London School of Hygiene & Tropical Medicine

The study "Evaluating the contribution of sociodemographic characteristics and geographic access to immunization service points on TIMEliness and deLaYs in infant vaccinations in The Gambia (TIMELY study)” was led by a group of researchers from the MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine and lasted for 33 months – October 2020 to July 2023. The purpose of the study was to understand if children in The Gambia were getting their vaccines on time according to the national childhood vaccine schedule. It was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP) and the results were published in both PLOS ONE and VACCINE. The study found delays with all recommended childhood vaccines, with the Hepatitis B vaccine having the most delays. It also identified areas in the Upper and Central River regions where late vaccinations occurred more frequently than elsewhere.

The workshop took place on Thursday, August 17, 2023, at the Ocean Bay Hotel in Bakau and was attended by representatives from the National Expanded Program on Immunization (EPI), World Health Organisation (WHO) and all Regional Health Teams across the country.

Mr. Sidat Fofana, the Expanded Program on Immunization (EPI) Program Manager, and Prof. Beate Kampmann, co-senior author of the study gave welcoming remarks. Mr. Fofana emphasized the importance of the Timely Study and said, “Studies like this will help focus our attention on the importance of timely vaccination. High coverage in the absence of timeliness yields very little impact and this critical information for policy makers,” he concluded.

Prof. Beate Kampmann’s welcoming remark noted the linkage between research and big data. She underscored the importance of using data and analytics to optimize public health outcomes and reduce the burden of preventable diseases.

Dr. Oghenebrume Wariri, lead researcher, stated that "vaccination timeliness matters because vaccines have to be given at the right time for them to work effectively in order to prevent infections and disease outbreaks." He went on to highlight that the burden of vaccination timeliness in The Gambia is significant, particularly with the Hepatitis B vaccine, which had delays for more than nine out of every ten children who received it late.

A session headed by Dr. Uduak Okomo engaged participants on challenges and solutions in delivering vaccines in a timely manner. Some of the challenges highlighted were the lack of effective communication with mothers and caregivers, distance for mothers living in borderline communities having to travel to neighboring countries to breastfeed and return, inaccessibility of some health posts during the rainy season and facilities running out of stock. According to Dr. Okomo, “different strategies should be used to tackle delays.” She added that women should be reminded of their next visit and facilities should be empowered to deliver.

Dr. Wariri further mentioned that certain districts and wards within the Upper and Central River regions of the country were found to have more issues with late vaccinations. In terms of the impact of COVID-19 on vaccination timeliness, he reported that there was a drop in the number of children who received their vaccinations late, especially after the first year of the pandemic. However, there was an increase in the number of children who were vaccinated too early.

Lastly, Dr. Wariri discussed ongoing and future work on vaccination timeliness in The Gambia. He stated that the upcoming project, funded by the US National Institute of Health (NIH), aims to observe any changes in the untimely vaccination trend discovered in the most affected districts and keep a close eye on districts with zero-dose children, that is who are not receiving any vaccines at all.