How is the restrictive vaccine vial opening policy of the childhood vaccination programme experienced by health care workers and health facility users? A qualitative study in rural Guinea-Bissau

Objectives: Any remaining doses of unpreserved multi-dose vaccines must be discarded 6 h after reconstitution. In many countries, these multi-dose vaccines are only opened if a certain number of children are present. In GuineaBissau, this results in health facilities (HFs) limiting BCG, measles, and yellow fever vaccinations to predefined days. This study aims to explore views, perceptions and experiences of caregivers of vaccine-eligible children and health care workers (HCWs) on the vaccination programme and restrictive vial opening policy (RVOP). Study design: A qualitative study nested within an ongoing vaccine trial in rural Guinea-Bissau. Methods: Focus group discussions (FGDs) and semi-structured interviews were conducted in the regions Biombo, Oio, and Farim and a thematic networks analysis was performed. Results: Vaccines were well considered, and no caregivers (n = 29, 4 FGDs) or HCWs (n = 9), expressed negative perceptions of vaccines. Most caregivers reported several difficulties in seeking and obtaining vaccinations, especially unpreserved multi-dose vaccines, including vaccine stock-outs, HCW strikes, cost/availability of transportation, and waiting time at HFs. Many stated returning to the same HFs repeatedly was their only option for obtaining vaccinations. Most HCWs perceived the RVOP as a logical result of limited vaccine availability but balancing vaccine uptake and dose wastage negatively affected their sense of purpose and job satisfaction. To optimize the vaccination process, many participants recommended abandoning the RVOP, and allocating more resources to the HFs. Conclusions: The RVOP afflicts both caregivers and HCWs and is one of several persisting barriers for vaccinations in rural Guinea-Bissau that should be addressed.