Harnessing synergies to expand Rwanda's immunization program: The national rollout of pneumococcal, HPV, and rotavirus vaccines

Background: In 2008, Rwanda had attained over 80% coverage for BCG, measles, hepatitis B, Haemophilus influenzae type b and three doses each of DTP and polio. Over the next 4 years, Rwanda successfully rolled out the pneumococcal conjugate vaccine (PCV) in April 2009, human papillomavirus (HPV) vaccine in April 2011, and rotavirus vaccine in May 2012. Data: Data was obtained from the vaccine preventable diseases division database. Birth cohort projections were used to calculate PCV and rotavirus coverage in collaboration with WHO and UNICEF. For HPV, eligible girls were registered prior to vaccine rollout; this number was used to determine coverage. Methods: Rwanda's Ministry of Health engaged in extensive, cross-sectoral planning at least one year before introducing each vaccine. Rwanda's local leaders, development partners, civil society organizations and extensive community health worker network were mobilized to support communication efforts and vaccine delivery through MoH-organized campaigns. Support from the GAVI Alliance, WHO, UNICEF and USAID was leveraged to strengthen the overall vaccination system and prime it for future rollouts. To reinforce country ownership, Rwanda co-financed all rollouts. Results: In 2011, Rwanda had achieved three-dose coverage of 97.0% for PCV among children under 1, and 93.2% three-dose HPV vaccine coverage among eligible adolescent girls. Between May and November 2012, Rwanda achieved three-dose coverage of 93.0% against rotavirus among children under 1. No vaccine stockouts occurred in health centers. Interpretation: Other countries considering rapid consecutive or simultaneous rollouts of novel vaccines may consider lessons from Rwanda's experience while tailoring strategies to local context.