Improving modes of delivery, deployment, and uptake of vaccines through phase IV/implementation research

Despite offering strong protection against infectious diseases, global vaccination rates have been declining for a few years resulting in the re-emergence of preventable infectious diseases that were thought to be on the verge of elimination. This trend further worsened during the COVID-19 pandemic because of severe interruptions in public health services, restrictions of non-urgent medical care and diversion of limited health care resources, resulting in cancellation or delays of routine vaccinations. Underserved communities in SSA have been most affected, leaving them less protected against vaccine-preventable diseases. Under immunised individuals and zero-dose-children (not having received any vaccine) are also found in other communities. Furthermore, there has been a significant erosion of trust in governments and public health institutions that coordinate and conduct such immunisation efforts. Novel logistical and clinical solutions for vaccine delivery and a better understanding of the behavioural barriers driving vaccine hesitancy in SSA as well as better data to document beneficial vaccine effects on individual and public health are therefore of critical importance. Furthermore, there remain open questions on the use of vaccines, also in view of changing environments.

Accordingly, the proposed research is expected to deliver on the following:

• Carry out phase IV/implementation research studies on the deployment and uptake of registered vaccines^[1] in SSA, examining operational aspects, access, coverage, vaccine acceptability/hesitancy, community engagement, real-life impact on overall health and cost-effectiveness;
• Develop and test novel logistical solutions for vaccination;
• As relevant, develop and test novel clinical solutions for vaccine delivery, including new delivery modes;
• Gain a better understanding of different health care systems in sub-Saharan Africa as regards the factors driving structural inequalities in vaccine deliveries;
• Identify the social, economic, political, religious, cultural, and personal factors driving vaccine hesitancy in SSA and develop targeted solutions, as appropriate. Vaccine hesitancy should be considered in the context of the specificities of different types of vaccines and their perceived risks and benefits. It is further essential to investigate the factors that are undermining coverage in different countries, regions, or communities both in terms of vaccine types and doses received. In many cases, this means targeted collaborations with local leaders who can effectively address their communities’ concerns and with caregivers who bring children to vaccination services. Applicants are also encouraged to develop evidence-based tools that can guide people towards informed vaccination decisions, delivering tailored information based on each user’s concerns;

Applicants need to concisely describe any prior research findings and explain how the proposal builds on these results. Building on relevant results from projects supported under previous EDCTP programmes is encouraged.

The implementation research to be conducted must involve vulnerable groups, including participants from poorer, underserved, or hard-to-reach communities in SSA. The full range of relevant determining characteristics (sex, gender, age, socio-economic status, etc.) needs to be considered. Applicants are also encouraged to provide methodologies for translating research findings into public health practice and policy guidelines. They are welcome to draw on any relevant lessons from the COVID-19 vaccination strategies.

Proposals are expected to come from research consortia with a strong representation of institutions and researchers from African countries, including involvement of franco/lusophone countries where possible and relevant.

The proposals should involve all stakeholders, most notably policy makers, public health authorities, health care professionals and end-users. The applicants must ensure strong community engagement. International cooperation is encouraged, and the proposed research is expected to be multidisciplinary through the involvement of medical sciences, psychological sciences, social sciences, and the humanities.

All projects funded under this topic are strongly encouraged to participate in networking and joint activities, as appropriate. These networking and joint activities could, for example, involve the participation in joint workshops, the exchange of knowledge, the development and adoption of best practices, or joint communication activities. Therefore, proposals are expected to include a budget for the attendance to regular joint meetings and may consider covering the costs of any other potential joint activities without the prerequisite to detail concrete joint activities at this stage. The details of these joint activities will be defined during the grant agreement preparation phase. In this regard, the Global Health EDCTP3 Joint Undertaking may take on the role of facilitator for networking and exchanges, including with relevant stakeholders, if appropriate.

^[1]It is recognized that the vaccines may not have a marketing authorization in the country or all the countries where the study is being carried out. Registered vaccines need to meet WHO-recommended standards of quality, safety and immunogenicity: Health products policy and standards (who.int)