When Are Health Systems Ready for New Vaccines? The Introduction of Pneumococcal Vaccine in Malawi

Dados Bibliográficos

ID12116607
AutoresLot Nyirenda (0000-0003-1398-5454, University of Oslo, autor correspondente), Lot Jata Nyirenda (University of Oslo), Kristin Ingstad Sandberg (0000-0001-5040-7907, University of Oslo), Judith Justice (Department of Anthropology, History and Social Medicine, School of Medicine, University of California at San Fransisco (UCSF), 85 Fairlawn Drives, Berkeley, CA 94708, USA)
Ano2014
Volume41
Fascículo2
Páginas317-336
Data de publicação2014-03-31
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoForum for Development Studies (JOURNAL)
Identificadores do periódicoISSN: 0803-9410 • E-ISSN: 1891-1765
EditoraTaylor & Francis (PUBLISHER • GB)
DOI10.1080/08039410.2014.894936
OpenAlexW2047498924
IdiomaEN
Citações recebidas2
Referências citadas24

Increasing coverage of routine immunisation and new vaccines is key to reaching Millennium Development Goal number four (MDG 4) on reducing child mortality. Malawi, despite a weak health system, is on track to achieve MDG 4, partly because of its high-performing immunisation programme. Among the early adopters of new vaccines, with major support from Global Alliance for Vaccines and Immunisation, Malawi introduced pneumococcal vaccine in 2011 during a time of severe political and economic crisis. This exploratory case study (part of a larger research project on explaining differential immunisation coverage, conducted in 2010 and 2011, using primarily qualitative methods including in-depth interviewing) looks at the decision-making and policy process for vaccine introduction within the broader political–economic context. Based on a framework of benchmarks on preparedness of immunisation systems and assessments of integration with health systems, the study findings suggest that pneumococcal vaccine introduction was more integrated with key health system functions the closer it got to the point of service delivery. Furthermore, although the vaccine introduction succeeded in relation to immunisation targets and prevention of disease, it may have had substantial indirect costs to other targeted health interventions and broader health systems functions at times when basic amenities are in short supply or unavailable. For a donor-dependent country such as Malawi, policy choices are limited to what is on offer – and new vaccines were on offer; other crucial necessities were not. Further research could establish with more certainty the conditions under which vaccine introduction strengthens health systems that are already weak, and when they push systems further into crisis

Context (archaeology · Economic growth · Economics · Geography · Political science · Preparedness · Vaccination · Child and Adolescent Health · Global Maternal and Child Health · Medicine · Vaccine Coverage and Hesitancy · Immunology