Three Lessons from HPV to Consider for COVID-19 Vaccine Introduction

January 29th, 2021 | Viewpoint

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Worldwide, countries are developing and implementing strategies to introduce COVID-19 vaccines. JSI’s experience with life-course vaccination, notably supporting the preparation and introduction of the human papillomavirus (HPV) vaccine in eight countries, can be adapted to provide technical assistance for COVID-19 vaccine introduction. Three key lessons have emerged. 

Lesson 1: Innovative, multi-partner strategies are important to identify new target populations and shape vaccine distribution plans.

Many country Expanded Programmes on Immunization (EPI) have not worked with the HPV and COVID-19 vaccines target populations before, and identifying them requires new ways of thinking. For HPV vaccine introduction, ministries of health have developed strategies and partnerships to identify and understand adolescent girls. In Kenya for example, the National Vaccines and Immunization Program (NVIP) first turned to the Ministry of Education (MOE) for information. However, the data were found to be incomplete, which led the NVIP, JSI, and other partners to develop a detailed micro-mapping strategy engaging health facilities, communities, and schools to identify girls eligible for vaccination and strategies to reach them. This information also informed the HPV vaccine distribution plan. 

When introducing COVID-19 vaccines, countries will have to use multiple data sources and undergo iterative processes with new partners and stakeholders to identify their target populations and how to reach them. This information must be fed into the supply chain system continuously to ensure adequate vaccine supply and well-managed distribution. Countries and partners need to determine and identify priority populations and eligible individuals for COVID-19 vaccination and adapt tools and resources quickly to inform vaccine distribution plans.

Lesson 2: Communication strategies should be designed with the needs of the new priority populations in mind, and include strong community engagement.

Like HPV, COVID-19 vaccination focuses on populations different from the usual infant vaccinations and requires communication approaches to inform and empower the new audience to make decisions about getting vaccinated and mobilize their peers and communities to do the same. Through our HPV work, we learned that it is important to use communication strategies that engage girls in content creation, and that include community networks, religious and traditional leaders, and families. In Tanzania, the Immunization and Vaccine Development unit, along with JSI and other partners, developed an HPV communication plan that shaped the creation and distribution of materials throughout the health system, on social media, and at other venues. We also targeted messages and outreach to parents and local leaders to increase demand for the vaccine and to counter misperceptions about it. 

It will be important for national immunization programs to include older people and health workers, some of the first recipients of the vaccine, in message development, and identify communication dissemination pathways that resonate with them. Immunization programs can engage in social listening to determine how communities feel about the vaccine; what questions need to be answered to prevent the spread of misinformation; and if adjustments to existing communication strategies are needed. 

Lesson 3: Partnerships with nontraditional EPI stakeholders are critical to identify effective service delivery approaches, including integration. 

Expanding and maintaining partnerships with nontraditional stakeholders can help the EPI reach target populations with different service delivery approaches. For example, in Madagascar’s HPV vaccine demonstration pilot, the Ministry of Health and Family Welfare and the MOE partnered with schools, parents’ associations, community and religious leaders, and organizations that work with adolescents to implement school-based vaccination and other outreach services. 

As countries plan COVID-19 vaccine introduction, early engagement of partners with experience and access to priority populations can help ensure success. These partners can provide insight into the needs of priority populations as well as how to best reach them, including by integrating vaccine delivery with other health or social service programs. For example, countries can consider integrating COVID-19 communication and vaccination efforts with existing cancer, HIV, diabetes, or other disease screening programs that target older populations, leveraging different touchpoints with health centers. 

Our experience with HPV vaccine introduction demonstrates that country EPI can implement vaccination programs for new populations in innovative and different ways. Although the introduction of COVID-19 vaccines will pose its own challenges, EPI can take lessons from HPV and apply them to their COVID-19 vaccination strategies. These learnings can also be applied to future life-course vaccination. EPI and their partners should take advantage of vaccine introduction opportunities like COVID-19 to learn from what they’ve done, test new strategies, and refine programs to improve routine immunization systems. 

By Kate Bagshaw and Nicole Davis

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