Influenza Vaccination Programs in Sub-Saharan Africa-Forging a Path for Decision-Making

Abstract

New Global Burden of Disease estimates attribute nearly 2% of all-cause mortality during the first five years of life to influenza. Of influenza deaths, 99% are estimated to occur in low and middle income countries. Effective influenza vaccines have been available for decades, but their use in sub-Saharan Africa has been limited. Lack of data on seasonal influenza in the region has left questions regarding risk groups and disease burden largely unanswered. Sub-Saharan African countries have limited expertise with data on influenza epidemiology and with influenza vaccines. Such regional capacity must be strengthened if countries are to make the best evidencebased decisions about influenza vaccine use and to maintain a sense of program ownership. A regionalization of efforts would be the most realistic and feasible approach for future influenza vaccine policy consideration as it would leverage individual country strengths and capacities. The pathway for influenza vaccine introduction in sub-Saharan Africa could be as follows: (i) strengthening laboratory capacity and influenza surveillance; (ii) conduct of research studies, such as burden studies, in a few key countries; (iii) improved communication of data; (iv) development of policy strategies; (v) building vaccine production capacity; (vi) identification of financing and development of political will; (vii) and reliance on well-informed technical advisory committees. Additional concerns regarding influenza vaccine implementation include capacity to administer vaccine outside of existing routine immunization systems, program sustainability, and the importance of local and regional program control. Successful introduction of sustained influenza vaccination programs into the sub-Saharan African region will require adherence to a clear plan that includes strong evidence-based decision-making processes, evidence of operational feasibility, and assurances of sustainability.