4th Global Meeting on Implementing New and Under-utilized Vaccines, 23-25 June 2010
Workgroup 4. Introduction of more than one new vaccine at a time
With an increasing number of safe and efficacious vaccines becoming available, countries are faced with an array of choices about how to optimize their vaccine introduction processes and budgets. The proactive planning for the introduction of multiple vaccines has the potential to generate economies of scale, logistical efficiencies, and more cohesive public health policies resulting from combining the multiple data collection efforts, decision-making processes, and vaccine introduction efforts. However, there may be programmatic costs and/or challenges inherent in combining multiple vaccine introduction and immunization planning activities that are not yet well understood or documented. Despite such challenges, low- and lower– middle-income countries are proposing to introduce multiple vaccines over shorter timelines and within a single planning period. The objectives of this session were to identify:
- The rationale used by countries when determining whether to schedule multiple or sequential (single) vaccine introduction into their national immunization planning cycles;
- The experiences and lessons learned from countries that have concurrently introduced multiple vaccines, either through phased or nation-wide introduction, or have introduced multiple vaccines within an accelerated timeline; and
- The key issues considered in national immunization planning cycles concerning multiple and sequential vaccine introduction, and the key factors seen as driving the decision processes around timing and choice of vaccines to introduce.
Main Topics of Discussion
- Mixture of burden of disease, cost-effectiveness and political considerations as a rationale for introduction
- Training and staffing up were major considerations in both case studies and if not adequately addressed, became a major bottleneck
- Changes in supply or presentation can be a significant issue (needs to be secured early)
- Careful calculation of cold chain and logistics at all levels is essential
- South Africa experience:
- Rota, pneumo and penta introduced in 2008/09; rationale for introduction: burden of disease, local clinical trials, NAGI recommendation, fit with EPI schedule, political commitment
- Time and financial constraints for introduction big challenges
- Significant cold chain expansion needed (+450%) with implementation problems
- Training and staffing of personnel major constraint
- Logistics challenges with buffer stocks
- Budgeting and adequate planning need to be properly timed
- Peru experience:
- Pneumo, rota and influenza introduced in 2008
- Political commitment significant
- Integrated strategy across health sector and with other sectors including finance
- Burden of disease and central nature of prevention in national strategy were key reasons
- Significant budgeting made available for systems strengthening including staffing and training
- Cold chain assessment done pro-actively and investment made
- Engagement with political leaders and ministry of finance were critical drivers of concurrent introduction
- Management at local level needs to be strengthened early
- Since many decisions are often made on a political basis, it is recommended that decision-making needs to consider a broader array of evidence in a more structured and timely fashion. Decision-making should also consider the true cost of vaccine introduction BEYOND the actual vaccine cost (training, cold chain, staffing). An integrated plan should be developed to include all components of vaccine introduction, particularly including the scale-up of human resources.
- Comprehensive planning should be performed and supported through appropriate financing to ensure the most efficient and effective mechanisms for concurrent introduction.
- Guidelines alone are not sufficient; workshops, training, other capacity building activities are critical for healthcare workers and decision makers alike.
- Procurement process and pricing of vaccines can limit financing for other components of the introduction; procurement and tender process critical.
- Lower-middle income countries lack adequate support and financing.
- Timing of vaccine introduction can be creatively aligned with fiscal cycles to maximize resource availability.
- A number of projects are under way that consider the decision making process around vaccine introduction (i.e. PROVAC, PATH, LSHTM SIVAC, vaccine product menu). These projects should consider the findings of this workshop in the development of their final product and provide countries with the best resource tool-kit to decide on and plan their introductions.