A field team conducting parent interviews in Fiji’s Central Health Division as part of the post-introduction evaluation of the hexavalent vaccine, HEXASIIL.

Fieldwork completed for hexavalent vaccine post-introduction evaluation in Fiji

In a collaborative effort to improve health outcomes for children and communities in Fiji, the Fiji Ministry of Health and Medical Services (MHMS) and NCIRS have undertaken a post-introduction evaluation of the infant hexavalent vaccine, HEXASIIL, across the Pacific nation.

Fiji was the first country globally to introduce the newly prequalified whole-cell pertussis (wP)-containing vaccine into the country’s Essential Program on Immunization in 2025.

The 6-in-one vaccine protects against diphtheria, tetanus, pertussis, hepatitis B, polio and Haemophilus influenzae type b (Hib). It also reduces the number of injections a baby needs during early childhood, replacing the previous 5-in-one vaccine, which did not include protection against polio.

Many people in Fiji live on remote islands without easy access to health facilities. Reducing the number of immunisation visits for these communities – often requiring long boat trips in difficult weather – can make a big difference to families and improve health outcomes for children.

A final evaluation report on the introduction of the infant hexavalent vaccine will be completed at the end of 2026, with the recommendations expected to inform future national immunisation strategy development across the archipelago.

Lessons learned are also likely to contribute to the widespread introduction of the infant hexavalent vaccine to other countries across the Pacific and Southeast Asia under the World Health Organization’s (WHO) Essential Program on Immunization (EPI).
 

The first step – Hex PIE workshop in Suva

The NCIRS Global Health team brought together senior MHMS staff, nurses and technical experts, alongside representatives from WHO and the Australian Government Department of Foreign Affairs and Trade (DFAT), at a 3-day workshop in Suva. The workshop provided field teams with:

• an overview of Fiji’s vaccination landscape and healthcare system
• a detailed review of the hexavalent vaccine introduction and the chosen WHO post-introduction evaluation tool
• training in both digital and paper-based data-collection tools and standard operating procedures
• practical guidance on conducting interviews, focus groups and qualitative research
• team-building activities and fieldwork planning prior to site visits across the country.
   

In the field

MHMS and NCIRS Global Health teams then travelled across Fiji’s Central, Eastern, Western and Northern Divisions to conduct fieldwork at:

• Nausori Health Centre and Nailili Nursing Station
• Levuka Health Centre and Moturiki Nursing Station 
• Nadi Health Centre and Nagado Nursing Station
• Savusavu Health Centre and Nabalebale Nursing Station.

Teams also conducted interviews and observations at national, divisional and health-facility levels, with parents and caregivers given the opportunity to provide insights on the experiences of their children being vaccinated through a series of focus groups.

Interviews with health workers, program managers and national stakeholders explored how the vaccine introduction had been implemented, what had worked well and where opportunities existed to improve the transition from a pentavalent to a hexavalent vaccine. Field teams also collected vaccine administration and coverage data to support the evaluation.
 

Health workers key to successful rollout

The evaluation found that Fiji nurses have played a central role in the successful introduction of the vaccine, developing educational materials and working directly with parents to explain the benefits of the change, including fewer injections for babies to maintain protection against serious childhood diseases.

In the face of often challenging environments and limited resources, Senior Nursing Officer and National EPI Manager, Sr Litiana Volavola, praised the dedication of frontline staff.

‘I am very impressed with the great work the nurses do on the ground across Fiji. We have successfully developed a highly driven team in health and have been very effective programmatically – we are one family.’ 
 

Key observations and early recommendations

After completing their work in the field, teams shared preliminary findings, key observations and early recommendations at a briefing attended by senior representatives from Fiji MHMS, including the Chief of Nursing and Midwifery and the Chief Pharmacist, as well as representatives from Fiji National University, The Pacific Community, and international partners including DFAT and WHO.

NCIRS thanks Sr Litiana Volavola, Fiji’s National EPI Manager, and Sr Amelia Nasetava, Director of Nursing (Western Division) for their leadership and support. We also acknowledge the valuable support of DFAT and UNICEF, whose funding helped make this work possible.

We also extend our sincere thanks to the parents and caregivers who participated in focus group discussions and the healthcare workers who contributed to the evaluation. Their dedication, professionalism and commitment to improving immunisation services continues to play a vital role in protecting the health of children and communities across Fiji.