Case Studies of IPV Introduction: Albania, Nigeria, and Tunisia

"Documenting vaccine introductions and case studies is a crucial part of the improvement process. Given the large number of countries about to introduce IPV, there is a unique opportunity to put this learning immediately into practice."

As the International Vaccine Access Center (IVAC) explains in this case study document, for decades, the Oral Polio Vaccine (OPV) has been the main tool used to eradicate polio. But, at the end of 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) recommended that every country in the world exclusively using OPV should add at least one dose of the inactivated polio vaccine (IPV) to their national immunisation schedule by the end of 2015. This new global policy means that 126 countries around the world will have to introduce a new vaccine within a short timeframe. Since the SAGE recommendation was made, 27 countries have introduced IPV (data as of July 2015) into their routine immunisation schedule.

To share lessons learned with the additional 99 countries working on this issue, IVAC developed 3 case studies of IPV introduction in Albania, Nigeria, and Tunisia. Each case study details the decision-making process, pre-introduction activities, implementation, and lessons learned.

For example:

• In Albania, lessons learned included:
  1. "Strong political commitment to immunization made for the smooth introduction of IPV."
  2. "Public trust in the immunization system was foundational to the acceptance of IPV."
  3. "A good recommendation from a healthcare professional was critical to caregiver acceptance of IPV." As Klodjan Rjepaj said: "I think it is crucial to understand that communication is not just media. It is training of our professionals in a capitulary way so that they communicate with the parents in their area. It is that daily communication."
  4. "Using date of birth to determine eligibility for IPV was easy and effective."
  5. "It was not possible to revise, reprint, and distribute immunization cards by introduction date."
  6. "Using an electronic Immunization Information System (IIS) simplified many aspects of IPV introduction."
  7. "Taking advantage of the opportunity of a new vaccine introduction to make other changes to immunization schedule was beneficial."
  8. "IPV might have impacted the introduction of rotavirus vaccine."
  9. "Clear, positive, and simple messaging to caregivers is effective." Albania emphasised two messages during IPV introduction: "We are improving our immunization schedule!" and "Our schedule is now comparable to the other European countries." [Please click here to watch a short video entitled "Keeping Albania polio-free: The introduction of the Inactivated Polio Vaccine (IPV)".]

• In Nigeria, information, education, and communication (IEC) materials were developed for caregivers, while IPV training materials were developed for both facilitators and participants in May 2014. Subsequently, follow-up meetings to finalise IPV materials were held in December 2014. The RI data tools (child immunisation cards, immunisation registers, tally sheets, summary forms, monthly vaccination performance chart, and vaccine management tools) were revised in June 2014 to include IPV, and immunisation managers and officers were trained on how to use the tools to capture IPV vaccination data. One related lesson learned: Printed training manuals were found to be a better way to maintain consistency in training content in contrast to PowerPoint Presentations. [Please see below to watch a short video entitled "Conquering polio for good in Nigeria: The introduction of the Inactivated Polio Vaccine (IPV)".]
• In Tunisia, several lessons learned related to decision-making strategies. "National Immunization Technical Advisory Groups (NITAGs) are multidisciplinary groups of experts responsible for providing independent, evidence-informed advice to governments on vaccine policy-related issues. In Tunisia, the National Vaccine Technical Committee (CTV) is the NITAG equivalent....Once the CTV recommended IPV introduction, the national immunization program immediately began preparation for the nationwide introduction of the vaccine....Before making a decision, the CTV had an important debate about the advantages and disadvantages of the different dosing schedules. Because the NITAG was comprised of a diverse set of stakeholders (national, regional, programmatic, scientific), they were able to consider all aspects of IPV introduction when making a decision. Following the discussion, the CTV chose the schedule that they felt was the best fit for the Tunisian context. [Please click here to watch a short video entitled "Preventing Polio in Tunisia: The introduction of the Inactivated Polio Vaccine".]

Overarching reasons for success are shared. For example, in some countries, the most effective messages did not specifically mention polio, IPV, or OPV. Instead, the messages simply stated that a new vaccine was being introduced to improve the immunisation schedule. Cross-cutting challenges are also outlined.

Click here to access the 24-page resource in PDF format.