What will it take? Perspectives from five low- and middle-income countries on opportunities and challenges of introducing new maternal vaccines.

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New vaccines for pregnant women have recently been introduced in some high-income countries to protect infants in early life. Implementing maternal immunisation (MI) successfully in low- and middle-income countries will require planning and adaptations to immunisation and maternal health programs. To inform cost of MI delivery studies, we gathered perspectives from key stakeholders in five countries (Bangladesh, Ghana, Kenya, Mozambique, and Nepal) regarding health system requirements, opportunities, and challenges to introducing new maternal vaccines into routine health programs. We convened national stakeholders for country workshops to deliberate potential delivery strategies, opportunities, and constraints for implementing new MI interventions. Divided into thematic areas, participants discussed health system adaptations needed to establish or strengthen an MI platform. Stakeholders felt that existing programs that administer vaccines to pregnant women, primarily tetanus-containing vaccines, provide a proven path for the delivery of additional maternal vaccines. Maternal health and immunisation program integration was perceived strongest at the health care provision level and weakest at the national level. Concerted coordination at the national level was identified as critical to the success of introducing new interventions. Stakeholders perceived that most health workforce providing immunisation and antenatal care services undergo similar training and have transferrable skills, however developing operational guidelines with clear roles and responsibilities was deemed critical for ownership and accountability. Human resource constraints were cited as a challenge for some countries. The importance of raising awareness of disease burden and new MI interventions was also highlighted across countries. Sustainable financing was a recurring challenge cited, especially with transitions from Gavi support. The workshops enabled country stakeholders to deliberate needs to support the introduction of new maternal vaccines. While circumstances and needs differed, stakeholders across countries were optimistic about the capability of their health systems to integrate new maternal vaccines.