Meningococcal Vaccine Introduction in Mali through Mass Campaigns and Its Impact on the Health System

"Social mobilization raised awareness about the vaccine, and rumors were well-managed. Because of its large reach, respondents felt that the MenA vaccine campaign had improved awareness of the benefits of vaccination and had increased credibility of the EPI."

This study sought to evaluate the impact of the meningococcal A (MenA) vaccine introduction in Mali through mass campaigns on the routine immunisation (RI) programme and the wider health system - including the Expanded Programme on Immunization (EPI), which delivers 10 different antigens to children under 5 years old - e.g., the oral polio vaccine (OPV) - through a combination of fixed immunisation sessions at health facilities, outreach services to community sites, and campaigns.

Researchers used a mixed-methods case-study design, combining semi-structured interviews with 31 key informants, a survey among 18 health facilities, and analysis of routine health facility data on number of routine vaccinations and antenatal consultations before, during, and after the MenA vaccine campaign in December 2010. Survey and interview data were collected at the national level and in 2 regions in July and August 2011, with additional interviews in January 2012.

In addition to the quotation above highlighting the role of social mobilisation, it was found that "[n]ational and sub-national health service managers overwhelmingly stated that training for the MenA vaccine introduction had enhanced provider skills, often beyond those required for the specific vaccine, acting as a general refresher on vaccination skills. They commented that a particular emphasis had been placed on adverse events following immunization (AEFI), waste management, surveillance, and social mobilization."

Furthermore, while no fundamental changes to the health information system as a result of introducing the new vaccine were found, "a strong emphasis was placed on AEFI surveillance during the introduction itself, including strengthening the skills of health workers to recognize and report AEFI and training of laboratory staff. Despite perceived better awareness, interviewees at the national and regional level acknowledged that AEFIs were still not routinely reported."

According to the report, interviewees noted that the government had demonstrated "high political commitment to the vaccine introduction and that some aspects of governance were strengthened. For instance, AEFI surveillance was developed through the activation of national and sub-national committees on AEFI. Capacities were further enhanced through locally conducted clinical trials to assess the safety and efficacy of the new vaccine and participation in multicountry studies. [cited in the report] Also, regulatory norms and standards were updated in preparation for the introduction of the MenA vaccine, including guidelines and training modules."

Furthermore, collaboration among the National Communication Agency for Health, the Centre for Vaccine Development, and the Ministry of Health was "established or strengthened during the preparatory phases of the introduction, which was judged to have long-term positive effects. This resulted in the use of scientific evidence, including formative research, for communication, which benefited the broader EPI communication strategy and helped to focus on aspects such as safety and preventing rumors. Multidisciplinary teams for hospital surveillance studies were also established. However, enhanced collaboration did not occur between departments within the Ministry of Health; there was no involvement of other service delivery departments in planning for the campaign and no discussion of co-delivering other interventions with the new vaccine."

The authors conclude that "data collected from health facilities before, during, and after the MenA vaccine campaign suggest that the campaign had considerable impact on routine vaccination activities and, to some extent, on ANC consultations. The average daily number of children vaccinated during routine services was 79% lower during the 10-day campaign period in December 2010 than during the first 13 days of the month before the campaign started, and 87% lower than during the last 8 days of the month when the campaign was over."