Insights from the Hexavalent Switch: A Process Point Risk Mitigation Compendium

Executive Summary

The transition from separate pentavalent (penta) and inactivated poliovirus (IPV) vaccines to the combined hexavalent (hexa) vaccine represents a major programmatic shift for national immunization systems. While the hexa vaccine offers clear advantages—fewer injections, simplified schedules, logistical efficiencies, and stronger integration of polio vaccination into routine services—the switch requires coordinated action across policy, financing, supply chains, service delivery, data systems, workforce capacity, communication, and vaccine safety surveillance. Experience from early adopters shows that success depends not on a single decision, but on the alignment of multiple interdependent system components over time.

To support countries navigating this complexity, the Hexavalent Vaccine Switch Early Adopters Workshop, convened in Dakar, Senegal in November 2025, brought together national immunization leaders, Immunization Technical Advisory Group (NITAG) members, regional partners, and global technical agencies from ten African countries at different stages of readiness. The workshop was intentionally designed as a practice-oriented, peer-learning platform, moving beyond information sharing to collective problem solving and tool co-creation. Through country case studies, structured discussions, interactive exercises, and facilitated group work, participants identified and discussed common risks, contextual constraints, and practical solutions encountered across the hexa switch pathway.

This Policy Brief Compendium translates those workshop outputs into applied, country-relevant tools. It is organized around ten process points across three programmatic phases that reflect the full vaccine switch lifecycle:

Planning Phase:

• Decision-making, governance and policy
• Financial planning
• Demand forecasting and procurement planning

Pre-implementation:

• Logistics and cold chain management
• Health worker training and supportive supervision
• Service delivery implementation

Implementation:

• Communication and social mobilization
• Program management and coordination
• Monitoring, evaluation, and reporting
• Adverse events following immunization (AEFI) surveillance

Each process point is presented as a mini policy brief, summarizing background considerations, key risks and barriers identified by countries, and actionable solutions drawn from early adopter experience and peer exchange.

Complementing these briefs, the compendium includes a crowd-sourced Health System Adaptation Checklist, co-developed during the workshop. Using the same process points, the checklist translates shared experience into time-bound operational prompts that national teams can use to assess readiness, prioritize actions, and strengthen coordination across the switch timeline. While developed specifically for the hexavalent vaccine transition, these tools are deliberately designed to be adaptable and may be applied to other vaccine switches, schedule changes, or major programmatic transformations within national immunization programs.