LNCT Member Newsletter November 2019

LNCT Updates

Announcing LNCT’s Vaccine Hesitancy Workshop
On November 18-19, delegates from six LNCT countries are gathering with experts from Gavi, WHO, UNICEF, Common Thread, the London School of Hygiene and Tropical Medicine, and Results for Development in Geneva, Switzerland to put their heads together on developing local solutions to the global challenge of vaccine hesitancy.  With a focus on building trust, social media monitoring, managing safety perceptions, health worker hesitancy, and engaging minority and vulnerable populations, participants will share experiences, identify global and regional tools that may be adapted to address challenges, and develop action plans for their implementation. Find out more details in our new blog. You can also view materials from the workshop in English and Russian in our Resource Library*. *Note: You will need to log-in to view the materials from the workshop. 

New LNCT Report: Supporting LNCT Countries in Assessing and Addressing Their Vaccine Hesitancy
Recognizing that addressing vaccine hesitancy is a priority in many LNCT countries, the Vaccine Confidence ProjectTM at the London School of Hygiene & Tropical Medicine (LSHTM) conducted a landscape to identify the key hesitancy challenges faced by LNCT countries and the strategies they use to address them. To capture and frame country experiences with vaccine hesitancy, LSHTM and Curatio International Foundation conducted in-depth interviews and focus group discussions with immunization experts (e.g. EPI program, Ministry of Health, and National Immunization Technical Advisory Groups (NITAGs)) from LNCT countries. In total, 41 immunization experts from 12 countries (Armenia, Georgia, Ghana, Indonesia, Lao PDR, Moldova, Nigeria, São Tomé e Príncipe, Sudan, Timor-Leste, Uzbekistan, and Vietnam) provided valuable insights for this report.

• The most prevalent concerns among parents stemmed from potential side effects of vaccines reported in the media, by GPs, or by people they knew; trust issues around new vaccines; the halal status of vaccines; and distrust in the government.
• Multiple participants reported mistrust of new vaccines and concerns about new products and manufacturers and the impact of rumors and misconceptions.
• Participants referred to healthcare professionals, such as doctors and nurses, as having influence on vaccination decisions. Particularly highlighted were issues with healthcare staff, including healthcare provider attitudes to vaccination and a lack of education on vaccines.
• Many participants stressed the issue of anti-vaccination and misinformation spreading on social media.

LET’S DISCUSS: Transition Talks
Have you engaged in any of our recent Transition Talks? These are bi-weekly discussions on topics in which LNCT countries have expressed an interest.  We would love to hear from more of our members to share their experiences or pose questions to other countries, our technical experts, and/or our partners. Some of the recent Transition Talks that are ongoing include:

1. Roles in the vaccine procurement process*
2. Tools and strategies to address vaccine hesitancy challenges*
3. Sub-national government contributions to vaccine forecasting and budgeting*
4. Providing reliable private sector immunization coverage data*

Presentations from Malawi and Georgia’s Experiences Engaging with Private Providers will be Available Soon 
LNCT hosted a webinar on November 26, 2019 on Strengthening Public-Private Engagement for Immunization Delivery. Participants learned about key findings and observations from case studies on different ways that the MoH engages with private sector providers to support immunization program performance and heard experiences from two countries — Malawi and Georgia — with different models for engaging with private providers. For those who were unable to attend, materials from the webinar will be available soon in all LNCT languages on lnct.global. Please check the Resource Library in the coming days to access the materials.

Country Spotlight

Lao PDR’s Takeaways from National Health Insurance Workshop
What did LNCT members from Lao PDR learn from our National Health Insurance Workshop, which was held on July 3, 2019 in Tangerang, Indonesia? Listen to their top takeaways from the workshop in this interview with Bouaphat Phonvixay, Deputy Director of National Health Insurance Bureau  and Panome Sayamoungkhoun, EPI Manager. The interview was conducted by Kwame Amponsa-Achiano, New Vaccine and Vaccine Safety Coordinator, EPI and Yaw Opoku-Boateng, Deputy Director, Quality Assurance from Ghana.

Côte d’Ivoire on What They Hope to Learn from LNCT
Mamadou Samba, Director General of Health of the Ministry of Health and Public Hygiene and Kouadio Daniel Ekra, Coordinating Director of the Expanded Program of Immunization from Côte d’Ivoire identified LNCT country experiences that they’d like to learn more about and also shared some of their lessons learned from LNCT’s 2019 Network-wide Meeting in this interview conducted by Alexis Mourou Moyoka, Head Doctor of the EPI, Congo.

São Tomé and Príncipe on Building an Effective CCG
LNCT Technical Facilitator and Professor at Federal University of Goiás (UFG) in Brazil, Cristiana Toscano, sat down with Feliciana Sousa Pontes, Director of Health Care, Carlos Alberto da Costa, Budget Directorate, Ministry of Finance, and Solange Correia Gomes, PAV Coordinator from São Tomé and Príncipe to talk about the process of building their Country Core Group (CCG), some accomplishments their CCG has had, and advice for other countries who are just beginning to structure their own CCG. Find out what they said in the interview.

Findings from São Tomé and Príncipe HPV Demonstrations
As part of cervical cancer prevention, Sao Tome conducted an HPV vaccination demonstration in all districts at the national level. The demonstration was carried out in two phases, in 2018 and 2019, the first targeting girls born from Jan 1st – Dec 31st 2007, and the second one targeting girls born in 2008. Two strategies were used to achieve the target in this demonstration project – vaccination in schools and vaccination outside of schools. The immunization coverage survey, which is one of Gavi’s recommended evaluation methods, aims to draw lessons about the challenges and opportunities related to the cost and feasibility of a possible national introduction of HPV vaccine. Sao Tome conducted a coverage survey at the national level in the period from 23 to 29 July 2018 to seven weeks after the second dose. The results showed that:

• Knowledge of the vaccine is high – the majority of respondents were aware of the two doses of HPV vaccine and the 6-month interval between the first and second doses
• The proportion of girls holding their vaccination card during the coverage survey was 86% for both doses of HPV vaccine
• The school immunization strategy was the most successful in reaching girls eligible for HPV vaccine, with the majority of girls being vaccinated in schools during the first dose
• Teachers, school principals, and health workers had the biggest influence on the decision to vaccinate girls
  • In addition to these influential groups, television and leaflets were also cited as sources of information about the HPV vaccine
• Respondents cited a belief that “vaccination contributes to girls’ good health by preventing certain diseases” as a primary reason for vaccinating their daughters.

Highlights from our Partners

A Polio-Free Pakistan: The Cure is Persistence
On the 24th of October, we marked World Polio Day. Pakistan remains one of the last places where Polio is endemic. Many factors including conflict, distrust of vaccines and the people who administer them, security concerns surrounding polio workers in the field, and general misinformation about vaccinations have led to reluctance and resistance to vaccinating children and violence against health workers. Together, these factors are holding Pakistan back from finally eradicating this disabling disease. In this commentary, Professor Heidi Larson highlights how the government in Pakistan must support public awareness and community engagement around the safety, importance and effectiveness of vaccination. This includes educating people about the misinformation that can circulate on social media and partnering with local communities, including religious clerics and local leaders, to build confidence in vaccines is essential to a polio-free Pakistan.

Next Iteration of UNICEF’s Online Course on Health Systems Strengthening Begins
The next round of the free, online course on Health Systems Strengthening (HSS) started on November 25. Developed by the Nossal Institute and UNICEF, this course will cover some of the greatest challenges and advances in global health demand systems strengthening intervention, including:

• Health system structures, functions and components, and how they interact.
• How to use evidence, and analysis of inequity, to drive interventions to strengthen health systems.
• Strengthening health systems through action in areas such as health policy, financing, human resources, supply chain management, quality of care and private sector engagement.
• Using complex systems thinking to address health system problems.

Featured Resources

How Organizations Promoting Vaccination Respond to Misinformation on Social Media: A Qualitative Investigation
Vaccination misinformation is associated with serious public health consequences, such as a decrease in vaccination rates and a risk of disease outbreaks. Although social media offers organisations promoting vaccination unparalleled opportunities to promote evidence and counterbalance misinformation, we know relatively little about their internal workings. The aim of this paper is to explore the strategies, perspectives and experiences of communicators working within such organisations as they promote vaccination and respond to misinformation on social media.

Systematic Review of the Costs and Effectiveness of Interventions to Increase Infant Vaccination Coverage in Low- and Middle-income Countries
This recent systematic literature review was conducted on the costs and cost-effectiveness of interventions to improve immunization coverage in low- and middle-income countries. The review shows that there is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data. For more information on immunization program costing, check out the Immunization Delivery Cost Catalogue (IDCC).

WHO Updated Guide on Standardization of Economic Evaluations of Immunization Programs
The growing number of vaccine options increases the demand for economic evaluation of immunization programs. In addition to the changes in vaccine options, there are also methodological developments in the vaccines and economics world. As such, WHO has recently published a new edition of the guidance to meet the increased need to carry out immunization economic evaluations for decision making using the latest methodologies. This updated guide brings together the recommendations and guidance from many recent guidelines, tools and other documents on specific aspects of immunization and on specific vaccines.

Looking Ahead

Upcoming LNCT Webinar: Implementing a High Performing Immunization Program within the Context of National Health Insurance: What can we Learn from Thailand?
How do two key actors in Thailand, the EPI unit within the Ministry of Public Health (MOPH) and the National Health Security Office (NHSO, the national health insurance administrator) work together to implement Thailand’s national immunization program? LNCT is hosting a webinar on December 11th featuring country policymakers who will  give an overview of the Thai health system, explain the roles and key contributions of each actor, and address the challenges of transitioning to joint responsibility. The webinar will conclude with 15 minutes of a moderated question & answer discussion with the panelists. Register for the webinar here. 

Announcing LNCT Sponsorship Program for Upcoming TVEE Training Workshops on Costing and Economics Evaluation
Teaching Vaccine Economics Everywhere (TVEE) develops and delivers training workshops to strengthen skills related to economics and financing of national immunization programs and to improve the sustainability of vaccine delivery in low and middle-income countries. LNCT will be sponsoring a scholarship program for individuals from LNCT member countries to attend select TVEE training workshops in their region. Please keep an eye out for future email invites with additional information and instructions on how to apply.