Seasonal influenza vaccination in middle-income countries: Assessment of immunisation practices in Belarus, Morocco, and Thailand
Vaccines for the control of seasonal influenza are recommended by the World Health Organisation (WHO) for use in specific risk groups, but their use requires operational considerations that may challenge immunisation programmes. Several middle-income countries have recently implemented seasonal influenza vaccination. Early programme evaluation following vaccine introduction can help ascertain positive lessons learned and areas for improvement.
An influenza vaccine post-introduction evaluation (IPIE) tool was developed jointly by WHO and the U.S. Centers for Disease Control and Prevention to provide a systematic approach to assess influenza vaccine implementation processes. The tool was used in 2017 in three middle-income countries: Belarus, Morocco and Thailand.
Data from the three countries highlighted a number of critical factors: Health workers (HWs) are a key target group, given their roles as key influencers of acceptance by other groups, and for ensuring vaccine delivery and improved coverage. Despite WHO recommendations, pregnant women were not always prioritised and may present unique challenges for acceptance. Target group denominators need to be better defined, and vaccine coverage should be validated with vaccine distribution data, including from the private sector. There is a need for strengthening adverse events reporting and for addressing potential vaccine hesitancy through the establishment of risk communication plans. The assessments led to improvements in the countries’ influenza vaccination programmes, including a revision of policies, changes in vaccine management and coverage estimation, enhanced strategies for educating HWs and intensified collaboration between departments involved in implementing seasonal influenza vaccination.
The IPIE tool was found useful for delineating operational strengths and weaknesses of seasonal influenza vaccination programmes. HWs emerged as a critical target group to be addressed in follow-up action. Findings from this study can help direct influenza vaccination programmes in other countries, as well as contribute to pandemic preparedness efforts.