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Partnerships in the introduction of new routine vaccines in Bangladesh: evidence from a prospective process
Sharmin Khan Luies1, Tahmina Sultana2, Ashwin Budden3
1Infectious Diseases Division, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh sharminkhan.luies@gmail.com.
Insights
Partnerships were crucial for introducing new vaccines in Bangladesh. Collaboration with WHO and UNICEF helped overcome challenges like supply shortages and schedule changes, strengthening the immunization program.
Area of Science:
- Public Health
- Vaccinology
- Health Systems Strengthening
Background:
- Bangladesh's Expanded Programme on Immunization (EPI) introduced two new vaccines concurrently: pneumococcal 10-valent conjugate vaccine (PCV-10) and inactivated polio vaccine (IPV).
- The introduction aimed to enhance national immunization coverage and disease prevention strategies.
Purpose of the Study:
- To evaluate the role and contribution of various partners in the successful introduction of PCV-10 and IPV into Bangladesh's routine EPI.
- To identify key factors and challenges in collaborative vaccine introduction processes.
Main Methods:
- A prospective process evaluation was conducted using a theory of change approach, root cause analysis, and in-depth investigation.
- Data collection involved document review, observation of training and meetings, and thematic analysis of interviews with key informants and frontline health workers across nine districts.
Main Results:
- The joint introduction of PCV-10 and IPV faced challenges including schedule changes, budget delays, supply shortages, and high wastage rates.
- Partners, notably the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), provided essential technical assistance, training, communication support, and logistical aid.
- Other government bodies and local authorities also contributed to overcoming operational hurdles.
Conclusions:
- Effective partnerships among EPI stakeholders were vital in navigating operational challenges during the concurrent introduction of PCV-10 and IPV.
- These collaborations significantly strengthened Bangladesh's immunization systems, offering valuable lessons for future vaccine introductions in Bangladesh and similar low- and middle-income countries.
Objective:
To assess the contribution of partners in the introduction of two new vaccines concurrently: pneumococcal 10-valent conjugate vaccine (PCV-10) and inactivated polio vaccine (IPV) into the routine Expanded Programme on Immunization (EPI) in Bangladesh.
Design:
We conducted a prospective process evaluation that included the theory of change development, root cause analysis and in-depth investigation. As part of process tracking, we reviewed relevant documents, observed trainers' and vaccinators' training and key stakeholder meetings. We analysed the data thematically.
Setting:
We purposively selected eight Upazila (subdistrict) and one city corporation covering nine districts and seven administrative divisions of Bangladesh.
Participants:
Nineteen national key informants were interviewed and 16 frontline health workers were invited to the group discussions considering their involvement in the vaccine introduction process.
Results:
The EPI experienced several challenges during the joint introduction of PCV-10 and IPV, such as frequent changes in the vaccine introduction schedule, delays in budget allocation, vaccine supply shortage and higher wastage rates of IPV. EPI addressed these challenges in collaboration with its partners, that is, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), who provided technical assistance to develop a training curriculum and communication materials and enhanced demand generation at the community level. In addition, the WHO conducted a country readiness assessment for PCV-10, and UNICEF supported vaccine shipment. Other government ministries, City Corporations and municipalities also supported the EPI.
Conclusions:
The partnership among the EPI stakeholders effectively addressed various operational challenges during the joint introduction of PCV-10 and IPV helped strengthen Bangladesh's immunisation systems. These accomplishments are attributed to several factors that should be supported and strengthened for future vaccine introductions in Bangladesh and other low and-middle countries.
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