Case Study C

Understanding vaccine production, distribution and uptake in Ghana and Uganda

Prof. Beate Kampmann, Dr. Hanna-Tina Fischer (Charité Universitätsmedizin Berlin, Germany)

Prof. Uli Beisel, Dr. René Umlauf (Freie Universität Berlin, Germany)

Prof. Augustina Koduah (University of Ghana, Ghana)

Dr. Suzanne Kiwanuka (Makerere University, Uganda)

Prof. Johanna Hanefeld (Robert Koch Institute, Germany)

Prof. Reinhard Busse, Dr. Elke Berger (Technische Universität Berlin, Germany)

Dr. Daniel Opoku (Kwame Nkrumah University of Science and Technology (KNUST) , Ghana)

Rationale

While the AU proclaimed a bold framework that envisions Africa to manufacture 60% of its vaccines locally by 2040 others have strongly cautioned expectations given the complexities involved in creating sustainable vaccine markets (Welcome Trust 2023). In our case study we argue that understanding the African Union’s and national government plans to establish vaccine manufacturing facilities across the continent requires a thorough understanding of the context of vaccine distribution and uptake in Africa which has traditionally been strongly shaped by donor driven policies across the entire vaccine value chain. Changes in often fragmented national vaccine ecosystems will have significant impact on stakeholders and institutions as well as distribution infrastructures (e.g. cold chains) and acceptance rates at frontline facilities.

Main Research Questions

1
How are vaccine cold chains organized, managed and integrated into national (routine) immunization programs? How do cold chains affect and impact local vaccine manufacturing? And how do they affect handling and administration of vaccines at front line facilities?
2
What determines the dynamics of public trust in vaccines? Are national policies able to shape trust and accessibility to vaccines?
3
Can Health Technology Assessment (HTA) be adapted - by using additional data sources and evaluation dimensions - so that vaccine-related decisions are locally grounded, context-sensitive, and capable of addressing Africa's specific health challenges?

Methods

Interdisciplinary methods.
Involving transdisciplinary stakeholders at each stage (see figure).
Mixed-methods approach, combining qualitative and quantitative techniques.
Semi-structured interviews with key informants and stakeholders, participant observation.
Survey among stakeholders.
Focus group discussions with health workers, patients and communities.
Social listening and sentiment analysis.
Discrete choice experiment, policy scenario analysis.
Predictive modeling.
Health Technology Assessment (HTA).

Expected Outcomes

Increased understanding of different valuations of first and second order infrastructures and their interaction.
Detailed understanding of dynamics of public trust in vaccines in Ghana.
A framework of the social determinants of vaccine trust in imported versus locally produced vaccines.
A modified HTA approach (incl. additional data sources, evaluation dimension) increasing the acceptability and quality of decision-making.

Work Packages

Vaccine Cold Chain

Vaccine Uptake And Acceptance

Health Technology Assessement (HTA)