Enablers and Barriers to the Scaling Up of Pneumococcal Conjugate Vaccine in India During the COVID-19 Pandemic: A Qualitative Study

Abstract

Background: Pneumonia is one of the leading causes of death in under-5 children in India. This led the Ministry of Health & Family Welfare (MoHFW) in India to decide for the nationwide roll-out of the Pneumococcal Conjugate Vaccine (PCV). However, the introduction of PCV became more complex in the face of unprecedented challenges set forth by the COVID-19 pandemic. The study aims to assess enablers and barriers to the introduction of PCV in India during the pandemic. Methodology: Qualitative research approach involving key-informant interviews from John Snow India (JSI), the lead technical agency that supported MoHFW in the PCV expansion was employed to delineate the enablers and barriers. Principle of saturation was employed to derive the sample size. Thematic analysis using inductive approach was based on the modified World Health Organization (WHO) framework for new vaccine introduction impact on the Immunization and Health Systems, using NVIVO 12 qualitative data analysis software. Results: A total of 11 key informants (4 national-level program managers and 7 state technical officers) were telephonically interviewed. The study found social acceptance, lower cost of the vaccine, and intensive communication activities as potential enablers. Other enablers for PCV introduction included a robust vaccine supply-chain system, ample cold-chain space availability, and strong political commitment, despite the ongoing second wave. Further, the identified barriers included poor physical access, insufficient social mobilization, and limited advocacy along with a stretched workforce. Conclusion: The study delineated several enablers and barriers to introducing PCV in the country during the pandemic. The existing barriers in the PCV roll-out prompted the need to address these gaps, making key program-based recommendations to improve future new vaccine introductions during the pandemic.

A Shot for All!: Addressing the Barriers to Pneumonia Vaccination Program in the Philippines

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Balancing Routine and Pandemic: The Synergy of India’s Universal Immunization Program and COVID-19 Vaccination Program

“…But the real breakthrough happened from 2021–2022 when PCV was expanded nationwide as part of the UIP. This was a courageous step taken by the Government of India (GoI) when the pandemic was at its peak [ 27 ].…”

Experiences of mothers and health workers with MomCare and SafeCare bundles in Kenya and Tanzania: A qualitative evaluation

“…Sample size estimation. No sample size was calculated but the number of people interviewed depended on a priori sample size deemed sufficient to achieve saturation, a point at which no new information emerges despite additional data collection as reported in previous qualitative studies [23][24][25]. Our a priori sample size estimate was 210 mothers (105 Kenya, 105 Tanzania) and approximately 150 health workers (75 Kenya, 75 Tanzania).…”