LNCT Member Newsletter March 2020

LNCT Updates

Updated Information on LNCT Scholarships for Teaching Vaccine Economics Everywhere (TVEE) Thailand Workshop
LNCT has selected three applicants to receive scholarships to attend TVEE’s training workshop in Bangkok, Thailand. The three applicants are Kapil Singh, National Project Officer, India, Nilton Costa Cruz, Program/Technical Assistant for the General Director of Health Services Delivery, Timor Leste, and Dang Thi Thanh Huyen, Deputy Head, National Office for Expanded Program on Immunization, Vietnam. At this time, the workshop has been postponed based on recommendations by the government and Mahidol University due to the COVID-19 outbreak. The organizers are planning to postpone the workshop to early- to mid-summer. Please keep an eye out for updated information on this workshop and future TVEE workshops.

New LNCT Brief: Considerations for Managing Immunization Programs within National Health Insurance
National health insurance (NHI) can bring benefits, but it can also bring unintended consequences, especially for immunization and other public health programs which may or may not be in the benefits package. LNCT produced this brief which presents and discusses the various options countries may consider, with respect to immunization program management and financing, when NHI is part of the health system.

Materials from Vaccine Hesitancy Webinar are now Available
Resources from LNCT webinar, Addressing Vaccine Hesitancy Challenges, are now available online. During the webinar, the London School of Hygiene and Tropical Medicine presented a summary of the key issues and lessons learned during LNCT’s vaccine hesitancy workshop which took place in Geneva in November 2019. Armenia shared their experience introducing the HPV vaccination, challenges (including on social media), what worked, and lessons learned. Ghana also shared lessons learned in building healthcare worker confidence to address questions and concerns. To follow up, LNCT is creating online learning and webinar opportunities to continue discussion of key challenges.

Tool Catalog for Assessing and Addressing Vaccine Hesitancy
LNCT has developed a tool catalog that provides a compilation of practical tools available for LNCT countries to assess and address vaccine hesitancy within their country, and to identify any gaps in available resources. 

LET’S DISCUSS: Does COVID19 pose new challenges for immunization programming in your country?
We recognize that countries and health systems across the world are being confronted with the burden of managing the COVID19 pandemic. We would like to understand its impact on immunization and transitions. Does COVID19 pose new challenges for immunization programming and/or the transition from Gavi assistance in your country? Please share your comments in this discussion post*You must be logged-in to respond to or to see responses on the discussion questions.

LET’S DISCUSS: Transition Talks on Advocating for Increased Budget
Have you engaged in our recent Transition Talks on the LNCT discussion forum? We would love to hear from more of our members to share their experiences or pose questions to other countries, our technical experts, and/or our partners. Some of the recent Transition Talks that are ongoing include:

*You must be logged-in to respond to or to see responses on the discussion questions.

LNCT Materials to Help you Make the Case for Investing in Immunization
In 2017, LNCT created PowerPoint presentations to enable immunization practitioners to make their best case for investing in immunization by drawing on the most up-to-date evidence available. The presentations have recently been updated with new data and separated by the types of key messages. We encourage LNCT members to use these materials to advocate for resources for immunization at national and sub-national levels.

Country Spotlight

Ghana Implements Effective Communication Strategies to Address Vaccine Hesitancy Concerns During Polio Campaign
At the end of February, Ghana’s successful nation-wide inactivated polio vaccine (IPV) catch-up campaign achieved nearly 100% coverage in the Greater Accra Region (population approximately 375,000) for children between 21 to 47 months old. Key to the EPI team’s success in Accra was the time they invested in understanding which populations had expressed vaccine hesitancy in the past and addressing their concerns through respectful and earnest face-to-face communication and trust-building. Here are some of the key communication approaches they implemented.

Adverse Events Following Immunization (AEFIs) were a concern for caregivers during previous campaigns. No serious AEFIs were reported this year, but health workers built trust with caregivers by taking care to attentively address non-serious AEFIs, visiting the families’ homes, recommending Paracetamol as needed, and asking that the child return to the health facility to be reviewed in a few days.

Some school officials were hesitant to allow campaign activities to take place on campus due to concerns about vaccine safety they had seen on social media, or because the campaign was not a high priority for them. To address these concerns, the EPI team sent letters to schools explaining the campaign in advance, and followed their letters with an in-person visit from an EPI staff member who took time to talk with school officials to build trust, assure them of the safety of the vaccine, and to update them on the details of the campaign. The EPI team also identified the authorities that school officials felt they could trust, such as private health care providers or higher-ranking Ghana Health Service (GHS) Ministry of Health officials, and worked with these individuals to communicate with the schools ahead of the campaigns.

In previous campaigns, some churches were hesitant to allow vaccination after services due to concerns about side effects and the contents of vaccines. Like with schools, the EPI sent a letter and visited these churches in advance, drawing on staff members who had existing relationships with the church leaders to discuss the churches’ concerns. When the vaccination day arrived, health workers respectfully attended the church service prior to the vaccination session.

Finally, the EPI built the confidence of health workers to do their jobs by including Social and Behavior Change Communications (SBCC) in their training, clarifying their questions (such as how to identify the target age group) as soon as they arose, and taking steps to ensure their safety following a robbery of several nurses who were working on the campaign.

To address vaccine hesitancy, the Accra EPI team’s successful implementation of the IPV catch-up campaign is a clear example of the importance of listening to people’s concerns, taking them seriously, and addressing them through face-to-face communication with leaders they trust. Ghana is reviewing the lessons they learned in this campaign so they can be applied in the future.

Delegates from Armenia Learn from Georgia on Mandatory Immunization Legislation
On February 12-14, 2020, Curatio International Foundation (CIF), hosted an Armenian delegation in Georgia to learn about Georgia’s experience implementing immunization legislation. CIF facilitated a twinning approach to support effective transfer of expertise and knowledge between the participating countries. The visit began with the introduction and discussion of the international evidence on mandatory immunization policy.  The Armenian delegation met policymakers and technical teams from the Parliament of Georgia, the Ministries of Health and Education and the National CDC, who were engaged in the policy dialogue, decision-making and legislative changes related to mandatory immunization policy in Georgia. Discussions were held around the initiation of mandatory immunization policy, evidence-based decision-making and advocacy activities, legislative changes and their feasibility, aspects of inter-sectoral collaboration, implementation issues, enforcement mechanisms, public/ civil society reactions, and impact on vaccination coverage.  LNCT will follow up with the Armenian delegation to assess the results of the twinning approach and potential for improvement.

Highlights from our Partners

Price Transparency is a Step Towards Sustainable Access in Middle Income Countries
Since 2014, WHO’s Market Information for Access to Vaccines (MI4A) database has provided middle income countries with much needed data on vaccine products, prices, and procurement. The aim of MI4A is to improve vaccine price transparency and therefore support country immunization planning and budgeting, price negotiation, and, ultimately, improve access to vaccines. This new article shows how greater price transparency is informing budget analysis, purchase choices, tendering strategies, adoption of new or improved procurement mechanisms, and may encourage vaccine manufacturers to articulate clearer pricing policies.

The Boost Community Previews Online Adaptive Leadership Course
The Boost Community offered a sneak peek of Boost’s inaugural “Introduction to Adaptive Leadership” online course in an interactive webinar held earlier this month. The webinar provided a deep dive into the concept of adaptive leadership, its practical applications, and ways participants can further their knowledge and learning of Adaptive Leadership in the Boost Community.  Not sure what Adaptive Leadership is? Want to learn more about how it applies to your work and career as an immunization professional? Watch the webinar recording here.

Featured Resources

Comparing 3 Approaches for Making Vaccine Adoption Decisions in Thailand
The World Health Organization (WHO) developed the Total System Effectiveness (TSE) framework to assist national policy-makers in prioritizing vaccines. The pilot was launched in Thailand to explore the potential use of TSE in a country with established governance structures and accountable decision-making processes for immunization policy. TSE may be a beneficial approach for LMICs that have not yet developed strong and accountable decision-making processes and governance structures for immunization policy. TSE could also be of value to a broader set of countries, including Thailand, for aligning prioritization mechanisms among multiple decision-making bodies.

Impact of HPV Vaccination and Cervical Screening on Cervical Cancer Elimination: A Comparative Modelling Analysis in 78 Low-income and Lower-middle-income Countries
To help inform global efforts, scientists modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. Predictions suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.

Papillomavirus Rapid Interface for Modelling and Economics (PRIME) Tool
The spreadsheet-based PRIME tool is intended for use by non-modeller users such as country program managers and planners and decision makers in low- and middle income countries who are advising national governments on HPV vaccine introduction. The tool helps give users an idea of the magnitude of the burden of cervical cancer, impact of introducing HPV vaccination for girls prior to sexual debut, healthcare costs incurred as a result of cervical cancer treatment, costs associated with vaccination, and long-term savings which may result from a vaccination program.

ProVac Toolkit: Providing Tools to Support Vaccine Decision Making at Country-level
The ProVac approach involves a clearly defined country-led process for developing evidence to inform decisions on the uptake of new vaccines that increases ownership and trust in the results by national authorities. This toolkit summarizes ProVac tools and guidance developed to date.

WHO Inequality Monitoring in Immunization: A Step-by-Step Manual
This new manual from the World Health Organization (WHO) applies the general steps of health inequality monitoring to the topic of immunization. It aims to serve as an introductory-level guide to build capacity for the uptake and improvement of inequality monitoring practices in immunization. Through this resource, we hope that regions, countries, districts and other jurisdictions will adopt regular reporting of immunization inequalities that, in turn, informs focused efforts to address situations of inequality.

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