Post Introduction Evaluation of New Vaccines

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Post Introduction Evaluation of New Vaccines
Dr. Tarande Manzila WHO/AFRO
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Historical perspectives

• No reliable documentation of new vaccine
  introduction in early introducing countries
  (Botswana, Zimbabwe, Swaziland, South Africa, The
  Gambia)

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Why PIE in AFRO

• Lack of regional reference
• Absence of documentation on experience of
  earlier countries
• Limited technical assistance to countries
• during preparation for introduction
• Result of observation of early assessment

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Objective

• The overall objective is to document the
  process of integrating a new vaccine into EPI
  programmes

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Specific objectives

• Specific Objectives
• Document the process of introduction
• Assess introductions impact on the
• programme
• Identify challenges and constrains and define
  ways of overcoming them

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PIE Audiences

• The country itself and its partners PIE aims at
  improving the introduction process and to achieve
  the goals set while providing the country with
  written references of what exactly happened
• Other countries introducing or that may do so in
  future apply lessons learnt from other countries

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Methodology

• Terms of reference created
• District sampling for field visits (attempts made
  to select representative sample of the country
  districts for the evaluation)
• Evaluation tool (use of standardize questionnaire
  for various levels Central, Province,
  district/health facility).
• Individual interviews
• Exit interviews with caretakers
• Observation of immunization session, the
  environment, cold chain system, vaccine
  management, injection safety, wastage management
  etc.

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Sequence of events leading to the PIE

• EPI review
• National plan for new vaccine introduction
• Vaccine fund application submitted
• New vaccine Introduced
• Early assessment in some cases
• PIE

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Timing of the evaluation

• Timing has been tailored to the country need
• If too closed, findings may be cluttered with
  short-live operational issues that will not have
  lasting effect on the program
• If too late, the program may lose the ability to
  detect problems early enough to allow prompt
  corrective action - Lost of memory
• Recommend time between is 8 to 18 months
  following introduction

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Similarities with other EPI reviews

• Address the 5 functions of immunization services
• Evaluate all levels of the health care system
• Select representative sample of the health system
• Opportunity to follow-up on recommendations of
  previous EPI reviews

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Comparative advantages

• Small teams
• Limited time
• No extensive data analysis
• Qualitative process description
• Inexpensive 3000-4000 (local expenses)
• Possible link with disease surveillance (Hib,
  Yellow Fever)

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ExampleBenin (9th month)

• Health facilities using all types of syringes
  and needles (ADs, standard and sterilizables)
• No national policy on injection safety
• Very weak/non-functioning ICC
• HepB introduced with catch-up, up to 2 years of
  age, risk of vaccine shortage
• Fear of vaccine wastage causing low coverage
• Lack knowledge of appropriate storage temperature
  for HepB vaccine

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ExamplesEritrea (10th month)

• Inability of health workers to forecast vaccine
  and supply needs
• The absence of monitoring system for drop outs
  and vaccine wastage
• Inappropriate storage temperatures even at
  regional level

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ExampleMozambique

• There were 200,000 doses of DTP still in one
  provincial cold store
• Has two columns of wastages, but only on the
  monthly reporting forms
• All vaccines frozen in one district cold store

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ExampleTanzania

• The implementation of MVP instituted, with
• reduction vaccine wastage
• Defective BCG syringes discovered and
• supply discontinued
• Authorities aaproved to consider Hib vaccine
  introduction

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Conclusion

• PIE proved to be a useful excercise in the early
  stage of NV intro in the region
• Process documentation of new vaccine introduction
  now available in most countries
• PIE is limited,focused and cost effective
• Provides an opportunity for supportive
  supervision.
• PIE provides an opportunity to follow up on
  recommendation of previous reviews
• Tool Has the potential to be expanded or
  integrated with other evaluations
• Lack of dry storage in most countries

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Way forward for PIE

• PIE tool could be expanded to include other EPI
  assessment tools (MNT risk assessment, vehicle,
  etc)
• It is possible to combine PIE with the rapid EPI
  assessment tool used in southern Africa or with
  formal EPI reviews

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Thank you!