Country Decision Making
EPI vaccines are considered to be among the most efficient uses of scarce health care resources. Past country experiences with introducing new vaccines have made it apparent that deliberations about incorporating a new vaccine into a national immunization schedule are influenced by multiple factors. Among other aspects, decision-makers will need information on their affordability and relative cost-effectiveness to determine the value for money of the new vaccine. The availability and awareness of disease burden is important and global burden of Hib and Streptococcus pneumoniae disease and mortality estimates for the year 2004 were published in 2008. Other important considerations for introducing new vaccines are the availability and price of vaccines, and the safety and suitability of available vaccine products for national programmes.
To assist countries with preparing for and evaluating the impact of such decisions, the global immunization partners provide a range of tools and information to national policy makers and programme managers. WHO has developed a web resource on "Introducing a vaccine - Policy and Programmatic Considerations" which is a generic framework that can be used as a reference for decision-making and implementation by country-level policy-makers, national immunization programme managers, and others working on immunization. Several vaccine and product-specific guidelines have been developed to facilitate introduction, and WHO Position Papers are available for all new vaccines. A tool to conduct post-introduction evaluations as well as one to support cold chain assessments to prepare countries for the increased space that will be required by the addition of new vaccines are also available.
To date, WHO and partners' activities for strengthening national decision making processes for new vaccine introduction have focused on providing technical information packages, promoting the establishment and strengthening the capacity of national immunization advisory bodies, and providing models and estimates of cost-effectiveness to allow prioritization of vaccine introduction. Further activities encompass the functions of policy advice, process guidance, other quantitative assessment, experience sharing and planning. The need to make important decisions about the use of new vaccines vis-à-vis other health interventions provides an excellent opportunity for countries to consider the use of broader advisory committees to deliberate and address strategic issues and health priorities at national level. These activities are important for a middle-income country strategy as well, though they should be carefully tailored to meet the different needs of the individual members of this group of countries.
Following the publication of the GIVS, WHO, UNICEF and their partners recommended that national programme managers attempt to consolidate existing plans for their multiple immunization objectives into a single document that includes an evaluation of the costs and financing of that plan. Comprehensive multi-year plans (cMYP) are also proposed as a mechanism to involve all relevant national and international partners in the planning process and the determination of the future financing mechanisms for the programme.
Last updated: September 2010
