Global considerations on maternal vaccine introduction and implementation

Abstract Despite the substantial progress over the past two decades in reducing under-five deaths, progress in protecting newborns has been comparatively slower. A priority of the United Nations Sustainable Development Goals is to end preventable newborn deaths by 2030. One of the main causes of mortality in this group is infection, therefore, maternal immunization has emerged as a key intervention and strategy to address this problem. Maternal tetanus vaccination provides the proof of concept for successfully administering vaccines during pregnancy and as a strategy to prevent neonatal deaths. Maternal tetanus vaccination programs have also provided an opportunity to understand the operational challenges that may hamper achieving high vaccine coverage. Operational challenges, along with significant gaps in local burden of disease data, have become evident with maternal influenza vaccine programs that are not yet widely introduced in low and middle-income countries. Tetanus and influenza vaccination demonstrate the relevance of careful planning an implementation of national immunization strategies, and also inform on the impact that vaccine hesitancy can have on the uptake of vaccine by pregnant women. With regards to implementation planning, identifying the optimal service delivery must include defining the optimal timing of vaccination during pregnancy and platform of service delivery, including a careful assessment of existing service delivery capacity. Furthermore, it is crucial to identify and address questions and concerns among pregnant women as well as among health care workers. With the emergence of new vaccines for use during pregnancy, such as Group B Streptococcus and Respiratory Syncytial Virus, other key issues common to all maternal vaccines need to be considered during implementation. Such issues include education, training and communication of key target groups including pregnant women and health workers. In addition, policy makers often rely on disease burden data to estimate the potential magnitude of benefit when deciding on the introduction of a new vaccine. This information is also crucial to inform the effect after implementation of the vaccine strategy. In addition to the key information required for policy makers, the education and training requirements, implementers need also to develop clear plans including capacity for maintaining supply and cold chain requirements, dosing recommendations and optimal service delivery in the context of antenatal care practices. Finally, ensuring safety vigilance, and evaluation of the proportional benefit to the mother and/or newborn is essential to ensure safe and sustainable use of vaccines in pregnant women.