The Operational Feasibility of Vaccination Programs Targeting Influenza Risk Groups in the World Health Organization (WHO) African and South-East Asian Regions

Abstract

Background Influenza vaccination is uncommon in low-resource settings. We evaluated aspects of operational feasibility of influenza vaccination programs targeting risk groups in the WHO African (AFR) and South-East Asian (SEAR) Regions. Methods We estimated routine immunization and influenza vaccination campaign doses, doses per vaccinator, and cold storage requirements for one simulated country in each region using evidence-based population distribution, vaccination schedule, and vaccine volumes. Influenza vaccination targeted persons <5 years, pregnant women, persons with chronic diseases, persons ≥65 years, and healthcare workers (HCW). For the AFR country, we compared vaccine volumes to actual storage capacities. Results Targeting HCW had a small operational impact, and subsequent findings exclude this group. During three-month influenza vaccination campaigns, monthly doses delivered in the AFR country increased from 15.0% for ≥65 years to 93.1% for <5 years and in the SEAR country from 19.6% for pregnant women to 145.0% for persons with chronic diseases. National-level cold storage capacity requirements increased in the AFR country from 4.1% for ≥65 years to 20.3% for <5 years and in the SEAR country from 3.9% for pregnant women to 28.8% for persons with chronic diseases. Subnational-level cold storage capacity requirements increased in the AFR country from 5.9% for ≥65 years to 36.8% for <5 years and the SEAR country from 17.6% for pregnant women to 56.0% for persons with chronic diseases. Conclusions Influenza vaccination of most risk groups will require substantial increases in doses, doses per vaccinator, and cold storage capacity in countries where infrastructure and resources are limited.

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“…An assessment of the operational feasibility of influenza vaccination programmes targeting risk groups in the South-East Asian Region concluded that targeting healthcare workers had little operational impact 39 . However, addressing other risk groups would require considerable augmentation of production, doses per vaccinator and cold storage capacity 39 .…”

“…An assessment of the operational feasibility of influenza vaccination programmes targeting risk groups in the South-East Asian Region concluded that targeting healthcare workers had little operational impact 39 . However, addressing other risk groups would require considerable augmentation of production, doses per vaccinator and cold storage capacity 39 . Some of the major barriers, in order of frequency, to initiation of influenza vaccination programmes identified in a survey amongst LMICs were lack of local cost-effectiveness estimates of influenza vaccination (87%), lack of local data on burden due to influenza (84%), competing health priorities (80%), low perceived risk from influenza amongst the public (79%), lack of good risk communication tools (77%), lack of financial support for influenza vaccine programmes (75%) and vaccine-related concerns 40 .…”