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Packham A, Taylor AE, Karangwa MP, Sherry E, Muvunyi C, Green CA. Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries. Int J Public Health 2024; 69:1606997. [PMID: 38725903 PMCID: PMC11079172 DOI: 10.3389/ijph.2024.1606997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.
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Affiliation(s)
- Alice Packham
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alice E. Taylor
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Emma Sherry
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Christopher A. Green
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Addis M, Mekonnen W, Estifanos AS. Health system barriers to the first dose of measles immunization in Ethiopia: a qualitative study. BMC Public Health 2024; 24:665. [PMID: 38429806 PMCID: PMC10908078 DOI: 10.1186/s12889-024-18132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Ethiopia has made considerable progress toward measles elimination. Despite ongoing efforts, the country remains among those with the highest number of children missing their initial dose of measles vaccine, and the disease continues to be a public health emergency. The barriers within the health system that hinder the first dose of measles immunization have not been thoroughly investigated. This study aims to identify these barriers within the Ethiopian context. METHODS Qualitative research, using purposive expert sampling to select key informants from health organizations in Addis Ababa, Ethiopia was employed. We conducted in-depth face-to-face interviews using a semi-structured interview guide. A thematic analysis based on the World Health Organization's health systems building blocks framework was conducted. RESULTS The study uncovered substantial health system barriers to the uptake of the first dose of the measles vaccine in Ethiopia. These barriers include; restricted availability of immunization services, vaccine stockouts, shortage of cold chain technologies, data inaccuracy resulting from deliberate data falsification or accidental manipulation of data, as well as data incompleteness. CONCLUSION Our research highlighted significant health system barriers to MCV1 immunization, contributing to unmet EPI targets in Ethiopia. Our results suggest that to accelerate the country towards measles elimination, there is an urgent need to improve the health systems components such as service delivery, information systems, as well as access to vaccine and cold chain technologies.
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Affiliation(s)
- Meron Addis
- Department of Reproductive, Family and Population Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Wubegzier Mekonnen
- Department of Reproductive, Family and Population Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mvundura M, Ng J, Reynolds K, Theng Ng Y, Bawa J, Bambo M, Bonsu G, Payne J, Chua J, Guerette J, Odei Antwi-Agyei K, Ribe S, Chinavane D, Arhin-Wiredu K, Shah A, Sitoe J, Yunus S, Powelson J, Amponsa-Achiano K, Eshioramhe Kojak K, Fredick Dadzie J, Asghar N, Caetano Correa G, Robertson J. Vaccine wastage in Ghana, Mozambique, and Pakistan: An assessment of wastage rates for four vaccines and the context, causes, drivers, and knowledge, attitudes and practices for vaccine wastage. Vaccine 2023:S0264-410X(23)00582-0. [PMID: 37270365 DOI: 10.1016/j.vaccine.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
Vaccine procurement costs comprise a significant share of immunization program costs in low- and middle-income countries, yet not all procured vaccines are administered. Vaccine wastage occurs due to vial breakage, excessive heat or freezing, expiration, or when not all doses in a multidose vial are used. Better estimates of vaccine wastage rates and their causes could support improved management of vaccine stocks and reduce procurement costs. This study examined aspects of wastage for four vaccines at service delivery points in Ghana (n = 48), Mozambique (n = 36), and Pakistan (n = 46). We used prospective data from daily and monthly vaccine usage data entry forms, along with cross-sectional surveys, and in-depth interviews. The analysis found that estimated monthly proportional open-vial wastage rates for vaccines in single-dose vials (SDV) or in multi-dose vials (MDV) that can be kept refrigerated up to four weeks after opening ranged from 0.08 % to 3 %. For MDV where remaining doses are discarded within six hours after opening, the mean wastage rates ranged from 5 % to 33 %, with rates being highest for measles containing vaccine. Despite national-level guidance to open a vaccine vial even when only one child is present, vaccines in MDV that are discarded within six hours of opening are sometimes offered less frequently than vaccines in SDV or in MDV where remaining doses can be used for up to 4 weeks. This practice can lead to missed opportunities for vaccination. While closed-vial wastage at service delivery points (SDPs) was relatively rare, individual instances can result in large losses, suggesting that monitoring closed-vial wastage should not be neglected. Health workers reported insufficient knowledge of vaccine wastage tracking and reporting methods. Improving reporting forms would facilitate more accurate reporting of all causes of wastage, as would additional training and supportive supervision. Globally, decreasing doses per vial could reduce open-vial wastage.
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Basu S, Rustagi R. Multi-dose vials versus single-dose vials for vaccination: perspectives from lower-middle income countries. Hum Vaccin Immunother 2022; 18:2059310. [PMID: 35416750 PMCID: PMC9746400 DOI: 10.1080/21645515.2022.2059310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The choice of the vaccine packaging type either as single- or multi-dose vial is a crucial determinant of vaccine coverage. The experience of vaccination strategies in lower-middle-income countries suggests that multi-dose vaccine vials translate into greater economic-logistic advantages due to lower packaging and storage costs with significant environmental benefits accrued from reduced medical waste generation. However, the use of multi-dose vials is associated with a theoretical risk of contamination particularly from human error. Moreover, the overall economic advantage of multi-dose vials is contingent on the reduction of the extent of vaccine wastage associated with their use. Robust data collection for monitoring of vaccine wastage rates and adverse effects following immunization is therefore needed to understand the extent of economic benefit and risks involved with multi-dose vial use.
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Affiliation(s)
- Saurav Basu
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Delhi, India,CONTACT Saurav Basu Indian Institute of Public Health – Delhi, Public Health Foundation of India, Delhi, India
| | - Ruchir Rustagi
- Department of Health and Family Welfare, Government of National Capital Territory – Delhi, Delhi, India
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5
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Perceived Vaccine Availability and the Uptake of Measles Vaccine in Sudan: The Mediating Role of Vaccination Hesitancy. Vaccines (Basel) 2022; 10:vaccines10101674. [PMID: 36298539 PMCID: PMC9611017 DOI: 10.3390/vaccines10101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate whether measles vaccine uptake can be predicted directly or indirectly by parental perceptions about the availability of measles vaccine services with parental hesitancy towards the measles vaccine as a potential mediator. This was a community-based cross-sectional study conducted at Omdurman locality in Khartoum state, Sudan in February 2019. The study population included parents/guardians having at least one child aged 2-3 years old. Mediation analysis was conducted using two models, the ordinary least squares path analysis and multiple logistic regression. These models considered perceived vaccine accessibility and availability as independent factors, vaccine uptake as dependent factors, and vaccine hesitancy (PACV scores) as a mediator. A total of 495 responded and the mean age of the mothers who participated in the study was 31.1 (SD = 5.73). Half of the respondents (50.1%) completed university education and nearly three-quarters of the respondents (74.7%) were housewives. After controlling for the other factors, including the mother's age and the number of children, parental perception about the accessibility and availability of the measles vaccine influences the uptake of the measles vaccine indirectly through the mediation effect of measles vaccine hesitancy. We suggest that intervening in measles vaccine hesitancy in addition to measles vaccination access issues will have a positive impact on the uptake and coverage of the measles vaccine in Sudan.
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Lazarus JV, Abdool Karim SS, van Selm L, Doran J, Batista C, Ben Amor Y, Hellard M, Kim B, Kopka CJ, Yadav P. COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps. BMJ Glob Health 2022; 7:bmjgh-2022-009010. [PMID: 35474267 PMCID: PMC9044511 DOI: 10.1136/bmjgh-2022-009010] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, Barcelona, Spain .,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Salim S Abdool Karim
- Department of Epidemiology, Columbia University, New York, New York, USA.,Center for the AIDS programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, Barcelona, Spain
| | - Jason Doran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, Barcelona, Spain.,UK Health Security Agency, London, UK
| | - Carolina Batista
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, Barcelona, Spain.,Médecins Sans Frontières, Geneva, Switzerland.,Baraka Impact Finance, Geneva, Switzerland
| | - Yanis Ben Amor
- Center for Sustainable Development, Columbia University, New York, New York, USA
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Infectious Diseases and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Booyuel Kim
- Department of Environmental Planning, Graduate School of Environmental Studies, Seoul National University, Seoul, South Korea
| | | | - Prashant Yadav
- Center for Global Development, Washington, District of Columbia, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,INSEAD Business School, Fontainebleau, France
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7
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Davis B, Krautmann M, Leroueil PR. A method for estimating the impact of new vaccine technologies on vaccination coverage rates. PLoS One 2022; 17:e0263612. [PMID: 35143563 PMCID: PMC8830667 DOI: 10.1371/journal.pone.0263612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Vaccines are one of the most cost-effective tools for improving human health and well-being. The impact of a vaccine on population health is partly determined by its coverage rate, the proportion of eligible individuals vaccinated. Coverage rate is a function of the vaccine presentation and the population in which that presentation is deployed. This population includes not only the individuals vaccinated, but also the logistics and healthcare systems responsible for vaccine delivery. Because vaccine coverage rates remain below targets in many settings, vaccine manufacturers and purchasers have a shared interest in better understanding the relationship between vaccine presentation, population characteristics, and coverage rate. While there have been some efforts to describe this relationship, existing research and tools are limited in their ability to quantify coverage rate changes across a broad set of antigens, vaccine presentations, and geographies. In this article, we present a method for estimating the impact of improved vaccine technologies on vaccination coverage rates. It is designed for use with low- and middle-income country vaccination programs. This method uses publicly available data and simple calculations based on probability theory to generate coverage rate values. We first present the conceptual framework and mathematical approach. Using a Microsoft Excel-based implementation, we then apply the method to a vaccine technology in early-stage development: micro-array patch for a measles-rubella vaccine (MR-MAP). Example outputs indicate that a complete switch from the current subcutaneous presentation to MR-MAP in the 73 countries ever eligible for Gavi support would increase overall vaccination coverage by 3.0-4.9 percentage points depending on the final characteristics of the MR-MAP. This change equates to an additional 2.6-4.2 million children vaccinated per year. Our method can be readily extended to other antigens and vaccine technologies to provide quick, low-cost estimates of coverage impact. As vaccine manufacturers and purchasers face increasingly complex decisions, such estimates could facilitate objective comparisons between options and help these decision makers obtain the most value for money.
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Affiliation(s)
- Ben Davis
- William Davidson Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael Krautmann
- William Davidson Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Pascale R. Leroueil
- William Davidson Institute, University of Michigan, Ann Arbor, MI, United States of America
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Sabahelzain MM, Moukhyer M, van den Borne B, Bosma H. Vaccine Hesitancy among Parents and Its Association with the Uptake of Measles Vaccine in Urban Settings in Khartoum State, Sudan. Vaccines (Basel) 2022; 10:vaccines10020205. [PMID: 35214664 PMCID: PMC8875338 DOI: 10.3390/vaccines10020205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/10/2022] Open
Abstract
Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother’s age and the number of children (aOR 1.055; 95% CI 1.028–1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620–0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.
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Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Correspondence:
| | - Mohamed Moukhyer
- Department of Research and Development, Faculty of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia;
- Department of Emergency Medical Services, Faculty of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia
- Public Health Programmes, School of Medicine, University of Limerick, V94 PX58 Limerick, Ireland
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:686-693. [DOI: 10.1093/trstmh/trac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 02/13/2022] [Indexed: 11/13/2022] Open
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10
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Giersing B, Shah N, Kristensen D, Amorij JP, Kahn AL, Gandrup-Marino K, Jarrahian C, Zehrung D, Menozzi-Arnaud M. Strategies for vaccine-product innovation: Creating an enabling environment for product development to uptake in low- and middle-income countries. Vaccine 2021; 39:7208-7219. [PMID: 34627624 PMCID: PMC8657812 DOI: 10.1016/j.vaccine.2021.07.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
Vaccine-product innovations that address barriers to immunization are urgently needed to achieve equitable vaccine coverage, as articulated in the new Immunization Agenda 2030 and the Gavi 5.0 strategy. In 2020, the Vaccine Innovation Prioritisation Strategy (VIPS) prioritized three innovations, namely microarray patches (MAPs), heat-stable and controlled-temperature chain (CTC) enabled liquid vaccine formulations and barcodes on primary packaging. These innovations were prioritized based on the priority immunization barriers that they may help overcome in resource constrained contexts, as well as by considering their potential impact on health, coverage and equity, safety, economic costs and their technical readiness and commercial feasibility. VIPS is now working to accelerate the development and lay the foundation for future uptake of the three priority vaccine-product innovations, with the long term-goal to ensure equitable vaccine coverage and increased impact of vaccines in low- and middle- income countries. To inform our strategic planning, we analyzed four commercially available vaccine product-innovations and conducted interviews with individuals from 17 immunization organizations, and/or independent immunization experts. The findings are synthesized into an 'innovation conundrum' that describes the challenges encountered in developing vaccine-product innovations and a vaccine-product innovation 'theory of change', which highlights actions that should be undertaken in parallel to product development to incentivize sustainable investment and prepare the pathway for uptake and impact.
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Affiliation(s)
- Birgitte Giersing
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Natasha Shah
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | | | | | - Anna-Lea Kahn
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | | | | | - Darin Zehrung
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Marion Menozzi-Arnaud
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218, Grand-Saconnex, Geneva, Switzerland
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11
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Prosser W, Spisak C, Hatch B, McCord J, Tien M, Roche G. Designing supply chains to meet the growing need of vaccines: evidence from four countries. J Pharm Policy Pract 2021; 14:80. [PMID: 34587993 PMCID: PMC8482642 DOI: 10.1186/s40545-021-00368-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Immunization supply chains (iSCs) move vaccines from manufacturer to point of use with the added complexities of requiring cold chain and an increasing need for agility and efficiency to ensure vaccine quality and availability. Underperforming iSCs have been widely acknowledged as a key constraint to achieving high immunization coverage rates in low- and middle-income countries. This paper details the system design approach used to analyze the iSC network in Sierra Leone, Madagascar, Niger and Guinea and documents six lessons. Methodology Between 2018 and 2020, these countries implemented the system design approach, involving four key steps: (1) advocate and introduce to engage stakeholders and prioritize identification of modeling scenarios; (2) collect data and plan analysis through document review and key informant interviews; (3) analyze system design scenarios using computer software modeling tools (LLamasoft’s Supply Chain Guru and AnyLogic's AnyLogistix) for optimization and simulation modeling as well as further analysis with Excel, Google maps, and OpenStreetMap; and (4) build consensus on optimized model and implementation roadmap using the Traffic Light Analysis tool and building on stakeholder input. Findings Key lessons include the following: (1) define system design objectives based on country priorities; (2) establish consensus with stakeholders on scenarios to model; (3) modeling provides the evidence but not the answer; (4) costs should not be weighted above other decision criteria; (5) data collection—work smarter, not harder; (6) not all questions can be answered with a computer model. Discussion A system design approach can identify changes to the design of the supply chain that can introduce efficiencies and improve reliability. This approach can be more effective when these lessons and principles are applied at the country level. The lessons from these four countries contribute to global thinking and best practices related to system design. The modeling and system design approach provides illustrative results to guide decision-makers. It does not give a "final answer", but compares and contrasts.
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Affiliation(s)
- Wendy Prosser
- John Snow, Incorporated, 2733 Crystal Drive, 4th Floor, Arlington, VA, 22202, USA.
| | - Cary Spisak
- John Snow, Incorporated, 2733 Crystal Drive, 4th Floor, Arlington, VA, 22202, USA
| | - Benjamin Hatch
- John Snow, Incorporated, 2733 Crystal Drive, 4th Floor, Arlington, VA, 22202, USA
| | - Joseph McCord
- John Snow, Incorporated, 2733 Crystal Drive, 4th Floor, Arlington, VA, 22202, USA
| | - Marie Tien
- John Snow, Incorporated, 2733 Crystal Drive, 4th Floor, Arlington, VA, 22202, USA
| | - Greg Roche
- John Snow, Incorporated, 2733 Crystal Drive, 4th Floor, Arlington, VA, 22202, USA
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12
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Collins J, Westerveld R, Nelson KA, Rohan H, Bower H, Lazenby S, Ikilezi G, Bartlein R, Bausch DG, Kennedy DS. 'Learn from the lessons and don't forget them': identifying transferable lessons for COVID-19 from meningitis A, yellow fever and Ebola virus disease vaccination campaigns. BMJ Glob Health 2021; 6:bmjgh-2021-006951. [PMID: 34535490 PMCID: PMC8450956 DOI: 10.1136/bmjgh-2021-006951] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever) and rVSV-ZEBOV (Ebola virus disease). METHODS We conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants' experiences. Interview data were analysed thematically according to seven implementation domains. RESULTS Participants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities. CONCLUSION As supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.
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Affiliation(s)
- Julie Collins
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | - Rosie Westerveld
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate A Nelson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hana Rohan
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | - Hilary Bower
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | | | | | | | - Daniel G Bausch
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | - David S Kennedy
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
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13
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Fatiregun AA, Lochlainn LN, Kaboré L, Dosumu M, Isere E, Olaoye I, Akanbiemu FA, Olagbuji Y, Onyibe R, Boateng K, Banda R, Braka F. Missed opportunities for vaccination among children aged 0-23 months visiting health facilities in a southwest State of Nigeria, December 2019. PLoS One 2021; 16:e0252798. [PMID: 34449777 PMCID: PMC8396738 DOI: 10.1371/journal.pone.0252798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. Methods This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0–23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. Results 984 caregivers with children aged 0–23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. Conclusions One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers’ engagement and screening of vaccination documentation by health workers during every health service encounter.
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Affiliation(s)
| | | | - Lassané Kaboré
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Elvis Isere
- World Health Organization Ondo State Office, Akure, Nigeria
| | - Itse Olaoye
- World Health Organization Ondo State Office, Akure, Nigeria
| | | | - Yetunde Olagbuji
- Ondo State Primary Health Care Development Agency, Ministry of Health, Akure, Ondo State, Nigeria
| | - Rosemary Onyibe
- World Health Organization Southwest Zonal Office Ibadan, Ibadan, Nigeria
| | - Kofi Boateng
- World Health Organization Country Office, Abuja, Nigeria
| | - Richard Banda
- World Health Organization Country Office, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
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14
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Agócs M, Ismail A, Kamande K, Tabu C, Momanyi C, Sale G, Rhoda DA, Khamati S, Mutonga K, Mitto B, Hennessey K. Reasons why children miss vaccinations in Western Kenya; A step in a five-point plan to improve routine immunization. Vaccine 2021; 39:4895-4902. [PMID: 33744047 DOI: 10.1016/j.vaccine.2021.02.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022]
Abstract
Global childhood vaccination coverage has stagnated over the past decade and raising coverage will require a collection of approaches since no single approach has been suitable for all countries or situations. The American Red Cross has developed a 5-Point Plana to geolocate under-vaccinated children and determine the reasons why they miss vaccination by capitalizing on the Red Cross Movement's large cadres of trusted community volunteers. The Plan was piloted in Bobasi sub-county in Western Kenya, with volunteers seeking to conduct a face-to-face interview in all households, visiting over 60,000 over 7 days. Six pockets of 233 children without a home-based vaccination record or missing an age-appropriate dose of Penta1, Penta3 or measles-containing vaccine were identified. Three activities were carried out to learn why these children were not vaccinated: 1) one-on-one interviews and 2) focus group discussions with the caregivers of the under-vaccinated children and 3) interviews with healthcare workers who vaccinate in Bobasi. Complacency was commonly reported by caregivers during one-on-one interviews while bad staff attitude or practice was most frequently reported in focus group discussions; health staff reported caregiver hesitency, not knowing vaccination due date and vaccine stock-outs as the most common reasons for caregivers to not have their child vaccinated. As reasons varied across the three different activities, the different perspectives and approaches helped characterize vaccination barriers. Civil society organizations working together with the Ministry of Health can provide valuable information for immunization managers to act on.
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Affiliation(s)
- Mary Agócs
- American Red Cross, 431 18(th) Street NW, Washington DC, 2006, United States.
| | - Amina Ismail
- American Red Cross, 431 18(th) Street NW, Washington DC, 2006, United States; Kenya Red Cross Society, South C, Red Cross Road, Off Popo Road, P.O. Box 40712-00100, Nairobi, Kenya.
| | - Kenneth Kamande
- Kenya Red Cross Society, South C, Red Cross Road, Off Popo Road, P.O. Box 40712-00100, Nairobi, Kenya.
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health of Kenya, Afya House, Cathedral Road, P.O. Box: 43319-00100, Nairobi, Kenya
| | - Christine Momanyi
- National Vaccines and Immunization Program, Ministry of Health of Kenya, Afya House, Cathedral Road, P.O. Box: 43319-00100, Nairobi, Kenya
| | - Graham Sale
- American Red Cross, 431 18(th) Street NW, Washington DC, 2006, United States
| | - Dale A Rhoda
- American Red Cross, 431 18(th) Street NW, Washington DC, 2006, United States; Biostat Global Consulting, 330 Blandford Drive, Worthington, OH, 43085, United States
| | - Sylvia Khamati
- Kenya Red Cross Society, South C, Red Cross Road, Off Popo Road, P.O. Box 40712-00100, Nairobi, Kenya.
| | - Kelvin Mutonga
- National Vaccines and Immunization Program, Ministry of Health of Kenya, Afya House, Cathedral Road, P.O. Box: 43319-00100, Nairobi, Kenya.
| | - Bernard Mitto
- American Red Cross, 431 18(th) Street NW, Washington DC, 2006, United States
| | - Karen Hennessey
- American Red Cross, 431 18(th) Street NW, Washington DC, 2006, United States
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15
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Kanagat N, Krudwig K, Wilkins KA, Kaweme S, Phiri G, Mwansa FD, Mvundura M, Robertson J, Kristensen D, Gueye A, Dao SD, Thai PQ, Nguyen HT, Tran TC. Health Care Worker Preferences and Perspectives on Doses per Container for 2 Lyophilized Vaccines in Senegal, Vietnam, and Zambia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:680-688. [PMID: 33361235 PMCID: PMC7784065 DOI: 10.9745/ghsp-d-20-00112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/26/2020] [Indexed: 12/04/2022]
Abstract
When providing immunization services, health care workers balance the mandate of achieving high coverage with limiting vaccine wastage. Workers in 3 countries said that containers with fewer vaccine doses for measles and BCG would enable them to immunize all children who present, while reducing concerns about wasting vaccine. Introduction: Limited information exists on health care workers’ (HCWs) perceptions about use of multidose vaccine vials and their preferences about doses per container (DPC). We present findings from qualitative studies conducted in Senegal, Vietnam, and Zambia to explore HCWs’ behavior regarding opening vials and their perceptions and preferences for the number of doses in vials of BCG and measles-containing vaccine (MCV). Zambia and Senegal currently offer MCV in 10-dose vials and BCG in 20-dose vials; 10-dose vials are used for both vaccines in Vietnam. Unused doses in vials of these reconstituted vaccines must be discarded within 6 hours. Methods: Key informant interviews (KIIs) were conducted with frontline HCWs in Senegal, Vietnam, and Zambia. In Senegal and Vietnam, the KIIs were conducted as part of broader formative research; in Zambia, KIIs were conducted in control districts using 10-dose MCV vials only and in intervention districts that switched from 10- to 5-dose vials during the study. During analysis, themes common to all 3 countries were synthesized. Critical themes relevant to country contexts were also examined. Results: HCWs in all 3 countries preferred containers with fewer doses for BCG and MCV to reduce wastage and increase the likelihood of vaccinating every eligible child. HCWs in Senegal and HCWs using 10-dose vials in Zambia reported sending unvaccinated children away because not enough children were present to warrant opening a new vial. In Vietnam, where sessions are typically held monthly, and in Zambia when the 5-dose vials were used, almost all HCWs reported opening a vial of MCV for even 1 child. Discussion: HCWs prefer vials with fewer DPC. Their concerns about balancing coverage and wastage influence their decisions to vaccinate every eligible child; and their perspectives are crucial to ensuring that all target populations are reached with vaccines in a timely manner.
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Affiliation(s)
- Natasha Kanagat
- JSI Research & Training Institute, Inc., Arlington, VA, USA.
| | | | - Karen A Wilkins
- Consultant, JSI Research & Training Institute, Inc., Arlington, VA, USA
| | - Sydney Kaweme
- Consultant, JSI Research & Training Institute, Inc., Arlington, VA, USA
| | | | | | | | | | | | | | | | - Pham Q Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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