We have proposed new performance indicators of the existing childhood vaccination programme and that the introduction of new vaccines into the programme should be accompanied by testing the real-life effects of the vaccines. 


Currently, vaccination programme performance is assessed by 12-months vaccine coverage


However, this focus on coverage is based on the assumption that we know the full effect of the
vaccines. It comes as a surprise to most people that, with exception of pneumococcal vaccine (Cutts et al, 2005), effects of vaccines on mortality were not tested before the vaccines were introduced.


In a planned project, we will ensure that the introduction of new vaccines into the vaccination programme in Guinea-Bissau is accompanied by studies testing their real-life effects on child health and assess how the implementation of the current vaccination programme may be optimised.

Prior studies indicate that focussing on coverage by 12 months of age does not reveal timeliness of
vaccines, might fall short in terms of potential gains (view case study), or might even cause
harm (Fisker et al, 2018). Through Bandim Health Project’s Health and Demographic Surveillance System (Thysen et al, 2019) we have been able to describe how the implementation of the vaccination programme deviates from the planned programme  (Fisker et al, 2014), the effects thereof (Fisker et al, 2018, Fisker et al, 2014b) and the reasons behind.


To improve the implementation of the programme, we have proposed new performance indicators
associated with better survival (Fisker et al, 2018b): coverage of BCG vaccine by 1 month and proportion of children receiving measles vaccine after the third dose of diphtheria-tetanus-pertussis vaccine (DTP). 

In Guinea-Bissau, we will assess the impact of promoting the new performance indicators on the
current vaccination programme and how changing the indicators affects child health. We will examine whether the links between child mortality, timeliness of vaccination and order of vaccines documented in Guinea-Bissau can also be found elsewhere through studies in Burkina-Faso and other low-income countries.


In the future, more vaccines will be included in the vaccination programme. We will ensure, that such changes are accompanied by studies assessing the effect and that, where possible, the implementation is gradual, as opposed to non-monitored full scale implementation.


The project is supported by an Ascending investigator grant from Lundbeck Foundation and a Sapere Aude grant from Independent Research Fund Denmark .