanded Programme for Immunisation and little to none on broader health systems.

Carrier priming to improve pneumococcal disease control and reduce the international program’s cost in children

“…For example, in The Gambia, infant vaccination has reduced vaccine-type pneumococcal carriage not only among vaccinated children but also among non-vaccinated older children and adults, indicating a substantial herd effect [ 3 ]. However, not all countries have introduced vaccination of infants as implementation is limited by the high cost of the vaccine [ 4 ]. The cost of one dose of pneumococcal conjugate vaccine (PCV) can be very high in developed countries (> $100) [ 5 ].…”

Household fuel use and its association with potential respiratory pathogens among healthy mothers and children in Ethiopia

“…pneumoniae (the pneumococcus) is a major bacterial pathogen causing respiratory tract infections, with 515,000 deaths among children globally in 2015 [ 9 ]. The morbidity and mortality related to pneumonia of children under-five in Ethiopia is still high [ 10 , 11 ], despite the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in the infant immunisation program in 2011 [ 12 ].…”

New Vaccine Introduction and Childhood Vaccination Timeliness in Two Urban, Informal Settlements in Nairobi, Kenya

“…3,9 By contrast, other studies have found that the adoption of new vaccines was perceived as an opportunity to retrain and strengthen healthcare workforce capacity and to further promote the benefit of immunization services as a whole, leveraging the availability of additional government resources or donor funding. [10][11][12] Further, social mobilization, outreach, and information campaigns that often accompany the launch of new vaccines may promote higher uptake and timeliness of other vaccines recommended for routine use in communities, specifically because new vaccines are recommended for concomitant administration with other traditional vaccines at established age intervals for vaccination programs. 13 Kenya has made immunizations a health priority, introducing new vaccines ahead of many other LMICs in sub-Saharan Africa, such as pneumococcal conjugate vaccine (PCV) in 2011 and rotavirus vaccine (RV) in 2014.…”