Vaccine Wastage Research Articles

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.

COVID-19 vaccine wastage in private and public healthcare facilities in KwaZulu-Natal, South Africa.

In KwaZulu-Natal (KZN), South Africa, COVID-19 vaccinations commenced in May 2021. This study investigated the extent and reasons for COVID-19 vaccine (C19V) wastage in KZN and strategies undertaken to mitigate loss. This two-phase multicenter study was conducted at private and public healthcare facilities from May 2021 to July 2022. KZN reported 2% Pfizer and 1% Janssen C19V wasted, mainly due to expiry. C19V waste-minimization strategies reported by 100% public and private sector vaccination leads included cold chain monitoring, designated trained staff and the use of stock-management systems. The WHO's risk-mitigation factors should be implemented continuously to minimize vaccine wastage.

Minimizing Vaccine Wastage in Nigeria: A National Assessment of Vaccine Wastage Rates and Potential Determinants.

High vaccine wastage can serve as a critical barrier to achieving the gains of vaccination, especially in a country like Nigeria, where data on vaccine wastage are sparsely available. We determined the country-wide vaccine wastage rates and their determinants through a mixed-methods study conducted across 576 health facilities (primary and secondary) in 24 states in Nigeria. We collected facility-based immunization records from June 2018 to May 2019, in addition to healthcare workers' interviews and observations of fixed and outreach sessions. The results show that open-vial wastage ranged from 21.2% (95% CI: 20.2%, 22.2%) for the pentavalent vaccine to 72.6% (95% CI: 71.5%, 73.6%) for BCG. Open-vial wastage rates for BCG, measles, and yellow fever vaccines were higher during outreach sessions, with rates of 76.2%, 64.3%, and 65.2%, respectively. For the outreach and fixed sessions, PCV and Penta had the least wastages of 22.0% for fixed sessions and 20.4% for outreach sessions. This study identified vaccine presentation (liquid vs. lyophilized vaccines), vial size (4 dose vs. 5 dose vs. 10 dose vs. 20 dose), RI service delivery strategies (fixed vs. outreach sessions), number of children vaccinated, and human resources (healthcare workers position/cadre) as key determinants of vaccine wastages in Nigeria.

Development of multidose thermotolerant formulations of a vector-based Covid-19 vaccine candidate, NDV-HXP-S in different product formats: Stability and preservative efficacy study

Current lead coronavirus vaccines require continuous cold or ultra-cold storage from the manufacturing site to the field to maintain protective efficacy. Since cold chain capacity is limited and complex, logistics planning is crucial to limit vaccine wastage.[1] The restrictive storage concerns also make it difficult to share vaccines between public health departments and neighboring states, leading to increased vaccine wastage.[2] A Newcastle Disease Virus (NDV) vector-based severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) vaccine candidate, NDV-HXP-S, offers a cost-effective alternative which aims to improve global access to SARS CoV-2 vaccines.[3] The NDV-HXP-S vaccine candidate can be mass-produced in chicken eggs and has demonstrated efficacy in preclinical studies, as well as acceptable safety andpotent immunogenicity in clinical studies.[3,4–10] To further advance the NDV-HXP-S vaccine candidate, this manuscript describes work focused on the development of multidose thermotolerant vaccine formulations (i.e., those which would not require continuous extendedrefrigeration), making it convenient to use and store, and simplifying transport and distribution logistics, especially in outbreak settings. Liquid and lyophilized formulations for parenteral administration were rigorously screened for the vaccine formulation’s ability to maintain S-antigen stability after exposure to temperaturestress at 40 °C, 25 °C, and 2 °C to 8 °C storage for six months. Preservative efficacy was evaluated to enable a multidose liquid vaccine format as well as endotoxin testing in lyophilized formulations. Lead liquid vaccine formations were identified that were able to maintain S-antigen content at 2 °C to 8 °C and 25 °C storage for the entire six-month study. Lead lyophilized vaccine formulations were identified which were able to maintain S-antigen content for six months at 2 °C to 8 °C, 25 °C, and 40 °C. Both the liquid and lyophilized formulations identified are improved thermotolerant SARS-CoV-2 vaccine formulations.

Achieving sustainable, environmentally viable, solarized vaccine cold chain system and vaccination program-an effort to move towards clean and green energy-driven primary healthcare in Lebanon.

Lebanon faces severe economic and energy crises, impacting its healthcare system, particularly vaccine storage. Traditional gas or kerosene-powered refrigerators often fail to maintain necessary temperatures for vaccine efficacy. This study explores transitioning to solar direct-drive (SDD) refrigerators to ensure reliable vaccine storage. A multi-phase methodology was employed, beginning with an inventory assessment of existing cold chain equipment. The implementation involved stepwise replacement of identified refrigerators across health facilities, including Primary Health Care Centers (PHCCs) and dispensaries. Feasibility, cost-effectiveness, and environmental impact were evaluated. Findings indicate that solarization significantly reduces vaccine wastage, ensures stable temperatures, and cuts operational costs by decreasing dependence on non-renewable energy sources. Over 1,000 SDD units were installed across more than 800 health facilities. Additionally, PHCC solarization improved vaccine preservation and enhanced the resilience of health services overall. The solarization initiative demonstrates the critical role of renewable energy in strengthening healthcare infrastructure, especially in crisis-hit regions. Solar-powered systems provide a reliable and sustainable solution for vaccine storage, reduce carbon footprints, and build public trust in the immunization system. Challenges included geographical and structural limitations, which were addressed through comprehensive planning and collaboration with local stakeholders. Solarization of Lebanon's vaccine cold chain and PHCCs marks a significant step towards sustainable and resilient healthcare infrastructure. The model offers a robust framework for other regions facing similar economic and energy challenges, highlighting the importance of renewable energy solutions in healthcare.

Towards Addressing COVID‐19 Vaccine Wastage in Cameroon: Challenges and Way Forward

Towards Addressing COVID‐19 Vaccine Wastage in Cameroon: Challenges and Way Forward

Coronavirus Disease 2019 Vaccination Status at a Tertiary Care Hospital of Uttarakhand: A Retrospective Record-Based Study

Abstract Background: Coronavirus disease 2019 (COVID-19) vaccination has proved its importance and effectiveness in the fight against COVID-19. India began the world’s largest vaccination campaign against COVID-19 on 16th January 2021 with two vaccines, namely, Covishield and Covaxin. Aims: The present study was conducted to understand the trend of COVID-19 vaccination during the 1st year of the vaccination drive at a COVID Vaccination Centre in a tertiary care hospital of Uttarakhand. Patients and Methods: It was a retrospective record-based study conducted at a COVID-19 Vaccination Centre in a tertiary care hospital of Uttarakhand. Vaccination-related data of 1-year period (16th January 2021–16th January 2022) had been collected from the CoWIN app and COVID-19 vaccination register and analysed. Results: The total dose administered was 63,015 over a time period of 1 year during 299 vaccination sessions that were conducted. Analysis of total doses administered in relation to vaccination sessions held during different months of 1-year study period shows that on average, 199 individuals per session were vaccinated. There was an overall declining trend in the COVID-19 vaccine wastage rate for 1-year period of COVID-19 vaccination. Conclusion: This study will help us to understand how this experience of the past 1 year can be utilised for further planning and policy making.

Uptake of fIPV3 and implementation challenges as perceived by auxiliary nurse midwives at two primary healthcare centers in urban Bengaluru: a mixed-method study

Background: India introduced fractional-dose inactivated poliovirus vaccine (fIPV) into its routine immunization program as part of the polio eradication and endgame strategic plan. The study aimed to assess the uptake of the 3rd dose of fIPV among eligible beneficiaries and explore the implementation challenges perceived by auxiliary nurse midwives (ANMs) at two primary healthcare centers in urban Bengaluru. Methods: A mixed-method study was conducted between April and May 2023. A cross-sectional design was used for quantitative objectives, while in-depth interviews were conducted with ANMs for qualitative insights. Data were collected through vaccination registers, questionnaires, and key informant interviews. The study population included all eligible beneficiaries for the 3rd dose of fIPV from January to March 2023. Results: Out of 296 eligible beneficiaries, 139 (47%) had received the 3rd dose of fIPV. The challenges faced by ANMs in fIPV3 implementation included difficulties in recording and reporting activities, fear of managing adverse events, lack of confidence in administering intradermal injections, obtaining consent from parents, inadequate training, and concerns about vaccine wastage and increased workload. Conclusions: The uptake of fIPV3 was suboptimal, and ANMs encountered several challenges during implementation. To enhance fIPV3 integration into the vaccination schedule, the health system needs to improve awareness among the community, strengthen health worker capacity, and provide better training and support. Strengthening routine immunization programs can contribute to sustained polio eradication efforts.

Can redistribution of vaccine improve global welfare? Lessons from COVID-19.

The disparity in the distribution of COVID-19 vaccine has been recorded with more than 70% vaccination rate for high-income countries as compared to less than 40% for low-income countries. The low affordability of vaccines for the majority of low-income group invites the need for redistribution of vaccines. The disproportionate donation of vaccines across the globe motivates us to explore the incentive for the high-income group to redistribute. An exploratory analysis of cross-country COVID-19 vaccination distribution data shows that the countries which have received vaccines as donation has also contributed to vaccine wastage. This paper intends to provide a theoretical background for this counterintuitive observation using welfare analysis. We find that the market mechanism leads to a negative impact on global welfare due to redistribution. Only an invention with a defined redistribution mechanism may ensure an increase in global welfare. It is found that a critical value of redistribution mechanism reinforced by a minimum threshold level of income is essential to enhance welfare. The reduced form from the theoretical predictions is empirically validated with cross-country data on COVID-19 vaccination for all countries. As identified in theory, the internal support variables like political stability, government effectiveness, and health expenditure at the country level will impact global welfare. Therefore, when global cooperation is essential during a health crisis like COVID-19, improved internal coordination and intentions cannot be ignored.

Overcoming barriers to COVID‐19 herd immunity in Afghanistan

AbstractAfghanistan faces numerous obstacles in its endeavor to achieve herd immunity against COVID‐19. Inadequate resources, vaccine hesitancy, and the new government's lack of international recognition have impeded the country and harmed vaccine procurement and distribution. Although the recent power shift has led to a more secure situation, the country's vaccination coverage remains at 44.05% as of November 26, 2023. The main hurdles to herd immunity include limited vaccine accessibility, extensive vaccine hesitancy, an inefficient cold chain system causing high vaccine wastage rates, substandard service delivery, recent restrictions on women's healthcare access, low health literacy, and a weakened economy owing to decades of conflict and international sanctions. This article assesses vaccination progress, and herd immunity barriers, and provides solutions to overcome them in Afghanistan. A comprehensive approach is required, which involves enhancing public awareness of the benefits of vaccination, debunking vaccine‐related misconceptions through the media, expanding vaccine accessibility especially in remote areas, increasing vaccination personnel, promoting the cold chain and delivery system, reversing the ban on women's education and employment, boosting the economy, and increasing the inflow of humanitarian aid by lifting international sanctions. Successfully implementing these measures can help Afghanistan overcome obstacles to herd immunity, leading the country toward a safer and healthier future.

Strategic Planning of a Joint SARS-CoV-2 and Influenza Vaccination Campaign in the UK.

The simultaneous administration of SARS-CoV-2 and influenza vaccines is being carried out for the first time in the UK and around the globe in order to mitigate the health, economic, and societal impacts of these respiratory tract diseases. However, a systematic approach for planning the vaccine distribution and administration aspects of the vaccination campaigns would be beneficial. This work develops a novel multi-product mixed-integer linear programming (MILP) vaccine supply chain model that can be used to plan and optimise the simultaneous distribution and administration of SARS-CoV-2 and influenza vaccines. The outcomes from this study reveal that the total budget required to successfully accomplish the SARS-CoV-2 and influenza vaccination campaigns is equivalent to USD 7.29 billion, of which the procurement costs of SARS-CoV-2 and influenza vaccines correspond to USD 2.1 billion and USD 0.83 billion, respectively. The logistics cost is equivalent to USD 3.45 billion, and the costs of vaccinating individuals, quality control checks, and vaccine shipper and dry ice correspond to USD 1.66, 0.066, and 0.014, respectively. The analysis of the results shows that the choice of rolling out the SARS-CoV-2 vaccine during the vaccination campaign can have a significant impact not only on the total vaccination cost but also on vaccine wastage rate.

Using community-based, participatory qualitative research to identify determinants of routine vaccination drop-out for children under 2 in Lilongwe and Mzimba North Districts, Malawi

ObjectiveIn recent years, full childhood routine immunisation coverage has fallen by 5% to levels not seen since 2008; between 2019 and 2021, 67 million children were undervaccinated. We aimed to...

COVID-19 vaccine wastage in Africa: A case of Nigeria.

The World Health Organization has launched campaigns to boost immunisation rates to 70 percent globally by the middle of 2022. However, despite the global success of about 64% COVID-19 vaccination coverage, there is a big gap in Nigeria. To date, only 13.8% of the population has received the recommended dose. This demonstrates a significant disparity between the vaccinated and the unvaccinated. Amidst the wide gap in vaccination, COVID-19 vaccine wastage still occurs in Nigeria. At the end of 2021, it was estimated that over a million doses of the COVID-19 vaccine had been wasted. It is anticipated that there will be more COVID-19 vaccine wastage in Nigeria, because of the combined factors that threaten vaccination uptake including vaccine accessibility, lack of appropriate storage facilities, poor electricity supply, insecurity challenges, and inadequate health promotion. This results in concomitant financial and opportunity losses. In this paper, we discuss COVID-19 vaccine wastage in Nigeria including causes, and solutions that can be applied to mitigate this wastage.

Comparing performance of year-round and campaign-mode influenza vaccination strategies among children aged 6–23 months in Kenya: 2019–2021

IntroductionIn 2016, the Kenya National Immunization Technical Advisory Group requested additional programmatic and cost effectiveness data to inform the choice of strategy for a national influenza vaccination program among children aged 6–23 months of age. In response, we conducted an influenza vaccine demonstration project to compare the performance of a year-round versus campaign-mode vaccination strategy. Findings from this demonstration project will help identify essential learning lessons for a national program. MethodsWe compared two vaccine delivery strategies: (i) a year-round vaccination strategy where influenza vaccines were administered throughout the year at health facilities. This strategy was implemented in Njoro sub-county in Nakuru (November 2019 to October 2021) and Jomvu sub-county in Mombasa (December 2019 to October 2021), (ii) a campaign-mode vaccination strategy where vaccines were available at health facilities over four months. This strategy was implemented in Nakuru North sub-county in Nakuru (June to September 2021) and Likoni sub-county in Mombasa (July to October 2021). We assessed differences in coverage, dropout rates, vaccine wastage, and operational needs. ResultsWe observed similar performance between strategies in coverage of the first dose of influenza vaccine (year-round strategy 59.7 %, campaign strategy 63.2 %). The coverage obtained in the year-round sub-counties was similar (Njoro 57.4 %; Jomvu 63.1 %); however, more marked differences between campaign sub-counties were observed (Nakuru North 73.4 %; Likoni 55.2 %). The campaign-mode strategy exceeded the cold chain capacity of participating health facilities, requiring thrice monthly instead of once monthly deliveries, and was associated with a two-fold increase in workload compared to the year-round strategy (168 vaccines administered per day in the campaign strategy versus 83 vaccines administered per day in the year-round strategy). ConclusionAlthough both strategies had similar coverage levels, the campaign-mode strategy was associated with considerable operational needs that could significantly impact the immunization program.

The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon’s Expanded program on Immunization

BackgroundImmunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon.MethodsThrough a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software.ResultsOverall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part.ConclusionThis study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.

Designing drone delivery networks for vaccine supply chain: a case study of Niger

This research aims to evaluate the use of drones to deliver pediatric vaccines in remote areas of low-income and low-middle-income countries. Delivering vaccines in these regions is challenging because of the inadequate road networks and long transportation distances that make it difficult to maintain the cold chain’s integrity during delivery. We propose a mixed-integer linear program to determine the location of drone hubs to facilitate vaccine delivery. The model considers the operational attributes of drones, vaccine wastage in the supply chain, cold storage, and transportation capacities. We develop a case study using data from Niger to determine the impact of drone deliveries in improving vaccine availability. Based on our numerical analysis, regional centers should be considered potential locations for drone hubs. We demonstrate that outreach sessions supported by drone deliveries of vaccines can improve vaccine availability. These improvements depend on the available budget to build drone hubs and purchase drones, available cold storage capacity, and the population density in the study region.

Assessment of immunization data management practices in Cameroon: unveiling potential barriers to immunization data quality

BackgroundOne crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon.MethodsA descriptive cross-sectional study was conducted, involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX).ResultsA total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%).ConclusionOur findings unveil important gaps in data collection practices at the facility level that could adversely affect Cameroon’s immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.

Vaccine microarray patch self-administration: An innovative approach to improve pandemic and routine vaccination rates

The high-density microprojection array patch (HD-MAP) is a novel vaccine delivery system with potential for self-administered vaccination. HD-MAPs provide an alternative to needle and syringe (N&S) vaccination. Additional advantages could include reduced cold-chain requirements, reduced vaccine dose, reduced vaccine wastage, an alternative for needle phobic patients and elimination of needlestick injuries. The drivers and potential benefits of vaccination by self-administering HD-MAPs are high patient acceptance and preference, higher vaccination rates, speed of roll-out, cost-savings, and reduced sharps and environmental waste. The HD-MAP presents a unique approach in pandemic preparedness and routine vaccination of adults. It could alleviate strain on the healthcare workforce and allows vaccine administration by minimally-trained workers, guardian or subjects themselves. Self-vaccination using HD-MAPs could occur in vaccination hubs with supervision, at home after purchasing at the pharmacy, or direct distribution to in-home settings. As a result, it has the potential to increase vaccine coverage and expand the reach of vaccines, while also reducing labor costs associated with vaccination. Key challenges remain around shifting the paradigm from medical professionals administrating vaccines using N&S to a future of self-administration using HD-MAPs. Greater awareness of HD-MAP technology and improving our understanding of the implementation processes required for adopting this technology, are critical factors underpinning HD-MAP uptake by the public.

Ex-ante impact of pest des petits ruminant control on micro and macro socioeconomic indicators in Senegal: A system dynamics modelling approach.

Vaccination is considered as the main tool for the Global Control and Eradication Strategy for peste des petits ruminants (PPR), and the efficacity of the PPR-vaccine in conferring long-life immunity has been established. Despite this, previous studies asserted that vaccination can be expensive and consequently, the effectiveness of disease control may not necessarily translate to overall profit for farmers. Also, the consequences of PPR control on socioeconomic indicators like food and nutrition security at a macro-national level have not been explored thoroughly. Therefore, this study seeks to assess ex-ante the impact of PPR control strategies on farm-level profitability and the socioeconomic consequences concerning food and nutrition security at a national level in Senegal. A bi-level system dynamics model, compartmentalised into five modules consisting of integrated production-epidemiological, economics, disease control, marketing, and policy modules, was developed with the STELLA Architect software, validated, and simulated for 30 years at a weekly timestep. The model was parameterised with data from household surveys from pastoral areas in Northern Senegal and relevant existing data. Nine vaccination scenarios were examined considering different vaccination parameters (vaccination coverage, vaccine wastage, and the provision of government subsidies). The findings indicate that compared to a no-vaccination scenario, all the vaccination scenarios for both 26.5% (actual vaccination coverage) and 70% (expected vaccination coverage) resulted in statistically significant differences in the gross margin earnings and the potential per capita consumption for the supply of mutton and goat meat. At the prevailing vaccination coverage (with or without the provision of government subsidies), farm households will earn an average gross margin of $69.43 (annually) more than without vaccination, and the average per capita consumption for mutton and goat meat will increase by 1.13kg/person/year. When the vaccination coverage is increased to the prescribed threshold for PPR eradication (i.e., 70%), with or without the provision of government subsidies, the average gross margin earnings would be $72.23 annually and the per capita consumption will increase by 1.23kg/person/year compared to the baseline (without vaccination). This study's findings offer an empirical justification for a sustainable approach to PPR eradication. The information on the socioeconomic benefits of vaccination can be promoted via sensitization campaigns to stimulate farmers' uptake of the practice. This study can inform investment in PPR control.

Barriers and facilitators to hepatitis B birth dose vaccination: Perspectives from healthcare providers and pregnant women accessing antenatal care in Nigeria.

Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births.