The Impact Of Introducing New Vaccines On The Health System: Case Studies From Six Low- And Middle-Income Countries

Abstract

Objective: We aimed to explore the impacts of new vaccine introductions on immunization programmesand health systems in low- and middle-income countries.Methods: We conducted case studies of seven vaccine introductions in six countries (Cameroon, PCV;Ethiopia, PCV; Guatemala, rotavirus; Kenya, PCV; Mali, Meningitis A; Mali, PCV; Rwanda, HPV). Inter-views were conducted with 261 national, regional and district key informants and questionnaires werecompleted with staff from 196 health facilities. Routine data from districts and health facilities weregathered on vaccination and antenatal service use. Data collection and analysis were structured aroundthe World Health Organisation health system building blocks.Findings: The new vaccines were viewed positively and seemed to integrate well into existing healthsystems. The introductions were found to have had no impact on many elements within the buildingblocks framework. Despite many key informants and facility respondents perceiving that the new vaccineintroductions had increased coverage of other vaccines, the routine data showed no change. Positiveeffects perceived included enhanced credibility of the immunisation programme and strengthened healthworkers’ skills through training. Negative effects reported included an increase in workload and stockouts of the new vaccine, which created a perception in the community that all vaccines were out of stockin a facility. Most effects were found within the vaccination programmes; very few were reported on thebroader health systems. Effects were primarily reported to be temporary, around the time of introductiononly.Conclusion: Although the new vaccine introductions were viewed as intrinsically positive, on the wholethere was no evidence that they had any major impact, positive or negative, on the broader health systems.© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/3.0/).