From research to impact: How VACFA is transforming vaccine policy in Africa

This year’s World Immunization Week, a global public health campaign, is themed: “Immunization for all is humanly possible”. This slogan echoes the vision of the University of Cape Town’s Vaccines for Africa Initiative (VACFA) of creating an African continent free of vaccine-preventable diseases. The work of VACFA, established in 2005, spans research, postgraduate training, capacity building and technical support across numerous African countries.

Based at the university’s Institute of Infectious Disease and Molecular Medicine, VACFA’s work is made particularly effective through its ability to link research to policy and practice. The unit doesn’t pursue research only for the sake of academic publishing, it conducts research to drive impact.

“At VACFA, we pride ourselves on serving as the bridge between research and translation,” said Dr Benjamin Kagina, co-director of the initiative. “This allows us to identify bottlenecks in translating research evidence into policy and respond accordingly.”

Their research and other work thus spans from very specific vaccine programmes, such as prenatal and infant vaccination regimens or the eradication of a particular virus, to supporting national policy frameworks through evidence-based research and capacity building.

Understanding attitudes and decision-making around vaccines in pregnancy

Dr Imen Ayouni, a PhD researcher at VACFA, is working to understand the attitudes and decision-making process of pregnant women in the Western Cape towards vaccines that protect both moms and their babies during pregnancy.

A useful finding in Dr Ayouni’s research however is that women trust their healthcare workers. And often if their midwife or nurse in the clinic advises them to take a particular vaccine, they are more likely to comply.

“Understanding how pregnant women make decisions — and how we can better support them with accurate information and accessible services — is crucial for the future success of maternal immunisation programmes.”

“Vaccines are one of the most effective tools to protect maternal and child health,” said youni, “but we are finding that acceptance varies dramatically between different vaccines.”

Her mixed-methods research explores the uptake of maternal vaccines like tetanus, influenza and the newly introduced DTaP (which includes protection against diphtheria, pertussis and tetanus).

Her research shows that attitudes towards vaccines are nuanced and differ according to vaccines. A key finding in her work is the role and influence healthcare workers play as a trusted source of information around vaccines.

“We found that even when women were totally against vaccines, if their healthcare worker in the clinic took the time to explain to them how important the vaccine is for the safety of their baby the women would often then choose to take the vaccine,” explained Ayouni.

This, she said, shows the importance of evidence translation to healthcare workers. While they are not vaccinology or public health experts, they evidently hold a lot of influence.

“Understanding how pregnant women make decisions — and how we can better support them with accurate information and accessible services — is crucial for the future success of maternal immunisation programmes,” she said.

Birth dose vaccine to eliminate Hepatitis B in South Africa

South Africa has a very high burden of hepatitis B, a viral infection spread through blood contact. Once a child is infected, they have a 90% chance of that infection progressing to a lifelong chronic infection with a high risk of developing liver cancer and liver failure in adulthood.

The introduction and rollout of the hepatitis B birth dose vaccine in South Africa is a major step in the country’s efforts to eliminate the disease as a public health threat by 2030. The SAFE BABE (Feasibility of the South African Selective Hepatitis B Birth Dose Vaccination Programme) study is led by Dr Edina Amponsah-Dacosta, a research officer at VACFA. She is investigating whether South Africa’s selective approach to birth-dose delivery, rolled out in 2024, can effectively reach all babies who need the intervention the most.

Historically, South Africa did not include a hepatitis B vaccine at birth, opting instead for infant vaccinations at six, 10 and 14 weeks. But with global momentum behind eliminating mother-to-child transmission, this new programme fills a critical gap.

Under a selective approach, only babies born to mothers who have tested positive for hepatitis B during pregnancy will receive the vaccine at birth. A deviation from the World Health Organization’s recommended universal approach which targets all babies regardless of their mothers’ status.

Dr Amponsah-Dacosta said this deviation is likely due to the cost of the universal rollout and has some challenges.

“There are a lot of moving parts with the selective strategy,” she said. “The pregnant mother needs to be tested during the antenatal visit then tracked and given her results. And the health facility where she gives birth needs to be equipped to give the hepatitis B dose at birth.”

The SAFE BABE study is assessing how feasible it is to implement this approach in real-world settings, considering healthcare worker attitudes, sociocultural beliefs, cost-effectiveness, and logistical barriers that may impact successful rollout.

Shaping policy environment for vaccines across Africa

VACFA also plays a unique and influential role in shaping the policy environment for vaccines across Africa. Each country should have a National Immunisation Technical Advisory Group (NITAG), which provides scientific, evidence-based and independent advice to national Ministries of Health. These advisory groups are essential for ensuring that vaccine policies are tailored to local contexts, based on science and financial sustainability. However, many African countries lack optimal resources to support the work of NITAGs, including the much-needed technical work expected from them.

“VACFA works directly with these groups in Africa to help build the technical capacity needed to provide independent, evidence-based guidance to Ministries of Health… the only such course tailored to NITAGs in the world.”

Through the NITAG Support Hub (NISH) project, VACFA works directly with these groups in Africa to help build the technical capacity needed to provide independent, evidence-based guidance to Ministries of Health. The NISH activities include annual vaccinology training for NITAGs, the only such course tailored to NITAGs in the world. VACFA also uniquely tailors its research endeavours to generate the robust local evidence these groups need to make context-specific vaccine recommendations.

From research and capacity building at the various stages and phases of vaccine implementation on the ground to work guiding overarching national policy around vaccination programmes, VACFA is an exemplar of the National Immunisation Week theme, making universal vaccine access not just a vision, but part of Africa’s future.