The impact of introducing new vaccines on the health system: Case studies from six low- and middle-income countries

Burchett, Helen; Mounier-Jack, Sandra; Torres-Rueda, Sergio; Griffiths, Ulla K.; Ongolo‐Zogo, Pierre; Rulisa, Stephen; Edengue, Jean-Marie; Chavez, Enrique; Kitaw, Y; Molla, Mitike; Konaté, Mamadou; Gelmon, Lawrence; Onyango-Ouma, Washington; Lagarde, Mylène; Mills, Anne

doi:10.1016/j.vaccine.2014.09.031

Cited by 36 publications

(34 citation statements)

References 19 publications

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“…This factor impacts, in particular, the ability to maintain a vaccine at the appropriate temperature, especially in remote areas with limited infrastructure [21], and there remains a need to develop and implement vaccines stable at ambient temperatures [60,61]. Poor vaccine stock supply may lead to under-provision of a newly-introduced vaccine, especially in the first few months of program delivery, when demand may exceed expectations or when a catch-up strategy has not been incorporated into forecasting predictions [15,62]. This, especially if accompanied by negative media coverage of shortfalls, as occurred in South Africa for a number of different new vaccines in 2009-2010 may affect public confidence in vaccination programs and reduce vaccine uptake [62].…”

Section: Vaccine Supply and Deliverymentioning

confidence: 99%

“…A range of factors may contribute to lower than desirable levels of vaccine introduction. Decision-making processes, economic and financial aspects of NVIs are critical ones and have been extensively described [10][11][12][13][14][15][16][17][18][19][20]. Besides these aspects, implementation and integration of new vaccines bring additional logistical complexity to delivery of existing immunization programs in LMICs.…”

Section: Introductionmentioning

confidence: 99%

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Introducing new vaccines in low- and middle-income countries: challenges and approaches

Guignard

Praet

Jusot

et al. 2019

Expert Review of Vaccines

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Introduction: The number of new vaccine introductions (NVIs) in low and middle-income countries (LMICs) has markedly increased since 2010, raising challenges to often overstretched and underfunded health care systems. Areas covered: We present an overview of some of these challenges, focusing on programmatic decisions, delivery strategy, information and communication, pharmacovigilance and post-licensure evaluation. We also highlight field-based initiatives that may facilitate NVI. Expert commentary: Some new vaccines targeting populations other than infants require alternative delivery strategies. NVIs impact upon existing supply chain management, in particular vaccines with novel characteristics. A lack of understanding about immunization and misconceptions may be detrimental to NVI, as well as insufficient or poorly trained health care workforce. Many barriers exist to achieving good vaccination coverage. Real-world evaluation of vaccine safety, effectiveness and impact in LMICs may be limited by lack of robust demographic and disease epidemiology data, as well as limited health care and surveillance infrastructure. A thorough planning phase is crucial to define the most suitable delivery strategy based on the vaccine's and country's specificities. A communication plan and social mobilization are essential. Implementation research and innovative approaches applied to logistics, delivery, communication and program evaluation can facilitate NVI. ARTICLE HISTORY

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Section: Vaccine Supply and Deliverymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Guignard

Praet

Jusot

et al. 2019

Expert Review of Vaccines

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“…The pneumococcal conjugate vaccines (PCVs) has been shown to be safe and highly effective in preventing invasive pneumococcal disease (IPD) and reducing the burden of pneumococcal disease in children, both in developed and developing countries [1–6]. In sub-Saharan Africa, which carries the highest burden of the disease worldwide, many countries have recently introduced PCVs into their childhood vaccination programs [7]. …”

Section: Introductionmentioning

confidence: 99%

“…Of remark, previous studies have shown that despite the fact that introduction of PCV led to a decline in the burden of pneumococcal meningitis caused by those serotypes that are covered by the PCV [1,2,4,5,7], on the other hand, it resulted in relative increase in the burden of pneumococcal meningitis caused by non–PCV serotypes. Thus, serotype-specific pneumococcal surveillance is key to assess and understand the impact of PCV in the epidemiology of pneumococcal meningitis, including to assess the potential replacement of PCV serotypes by non-PCV serotype, following the introduction of PCV [1–12].…”

Section: Introductionmentioning

confidence: 99%

Surveillance of impact of PCV-10 vaccine on pneumococcal meningitis in Mozambique, 2013 – 2015

et al. 2017

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BackgroundVaccination using the 10-valent conjugate vaccine (PCV-10) was introduced into the Extended Program on Immunization in Mozambique in March 2013, however its impact on pediatric pneumococcal meningitis is unknown. In this study, we assessed for the first time the impact of PCV10 on the burden of pneumococcal meningitis in children less than 5 years of age at the three largest hospitals in Mozambique.MethodBetween March 2013 and December 2015, a total of 744 cerebrospinal fluid (CSF) samples were collected from eligible children, of which 160 (21.5%) were positive for S. pneumoniae. Of these, only 86 samples met the criteria for serotyping and were subsequently serotyped using sequential multiplex PCR (SM-PCR), but 17 samples were non-typable.ResultsThe proportion of cases of pneumococcal meningitis decreased from 33.6% (124 of 369) in 2013 to 1.9% (3 of 160) in 2015 (p < 0.001). The relative frequency of PCV10 serotype cases also decreased from 84.2% (48 of 57) in 2013 to 0% (0 of 3) in 2015 (p = 0.006). Between 2013 and 2015, serotype coverage of PCV-10 and PCV13 vaccine formulations was 66.7% and 81.2%, respectively.ConclusionAltogether, our findings shows that introduction of PCV-10 immunization resulted in rapid decline of pneumococcal meningitis children less than 5 years old in Mozambique. This decline was accompanied by substantial changes in the pattern of circulating pneumococcal serotypes.

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“…This paper aims to explore the impact of PCV introductions on EPI and health systems in four countries in sub-Saharan Africa. The research was part of a larger study, exploring the impact of introducing four vaccines in six low-and middle-income countries 15 .…”

Section: African Health Sciences Vol 15 Issue 3 September 2015mentioning

confidence: 99%

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

Torres-Rueda¹,

Burchett²,

Griffiths³

et al. 2015

Afr H. Sci.

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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.

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The impact of introducing new vaccines on the health system: Case studies from six low- and middle-income countries

Abstract: Although the new vaccine introductions were viewed as intrinsically positive, on the whole there was no evidence that they had any major impact, positive or negative, on the broader health systems.

Cited by 36 publications

References 19 publications

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Surveillance of impact of PCV-10 vaccine on pneumococcal meningitis in Mozambique, 2013 – 2015

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

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