Ghana became something of a running theme at the Nairobi meeting, invoked again and again by researchers from other countries.
Through its leadership of the vaccine demand work package and its record as the consortium’s clearest example of research translating into policy, Ghana kept reappearing as the reference point other countries were told to learn from.
Dr Kwaku Poku Asante, public health physician and Director of the Kintampo Health Research Centre (KHRC), adds a dimension to that record that rarely features in vaccine policy conversations. The weather.
Heat, distance and the mechanics of uptake
The heat, Dr Asante argues, is an active barrier to vaccination campaigns.
“When the environment is very hot, nobody really wants to go out,” he says, and that reluctance is not evenly distributed. It compounds existing problems in areas with poor ventilation at health facilities and in communities where people already have to walk long distances to reach a delivery point. A hot day discourages a trip to the clinic and for a mother balancing that walk against a fussy infant and a queue once she arrives, it can tip the decision altogether.
Heat also threatens the vaccines themselves, and Dr Asante points out that in periods of extreme heat, even air conditioning units can fail, which means the safety of vaccine storage has to be actively evaluated rather than assumed.
Cold chain systems are typically designed and tested against a set of standard conditions; when those conditions are exceeded for sustained periods, the question of whether vaccines are being kept at the correct temperature at the point of delivery becomes urgent rather than theoretical. It is a concern that sits awkwardly alongside Ghana’s institutional strengths in vaccine demand and policy translation, a reminder that readiness is not only about health workers and government buy-in but about whether the infrastructure can physically withstand the climate it operates in.
New vaccines succeed or fail on whether communities understand the evidence behind the decision to offer them.
“People have to understand the data that backs the decision to give the vaccine to children or to mothers,” says Dr Asante adding that building that understanding requires community engagement, open discussion of the data itself, and a genuine process of gathering feedback and acting on it.
Skip any one of those steps, in his account, and both uptake and trust suffer together, since the two rise and fall in tandem.
This framing echoes what Dr Samuel Afari-Asiedu, also of Kintampo Health Research Centre and overall lead of MIRNA’s vaccine demand work package, presented to the Nairobi meeting. Afari-Asiedu explained the consortium’s decision to combine three behavioural frameworks, the WHO’s Behavioural and Social Drivers model, the socio-ecological model and the 6A taxonomy, rather than rely on a single lens, arguing that a mother’s decision operates simultaneously at the individual, household and health-system level. No single framework, he said, captures all three at once. He also described a deliberate process of what he called deduction and induction coding, designed to avoid forcing every research finding into a pre-existing theoretical box before the community’s own voice had been properly heard.
From research to policy, without the usual delay
Ghana’s most cited achievement at the meeting was not a dataset but a process. Both Dr Afari-Asiedu and UNICEF’s Gloria Lihemo held Ghana up as the consortium’s clearest example of research translating directly into policy. The Ghana Health Service’s EPI focal person was involved from the very start, sitting in on the user-centred design workshop that shaped the demand research. As soon as that workshop concluded, the MIRNA team’s findings were handed directly to her and incorporated into Ghana’s national demand strategy. Lihemo described this as proof that demand data can inform national immunisation technical advisory group and ministry decisions before other evidence is reviewed, rather than arriving as an afterthought once policy has already hardened. Uganda and Ghana were cited together as models other countries, including Uganda’s own team, would benefit from replicating with their national EPI focal points.
Ghana’s history was not presented as uniformly smooth, however. Dr Afari-Asiedu cited the country’s experience introducing the RTS,S malaria vaccine as a cautionary tale worth heeding. Rumours about the vaccine spread quickly enough that some health workers themselves refused to allow children to be vaccinated, requiring direct intervention from within the health system to counter the misinformation before it took hold more widely. It is a case study that sits close to Asante’s point about the mechanics of trust: even a well-resourced, well-governed system can be destabilised quickly if communication lags behind rumour.
To guard against that risk, Samuel proposed reactivating Ghana’s health promotion department, an existing structure specifically mandated to lead health education and demand generation, but one he described as currently underused. His argument was that relying solely on antenatal care visits for counselling places too much weight on a single, already stretched channel, and that a dedicated department could offer a steadier, more sustainable route for sustained public communication.
Watching what happens after the vaccine arrives
Dr Asante’s second major theme concerns what happens once a new vaccine is actually rolled out. Strong systems to identify the impact of a newly introduced vaccine, he argues, serve two distinct purposes. They confirm whether uptake is genuinely high, and they help determine what impact the vaccine is having within the community once it is in circulation. Population surveillance systems are, in his words, particularly valuable in places with the infrastructure to support them, and in areas where new vaccines have already been introduced, those surveillance systems have been deliberately strengthened to keep pace with the rollout. Health facility data systems need the same attention, he says, to ensure information is captured appropriately and is of sufficiently good quality to be trusted.
The payoff, in Dr Asante’s account, runs in several directions at once. Better surveillance and facility data improve vaccine confidence more broadly. They give regulatory authorities the tools to identify safety concerns early, and they give policymakers the evidence base they need to enhance delivery going forward. It is a closed loop, better data builds trust, trust supports uptake, and uptake in turn generates the data that keeps the whole system honest.
Ghana’s contribution to MIRNA, taken together, complicates the usual story of vaccine readiness as a matter of policy will and cold chain logistics alone. Asante’s account adds climate resilience and sustained community dialogue to that list, while Dr Afari-Asiedu’s framework work and Ghana’s own record of feeding research directly into policy show what disciplined follow-through can look like in practice.
A new vaccine can only travel as far as the trust, the temperature control and the willingness to keep listening will carry it.
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