With numerous newly-developed vaccines available on the market or expected in the next several years, countries face an increasingly complex decisions for their immunization programs. Gavi-supported countries, for example, can currently apply for thirteen vaccine programs1, and five more will be available to countries in 20242. As countries undertake the development and implementation of their National Immunization Strategy (NIS) as recommended by the WHO and additionally for some, a Full Portfolio Planning (FPP) as requested by Gavi, the Vaccine Alliance, they must consider which new vaccines to add to a national immunization program and the order they want to introduce them (new vaccine introduction prioritization and sequencing), as well as the optimization of existing vaccine programs by assessing change to vaccine products/presentations, schedules, and/or delivery strategies. Each country has a unique set of priorities and initiatives to consider with differential impact on disease burden, lives saved, health system cost savings, and feasibility/programmatic complexities. As countries consider new vaccine introductions, they must weigh their priorities in the context of increasing coverage of existing antigens, while also optimizing current programs and ensuring ongoing advocacy and improvements in their supply chain, data systems, communications and domestic financing.
The political process of introducing new vaccines in a country involves government and policymakers deciding on vaccine approval, distribution, and administration. In most countries, the National Immunization Technical Advisory Groups(NITAGs) are responsible for providing evidence-based recommendations to guide this decision-making, with the national immunization program as a key collaborator. Historically, most NITAGs review each new vaccine introduction individually, resulting in a recommended list of several new vaccines to be introduced over a short period without doing a preliminary prioritization exercise that would also consider the overall consequences on the financing, cold chain capacity and program delivery. This approach has sometimes required countries to delay vaccine introduction even if a NITAG recommendation was issued to introduce them.
Prioritization and sequencing exercises are needed in countries to make these recommendations and inform decision-making based on analysis of its epidemiological context, the capacity of its health system to absorb and maintain such introduction and the resources available. These processes must further optimize the chances of success by identifying programmatic synergies and streamlining processes and operations. However, existing prioritization processes and tools can be elaborate and time-consuming for countries, especially for Gavi-supported countries which face multiple priorities and constraints in human resources, technical capacity and time.
- Guidelines
