Table 1 Summary table of studies reporting PCV implementation in MICs

Blau et al. [14]

Albania, Azerbaijan, Georgia, Croatia

Lack of local expertise in health economic and economic evaluation.

Lack of available national data on disease burden and cost of treatment of disease preventable by new vaccines.

• to use cost-effectiveness analysis to strengthen decision making in immunization policy and to ensure the sustainability of vaccine introduction

• to provide economic evidence to help decide if introducing new vaccine should be prioritized along with other public health programs

• to maximise the commitment and support of existing advisory bodies in the country: National Immunization Technical Advisory Group (NITAG) or Interagency Coordination Committee (ICC)

• to provide scientific recommendations to support final decisions of introducing PCV

Bonner et al. [16]

LICs and MICs

(list of countries not specified)

The cost of PCV can be prohibitive, discouraging countries from including it in their EPI schedules.

• GAVI and its donors should respond to WHO recommendations and countries’ needs and expand the vaccine subsidy window for vaccination in children up to age five

• policy should be formulated to ensure that PCV is used in emergency contexts, including in extended age groups, as a rapid intervention to limit IPD-related morbidity and mortality

• the global immunization community should address the obstacles to systematically using PCV as part of the health service package in emergencies

Gordon et al. [18]

LICs and LMICs

(list of countries not specified)

Lack of economic expertise and an explicit desire to include economists in their NITAGs and interagency co-ordinating committees.

The availability and consistency of financing was uniformly reported to be the greatest challenge.

Levine et al. [20]

Global

• the need for post-introduction surveillance to monitor vaccine impact and any shifts in the serotype distribution

Moon et al. [17]

Developing countries

(list of countries not specified)

No mechanism is in place ensuring that poorer countries get the lowest possible prices. This case underscores the difficulty in determining what is a “fair” price for MICs.

Philippe et al. [13]

Global

Limited access to international support is resulting in LMICs beginning to lag behind the poorest countries in protecting their populations from vaccine-preventable diseases using newer vaccines and combination vaccines. Strong disease surveillance and programme monitoring systems are required.

• to seek more suitable formulations and presentations of new vaccines

• surveillance of diseases targeted by new vaccines including enhanced laboratory networks and centres of excellence

• supporting the establishment/strengthening of National Immunization Technical Advisory Committees

• to ensure evidence-based decision at country level, which is particularly needed in view of the complexity of the immunization programs and cost of new vaccines

Saxenian et al. [19]

GAVI graduating countries: Indonesia, Sri Lanka, Angola, Bolivia, Azerbaijan, Honduras, Georgia, Congo, Moldova, Armenia, Mongolia, Guyana, Bhutan, Kiribati

Countries had not carried out detailed financial projections of vaccine costs by funding source.

• Ministry of Health should ensure that vaccine procurement methods result in competitive prices for high quality products

• need to build specialised market knowledge and skills

• a well-functioning national regulatory agencies (NRA)

• to maximise the commitment and support of existing advisory bodies in the country (NITAG)

Shen et al. [15]

Developing countries

(list of countries not specified)

(1) policy, standards, and guidelines;

(2) governance, organization and management;

(3) human resources;

(4) vaccine, cold chain, and logistics management;

(5) service delivery;

(6) communication and community partnerships;

(7) data generation and use;

(8) sustainable financing.

An enabling environment, even in the poorest countries, depends on the political will of decision-makers.

• a strong routine immunization platform to benefit the overall health system by generating policy and skilled human resources

• NITAGs is to guide the development of national immunization policies, guidelines, and standards

• NRAs are necessary if countries are to self-procure and ensure a reliable supply of quality vaccines

• to improving governance, organization, and management of routine immunization include

• to invest to build the capacity and professional development of an appropriately trained health care

• educating and mobilising the public to support immunization and to use immunization services is central to EPI

• the generation of high-quality immunization data is important to informing programmatic decisions

• sustainable financing