4th Global Meeting on Implementing New and Under-utilized Vaccines, 23-25 June 2010
Workgroup 1. Pneumococcal and rotavirus vaccines, including surveillance and cost-effectiveness issues
Background
New vaccines against infectious diseases have the opportunity to make substantial gains in health, and to contribute in achieving the Millennium Development Goals. The relative value of these new vaccines depends on the burden of disease, the cost of the vaccines, and the available resources for introducing the vaccines into National Immunization Programs. As the burden of disease and the resources available vary between countries and sub-regions, the decision to introduce these more expensive vaccines requires that policy decisions be grounded in a greater body of evidence that reflects national conditions. National surveillance systems and the generation of cost-effectiveness analyses are important components of this framework of evidence. Furthermore, epidemiological surveillance has been used to assess program effectiveness once vaccines have been added to the routine schedule.
Main Topics of Discussion
- Generation of information to make a decision regarding the introduction of pneumococcal and rotavirus vaccines.
- Current information on rotavirus vaccines that can be pertinent to decision making
- Possible steps before vaccine introduction and how surveillance can support this decision
- Lessons learned about rotavirus vaccine introduction: results of post-introduction evaluation
- Challenges and lessons learned from countries regarding all the steps before and after the introduction of new vaccines.
- Tools and information needed by countries for decision making and vaccine introduction in order to inform partners what support is needed.
- How global surveillance can support decision making for introduction of new vaccines.
- Surveillance data are underestimates of disease and do not describe the full burden of disease, particularly with regards to mortality. It is important to use surveillance data in combination with models, vaccine coverage data, and vaccine effectiveness data to further report on vaccine impact, particularly on death, pneumonia, and mild disease, which are not adequately captured in the surveillance system.
- Additional data needs should be fulfilled through special studies.
- The components of a cost-effectiveness analysis using the ProVac model (TRIVAC) and the generation of cost-effectiveness analysis using country-based data.
Recommendations
Surveillance:
- Countries that have already established a surveillance system, should work to improve the quality of the data.
- Countries should encourage the integration of surveillance for rota and pneumo to optimize the use of resources.
- Improve the technical capacity and infrastructure of the laboratories, particularly for invasive bacterial disease.
- Continue to promote coordination between EPI and laboratory regarding information sharing and data quality.
- Evaluate how surveillance data can support decision making that countries need to make.
- Use the surveillance data collected to assess the benefits and cost-effectiveness of the vaccines.
Decision Making:
- A more integrated approach should be taken when evaluating the introduction of vaccine, including several components such as supply chain management, logistical implications of vaccine storage capacity, and surveillance systems.
- Countries should share their experiences (on surveillance, cost-effectiveness analysis, PIEs, etc.) through publications, conferences, and direct communications.
- Understand the economic tools that PAHO are currently using, and the feasibility and viability of use in other Regions.
- Provide information to help assess the uncertainty around the results of cost-effectiveness studies, and also around the input data.
Vaccine Introduction:
- Shared experiences between countries regarding vaccine introduction helped the process of introduction in the PAHO Region. Other Regions could use the same strategy of sharing lessons learned.
- Take advantage of the EPI structure to offer other health interventions when administering vaccines.
- Ensure a structured channel to share all the logistical and other issues raised in this workshop.