Online Program

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

Tuesday, November 5, 2013 : 12:30 p.m. - 12:50 p.m.

Maurice Gatera, Rwanda Biomedical Center, Kigali, Rwanda
Fidele Ngabo, Ministry of Health of Rwanda, Kigali, Rwanda
Corine Karema, Ministry of Health of Rwanda, Kigali, Rwanda
Cathy Mugeni, Ministry of Health of Rwanda, Kigali, Rwanda
Hassan Sibomana, Rwanda Biomedical Center, Kigali, Rwanda
Anicet Rwasangabo, Rwanda Biomedical Center, Kigali, Rwanda
Sunil M. Bhatt, Dartmouth College, Hanover
Claire M. Wagner, Global Health Delivery Partnership, Boston, MA
Cameron T. Nutt, Dartmouth Center for Health Care Delivery Science, Hanover, NH
Agnes Binagwaho, Ministry of Health of Rwanda, Kigali, Rwanda
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.

Learning Areas:

Assessment of individual and community needs for health education
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe delivery practices of a strong national immunization program Identify innovations employed to expand Rwanda’s immunization program to include three novel vaccines over the course of four years Discuss monitoring and evaluation techniques used in Rwanda to ensure proper vaccine rollout Evaluate the method of determining need for cold-chain expansion prior to new vaccine rollout

Keyword(s): Immunizations, Community Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the head of the Vaccine-Preventable Diseases Division of the Rwanda Biomedical Center and oversaw the rollout of the vaccination campaigns described in the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.