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Immunization Matters: November 2021 news from PATH on vaccine uptake and access


imageNovember 2021  |  View Online  |  Subscribe



  Immunization Matters  



In this issue

WHO recommends vaccines for malaria, polio, and HPV

A compelling public health value proposition for injectable next-generation rotavirus vaccines

Training Ghana pharmacists as vaccinators

TCV is safe and shows high efficacy in Africa and Asia

Q & A with Nanthalile Mugala

Resources and opportunities


WHO recommends vaccines for malaria, polio, and HPV

The recent months have seen several new vaccine recommendations by the World Health Organization (WHO), which will lead to protecting more children from preventable diseases and more options for countries and their vaccination programs. The recommendation for widespread use of the world’s first malaria vaccine, RTS,S/AS01 (RTS,S), by the WHO marks a historic moment in the global movement to control malaria. RTS,S was developed specifically for children in Africa and is currently in routine use in a pilot program implemented under the leadership of the Ministries of Health of Ghana, Kenya, and Malawi.

Last month, WHO’s Strategic Advisory Group of Experts on Immunization endorsed the strong safety performance of novel oral polio vaccine against type 2 polio (nOPV2) in real-world settings after a period of initial use under WHO’s Emergency Use Listing (EUL). The endorsement allows for continued use of the vaccine under EUL, which was first issued in November 2020 based on the urgent need to contain vaccine-derived polio outbreaks and on promising Phase 1 and Phase 2 clinical trial data. PATH has helped advance the development of nOPV2 since 2015, serving as the convener of the product development consortium, providing technical assistance and facilitating data-sharing among partners.

Finally, Cecolin®, a vaccine against human papillomavirus (HPV) received WHO prequalification. Cecolin protects against HPV types 16 and 18, the most common virus types that lead to cervical cancer. This new HPV vaccine will provide countries with an additional option at an affordable price and will contribute to a sustainable supply of HPV vaccine. PATH provided technical assistance for the WHO prequalification process and is currently sponsoring a Phase 3 trial of Cecolin to generate data regarding the safety and immunogenicity of alternative dosing regimens across a broad geography.


A compelling public health value proposition for injectable next-generation rotavirus vaccines

While current live, oral rotavirus vaccines are reducing severe diarrhea in all settings, they are not as effective in places with the highest burden. Alternative approaches are in advanced stages of clinical development, including injectable next-generation rotavirus vaccine (iNGRV) candidates such as the trivalent P2-VP8 candidate currently in a Phase 3 trial. PATH conducted a series of studies to understand the real public health value of iNGRVs to help inform decisions by international agencies, funders, vaccine manufacturers, and countries.

These value proposition results indicate that the potential impact, cost-effectiveness, and national stakeholder interest in iNGRVs are markedly dependent on the product profile. While efficacy level is a key factor, perhaps even more important is whether an iNGRV could be integrated into existing diphtheria, pertussis, and tetanus-containing vaccines. This type of combination vaccine was preferred by the vast majority of country stakeholders and was cost-effective in all low- and middle-income countries and even cost-saving in many. These wide-ranging and comprehensive findings may help to steer donor and vaccine development investments toward the most preferred and cost-effective formulations of iNGRVs. image

Training Ghana pharmacists as vaccinators



Participant pharmacists learn how to give vaccinations through a training program in Ghana. Photo: PATH/John Bawa

In September, PATH, in collaboration with the Ghana College of Pharmacy and the University ofWashington School of Pharmacy, kicked off a model program to train approximately 200 pharmacists as vaccinators in Ghana and link them to the nation’s Expanded Program on Immunization. This one-year project, funded by Twilio, enables pharmacists to become an integral component of the immunization program nationwide. Initial efforts will focus on the government’s immediate need for trained vaccinators to provide COVID-19 vaccines. The project is designed to eventually include training, support, planning, and access to other life-course vaccines such as RTS,S, yellow fever, typhoid, and maternal immunizations; and to integrate pharmacists into the adverse events monitoring system. Pharmacies are often much more accessible than public facilities, especially among lower-income and transient urban populations. In Ghana, the majority of under-vaccinated children live in urban areas. Pharmacies have more convenient hours and locations and are viewed as trusted and knowledgeable sources of information and services. image

TCV is safe and shows high efficacy in Africa and Asia

Results from three large Phase 3 efficacy studies have found that typhoid conjugate vaccines (TCVs) are safe and have high efficacy in typhoid endemic countries in both Africa and Asia. The studies were conducted in Bangladesh, Malawi, and Nepal by the Typhoid Vaccine Acceleration Consortium (TyVAC), and collectively included more than 100,000 children aged 9 months to 16 years old. TCV prevented 85%, 84%, and 79% of typhoid cases in vaccinated children in Bangladesh, Malawi, and Nepal, respectively. These data demonstrate the potential of TCVs to protect children most at-risk of typhoid and provide robust evidence to typhoid endemic countries that TCVs are a powerful tool to prevent disease. Decision-makers in Malawi and Nepal will introduce TCV in 2022. PATH, as a core partner of TyVAC, is currently supporting introductory campaign efforts in both countries. image



Q & A with Nanthalile Mugala

Nanthalile Mugala, MD, MMed, Chief of the Africa Region for PATH, discusses the WHO
recommendation for malaria vaccine.

Q: What might the WHO recommendation meaimagen for malaria-endemic countries in Africa?

A: In my country of Zambia, more than 2.5 million cases of malaria and
nearly 8,000 deaths from the disease occurred in 2019. As a pediatrician and a public health champion, I have seen the devastating effects of malaria on children, families, and communities. The WHO’s recommendation for broader use of the malaria vaccine could save tens of thousands of children’s lives every year.

Q: How do you see the vaccine fitting into overall malaria prevention?

A: Malaria control interventions such as insecticide-treated bed nets, indoor residual spraying, and seasonal malaria chemoprevention have driven down the burden of malaria significantly, but progress has stalled in many countries. We need new tools to get us back on track and RTS,S, is poised to help us do that.

Q: Could you tells us more about the vaccine?

A: RTS,S was developed specifically for children in Africa, as they are most at risk of dying from malaria. The vaccine reduces malaria cases in children, including cases of severe, life-threatening malaria. RTS,S  provides significant benefit when used in combination with existing prevention measures. In addition, the vaccine has been shown to provide protection to children who may not have access to other WHO-recommended malaria tools.

Q: Could you describe progress of the vaccine pilot program in parts of Ghana, Kenya, and Malawi?

A: Since the pilot program began in 2019, the ministries of health in these countries have administered more than 2.3 million doses of the vaccine through routine immunization services. These numbers indicate strong community demand and acceptance for the vaccine, and we are grateful for the strong involvement of communities in the pilot.

Q: What has PATH’s specific role been with the pilots?

A: PATH is leading studies on the use and acceptability of RTS,S in vaccinating communities as well as research on the economics and impact of malaria vaccine implementation. We are finding that the vaccine is cost-effective and could have a considerable public health impact, averting one death for every 220 children vaccinated.

Q: What are the next steps following WHO recommendation of the vaccine for wider use?

A: Expanding access to the vaccine will require funding for—among other things—vaccine supply and rollout. As policymakers around the world consider next steps for RTS,S, we urge them to contribute financing to support use of the vaccine while maintaining other malaria control measures—because only through sustained, multipronged action will the world finally overcome malaria.



Resources and opportunities

New CVIA resources

A compelling public health value proposition for injectable next-generation rotavirus vaccines brief

COVID-19 vaccine equity project - Kenya report

Defeating meningitis by 2030: A global road map

Getting to 70 percent: The commitment to vaccinate the planet in one year webinar

Impact and cost-effectiveness of an injectable rotavirus vaccine candidate compared to oral rotavirus vaccines fact sheet

The untapped opportunity for sustainable sanitation web page

What could a single-dose HPV vaccine mean for Uganda? brief

Stakeholder preferences for a new rotavirus vaccine candidate country briefs

What pneumonia can teach us about COVID-19 web article

Why moms should have access to vaccines web article 

CVIA at upcoming event

34th International Papillomavirus Conference
November 15 to 19

American Society of Tropical Medicine & Hygiene Annual Meetin
November 17 to 21

2021 International Conference on Typhoid & Other Invasive Salmonelloses
December 6 to 8

CVIA job opportunities

Project manager

Senior clinical research manager

Senior program assistant

Senior project manager 


PATH’s Center for Vaccine Innovation and Access brings together our expertise across every stage of the long and complex process of vaccine research, development, and delivery to make lifesaving vaccines widely available to children and communities across the world.


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