Establishing and Utilizing Strategic Partnerships for Vaccine-Preventable Diseases: Best Practices in Haiti

"Internal and external communications are important tools for vaccine campaigns."

This article outlines a model for effective partnerships for vaccines, a model that can transcend response to specific diseases and apply to all global health partnerships. It does so by summarising the presentations and conclusions of a March 2016 conference in Port-au-Prince, Haiti, that brought together Ministry of Health officials, researchers, clinicians, academics, public health professionals, and other stakeholders to discuss vaccine programmes and policies in Haiti.

Infectious diseases cause up to 63% of deaths in low- and middle-income countries (LMICs) like Haiti. Many of these infections are vaccine preventable. However, there are a variety of barriers preventing access to health services and immunisation. Participants in the March 2016 meeting, which was hosted by the Ministère de la Santé Publique et de la Population (MSPP, the Ministry of Public Health and Population of Haiti) and the Global Health Initiative at Henry Ford Health System, agreed that a global collaborative is needed to assist in developing initiatives to overcome barriers to prevention and control. Governmental agencies and ministries, non-governmental organisations (NGOs), academia, and community-based organisations (CBOs) can get involved by providing education and preventive care, conducting applied vaccine research, assuming institutional responsibility for maximising the health of a defined population, developing expertise in deployment of health resources, providing advocacy and equity for the health of the population, and creating a global health risk framework.

The article examines social and behavioural research for community-based vaccine trials and vaccine introduction. As noted here, multi-level community engagement needs to be fostered throughout planning, implementation, and dissemination phases of vaccine trials, demonstration projects, and introduction. Levels of trust and concerns about vaccines demand an understanding of historical experiences and socioeconomic contexts. Examples are provided to illustrate the importance of community research and outreach prior to and during vaccine trials and demonstration projects in order to target specific challenges by site, meet local needs, and be responsive to community concerns and questions. Factors associated with participation include general healthcare utilisation patterns and trust of the local health system and health workers.

Two examples of large partnerships relating to vaccines include safety studies for the Ebola vaccine and Pink Ribbon, Red Ribbon. As part of the latter, Zambia is launching a human papillomavirus (HPV) immunisation programme. Partnerships can provide leadership, funding, skills, teaching capabilities, equipment, and, particularly, enthusiasm. Partners in these examples are notable for:

• Articulating one very clear, concise, and compelling goal to create focus, momentum, and excitement;
• Establishing accountable leadership, which encompasses being courageous, collaborative, credible, trustworthy, and transparent;
• Engaging partners by defining needs and understanding and leveraging diverse capabilities and contributions;
• Formalising commitment and delineating what it means to be a partner, including creating a detailed action plan;
• Developing transparent milestones and measures (e.g., at least 1 impact measure) that focus on action, with the realisation that milestones will evolve over time; and
• Ensuring regular communication, including all existing and potential stakeholders to share best practices and lessons learned.

In short, characteristics of effective partnerships include those where stakeholders have a shared vision of success and collaborate to achieve a compelling goal, where innovation is encouraged, where resources and rewards align with desired results, where results are measured and transparent, and where information is shared and learning occurs.

In addition to describing the surveillance of vaccine-preventable diseases (VPDs) in Haiti, the article looks at the country's Expanded Program on Immunization (EPI) and its logistical and funding challenges. Despite these challenging circumstances, the EPI has gradually increased vaccine coverage in Haiti because of close collaboration and support from strategic partners. However, Haiti has never caught up to regional or global levels, and socioeconomic disparities remain. Among the recommendations to strengthen EPI's sustainability: knowledge transfer and advocacy to improve national ownership.

The EPI, in collaboration with the Directorate of Health Promotion and Environmental Protection, has developed communication strategies in an effort to reach populations most vulnerable to VPDs, as well as those who have influence over social norms and can make the environment more favourable to behaviour change and vaccine promotion. The mass media approach includes audio and video materials (documentaries, press conferences), print materials (journal articles, bulletins, posters, billboards), and electronic materials (website). Community approaches include community meetings, household visits, and community mobilisation. As reported here, the EPI's strengths in regard to communication include: the availability of a multi-year plan; the existence of data on the knowledge, attitudes, and practices of the population; the public's positive attitude toward vaccination; and the availability of daily vaccination services in the majority of institutions. Challenges include insufficient resources for social mobilisation activities and routine communication, as well as institutional challenges (e.g., long wait times resulting in less vaccination). In the estimation of the authors, more communication strategies are needed to raise awareness about vaccination benefits and adhering to the vaccine calendar, especially in communities with poor vaccination coverage. One planned strategy is to launch interpersonal communication activities with mothers when they visit health centres with their children. Other solutions include reactivating the technical committee on communication, as well as regularly updating the EPI's website, publishing press articles, and elaborating an internal communication plan.

After examining community approaches to vaccination in rural areas, the article looks at the role of partnerships in introducing various vaccines in Haiti: dengue, pentavalent and rotavirus, oral cholera, and HPV. For example, key lessons learned from the oral cholera vaccine pilot include the importance of following the ethics committee's recommendations, the need to continue to strengthen Haitian partners, and the need to increase participation of local partners in international scientific forums to share information.

In conclusion: "The Scientific Conference on vaccination in Haiti provided a forum for exchange, reflection, and counsel for the MSPP. The most important lesson is the ability to build on partnerships to achieve tangible mutual benefits....Ownership and leadership of the MSPP - and close collaboration with the community - are paramount to achieving success in vaccination strategies and reducing VPDs in Haiti. This model for partnership can be applicable to health challenges globally. Moreover, best practices learned from Haiti's experience can inspire new policy strategies for more effective health partnerships in the context of the global health security agenda."