Introduction of the pneumococcal conjugate vaccine in humanitarian and fragile contexts: Perspectives from stakeholders in four African countries

Figures & data

Table 1. Participant details.

Country	Interviews/number of participants	Participants’ affilations
Chad [CD]	4	NGOs, health agency, MOH
Guinea [GA]	3	MOH, health agency
Somalia [SA]	6	MOH, NGOs, Research Institution
South Sudan [SS]	3	MOH, health agency, NGO

Table 2. Key findings from In-depth interviews.

Finding	Detail	Quote
Specific factors contribute to increased pneumonia vulnerability.	Climate change and maternal education were two of most cited factors. Environmental conditions such as flooding and changes in weather patterns were seen as having a negative impact on the burden of pneumonia. Poor maternal education was also associated with overlooking the danger signs of pneumonia and delaying care-seeking.	“Remote areas are very hot, and climate is the most serious factor contributing to pneumococcal risk for children.” [SA]
Gaps in country-level surveillance systems hinder efforts to study the potential impact of PCV introduction.	Participants described limited surveillance capacity as contributing to the lack of data on specific pneumonia burden. Strengthening surveillance systems was noted as being important to facilitate understanding of disease burden and vaccine impact. Public sector data sources could be supplemented with private hospital data.	“We don’t have that kind of specific data (surveillance) for pneumonia in the country. We’re thinking of setting up a surveillance system so that prior to introduction we would have baseline data.” [SS]
Despite concerns and potential barriers, there is strong commitment to develop and leverage decision-making processes to sustainably introduce PCV.	Participants described global advocacy, including a summit with leaders from multiple countries, as energizing efforts for PCV introduction. However, leaders expressed uncertainty about balancing multiple vaccine priorities, particularly in settings with less formalized technical advisory groups on immunization policy making. Further, the financial aspects of introduction, including logistics, were one of the largest considerations of vaccine introduction.	“Who will pay for the vaccine? Partners? In any case, it is the state that must finance, and the modalities must be defined so that, once the vaccine is introduced, stock-outs can be avoided.” [GA]
Key steps ahead of PCV introduction will bolster implementation and sustainability.	Implementation priorities to support the rapid and sustainable introduction of PCV include communication campaigns, enhancing cold chains, training for healthcare workers, and building on pandemic-related learnings.	“They have introduced COVID-19 vaccine in a short time. This paves the way now for the Minister of Health to believe in themselves, and to have more experience in introducing new vaccines.” [SA]