3rd Global Meeting on Implementing New and Under-utilized Vaccines, 16-18 June 2009
Workgroup 7. Opportunities and barriers in new vaccine introduction decisions in GAVI-eligible countries, including large countries
In 2005, 75% of the world’s children still did not have access to Hib vaccine. Historically 15-20 years passed before new vaccines reached the poorest children after having been introduced in industrialized countries. Although in the 1st phase of GAVI five years' support for Hib vaccine was made available at no charge to eligible countries, few countries beyond the initial early adopters took advantage of the vaccine. At the onset of the Hib Initiative in 2005, a series of country consultations, meetings with partners and regional fora, helped reveal a lack of awareness and uncertainty about disease burden, concerns about both supply and sustainable financing and low political will. These factors influencing decision making were addressed through a stronger and clearer recommendation from WHO's Strategic Advisory Group of Experts (SAGE), new financing guidelines from GAVI and by the Hib Initiative, partners and countries (including local advocates) to help accelerate introduction.
Large countries, particularly India and Nigeria, posed unique challenges and opportunities, requiring greater focus and collaboration with a larger and more diverse number of stakeholders as well as a recognition of the role of de-centralized government through the countries' states.
Today, 161 countries, including 64 (88%) of GAVI-eligible countries have introduced the Hib vaccine. Can some of the lessons learned be used to facilitate a speedier introduction process for pneumococcal and rotavirus vaccines in the coming years?
Main Topics of Discussion
- A global scientific recommendation fast-tracked Hib introduction - this has already been achieved for pneumococcal and rotavirus vaccines. Additional discussions were needed to further convince some countries that they did not need to wait for local data
- Availability of finances was addressed by GAVI through its generous co-financing policy, although questions were raised as to whether it addresses financial sustainability.
- The Hib Initiative played a catalytic role in the introduction of new vaccines.
- Early adopting countries were necessary to broaden the advocacy for other countries. Global and regional advocates play an important role in building awareness and political will in other countries.
- There is no standard prescription that is applicable to all countries - each country's situation requires an approach that targets its particular barrier to introduction.
- Local champions are vital to the decision making process.
- The media can be a valuable tool to build awareness of the need for vaccines, but some messages are better communicated directly to decision makers or the scientific community.
- Different packaging of messages is required for different levels and stakeholders.
- Partners need to be consistent in their messaging, and countries need to be ready for introduction of a new vaccine.
- Assist countries in revising immunization plans and applying for GAVI support. Involve a broad range of stakeholders in the introduction decision, particularly to build support for sustainable financing.
- Identify and develop advocates to stay up to date on global and regional developments, communicate the experiences of countries within a region and help address some of the issues that come up in various countries
- Ensure that countries plan for implementation well in advance of a decision (e.g, plan for expanding cold chain, addressing need for reduced wastage, improving forecasting, logistics planning, training, sensitization of health providers and public), as this is as important as decision-making.
- Evaluate potential demand vs. capacity constraints and ensure the supply outlook is communicated to countries, donors and suppliers.
- Set realistic expectations about pricing and when prices are expected to decline.
- Advocate for financial resources with global donors and in-country donors.
- Develop specific large country strategies supported by a separate team to address the complexities of large country issues and maintain focus. Sensitize the states in these countries as they will play a significant role in implementation and may contribute to advocacy efforts.