Issues and experiences in adolescent and adult vaccination campaigns

1. Issues and experiences in adolescent and adult vaccination campaigns Pathways to global introduction of new TB vaccines Third Global Forum on TB Vaccines Cape Town, March 26, 2013 F. Marc LaForce, MD Serum Institute of India

2. Vaccines aimed at teens and young adults • Special problems of immunizing adolescents and young adults • An upside: • Schools can be an efficient venue • The downside • Once they are out of school – they can be a a difficult group to reach (now married, making a living, etc…)

3. The core issues (1) • What is being prevented? • If the problem is not viewed as a “serious” one by the target group there is a major acceptance issue • Who is recommending the intervention? • If the source of the recommendation is not perceived well the intervention will be questioned • Is the intervention culturally acceptable? • The cultural context largely determines acceptability

4. The core issues (2) • Who pays? • In general, adults in resource poor environments will only pay for what is deemed by the community as “an urgent need”. • The “cost” must be consistent with the locale. • Are there threats (or other downsides) to receipt of the vaccine or preventive service?

5. Planning for success (1) • Availability of sufficient funds • Creation of a “linked” communication plan that begins at least two years before the intervention is planned • Identify “champions”. If at all possible the President (and/or his wife/husband)

6. Planning for success (2) • Technical and regulatory issues • Make double sure that the regulatory steps, particularly as they apply to safety of the vaccine, have been carefully followed. • That WHO/UNICEF/GAVI support is visible and concrete

7. Planning for success (3) • Logistics • Logistical snafus are notoriously common in mass vaccination campaigns • There is no substitute for district-based microplanning (a la measles, polio and meningitis vaccine campaigns) • Every campaign discovers a new problem that was either not included or underappreciated

8. Planning for success (4) • Politics • Government • Ensure that the same message emanates at all levels • Identify and work with potential problem persons • Ministry of Health • Lavish organizational time and be prepared to support MOH and regional activities, if necessary • International agencies • Understand every agencies “win position” and work towards meeting their expectations

9. Planning for success (5) • Staffing • Make sure that in country project staffing is sufficient to meet needs • Fund communication activities and stay closely connected with that work

11. Dec. 6, 2010 - Official launch day – President of Burkina Faso

12. Official launch day – health workers

15. Burkina Faso campaign: 6-15 December, 2010 Target population: 10,677,781 Burkinabes between 1 and 29 years of age Duration of the campaign: 10 days Results: 10.8 million personsimmunized Coverage: 95.9% Burkinabes 1–29 years of age Verysuccessfulcampaignwith high acceptance !

16. Reported meningitis cases with percent distribution of serogroup A meningococci—Burkina Faso, 2005-2012

17. Rough timelines • Product development – impossible to predict since such timing is product specific • Regulatory – licensure and safety studies • at least two years • Introduction • Communication plan, funding and preparation • Start two years before planned introduction • Evaluation plan

18. In summary • Mounting successful adolescent to young adult immunization campaigns is not easy. • Nonetheless, these campaigns have to succeed so that teen and adult populations also benefit from new vaccines. • No substitute for country-based commitment, planning, coordination and adequate funds.