{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:39:51Z","timestamp":1790930391314,"version":"4.1.0"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Interventions such as antimalarial drugs, bed nets and insecticides have helped curb the burden of malaria in the past decade, yet malaria remains a leading cause of morbidity and mortality in children below the age of 5\u2009years. In 2019, Ghana, Malawi and Kenya in sub-Saharan Africa (countries with moderate to high transmission areas of malaria and deaths) started piloting the RTS,S\/AS01E malaria vaccine in selected regions. Using qualitative methods, this study examined the main factors (forces) that will influence or hinder the nationwide implementation of the malaria vaccine, if approved, in Ghana. We conducted in-depth interviews with 12 key individuals (national, research\/academia and programme implementing partners) in the public health sector in Ghana from October 2018 to February 2019. Results were analysed using Kurt Lewin\u2019s force field analysis to understand how organizations interact with their external environment in the delivery of health policies such as the implementation of the malaria vaccine. We found that the disease burden of malaria deaths in Ghana, the efficacy of the vaccine, stakeholder involvement and evidence for the feasibility of vaccine delivery generated by the consortium of researchers (body of researchers) that can track the implementation were the driving forces to scale up the vaccine into a routine health system. On the other hand, the needed logistics, funding, administration of the four-dose vaccine and follow-up were identified as potential barriers. The most influential force collectively highlighted by the respondents was the disease burden, and the most influential barrier was the logistics of delivering the vaccine. Our findings provide decision makers with key barriers and facilitators to guide policy and decision-making for malaria control in Ghana and other similar settings in low- and middle-income countries.<\/jats:p>","DOI":"10.1093\/heapol\/czac077","type":"journal-article","created":{"date-parts":[[2022,9,10]],"date-time":"2022-09-10T00:04:57Z","timestamp":1662768297000},"page":"28-37","source":"Crossref","is-referenced-by-count":33,"title":["Barriers and facilitators to nationwide implementation of the malaria vaccine in Ghana"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8778-2943","authenticated-orcid":false,"given":"Omolola Oyinkan","family":"Adeshina","sequence":"first","affiliation":[{"name":"Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine , 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Nyame","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre, Ghana Health Service , P.O. Box 200, Kintampo North Municipality, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0304-639X","authenticated-orcid":false,"given":"James","family":"Milner","sequence":"additional","affiliation":[{"name":"Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine , 15-17 Tavistock Place, London WC1H 9SH, UK"},{"name":"Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine , Keppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Milojevic","sequence":"additional","affiliation":[{"name":"Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine , 15-17 Tavistock Place, London WC1H 9SH, UK"},{"name":"Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine , Keppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwaku Poku","family":"Asante","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre, Ghana Health Service , P.O. Box 200, Kintampo North Municipality, Ghana"},{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine , Keppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"2023011905294976900_R1","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(19)30937-7","article-title":"RTS,S malaria vaccine pilots in three African countries","volume":"393","author":"Adepoju","year":"2019","journal-title":"The Lancet"},{"key":"2023011905294976900_R2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.3934\/microbiol.2021007","article-title":"Bacillus Calmette-Guerin (BCG): the adroit vaccine","volume":"7","author":"Adesanya","year":"2021","journal-title":"AIMS Microbiology"},{"key":"2023011905294976900_R3","article-title":"RTS,S Clinical Trials Partnership. Efficacy and safety of the RTS,S malaria vaccine during 18 months after vaccination: a phase 3 randomized, controlled trial in children and young infants at 11 African sites","volume":"11","author":"Agnandji","year":"2014","journal-title":"Public Library of Science Medicine"},{"key":"2023011905294976900_R4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(15)60721-8","article-title":"RTS,S Clinical Trials Partnership. Efficacy and safety of RTS,S malaria vaccine with or without a booster does in infants and children in Africa: final results of a phase 3, individually randomized, controlled trial","volume":"386","author":"Agnandji","year":"2015","journal-title":"The Lancet"},{"key":"2023011905294976900_R5","doi-asserted-by":"crossref","DOI":"10.1186\/s12936-017-1828-6","article-title":"Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005\u20132015, Ghana","volume":"16","author":"Aregawi","year":"2017","journal-title":"Malaria Journal"},{"key":"2023011905294976900_R6","first-page":"25","article-title":"RTS,S malaria vaccine development: progress and considerations for postapproval introduction","volume":"6","author":"Asante","year":"2016","journal-title":"Vaccine: Development and Therapy"},{"key":"2023011905294976900_R7","doi-asserted-by":"crossref","first-page":"252","DOI":"10.4314\/gmj.v53i3.10","article-title":"Re: musings on malaria morbidity and mortality after the new Mosquirix\u00ae vaccine","volume":"53","author":"Asante","year":"2019","journal-title":"Ghana Medical Journal"},{"key":"2023011905294976900_R8","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2017.1381471","article-title":"Towards malaria control and elimination in Ghana: challenges and decision making tools to guide planning","volume":"10","author":"Awine","year":"2017","journal-title":"Global Health Action"},{"key":"2023011905294976900_R9","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1046\/j.1365-2834.2003.00401.x","article-title":"Management of change through force field analysis","volume":"11","author":"Baulcomb","year":"2003","journal-title":"Journal of Nursing Management"},{"key":"2023011905294976900_R10","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09039-z","article-title":"Environmental modifiers of RTS,S\/AS01 malaria vaccine efficacy in Lilongwe, Malawi","volume":"20","author":"Bell","year":"2020","journal-title":"BMC Public Health"},{"key":"2023011905294976900_R11","article-title":"Stakeholder Mapping","author":"BSR","year":"2011"},{"key":"2023011905294976900_R12","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jik.2016.07.001","article-title":"Leveraging intellectual capital through Lewin\u2019s Force Field Analysis: the case of software development companies","volume":"2","author":"Capatina","year":"2017","journal-title":"Journal of Innovation & Knowledge"},{"key":"2023011905294976900_R13","article-title":"Pursuing graduate studies in nursing education: driving and restraining forces","volume":"16","author":"Cathro","year":"2011","journal-title":"The Online Journal of Issues in Nursing"},{"key":"2023011905294976900_R14","first-page":"1","article-title":"Indoor residual spraying for preventing malaria","volume":"2019","author":"Choi","year":"2019","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"2023011905294976900_R15","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiaa393","article-title":"The long and winding road to eradicate vaccine-related polioviruses","volume":"223","author":"Cochi","year":"2021","journal-title":"The Journal of Infectious Diseases"},{"key":"2023011905294976900_R16","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.1908433116","article-title":"Stakeholder engagement increases transparency, satisfaction, and civic action","volume":"116","author":"Coleman","year":"2019","journal-title":"PNAS"},{"key":"2023011905294976900_R17","doi-asserted-by":"crossref","first-page":"757","DOI":"10.2147\/IJGM.S45842","article-title":"Vaccination against pneumococcus in West Africa: perspectives and prospects","volume":"6","author":"Donkor","year":"2013","journal-title":"Int J Gen Med"},{"key":"2023011905294976900_R18","first-page":"1","article-title":"Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study","volume":"14","author":"Enweronu-Laryea","year":"2014","journal-title":"BioMed Central Infectious Diseases"},{"key":"2023011905294976900_R19","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2334-14-431","article-title":"Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study","volume":"14","author":"Enweronu-Laryea","year":"2014","journal-title":"BMC Infectious Diseases"},{"key":"2023011905294976900_R20","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2019.34.179.18458","article-title":"Community stakeholder engagement during a vaccine demonstration project in Nigeria: lessons on implementation of the good participatory practice guidelines","volume":"34","author":"Folayan","year":"2019","journal-title":"Pan African Medical Journal"},{"key":"2023011905294976900_R21","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0140-6736(14)61682-2","article-title":"Global, regional, and national age\u2013sex specific all-cause and cause-specific mortality for 240 causes of death, 1990\u20132013","volume":"385","author":"Geleijnse","year":"2015","journal-title":"The Lancet"},{"key":"2023011905294976900_R22","article-title":"Map and Regions of Ghana","author":"GhanaMissionUN"},{"key":"2023011905294976900_R23","article-title":"National Malaria Control Programme [NMCP]","author":"GHS","year":"2015"},{"key":"2023011905294976900_R24","article-title":"Ghana Malaria Indicator Survey 2019","author":"GSS","year":"2020"},{"key":"2023011905294976900_R25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003377","article-title":"Estimated impact of RTS,S\/AS01 malaria vaccine allocation strategies in sub-Saharan Africa: a modelling study","volume":"17","author":"Hogan","year":"2020","journal-title":"PLoS Medicine"},{"key":"2023011905294976900_R26","article-title":"Malaria Vaccine Implementation Programme (MVIP)","author":"IFPMA"},{"key":"2023011905294976900_R27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003537","article-title":"Estimated impact of the pneumococcal conjugate vaccine on pneumonia mortality in South Africa, 1999 through 2016: an ecological modelling study","volume":"18","author":"Kleynhans","year":"2021","journal-title":"PLoS Medicine"},{"key":"2023011905294976900_R28","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1080\/21645515.2019.1669415","article-title":"RTS,S\/AS01 vaccine (Mosquirix\u2122): an overview","volume":"16","author":"Laurens","year":"2020","journal-title":"Human Vaccines & Immunotherapeutics"},{"key":"2023011905294976900_R29","volume-title":"Field Theory in Social Science","author":"Lewin","year":"1947"},{"key":"2023011905294976900_R30","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/1524839903257994","article-title":"Force field analysis: a model for promoting adolescents\u2019 involvement in their own health care","volume":"5","author":"MacDuffie","year":"2004","journal-title":"Health Promotion Practice"},{"key":"2023011905294976900_R31","article-title":"RTS,S malaria vaccine technical brief Ghana","author":"MOH","year":"2016"},{"key":"2023011905294976900_R32","article-title":"Anti-malarial Medicines Policy","author":"MOH","year":"2020"},{"key":"2023011905294976900_R33","first-page":"1","article-title":"Comprehensive multi-year plan for immunization (2015-2019)","author":"MOH\/GHS","year":"2014"},{"key":"2023011905294976900_R34","article-title":"Social and Behavior Change Communication (SBCC): Training for Information, Education, amd Commuincation Officers","author":"MOHFW","year":"2013"},{"key":"2023011905294976900_R35","doi-asserted-by":"crossref","DOI":"10.1038\/nbt1015-1015","article-title":"Landmark green light for Mosquirix malaria vaccine","volume":"33","author":"Morrison","year":"2015","journal-title":"Nature Biotechnology"},{"key":"2023011905294976900_R36","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-018-1291-8","article-title":"Prevalence of rotavirus infection among children with acute diarrhoea after rotavirus vaccine introduction in Kenya, a hospital cross-sectional study","volume":"18","author":"Muendo","year":"2018","journal-title":"BMC Pediatrics"},{"key":"2023011905294976900_R37","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-8347-z","article-title":"Health workers\u2019 perceptions and challenges in implementing meningococcal serogroup A conjugate vaccine in the routine childhood immunization schedule in Burkina Faso","volume":"20","author":"Nkwenkeu","year":"2020","journal-title":"BMC Public Health"},{"key":"2023011905294976900_R38","article-title":"An open label, randomised trial of artesunate+amodiaquine, artesunate+chlorproguanil-dapsone and artemether-lumefantrine for the treatment of uncomplicated malaria","volume":"3","author":"Owusu-Agyei","year":"2008","journal-title":"Public Library of Science Medicine"},{"key":"2023011905294976900_R39","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.4161\/hv.24961","article-title":"Public trust and vaccine acceptance-international perspectives","volume":"9","author":"Ozawa","year":"2013","journal-title":"Human Vaccines & Immunotherapeutics"},{"key":"2023011905294976900_R40","article-title":"Rotavirus disease and vaccines in Ghana","author":"PATH"},{"key":"2023011905294976900_R41","doi-asserted-by":"crossref","first-page":"P367","DOI":"10.1016\/S0140-6736(15)00725-4","article-title":"Public health impact and cost-effectiveness of the RTS,S\/AS01 malaria vaccine: a systematic comparison of predictions from four mathematical models","volume":"387","author":"Penny","year":"2016","journal-title":"The Lancet"},{"key":"2023011905294976900_R42","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-015-0408-2","article-title":"The public health impact of malaria vaccine RTS,S in malaria endemic Africa: country-specific predictions using 18 month follow-up Phase III data and simulation models","volume":"13","author":"Penny","year":"2015","journal-title":"BMC Medicine"},{"key":"2023011905294976900_R43","article-title":"NVivo transcription","author":"QSRInternational"},{"key":"2023011905294976900_R44","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001107","article-title":"Effects of community-wide vaccination with PCV-7 on pneumococcal nasopharyngeal carriage in the Gambia: a cluster-randomized trial","volume":"8","author":"Roca","year":"2011","journal-title":"PLoS Medicine"},{"key":"2023011905294976900_R45","first-page":"1","article-title":"Efficacy and safety of the RTS,S\/AS01 malaria vaccine during 18 months after vaccination: a phase 3 randomized, controlled trial in children and young infants at 11 African sites","volume":"11","author":"RTS","year":"2014","journal-title":"Public Library of Science Medicine"},{"key":"2023011905294976900_R46","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(15)60721-8","article-title":"Efficacy and safety of RTS,S\/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial","volume":"386","author":"RTS","year":"2015","journal-title":"Lancet"},{"key":"2023011905294976900_R47","article-title":"Managing stakeholders to achieve true implementation success","author":"Siegelaub","year":"2005"},{"key":"2023011905294976900_R48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpubh.2021.709127","article-title":"COVID-19 vaccination in lower-middle income countries: national stakeholder views on challenges, barriers, and potential solutions","volume":"9","author":"Tagoe","year":"2021","journal-title":"Frontiers in Public Health"},{"key":"2023011905294976900_R49","article-title":"Health care improvement project: force-field analysis","author":"URC","year":"2008"},{"key":"2023011905294976900_R50","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-019-3391-7","article-title":"RTS,S malaria vaccine pilot studies: addressing the human realities in large-scale clinical trials","volume":"20","author":"van den Berg","year":"2019","journal-title":"Trials"},{"key":"2023011905294976900_R51","article-title":"Module 6: Community Engagement","author":"WHO","year":"2018"},{"key":"2023011905294976900_R52","article-title":"Malaria vaccine implementation programme (MVIP)","author":"WHO","year":"2018"},{"key":"2023011905294976900_R53","first-page":"1","article-title":"Ghana: WHO and UNICEF estimates of immunization coverage: 2016 revision","author":"WHO\/UNICEF","year":"2017"},{"key":"2023011905294976900_R54","first-page":"1","article-title":"The public health value of vaccines beyond efficacy: methods, measures and outcomes","volume":"15","author":"Wilder-Smith","year":"2017","journal-title":"Biomed Central Medicine"},{"key":"2023011905294976900_R55","doi-asserted-by":"crossref","DOI":"10.1186\/s12936-019-2755-5","article-title":"Prioritizing the scale-up of interventions for malaria control and elimination","volume":"18","author":"Winskill","year":"2019","journal-title":"Malaria Journal"},{"key":"2023011905294976900_R56","doi-asserted-by":"crossref","DOI":"10.1186\/s12936-019-2709-y","article-title":"Geostatistical analysis and mapping of malaria risk in children under 5 using point-referenced prevalence data in Ghana","volume":"18","author":"Yankson","year":"2019","journal-title":"Malaria Journal"},{"key":"2023011905294976900_R57","doi-asserted-by":"crossref","DOI":"10.1186\/s13690-017-0179-7","article-title":"Regional disparities in immunization services in Ghana through a bottleneck analysis approach: implications for sustaining national gains in immunization","volume":"75","author":"Yawson","year":"2017","journal-title":"Archives of Public Health"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czac077\/45946372\/czac077.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/38\/1\/28\/48763000\/czac077.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/38\/1\/28\/48763000\/czac077.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T05:33:05Z","timestamp":1674106385000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/38\/1\/28\/6694852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":57,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,9,9]]},"published-print":{"date-parts":[[2023,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czac077","relation":{},"ISSN":["1460-2237"],"issn-type":[{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,1,1]]},"published":{"date-parts":[[2022,9,9]]}}}