Decision-making process for introduction of maternal vaccines in Kenya, 2017–2018

• DOI: 10.1186/s13012-021-01101-7
• Publication Date: 2021-04-12T19:03:02Z
• Authors: Nancy A. Otieno; Fauzia A. Malik; Stacy W. Nganga; Winnie N. Wairimu; Dominic O. Ouma; Godfrey M. Bigogo; Sandra S. Chaves; Jennifer R. Verani; Marc-Alain Widdowson; Andrew D. Wilson; Irina Bergenfeld; Ines Gonzalez-Cas...; Saad B. Omer
• Keywords: Medicine (General); Public relations; Epidemiology; Public policy; Economics; FOS: Political science; Social Sciences; Nursing; FOS: Health sciences; 03 medical and health sciences; R5-920; 0302 clinical medicine; Sociology; Qualitative research; Health Sciences; Humans; Government (linguistics); Health services research; Political science; Economic growth; Global Maternal and Child Health Outcomes; Vaccines; Public health; Immunization Programs; Research; Health Policy; Vaccination; Infant, Newborn; Linguistics; Policy implementation; Social science; Kenya; Health policy; FOS: Sociology; FOS: Philosophy, ethics and religion; 3. Good health; Philosophy; Health; Pediatrics, Perinatology and Child Health; FOS: Languages and literature; Factors Affecting Vaccine Hesitancy and Acceptance; Medicine; Vaccination Intention; Maternal vaccines; Influenza Virus Research and Epidemiology; Policy formulation; Decision-making

Abstract Background Maternal immunization is a key strategy for reducing morbidity and mortality associated with infectious diseases in mothers and their newborns. Recent developments in the science and safety of maternal vaccinations have made possible development of new maternal vaccines ready for introduction in low- and middle-income countries. Decisions at the policy level remain the entry point for maternal immunization programs. We describe the policy and decision-making process in Kenya for the introduction of new vaccines, with particular emphasis on maternal vaccines, and identify opportunities to improve vaccine policy formulation and implementation process.

Methods We conducted 29 formal interviews with government officials and policy makers, including high-level officials at the Kenya National Immunization Technical Advisory Group, and Ministry of Health officials at national and county levels. All interviews were recorded and transcribed. We analyzed the qualitative data using NVivo 11.0 software.

Results All key informants understood the vaccine policy formulation and implementation processes, although national officials appeared more informed compared to county officials. County officials reported feeling left out of policy development. The recent health system decentralization had both positive and negative impacts on the policy process; however, the negative impacts outweighed the positive impacts. Other factors outside vaccine policy environment such as rumours, sociocultural practices, and anti-vaccine campaigns influenced the policy development and implementation process.

Conclusions Public policy development process is complex and multifaceted by its nature. As Kenya prepares for introduction of other maternal vaccines, it is important that the identified policy gaps and challenges are addressed.