1. Collaborative Efforts

· Malawi’s Success Story: In Malawi, the collaboration between the Ministry of Health, CSOs, and other partners like the Malawi Health Equity Network (MHEN) was essential for a successful rollout. Hannah Hausey, a Senior Immunization Technical Advisor from Malawi, shared that CSOs not only helped mobilize financial resources but also played a critical role in community-level engagement, ensuring that the vaccination program reached even remote areas. The use of mother care groups, who went door-to-door to monitor children’s vaccination statuses, significantly improved coverage. Hannah Hausey explained, “These women played a critical role, revising their tools to ensure that malaria vaccines were included, which helped improve the uptake for doses one, two, and three.”

· Community Mobilization in Cameroon: In Cameroon, Dr. Bizong, the Regional Technical Coordinator for the Fight Against Malaria, shared that CSOs worked closely with government health programs to support vaccine rollout, especially in hard-to-reach and conflict-affected regions. The partnership with faith-based organizations

like the Cameroon Baptist Convention Health Services ensured the vaccine reached communities that were otherwise difficult to access. Dr. Bizong noted, “The collaboration between the malaria program and expanded immunization programs improved our reach into these communities, ensuring they were informed and motivated to bring their children for vaccination.”

2. Communication and Behavioral Change

· Addressing Misinformation: Across both Malawi and Cameroon, one of the greatest challenges was misinformation. After COVID-19, many communities believed that the malaria vaccine was linked to the COVID vaccine, which hindered initial uptake. Dr. Gordon explained that CSOs played a vital role in dispelling these rumors and promoting accurate information about the vaccine’s safety and efficacy.

· Strategic Communication in Malawi: Malawi employed interpersonal communication strategies, using trusted local leaders to relay messages about the importance of the vaccine. However, Hannah Hausey noted that due to limited resources, the program could not rely on mass media. This made reaching every community a slow and arduous process. The CSOs’ work with local care groups became even more essential in this context.

3. Reaching Hard-to-Reach Communities

Dr. Eugene, from Cameroon Baptist Convention Health Services, highlighted the work of CSOs in conflict-affected and remote areas. Through close collaboration with community leaders and local churches, CSOs ensured vaccine accessibility in fragile districts, where healthcare infrastructure was limited. Dr. Eugene explained: “We know where the children are, and through close engagement with religious leaders and community groups, we ensured that these communities were not left behind.”

1. Dropout Rates and Loss of Health Profiles

· In both Malawi and Cameroon, dropout rates between the first and fourth doses of the malaria vaccine were alarmingly high. In Cameroon, Dr. Andreas shared that the dropout rate from the first to the third dose was over 50%, with many children failing to receive the fourth dose. Similarly, Malawi struggled to ensure that children returned for the later doses. Hannah Hausey cited challenges with caregivers losing

child health profiles, which made it difficult to track vaccination statuses. Dr. Andreas noted: “One of the biggest hurdles has been maintaining the momentum from the first dose to the fourth, especially since the fourth dose is administered at 22 months, outside the typical first-year vaccination schedule.”

2. Vaccine Supply and Equity

· Initially, vaccine supply limitations meant that only select districts in high-prevalence areas could receive the malaria vaccine. Dr. Gordon explained that, as vaccine supplies have increased, countries like Malawi are now planning to expand the vaccine to additional districts. This expansion is critical for achieving vaccine equity.

· Resource Mobilization: Both Malawi and Cameroon faced challenges with securing enough funding to implement widespread communication and community engagement strategies. Hannah Hausey mentioned that there were “too few CSOs engaged to provide support for the malaria vaccine, and this limited the reach of community mobilization efforts.”

3. Second-Year Life Immunization

· The malaria vaccine’s fourth dose is administered at 22 months, which falls outside the traditional first-year immunization schedule. This has proven challenging, as many caregivers do not return to health centers after the child’s first year. CSOs have worked to close this gap by emphasizing the importance of all four doses in community outreach campaigns.

1. Strengthen CSO-Government Collaboration

CSOs must continue working closely with Ministries of Health to address coverage gaps, especially in remote areas. Dr. Eugene highlighted the importance of working together from the planning stage: “We need inclusive engagement that reflects the needs and realities of the communities.”

2. Integrated Health Services

CSOs and governments should work to integrate malaria vaccines with other health services, such as nutrition programs and growth monitoring, to ensure regular contact

between caregivers and health workers. Dr. Gordon suggested aligning vaccination touchpoints with other health services, such as vitamin A distribution and early childhood screenings, to encourage parents to bring their children back to health centers.

3. Addressing the Dropout Rate

To address the significant dropout rate, CSOs should enhance follow-up mechanisms, using digital tools such as SMS reminders and setting up community tracking systems. Community leaders should also organize fixed vaccination days at accessible locations like markets or churches to make the process more convenient for caregivers.

4. Continuous Funding for CSO-led Initiatives

Increased funding is essential for CSOs to continue their work in educating and mobilizing communities. More financial support would allow CSOs to scale their operations and reach more remote areas.

5. Engage Women and Religious Groups

CSOs should continue leveraging women’s groups and religious organizations to engage communities. Women’s care groups in Malawi proved effective in promoting vaccination uptake, while faith-based organizations in Cameroon were instrumental in accessing conflict-affected regions.