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Emerging Ideas from MCHIP Immunization Workshop, Harare, Zimbabwe March 13, 2014

New Vaccines: lessons learned with their introduction and beyond


The introduction of new vaccines presents an opportunity to strengthen routine immunization (RI) and
other health programs more broadly. However, in the absence of careful preparation, new vaccine
introduction (NVI) can stress immunization programs.
While immunization programs can be strengthened by NVI, this outcome must be deliberately planned
because it does not happen automatically.
The effectiveness of NVI depends on the quality of NVI planning and preparations as well as the
underlying strength of the RI system.
To reap the benefit and protect USAIDs annual $175 million investment in buying vaccines through
GAVI, technical assistance (TA) is also needed in some countries to support the many operational and
technical steps for NVI and use.
The introduction of new, powerful life-saving vaccines against some of the major causes of mortality
and disability, such as pneumonia and diarrhea, attracts high-level political and popular interest. Because
a new vaccine becomes an old vaccine the day after it is introduced, forward-looking Ministries of
Health can channel this high-level interest to strengthen the RI program to achieve maximum
vaccination coverage and benefit with the new vaccines.
Some illustrative examples to ensure smooth NVI and strengthen RI and, in some cases, other
health services at the same time include:
Attract attention for integrated approaches to treat and prevent pneumonia and diarrhea.
Revitalize the RI program by identifying and remedying bottlenecks.
Reinvigorate partnerships, including with civil society, and mobilize popular demand.
Establish steering and other committees to advise the MOH on policy considerations, monitor NVI
preparations and implementation of the introduction, and to strengthen the RI system more broadly.
Update the existing immunization schedule, recording and reporting forms, job aids, and management
tools.
Prepare micro-plans at various levels, including implementation budgets.
Assess requirements for cold chain, logistics and vaccine supply management.
Build work force capacity through training and supportive supervision.
Conduct targeted communications and provide public information.



Monitor NVI closely to rapidly remedy any problems, so as to enhance the positive effect on RI and
avoid any negative effects.
Some illustrative concerns with NVI and its effect on RI and, in some cases, on other health
services include:
High vaccine costs challenge many countries and jeopardize prospects for long-term financial
sustainability.
Global and national attention is sometimes focused too narrowly on the development, supply, and
financing of new vaccines, rather than more broadly on strengthening the entire vaccination program.
To protect the investment in expensive vaccines, many countries do not receive a balanced and adequate
package of TA across the various immunization-program components needing attention.
New target and age groups must be reached through new service delivery and communication channels.
In some countries, staff do not have the right skills and knowledge to handle and administer many
vaccines with differing characteristics.
New, bulkier vaccines greatly increase requirements for cold chain storage space and transportation
capacity.
In some countries, concerns by health workers and parents about the increasing number of injections
offered on the same day must be addressed.
Tracking adverse events following immunization and surveillance is often inadequate.
With so many new vaccines and the chronic unavailability of parent-retained vaccination cards,
coverage surveys relying on parental recall become more difficult to implement and interpret.
Cold chain repair and maintenance facilities are often neglected, even as new equipment is purchased.
Increased volumes of medical sharps waste must be managed and disposed in ways to avoid risks to
health staff and the public.
Interpersonal communication is often not prioritized to address parental and health worker concerns
about new and unfamiliar vaccines.
High-level political interest to launch the new vaccine sometimes inadequately takes into consideration
the programmatic and operational readiness for a successful introduction.
NVI is not an isolated event or launch. Concerted attention and coordination of many stakeholders is
necessary to ensure a smooth introduction and also benefit the RI program, so that the life-saving
potential of new vaccines is fully realized.

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