It’s a public health nightmare: 250,000 doses of substandard vaccines for diphtheria, whooping cough and tetanus administered to children through a government health program. While China has had scandals over tainted food or drugs before, this recent debacle threatens to destroy already shaky public confidence in the country’s growing pharmaceutical industry.
Vaccines are some of our best tools to prevent communicable and even noncommunicable diseases. And yet, introducing a vaccine into a country is full of pitfalls, from supply chain failures to public opinion backlash that can permanently derail a rollout. Take Japan: After unconfirmed reports that the HPV vaccine caused brain damage and seizures, the government actually withdrew its recommendation and funding for it. As Ashish K. Jha, director of the Harvard Global Health Institute, said in a July 23 New York Times article on China’s vaccine woes, “It takes years to build up confidence and one scandal to break it.”
A well-planned and executed rollout can help countries navigate this potentially perilous process and ensure the success of a vaccine’s uptake. I should know. I was in charge of introducing Gardasil, the vaccine for HPV prevention, into more than 80 countries when I worked for Merck.
It was a complex, years-long task to assess the needs of each market and customize rollouts according to cultural aspects and financing issues. A marketing team in each country worked with local stakeholders to get Gardasil approved, recommended, funded and used. We needed to win the hearts and minds of the local policy and medical leaders who would be championing the vaccination programs.
Some leaders gravitated to the product quite easily, excited to be fighting cancer. Others were worried about difficult conversations around adolescents and sex. We were most successful when we kept the focus on the public health prize and provided as much information as possible to answer the inevitable questions. Australia, for example, had a fainting episode in one school involving dozens of girls during the early days of the vaccine rollout. However, the government stayed committed to the goal of not only reducing cancer, but also HPV-related low-grade cervical abnormalities. In the end, Australia posted some of the first and most dramatic reductions in HPV infections.
Based on my experience, here’s what needs to happen. First, good laws and policies help ensure that enough people get a vaccine to make it effective. As of this year, French parents are legally required to vaccinate their children against 11 common infectious diseases. When California did away with the personal exemption clause for childhood vaccines in 2017, vaccine rates went up. Slovenia has some of the toughest vaccination laws, and compliance rates are above 90% on average. For the HPV vaccine, however, which isn’t mandatory, coverage in the country is below 50%.
Second, political and medical leaders must engage the people that the vaccine is intended for. In most cultures, decision-making around health care for minors is a balance among health care policymakers, providers and parents. Yet empowering young people—especially adolescents—can be a powerful way to promote health. We must find a sensitive way to include them in the conversation, without undermining parental authority and social structures. For example, in Mali, an education session prior to introducing the HPV vaccine increased acceptance among adolescents to more than 90%.
Third, strong health systems are needed to ensure access to the new vaccine and to make sure it is safe, effective, and supported by disease detection and vaccine distribution. This includes good information and supply chain management, adequate and sustainable financing, knowledgeable dispensing and follow-up, and surveillance to monitor and analyze side effects.
Fourth, committed leadership is essential for successful rollouts. The organization I now work for, Management Sciences for Health, worked on a USAID-funded program to help introduce vaccines to remote areas in Afghanistan. With strong support from the Ministry of Health, traveling vaccinators went to local communities to review immunization rates, identify why families did not yet have their children vaccinated, and propose solutions appropriate to the local situation. This resulted in 53% of those children receiving their recommended vaccines.
Fifth, political leaders and health care providers need common, consistent messaging, whether it’s during a press conference, at a debate or in a doctor’s office with a patient. Information shared with the public has to be accurate, easy to understand and consistently delivered at all times. Opinion leaders, local decision makers, community groups and health care workers need facts and scripts to work with. Manufacturers must also respond swiftly to new information. A year after the dengue vaccine rollout in the Philippines, its maker, Sanofi, revealed that the vaccine might actually exacerbate symptoms of the disease in some people who become infected. Even though the risk was extremely low, the Philippines’ government was outraged and its people scared and confused. The government has since cut off the program.
It’s amazing what can be accomplished when things work as they should. Faced with some of the highest cervical cancer rates in the world, Malawi is implementing an HPV vaccination program. The government helped introduce the vaccine primarily to girls through a school program. Uptake was above 80% for the first 3 years, and the country is on track for a national rollout. Rwanda rolled out 4 new vaccines over 5 years, collaborating with global partners on planning and messaging and combining vaccines with other community health interventions to go the last mile.
All of these efforts take coordination and engaged leadership with an unwavering vision and a commitment to doing the right thing. Governments and NGOs—including Gavi, The Vaccine Alliance—are ready to support leaders with management guidelines and the resources needed to create and sustain health systems and, in turn, provide lifesaving vaccines. We have the technology to stem epidemics and even to eradicate cervical cancer.
Government and health leaders, over to you. Please prepare well and stand tall to ensure that lifesaving vaccines reach the people who need them. Your people will thank you.
Marian W. Wentworth is President and CEO of Management Sciences for Health, a nonprofit global health organization.
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