Evaluation of the first malaria vaccine introduction: ongoing learning opportunities during the introduction into routine immunisation in Cameroon

Abstract

BACKGROUND: Cameroon is the first country to introduce malaria vaccine (MV) into routine immunisation, following the pilot programme. The vaccine was introduced in 42 health districts across all 10 regions, with plans to scale up in additional districts in future. A mini-postintroduction evaluation (mini-PIE) was conducted to rapidly review the MV programme, make improvements and inform future strategies. METHODS: A programme evaluation was conducted using desk review and field data collection with standardised interviews of immunisation staff and caregivers. A facilitated discussion was then conducted with key immunisation and malaria staff and partners using WHO intra-action review methodology. RESULTS: The desk review found that completeness of monthly reports exceeded 95% in all regions in April 2024 except North-West and Adamawa (87%). Only 56% of eligible children received their first dose; however, coverage of the second and third doses was 31% and 28%, respectively. All 10 regions had high drop-out rates. Based on field data collection, 8 of 10 health facilities received communications materials for community awareness. Among caregivers interviewed, 88% (42/48) were aware of MV introduction (MVI); 60% (29/48) were informed by health workers and 81% (39/48) cited vaccine protection as the main reason to vaccinate children. 60% (29/48) knew the importance of continuing to use long-lasting insecticidal nets after malaria vaccination. During the facilitated discussion, 65% (n=37) of participants totally agreed that the mini-PIE methodology used was an effective way to identify challenges and lessons learnt. CONCLUSIONS: Cameroon's MVI was largely successful, despite vaccine misinformation, demonstrating the importance of community dialogue and engagement in successful vaccine introduction. The mini-PIE methodology is recommended for other countries to adopt 4-6 months after introduction, including field work tailored to country needs and thorough desk review of key indicators conducted in advance to inform the facilitated discussion.