Health Care Worker Preferences and Perspectives on Doses per Container for 2 Lyophilized Vaccines in Senegal, Vietnam, and Zambia

Natasha Kanagat; Kirstin Krudwig; Karen A. Wilkins; Sydney Kaweme; Guissimon Phiri; Frances D. Mwansa; Mercy Mvundura; Joanie Robertson; Debra Kristensen; Abdoulaye Gueye; Sang D. Dao; Pham Q. Thai; Huyen T. Nguyen; Thang C. Tran

doi:10.9745/GHSP-D-20-00112

Key Findings

Health care workers (HCWs) in all 3 countries preferred containers with fewer doses for reconstituted vaccines such as BCG and measles-containing vaccine.
HCWs believed that containers with fewer doses of these vaccines could reduce wastage and missed vaccination opportunities.
HCWs were more willing to open a vial for every eligible child when using containers with fewer doses.

Key Implications

Policy makers should consider HCW perspectives when deliberating a change in policy on vial size since HCWs have to balance concerns about open vial wastage with the guidance to open a vial to vaccinate every eligible child.
Program managers should consider shifting to containers with fewer doses for vaccines without preservatives to assuage HCW concerns about opening vials for every eligible child while managing wastage.

ABSTRACT

Introduction:

Limited information exists on health care workers’ (HCWs) perceptions about use of multidose vaccine vials and their preferences about doses per container (DPC). We present findings from qualitative studies conducted in Senegal, Vietnam, and Zambia to explore HCWs’ behavior regarding opening vials and their perceptions and preferences for the number of doses in vials of BCG and measles-containing vaccine (MCV). Zambia and Senegal currently offer MCV in 10-dose vials and BCG in 20-dose vials; 10-dose vials are used for both vaccines in Vietnam. Unused doses in vials of these reconstituted vaccines must be discarded within 6 hours.

Methods:

Key informant interviews (KIIs) were conducted with frontline HCWs in Senegal, Vietnam, and Zambia. In Senegal and Vietnam, the KIIs were conducted as part of broader formative research; in Zambia, KIIs were conducted in control districts using 10-dose MCV vials only and in intervention districts that switched from 10- to 5-dose vials during the study. During analysis, themes common to all 3 countries were synthesized. Critical themes relevant to country contexts were also examined.

Results:

HCWs in all 3 countries preferred containers with fewer doses for BCG and MCV to reduce wastage and increase the likelihood of vaccinating every eligible child. HCWs in Senegal and HCWs using 10-dose vials in Zambia reported sending unvaccinated children away because not enough children were present to warrant opening a new vial. In Vietnam, where sessions are typically held monthly, and in Zambia when the 5-dose vials were used, almost all HCWs reported opening a vial of MCV for even 1 child.

Discussion:

HCWs prefer vials with fewer DPC. Their concerns about balancing coverage and wastage influence their decisions to vaccinate every eligible child; and their perspectives are crucial to ensuring that all target populations are reached with vaccines in a timely manner.

Received: March 14, 2020.
Accepted: August 26, 2020.
Published: December 23, 2020.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00112

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