title: Successive introduction of four new vaccines in Rwanda: High coverage and rapid scale up of Rwanda's expanded immunization program from 2009 to 2013.
abstract: As the pace of vaccine uptake accelerates globally, there is a need to document low-income country experiences with vaccine introductions. Over the course of five years, the government of Rwanda rolled out vaccines against pneumococcus, human papillomavirus, rotavirus, and measles & rubella, achieving over 90% coverage for each. To carry out these rollouts, Rwanda's Ministry of Health engaged in careful review of disease burden information and extensive, cross-sectoral planning at least one year before introducing each vaccine. Rwanda's local leaders, development partners, civil society organizations and widespread community health worker network were mobilized to support communication efforts. Community health workers were also used to confirm target population size. Support from Gavi, UNICEF and WHO was used in combination with government funds to promote country ownership and collaboration. Vaccination was also combined with additional community-based health interventions. Other countries considering rapid consecutive or simultaneous rollouts of new vaccines may consider lessons from Rwanda's experience while tailoring the strategies used to local context.
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda. Electronic address: gamaurice2003@gmail.com.
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.affiliation: Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhatt
authors.affiliation: Ministry of Health, Government of Rwanda, PO Box 84, Kigali, Rwanda.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Utamuliza
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Hassan
authors.initials: H
authors.lastname: Sibomana
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda; Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, P.O. Box, Basel, 4002, Switzerland.
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.affiliation: Ministry of Health, Government of Rwanda, PO Box 84, Kigali, Rwanda.
authors.forename: Cathy
authors.initials: C
authors.lastname: Mugeni
authors.affiliation: Partners In Health, 3rd Floor, 888 Commonwealth Avenue, Boston, MA 02215, USA.
authors.forename: Cameron T
authors.initials: CT
authors.lastname: Nutt
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.affiliation: Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Wagner
authors.affiliation: Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Ministry of Health, Government of Rwanda, PO Box 84, Kigali, Rwanda; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D003142:Communication; D003150:Community Health Workers; D005544:Forecasting; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D008458:Measles Vaccine; D053918:Papillomavirus Vaccines; D022242:Pneumococcal Vaccines; D011156:Population Density; D022243:Rotavirus Vaccines; D012411:Rubella Vaccine; D012432:Rwanda; D014611:Vaccination / Q000706:statistics & numerical data*; D014612:Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D017778:Vaccines, Combined
chemical_list: D008458:Measles Vaccine; D053918:Papillomavirus Vaccines; D022242:Pneumococcal Vaccines; D022243:Rotavirus Vaccines; D012411:Rubella Vaccine; D014612:Vaccines; D017778:Vaccines, Combined
keywords: Immunization; Implementation science; Rwanda; Sub-Saharan Africa