Principles and Considerations for Adding a Vaccine to a National Immunization Programme

This resource document elaborates principles and issues to be considered when making decisions about, planning, and implementing the introduction of a vaccine (e.g., pneumococcal conjugate, rotavirus, meningococcal A, rubella, human papillomavirus (HPV), Japanese encephalitis, and inactivated polio vaccines) into a national immunisation programme. The document highlights ways to use the opportunity provided by the vaccine introduction to strengthen immunisation and health systems. It also shares references and tools related to vaccine decision-making, economic analyses, cold chain, integrated disease control and health promotion, vaccine safety, communications, and monitoring - providing URL links to many of these resources.

The World Health Organization (WHO) notes that some additions of a vaccine to a national immunisation programme may require a full range of activities - from an evidence-based decision by policymakers to additional training of health workers, a new communications and social mobilisation campaign, and so forth - while other vaccine additions may require only some of these activities. In support of that, for instance, Section 3.8 of the report focuses on advocacy, communication, and social mobilisation, stressing how critical these activities are to create and sustain the support of policymakers and opinion leaders for vaccine introduction, as well as to foster community acceptance of and demand for the new vaccine. "One best practice is to develop an advocacy and communications plan for the new vaccine. The plan should draw from the existing communications plan or strategy for the national immunization programme, if one exists, and be aligned with the Ministry of Health's overall health promotion and communication strategy. A technical sub-committee on advocacy and communications can be helpful in developing and implementing the plan. To ensure that the communications activities are effective in reaching all key target audiences and that messages about the new vaccine are appropriate for each audience, the sub-committee should include representatives from different sectors of society, such as parents, community leaders, women or children's associations, religious or ethnic groups and health workers. The sub-committee should also include experts in health promotion and social mobilization from the Ministry of Health."

It is noted that the communications plan and subsequent activities, materials, and messages will be most effective if they are informed by a study of the public's knowledge, attitudes, beliefs, and practices (KABP) about the targeted disease, the vaccine, and immunisation in general. KABP studies can range from a series of focus group discussions (FGDs) to more detailed community and household surveys. According to WHO, such studies should involve a range of different groups, including community and opinion leaders, health workers, and parents. To improve acceptance among health workers, parents, and others in the community, information, education, and communications (IEC) messages and activities should also address issues and concerns identified in the KABP study or others that may arise due to the nature of the vaccine. These IEC activities and materials should go beyond promoting just the new vaccine itself; they should include messages about the importance of children being up-to-date on all of their immunisations and include information on other interventions to prevent or control the disease or syndrome targeted by the vaccine. WHO also stresses the importance of developing materials tailored for different audiences, such as physicians, health workers, and journalists, as well as the general public. Furthermore, WHO suggests that a range of different channels and media to deliver the messages should be used, including health workers, community volunteers, and mass media (e.g., radio and television spots).

Another strategic direction involves direct advocacy: "Obtaining the support from and participation of respected political leaders and a broad range of influential groups and members of society in promoting the new vaccine can be critical to communicate information about the vaccine to the community, to renew awareness of immunization, and to allay possible safety concerns about the vaccine and correct misinformation. These partners can include opinion leaders (such as leading physicians), civil society, academics, community and religious leaders, and the private sector. It is also important to inform and educate the media about the new vaccine in advance of the introduction and to obtain their support in getting messages out, since they can have a major influence on public perceptions about vaccines. One effective way to do this is to hold one or more media workshops or seminars before the vaccine introduction, which can lead to a substantial amount of free publicity, such as newspaper articles, radio and television interviews and programmes concerning the new vaccine."

WHO states that "risk communications for the new vaccine is important to build trust with the public. This involves including information on possible side effects in the IEC materials and when communicating with parents and the community. Awareness among health workers and the public of possible adverse events will also facilitate early recognition and treatment of side effects, which may reduce their consequences. Another component of risk communications is the preparation of a crisis communications plan for the new vaccine. This allows for a rapid and effective response to adverse events following immunization (AEFI), to anti-vaccine movements, and to any allegation that can have a negative effect on public acceptance of the new vaccine and trust in the immunization programme."

"Finally, to maintain political and public support for the new vaccine, it is important to periodically disseminate information to policymakers and the media on the impact of the new vaccine in reducing the disease burden, as well as achievements of the overall immunization programme."