Introduction of multi-dose PCV 13 vaccine in Benin: from the decision to vaccinators experience

Abstract

Background: In 2011, Benin introduced the 13-valent pneumococcal conjugated vaccine (PCV13), in a single-dose vial, into its Expanded Programme for Immunisation (EPI) with support from Gavi. In April 2018, with the support of the Agence de Médecine Préventive Afrique (AMP) and other technical and financial partners, the single-dose vial was transitioned to a four-dose vial. Here we describe the decision-making process and the experience of the vaccinators during the change. Methods: We carried out semi-structured, individual interviews with 61 participants individuals involved in the EPI: 7 from central level, 5 from regional level, 7 from township level and 42 from district level. The interviews were recorded and transcribed, and the information categorised, using Nvivo software, and then analysed. Results: The Inter-agency Coordination Committee (ICC), the Benin National Advisory Committee for Vaccines and Vaccination, (BNACVV) and the World Health Organisation (WHO) (i.e., the traditional governance structures involved in vaccination decisions) were not involved in the decision to change to the four-dose vial for PCV13. The decision was taken by the EPI, supported by Gavi. The vaccination errors observed in the first months following the change in presentation were due to the absence of guidelines for changes in vaccine presentation and the central-level actors' perception that it was 'only a change in the vial', and therefore that the communication and training for a new vaccine were not required since the vaccine itself and its administration mode were unchanged.

The economic impact of the switch from single- to multi-dose PCV13 vial in Benin

“…Unsurprising, this result was associated with the fact that more children were vaccinated with the single-dose PCV13. In line with anthropological research findings on the switch in Benin, this could be explained by the fact that health personnel were not adequately trained on how to administer the multi-dose PCV13, therefore contributing to the observed increased missed vaccine opportunities [ 37 ]. For instance, some health personnel refrained to open a multi-dose PCV13 vial when the number of children to be vaccinated was not equal to the number of doses available in the vial.…”