Phased introduction

Nationwide implementation of a vaccine is usually preferred because of economies of scale, equity considerations, and the larger impact expected with a national introduction. However, in large countries, the complexities and potential lack of experience in providing vaccines to pregnant women may be a barrier to introducing influenza vaccine to this group. A phased introduction, in one or several districts with different characteristics (e.g. urban/rural, high/low coverage), can help to identify potential bottlenecks and facilitate the subsequent scale-up at national level.

A phased introduction delivering influenza vaccine on a small scale may be useful to:

• test programmatic feasibility by determining the costs of vaccine introduction as well as the human and financial resources needed to support optimal delivery;
• pilot and refine training and communication plans and materials to fit the local context;
• determine and test strategies on how to best access pregnant women and monitor vaccination in this group;
• provide a proof of concept for the proposed delivery strategies when current national capacities can support only a limited number of provinces or districts and demonstrating proof of concept may serve to secure external funding;
• evaluate attitudes, acceptability and barriers in the community, pregnant women, and among health professionals – to help refine communication strategies.