Effects of Good Practices for Catch-Up Vaccinations: Assessment with a Quasi-Experimental Study in Democratic Republic of Congo

Introduction: Despite the enormous resources deployed and the success achieved in vaccination, reducing the number of children who remain unvaccinated remains a major operational challenge in certain countries. In 2014, the Kalemie Expanded Program of Immunization outpost in the Democratic Republic of the Congo was faced with a high number of unvaccinated children. They instituted a “token” catch-up system based on a collaborative approach with community health workers. This study aims to document the effects of this strategy on vaccination coverage. Methods: This study was a comparative quasi-experimental test/control study. The “test” health area was Undugu where the catch-up strategy was implemented and the “control” health area was Kanunka. A vaccination coverage survey was conducted according to the WHO method in both health areas, examining children aged 12 to 23 months. The proportions were compared using a Pearson chi-square test and the odds ratios were estimated. Results: Vaccine coverage was significantly higher in the “test” health area for all the antigens. Full vaccination coverage was 69.4% in the “test” health area versus 31% in the “control” health area, with a 4.7 times greater chance of being fully vaccinated in the “test” health area (OR: 4.7;CI 95% [3.1 - 7.2];p = 0.0001). Conclusion: This study demonstrates the value of a strategy that can increase access to vaccination and use of vaccination services, leading to a reduction in inequality in this area. However, this is linked to adapting the collaborative model on which it is based. This must be taken into consideration in plans to reproduce the findings.

Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi

Background:The contribution of vaccination to global public health and community wellbeing has been described as one of the greatest success stories of modern medicine.However,13.5 million children still miss at least one of their routine vaccinations,and this contributes to about 1.5 million deaths from vaccine-preventable diseases.One of the contributing factors has been associated with vaccine hesitancy.Vaccine hesitancy is the delay or refusal of vaccines despite their availability.The study explored factors from multiple perspectives that influence hesitancy among caregivers of children and adolescent girls eligible for childhood routine immunisation and the Human Papillomavirus vaccine in Malawi.Methods:The methodology used was qualitative such as key informant interviews and focus-group discussion.Information was obtained from caregivers,community and religious leaders,leaders of civil society groups,teachers in schools where Human Papillomavirus vaccine were piloted,healthcare workers,national and district-level officials of the expanded program on immunisation.There were 25 key informant interviews and two focus-group discussions,with 13 participants.The study was conducted between April to May 2020.The Interviews and discussions were audio-recorded,transcribed,and analysed using a thematic content approach.Results:Most vaccine-hesitancy drivers for routine immunisation were also relevant for the HPV vaccine.The drivers included inadequate awareness of the vaccination schedule,rumours and conspiracy theories exacerbated by religious beliefs,low literacy levels of caregivers,distance and transport to the vaccination clinic,gender role and a disconnect between community healthcare workers and community leaders.Conclusions:The study demonstrated that a network of factors determines vaccine hesitancy for childhood Routine Immunisation and Human Papillomavirus,and some of them are interrelated with one another.This has implications both for current levels of vaccine acceptance and the introduction of any new vaccine,such as those against Malaria,HIV/AIDS,HPV or COVID-19(coronavirus disease 2019).Therefore,strategies developed to address vaccine hesitancy must be multi-component and wide-ranging.