Beyond the Launch: three key lessons from Ethiopia on monitoring a new vaccine post-introduction

Originally posted by Gavi on April 28, 2022

Vaccination of a second dose of measles vaccine (MCV2) has been introduced in many countries as a critical means to boost immunity and prevent disease from this highly contagious disease, yet coverage is lagging. We take a look at Ethiopia’s experience to share key principles for monitoring MCV2 (or any new vaccine) after introduction.

Much attention is given to the preparation for, and launch of, a new vaccine in a country. Health worker training, data recording and reporting, communication, supply chain management, financing and other considerations are reviewed and planned for, and there is often a splashy launch event with high-level advocacy to drum up public attention and interest in uptake of the new vaccine.

With these lessons Ethiopia, and other low- and middle-income countries, can continue to work towards reaching all children in their second year of life, and throughout their lives, with lifesaving vaccines.

In 2019, Ethiopia introduced a routine second dose of the measles vaccine (MCV2) for 15-month-olds, marking a change in the children’s vaccination schedule to extend into a child’s second year of life. Many low- and middle-income countries have similarly been introducing MCV2, however coverage has lagged behind compared to MCV1 and other vaccines. So, how can we work to address issues in reaching children with MCV2?

While preparation pre-launch is critical, it is equally important to closely monitor rollout after the launch, including two to three years onwards – to be able to course-correct implementation issues and enhance uptake of the vaccine continuously, on a longer-term basis. JSI has supported more than 75 new vaccine introductions in 24 countries for vaccines along the life course, and with Gavi funding we supported the Ministry of Health (MOH) in Ethiopia with scale-up and ongoing monitoring of MCV2 post-introduction. We have three lessons to share that can also apply to monitoring any new vaccine post-introduction.

1. Conduct targeted data analysis with health facilities and regions

During the initial rollout in Ethiopia, we not only reviewed MCV1 and MCV2 coverage reported in administrative data. We also looked at which health facilities were reporting routine immunisation data, but not reporting MCV2, through the administrative data reporting mechanism (DHIS2). This helped indicate training or reporting issues to be rectified, pinpointing the follow-up needed with specific health facilities across the country. This list of health facilities was shared with managers at the regional level (i.e. staff at Regional Health Bureaus) so they could follow up with facilities and provide support. These targeted data analysis and follow-up efforts helped MCV2 become routinely available in more than 95% of the 21,000+ health facilities across the country.

2. Focus coaching on the most difficult or complex parts of initial training

Since measles vaccination now included an additional dose and broader age range, proper screening and recording of doses for both MCV1 and MCV2 emerged as a challenge, identified during supportive supervision and review meetings. MOH and partners developed a job aid that included a reference table for health workers on proper screening and recording for infants through the second year of life for measles vaccination. This job aid was translated in multiple languages and distributed to health facilities, and it was also included in supervision materials, so supervisors could provide on-site coaching on this during regular visits.

3. Review progress frequently and communicate regularly to lower levels, including with NGO implementing partners

Building off learning from review meetings as an avenue for regular learning and improvement, a big focus during monitoring was regularly reviewing progress using both quantitative (e.g. administrative data) and qualitative (e.g. reflections from supportive supervision visits) data. From these reviews, specific follow-up actions for districts (woredas) and health facilities were developed, shared, and discussed together. This also included ensuring that NGO partners working at lower levels across the country in immunisation and child health were able to follow-up on MCV2-related issues on a regular basis.

These practices for continuous monitoring, along with standard new vaccine introduction activities such as post-introduction evaluations (PIEs), have helped Ethiopia steadily raise its MCV2 coverage since introduction in 2019; administrative data showed national coverage at 54% in 2020 and 72% in 2021, a considerable achievement given disruptions from COVID-19 and internal conflict in several parts of the country.

With these lessons, Ethiopia, and other low- and middle-income countries, can continue to work towards reaching all children in their second year of life, and throughout their lives, with lifesaving vaccines.

Written by Adriana Almiñana