Innovative vaccine delivery strategies in response to a cholera outbreak in the challenging context of Lake Chilwa. A rapid qualitative assessment

Abstract

A reactive campaign using two doses of Shanchol Oral Cholera Vaccine (OCV) was implemented in 2016 in the Lake Chilwa Region (Malawi) targeting fish dependent communities. Three strategies for the second vaccine dose delivery (including delivery by a community leader and self-administration) were used to facilitate vaccine access.This assessment collected vaccine perceptions and opinions about the OCV campaign of 313 study participants, including: fishermen, fish traders, farmers, community leaders, and one health and one NGO officer. Socio-demographic surveys were conducted, In Depth Interviews and Focus Group Discussions were conducted before and during the campaign.Some fishermen perceived the traditional delivery strategy as reliable but less practical. Delivery by traditional leaders was acceptable for some participants while others worried about traditional leaders not being trained to deliver vaccines or beneficiaries taking doses on their own. A slight majority of beneficiaries considered the self-administration strategy practical while some beneficiaries worried about storing vials outside of the cold chain or losing vials. During the campaign, a majority of participants preferred receiving oral vaccines instead of injections given ease of intake and lack of pain. OCV was perceived as efficacious and safe. However, a lack of information on how sero-protection may be delayed and the degree of sero-protection led to loss of trust in vaccine potency among some participants who witnessed cholera cases among vaccinated individuals.OCV campaign implementation requires accompanying communication on protective levels, less than 100% vaccine efficacy, delays in onset of sero-protection, and out of cold chain storage.

Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi

“…An anthropological survey carried out in parallel suggested that the innovative strategy was not well understood by some community leaders and, thus, communication with the community was poor. 12 …”

“It depends how one understands it:” a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia

“…The FGD guide included a set of predetermined questions covering topics on perception of cholera causation, vaccines, and OCV acceptability; practices to prevent and treat cholera; and logistical inputs on space and timeline of vaccine delivery. The FGD Guide was designed on the basis of qualitative assessments of OCV campaigns in Malawi and Mozambique conducted by two authors of this paper [28, 29]. One Research Assistant facilitated the FGD while another recorded and took notes.…”

Oral cholera vaccine in cholera prevention and control, Malawi

“…However, a cholera outbreak that affected all regions of Malawi from October 2017 to March 2018 resulted in few or no cases in Nsanje, Chikwawa and the Lake Chilwa area, all which have had almost annual outbreaks with moderate-to-high incidence since 2001, but had been recently vaccinated ( Table 1 ). 6 , 7 …”

“…4 In the light of increased global availability of the vaccine, in 2015 the global cholera vaccine stockpile 4 , 5 was extended for use in areas experiencing recurrent cholera outbreaks. Emergency vaccination campaigns, including campaigns in Malawi, 6 , 7 have largely been conducted with the support of nongovernmental organizations (NGOs), with little integration into local health systems. Vaccine use in areas with recurrent cholera transmission provides an opportunity for comprehensive cholera prevention integrated with government health and infrastructure programmes.…”