Greetings, everyone. I hope that you are healthy and keeping your spirits up amidst these trying times.
In March this year, just before COVID-19 shutdowns, I visited health facilities in Kinshasa - where mothers were being asked to wait (one for over 2 hours) and turned away for measles vaccination because there were not enough infants to open the measles vial. I have witnessed this firsthand in over 20 countries, repeatedly. I’ve spoken with hundreds of health workers in facilities, including these dedicated staff in Kinshasa, who would welcome 5 dose vials to make their work easier and to enable them to provide a better service experience for their clients.
A new article published in VACCINE addresses many of the concerns that are being raised related to session size in the time of COVID-19 and how to continue to ensure that all children are routinely vaccinated. This article describes the results of an implementation study in Zambia, conducted by the MOH with technical support from JSI and funding from the BMGF, which compared the programmatic impact of using 5-dose MR instead of 10-dose MR for routine immunization. The results showed that coverage for both first and second doses of MR improved, and wastage rate decreased when using 5-dose MR. There was practically no difference in wastage-adjusted purchase price per dose, and a negligible effect on the cold chain. Importantly, healthcare workers reported being more willing to open a 5-dose vial than a 10-dose vial for one child, as they were less concerned about wastage. The Zambia study was part of the Dose per Container Partnership, which also developed the Decision Support Resource to help decision makers weigh the trade-offs of vial size.
These results are quite timely, as WHO guidance recommends frequent routine immunization sessions of smaller size due to the pandemic to reduce the risk of spreading COVID-19. As 5-dose measles containing vaccines are now available through UNICEF procurement, a few countries are already using 5-dose vials (e.g., India, Timor-Leste and Lao PDR) and others are planning to introduce 5-dose vials. This can improve health worker motivation and confidence - and caregiver satisfaction and trust - with the immunization program, while reducing missed opportunities for vaccination.
A few questions for discussion:
• For the countries that are using 5-dose MCV or have recently switched, what has been your experience, particularly related to health care worker willingness to open a vial?
• Do decision makers in your countries see benefit in smaller vial size? Is there interest in other places to consider introducing 5-dose vials of MCV?
• Do you have any concerns or guidance?
It seems to be an opportune moment to review the advantages and disadvantages of different vial sizes, including weighing the trade-offs and benefits within each country’s context and health system -- particularly as we are working to improve immunization confidence, trust, performance and the service experience to meet client and health worker needs. This is particularly timely as countries are preparing their annual vaccine forecasts for procurement through UNICEF.
We need to work innovatively and practically to help immunization programs rapidly adapt and act to address the challenges with ensuring immunization services and reducing missed opportunities that COVID-19 has caused. There are operational considerations that can be beneficial with 5 dose measles vials, for example:
- ability to schedule appointments and ensure optimal use of the vials within the timeperiod;
- convenience for caregivers, who are not turned away or forced to wait until other clients are available;
- confidence-building with health workers that they can provide the service, meet client needs, and not be concerned with chastisement related to wastage (which can be substantially less with 5 dose vials, thereby saving on the number of doses needed in procurement).
That health worker in Kinshasa’s eyes lit up and she exclaimed “yes, please!”, when I mentioned the option of a 5 dose vial. I wish that I had it on video. What are we doing as an immunization community to prioritize solutions like this to improve the service experience?
Thanks in advance for sharing your perspectives, particularly from on-the-ground.
Best regards, Lora
Lora Shimp, Director - Immunization Center, John Snow, Inc
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