Maternal Immunization Readiness Initiative (MIRI): Preparing Countries for New Vaccines in Pregnancy (RSV, GBS, COVID-19)

The Maternal Immunization Readiness Initiative (MIRI) focuses on current attitudes and policies regarding maternal COVID-19 vaccination, and preparing countries for uptake of maternal respiratory syncytial virus (RSV) and group B streptococcus (GBS) vaccines, which are anticipated to become available during the next decade. MIRI projects, which are funded by the Bill & Melinda Gates Foundation, have focused on three areas: demand generation and communication, health facility readiness for maternal vaccine introduction, and mapping of country-level COVID-19 maternal vaccination policies over time.

• Demand Generation and Communication
• Health Facility Readiness
• COVID-19 Maternal Immunization Policy
• Exploring Knowledge, Attitudes, and Practices Related to Vaccine Decision-Making among Pregnant People in Brazil, Ghana, Kenya, and Pakistan

Demand Generation and Communication

Work on demand generation and communication, which is led by the Johns Hopkins Bloomberg School of Public Health, aims to gather insights on knowledge, attitudes, and behaviors relevant to maternal immunization for demand generation strategies using in-depth interviews and cross-sectional surveys among pregnant and lactating people, community members, healthcare providers, and policymakers in Kenya and Bangladesh. Objectives of this work have included an exploration of disease conceptualization of COVID-19, RSV, and GBS among pregnant and lactating people and other key stakeholders and decision-making processes for uptake of maternal vaccines among these communities. These findings are being used to design communication strategies which will be tested and optimized with target audiences.

Health Facility Readiness

Comprehensive health system readiness for new maternal vaccines requires assessment of and response to needs across a range of domains at national, sub-national, and facility levels. The Health Facility Readiness project, led by Jhpiego, aimed to create tools to assess readiness at the facility level for offering COVID-19 and other currently available maternal vaccines to pregnant people, as well as new maternal vaccines anticipated to be available in the near future. A Health Facility Readiness Assessment Tool for Maternal Immunization Services has been developed and adapted for use at facilities providing antenatal care (ANC) in Kenya and Bangladesh. In addition to assessing facility readiness for vaccine introduction, the tool can also be used to monitor ongoing quality of ANC as new maternal vaccines are offered. A form of the tool which can be adapted for use in other countries is posted on the AlignMNH Resource Library (hyperlink: https://www.alignmnh.org/resources/resource-library/?_full_text=readiness).

COVID-19 Maternal Immunization Policy

The COVID-19 Maternal Immunization Policy project, led by the Johns Hopkins Berman Institute of Bioethics and the Bloomberg School of Public Health, aimed to assess the policy environment for maternal immunization against SARS-CoV-2. Through maps, tables, and country profiles, the COVID-19 Maternal Immunization Tracker (COMIT) provided a global snapshot of public health policies implemented between 2021 and 2023 that influenced access to COVID-19 vaccines for pregnant and lactating people. 

Exploring Knowledge, Attitudes, and Practices Related to Vaccine Decision-Making among Pregnant People in Brazil, Ghana, Kenya, and Pakistan

An additional mixed-methods study led by Johns Hopkins Bloomberg School of Public Health and WHO focuses on maternal vaccine decision-making among pregnant and postpartum people in four countries - Brazil, Ghana, Kenya, and Pakistan. Within these groups, our study aims to understand the risk perception of COVID-19 disease, document knowledge of COVID–19 vaccines, identify sources of information, and identify decision-making factors and processes. The study also aims to assess attitudinal and behavioral correlates with COVID-19 vaccine status as well as intentions to receive future maternal vaccines such as RSV, GBS, tuberculosis, and malaria vaccines.