What does new maternal vaccine delivery look like?

January 4, 2024 by Sadaf Khan and Jessica Fleming

As more vaccines intended to be given in pregnancy become available, PATH is conducting research in Africa to gain a fuller picture of adoption readiness.

A community clinic in Kalulushi, Zambia

A community clinic in Kalulushi, Zambia, displays posters sharing information on various health care topics, including safe motherhood and disease prevention. Photo: PATH/Gena Morgan.

Vaccination in pregnancy, or maternal immunization, isn’t new.

In fact, it’s helped most countries around the world eliminate maternal and newborn tetanus and is also used against diseases like COVID-19, influenza, and whooping cough (albeit mostly in higher-income countries). It works by enhancing maternal antibodies that then pass through the placenta to the baby, protecting in early life when some infections are particularly dangerous given infants' immature immune systems.

Despite a successful track record, maternal immunization is not widely available beyond tetanus prevention in most settings, including in Africa. Now, however, new maternal vaccines are advancing in development and achieving licensure against diseases that have historically had limited or no prevention options, especially for young infants. Their delivery to pregnant populations will require coordination across immunization and antenatal care (ANC) programs, likely in new ways for many countries.

Having lifesaving tools like these on the horizon underscores the urgency of closing the maternal immunization access gap, which hinges in no small part on countries being primed and ready for adoption.

To support decision-making around maternal vaccine adoption, PATH is conducting a new study in 2024 that will explore delivery requirements in different African contexts—Ghana, Senegal, Tanzania, and Zambia. The research will support a more complete understanding of the decision-making drivers and issues around implementation feasibility as countries consider adding new maternal vaccines to their public health agendas.

New maternal vaccines and their nuances

Scientific breakthroughs in the past decade have resulted in a maternal vaccine development cascade out of which products come with some delivery nuances likely to be outside the norm of processes for pediatric vaccine delivery for many countries.

One of these products is the first-ever respiratory syncytial virus (RSV) maternal vaccine, which achieved European and US licensure in 2023. Its approval marks a huge milestone toward addressing an important, but somewhat neglected virus, that causes more severe infant respiratory infections and hospitalizations annually than any other pathogen worldwide. Though only available in wealthy nations for now, efforts are underway to broaden the vaccine’s availability globally.

Other maternal immunization products include vaccine candidates in development against Group B Streptococcus (GBS), which, if successful, could provide groundbreaking protection against the world’s leading cause of sepsis and meningitis in newborns.

These vaccines have the potential to improve infant health and survival but come with nuanced challenges. For instance, they will likely be given during ANC visits, so maternal health programs and immunization programs will need to coordinate to ensure smooth delivery. Moreover, new maternal vaccines are designed to be given during specific gestational age windows in the late second or third trimesters of pregnancy to optimize protection for the baby—making vaccination timing more complicated than usual. Tetanus vaccines, for instance, can be given any time during pregnancy.

Additional potential challenges include low awareness about relevant diseases (e.g., RSV and GBS); unknown acceptability of new maternal vaccines in communities and among health workers; other competing public health priorities in an already crowded vaccine landscape and stretched ANC system; workforce readiness; and so forth.

PATH’s study will help characterize these challenges in specific country contexts and contribute to the knowledge base of maternal vaccine delivery requirements for low- and middle-income economies.

The lifesaving potential of these tools underscores the urgency of closing the maternal immunization access gap, which hinges in no small part on countries being primed and ready to adopt.

What we’re trying to learn

To help identify practical areas that can be addressed to improve adoption readiness, PATH teams in Ghana, Senegal, Tanzania, Zambia, and the US will collaboratively assess the current state of ANC and immunization programs across the healthcare hierarchy in each African country. Informing our research will be the following stakeholders across immunization and maternal health programs:

  • National (policymakers and program managers)
  • Subnational (district program managers, health care providers across the continuum of care)
  • Community (pregnant and recently pregnant women, family, community health workers, and community/religious leaders).

Several areas of inquiry will guide our research, which we’ll conduct via stakeholder interviews, facility assessments across different tiers of the health system, and focus group discussions in communities.

How ready is the ANC platform to deliver vaccines?

We will be assessing the suitability of the ANC platform for maternal immunization delivery in each country. In short, we’ll look at what ANC and immunization systems would need to change programmatically to successfully introduce a new maternal vaccine. We’ll also explore how delivering maternal vaccines might impact these systems positively or negatively.

How well do ANC visits align with vaccination gestational age windows?

We will examine current ANC visit timing alignment with recommended gestational age windows for vaccination and what might need to change to achieve optimal timing. We’ll also assess how many patients are participating in ANC sessions to gain a better handle on vaccine coverage potential.

How do stakeholders feel about new maternal vaccines?

We will talk with stakeholders across the continuum of pregnancy care and immunization to identify their knowledge, attitudes, perceptions, and practices around quality of pregnancy care, maternal immunization, and relevant diseases. Information gathered will clarify how well new maternal vaccines may be accepted when considering adoption.

Steps toward a feasible future

Maternal immunization is a powerful public health intervention. Even greater impact could be achieved by harnessing synergies in maternal immunization delivery approaches that address additional diseases, improve the quality of overall ANC, and reach pregnant populations more broadly in underserved communities.

From the information we will gather via this multi-country study, we envision actionable steps to emerge that will support progress to this end—and a better future for infant and maternal health.

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