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Jimbo-Sotomayor R, da Costa Oliveira MT, Acurio LA, Bastías M, Carvalho M, Sánchez X, de Oliveira LH. Systematic documentation of the introduction of COVID-19 vaccines in Latin America and the Caribbean. Rev Panam Salud Publica 2024; 48:e50. [PMID: 38765497 PMCID: PMC11099337 DOI: 10.26633/rpsp.2024.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/26/2024] [Indexed: 05/22/2024] Open
Abstract
Objective To document the process of introducing COVID-19 vaccines in a selection of Latin American and Caribbean countries, including the lessons learned and the strengths and weaknesses, and similarities and differences among programs. Methods This descriptive study is based on a systematic evaluation of the process of introducing COVID-19 vaccines in Argentina, Belize, Brazil, Costa Rica, Panama and Peru. Data were collected through a questionnaire distributed to key stakeholders. Six informants from each of the included countries participated in this study. The period of the study was from December 2021 through September 2022. Results The main strengths reported by countries were health workers' commitment to delivering vaccinations, evidence-based decision-making, the development of plans for vaccine introduction, the participation of national immunization technical advisory groups, the availability of economic resources and positive actions from the respective Ministry of Health. The main challenges were the actions of antivaccination groups, problems with electronic immunization registries, a lack of vaccines, delays in the delivery of vaccines and the scarcity of health personnel at the local level. Conclusions Commitment, the participation of multiple sectors, the availability of resources and preparedness planning were some of the many strengths shown by countries introducing COVID-19 vaccines. Weaknesses included third parties' interests, the lack of information systems and difficulty in accessing vaccines and vaccine services. There is a window of opportunity for countries to maintain the good practices that allowed for the processes' strengths and to assess the identified weaknesses to invigorate immunization programs and prepare for future health crises.
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Affiliation(s)
- Ruth Jimbo-Sotomayor
- Centro de investigación para la Salud en América LatinaPontificia Universidad Católica del EcuadorQuitoEcuadorCentro de investigación para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - María Tereza da Costa Oliveira
- Special Program for Comprehensive ImmunizationPan American Health OrganizationWashington, D.C.United States of AmericaSpecial Program for Comprehensive Immunization, Pan American Health Organization, Washington, D.C., United States of America
| | - Luciana Armijos Acurio
- Centro de investigación para la Salud en América LatinaPontificia Universidad Católica del EcuadorQuitoEcuadorCentro de investigación para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Magdalena Bastías
- Special Program for Comprehensive ImmunizationPan American Health OrganizationWashington, D.C.United States of AmericaSpecial Program for Comprehensive Immunization, Pan American Health Organization, Washington, D.C., United States of America
| | - Marcia Carvalho
- Special Program for Comprehensive ImmunizationPan American Health OrganizationWashington, D.C.United States of AmericaSpecial Program for Comprehensive Immunization, Pan American Health Organization, Washington, D.C., United States of America
| | - Xavier Sánchez
- Centro de investigación para la Salud en América LatinaPontificia Universidad Católica del EcuadorQuitoEcuadorCentro de investigación para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Lucia Helena de Oliveira
- Special Program for Comprehensive ImmunizationPan American Health OrganizationWashington, D.C.United States of AmericaSpecial Program for Comprehensive Immunization, Pan American Health Organization, Washington, D.C., United States of America
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Durrance-Bagale A, Marzouk M, Agarwal S, Ananthakrishnan A, Gan S, Hayashi M, Jacob-Chow B, Jiayun K, Tung LS, Mkhallalati H, Newaz S, Omar M, Sittimart M, Ung M, Yuze Y, Yang HL, Howard N. Operationalising Regional Cooperation for Infectious Disease Control: A Scoping Review of Regional Disease Control Bodies and Networks. Int J Health Policy Manag 2022; 11:2392-2403. [PMID: 35042324 PMCID: PMC9818116 DOI: 10.34172/ijhpm.2021.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic demonstrates the value of regional cooperation in infectious disease prevention and control. We explored the literature on regional infectious disease control bodies, to identify lessons, barriers and enablers to inform operationalisation of a regional infectious disease control body or network in southeast Asia. METHODS We conducted a scoping review to examine existing literature on regional infectious disease control bodies and networks, and to identify lessons that can be learned that will be useful for operationalisation of a regional infectious disease control body such as the Association of Southeast Asian Nations (ASEAN) Center for Public Health Emergency and Emerging Diseases. RESULTS Of the 57 articles included, 53 (93%) were in English, with two (3%) in Spanish and one (2%) each in Dutch and French. Most were commentaries or review articles describing programme initiatives. Sixteen (28%) publications focused on organisations in the Asian continent, with 14 (25%) focused on Africa, and 14 (25%) primarily focused on the European region. Key lessons focused on organisational factors, diagnosis and detection, human resources, communication, accreditation, funding, and sustainability. Enablers and constraints were consistent across regions/ organisations. A clear understanding of the regional context, budgets, cultural or language issues, staffing capacity and governmental priorities, is pivotal. An initial workshop inclusive of the various bodies involved in the design, implementation, monitoring or evaluation of programmes is essential. Clear governance structure, with individual responsibilities clear from the beginning, will reduce friction. Secure, long-term funding is also a key aspect of the success of any programme. CONCLUSION Operationalisation of regional infectious disease bodies and networks is complicated, but with extensive groundwork, and focus on organisational factors, diagnosis and detection, human resources, communication, accreditation, funding, and sustainability, it is achievable. Ways to promote success are to include as many stakeholders as possible from the beginning, to ensure that context-specific factors are considered, and to encourage employees through capacity building and mentoring, to ensure they feel valued and reduce staff turnover.
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Affiliation(s)
- Anna Durrance-Bagale
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
| | - Manar Marzouk
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | | | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Sarah Gan
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Michiko Hayashi
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Beth Jacob-Chow
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Koh Jiayun
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Lam Sze Tung
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Hala Mkhallalati
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Sanjida Newaz
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maryam Omar
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Manit Sittimart
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Mengieng Ung
- Lee Kuan Yew Centre for Innovative Cities, Singapore University of Technology and Design, Singapore, Singapore
| | - Yang Yuze
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Hsu Li Yang
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Natasha Howard
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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Castañeda-Orjuela C, De la Hoz-Restrepo F. Criteria for New Vaccine Introduction in a National Expanded Program on Immunization: A Survey of Expanded Program on Immunization Managers. Value Health Reg Issues 2022; 31:142-147. [PMID: 35717704 DOI: 10.1016/j.vhri.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 04/07/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to critically review the decision-making (DM) processes for new vaccines introduction in Latin America's Expanded Program on Immunization (EPIs) and role of cost-effectiveness analyses (CEAs). METHODS An online survey was conducted between August and December 2019 to Latin America and the Caribbean (LAC) EPI managers, participants of the National Immunization Technical Advisory Group (NITAG). Information about criteria to introduce the most recent vaccine was asked. CEA role in that decision and technical knowledge of informants were investigated. Frequencies of categorical data were calculated. Bar plots and stacked bar plots were used to visualize the data. RESULTS A total of 26 EPI managers and stakeholders participated in the survey from 14 LAC countries. Respondents worked at the Ministry of Health and the Pan American Health Organization. Most recent vaccines included were human papillomavirus (42.3%), injectable polio (26.9%), and varicella (15.4%). High burden of disease and cost-effectiveness/cost-utility were identified as the main a priori criteria used to new vaccine introduction, but not all inputs are available or good quality. Discussion about vaccine introduction was conducted at NITAG meetings, reported as independent by most countries. Nevertheless, NITAG members did not master the essential CEAs concepts. CONCLUSIONS DM of vaccine introduction in LAC is reported by EPI managers as a process of discussion with participation of several actors where economic rationalities had a high role in the decision. It is necessary to strengthen the technical capacity to understand economical inputs to inform DM and advocate to include other rationalities as important in the discussion.
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Affiliation(s)
- Carlos Castañeda-Orjuela
- Epidemiology and Public Health Evaluation Group, Universidad Nacional de Colombia, Bogotá, Colombia; Colombian National Health Observatory, Instituto Nacional de Salud, Bogotá, Colombia.
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Knight F, Bourassa MW, Ferguson E, Walls H, de Pee S, Vosti S, Martinez H, Levin C, Woldt M, Sethurman K, Bergeron G. Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors. Ann N Y Acad Sci 2022; 1513:170-191. [PMID: 35443074 PMCID: PMC9546113 DOI: 10.1111/nyas.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low‐ and middle‐income country case studies and used thematic analysis to understand the data. NMTs were mostly applied by international organizations to inform national government decision making. NMT applications contributed to enabling environments for nutrition and influenced program design and policy in most cases; however, this influence could be strengthened. Influence was shaped by processes for applying the NMTs; ownership of the analysis and data inputs, and capacity building in NMT methods, encouraged uptake. Targeting evidence generation at specific policy cycle stages promoted uptake; however, where advocacy capacity allowed, modeling was embedded ad hoc into emerging policy discussions and had broader influence. Meanwhile, external factors, such as political change and resource constraints of local partner organizations, challenged NMT implementation. Importantly, policy uptake was never the result of NMTs exclusively, indicating they should be nested persistently and strategically within the wider evidence and advocacy continuum, rather than being stand‐alone activities.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Walls
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia.,Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Kavita Sethurman
- Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- New York Academy of Sciences, New York, New York.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia
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Sartori AMC, Rozman LM, Decimoni TC, Leandro R, Novaes HMD, de Soárez PC. A systematic review of health economic evaluations of vaccines in Brazil. Hum Vaccin Immunother 2017; 13:1-12. [PMID: 28129026 DOI: 10.1080/21645515.2017.1282588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program. OBJECTIVES To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013. METHODS Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items. RESULTS Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources. CONCLUSIONS HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.
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Affiliation(s)
- Ana Marli Christovam Sartori
- a Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Luciana Martins Rozman
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Tassia Cristina Decimoni
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Roseli Leandro
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | | | - Patrícia Coelho de Soárez
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
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Glassman A, Cañón O, Silverman R. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:913-920. [PMID: 27987640 PMCID: PMC5193155 DOI: 10.1016/j.jval.2016.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND In middle-income countries, vaccines against pneumococcal disease, rotavirus, and human papilloma virus are in general more costly, not necessarily cost saving, and less consistently cost-effective than earlier generation vaccines against measles, diphtheria, tetanus, and pertussis. Budget impact is also substantial; public spending on vaccines in countries adopting new vaccines is, on average, double the amount of countries that have not adopted. Policymakers must weigh the costs and benefits of the adoption decision carefully, given the low coverage of other kinds of cost-effective health and nonhealth interventions in these same settings and relatively flat overall public spending on health as a share of gross domestic product (GDP) over time. OBJECTIVE This paper considers lessons learned from recent vaccine cost-effectiveness analyses and subsequent adoption decisions in Latin America a, largely under the auspices of the Pro Vac Initiative. RESULTS The paper illustrates how small methodological choices and seemingly minor technical limitations of cost-effectiveness models can have major implications for the studies' conclusions, potentially influencing countries' subsequent vaccine adoption decisions. METHODS We evaluate the ProVac models and technical outputs against the standards and framework set out by the International Decision Support Initiative Reference Case for economic evaluation and consider the practical effects of deviations from those standards. CONCLUSIONS Lessons learned are discussed, including issues of appropriate comparators, GDP-based thresholds, and use of average versus incremental cost-effectiveness ratios as a convention are assessed. The article ends with recommendations for the future.
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Novaes HMD, de Soárez PC, Silva GA, Ayres A, Itria A, Rama CH, Sartori AMC, Clark AD, Resch S. Cost-effectiveness analysis of introducing universal human papillomavirus vaccination of girls aged 11 years into the National Immunization Program in Brazil. Vaccine 2016; 33 Suppl 1:A135-42. [PMID: 25919154 DOI: 10.1016/j.vaccine.2014.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the impact and cost-effectiveness of introducing universal human papillomavirus (HPV) vaccination into the National Immunization Program (NIP) in Brazil. METHODS The Excel-based CERVIVAC decision support model was used to compare two strategies: (1) status quo (with current screening program) and (2) vaccination of a cohort of 11-year-old girls. National parameters for the epidemiology and costs of cervical cancer were estimated in depth. The estimates were based on data from the health information systems of the public health system, the PNAD 2008 national household survey, and relevant scientific literature on Brazil. Costs are expressed in 2008 United States dollars (US$), and a 5% discount rate is applied to both future costs and future health benefits. RESULTS Introducing the HPV vaccine would reduce the burden of disease. The model estimated there would be 229 deaths avoided and 6677 disability-adjusted life years (DALYs) averted in the vaccinated cohort. The incremental cost-effectiveness ratios (ICERs) per DALY averted from the perspectives of the government (US$ 7663), health system (US$ 7412), and society (US$ 7298) would be considered cost-effective, according to the parameters adopted by the World Health Organization. In the sensitivity analysis, the ICERs were most sensitive to variations in discount rate, disease burden, vaccine efficacy, and proportion of cervical cancer caused by types 16 and 18. However, universal HPV vaccination remained a cost-effective strategy in most variations of the key estimates. CONCLUSIONS Vaccine introduction could contribute additional benefits in controlling cervical cancer, but it requires large investments by the NIP. Among the essential conditions for attaining the expected favorable results are immunization program sustainability, equity in a population perspective, improvement of the screening program, and development of a surveillance system.
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Affiliation(s)
- Hillegonda Maria Dutilh Novaes
- Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455 - 2(o) andar Cerqueira César, 01246-903 São Paulo, SP, Brazil
| | - Patrícia Coelho de Soárez
- Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455 - 2(o) andar Cerqueira César, 01246-903 São Paulo, SP, Brazil.
| | - Gulnar Azevedo Silva
- Rio de Janeiro State University, Social Medicine Institute, Rio de Janeiro, RJ, Brazil
| | - Andreia Ayres
- Rio de Janeiro State University, Social Medicine Institute, Rio de Janeiro, RJ, Brazil
| | - Alexander Itria
- Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, GO, Brazil
| | - Cristina Helena Rama
- Leonor Mendes de Barros Maternity Hospital, Health State Secretariat, São Paulo, SP, Brazil
| | - Ana Marli Christovam Sartori
- Clinic of Infectious and Parasitic Diseases, Hospital das Clínicas, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 455, 4(o) andar, sala 4028 Cerqueira César, 05403-000 São Paulo, SP, Brazil
| | - Andrew D Clark
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen Resch
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, United States
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Jauregui B, Garcia AGF, Bess Janusz C, Blau J, Munier A, Atherly D, Mvundura M, Hajjeh R, Lopman B, Clark AD, Baxter L, Hutubessy R, de Quadros C, Andrus JK. Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group's experience. Vaccine 2016; 33 Suppl 1:A28-33. [PMID: 25919170 DOI: 10.1016/j.vaccine.2014.10.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/12/2014] [Accepted: 10/21/2014] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Pan American Health Organization's (PAHO) ProVac Initiative aims to strengthen countries' technical capacity to make evidence-based immunization policy. With financial support from the Bill and Melinda Gates Foundation, PAHO established the ProVac International Working Group (IWG), a platform created for two years to transfer the ProVac Initiative's tools and methods to support decisions in non-PAHO regions. METHODS In 2011, WHO Regional Offices and partner agencies established the IWG to transfer the ProVac framework for new vaccine decision support, including tools and trainings to other regions of the world. During the two year period, PAHO served as the coordinating secretariat and partner agencies played implementing or advisory roles. RESULTS Fifty nine national professionals from 17 countries received training on the use of economic evaluations to aid vaccine policy making through regional workshops. The IWG provided direct technical support to nine countries to develop cost-effectiveness analyses to inform decisions. All nine countries introduced the new vaccine evaluated or their NITAGs have made a recommendation to the Ministry of Health to introduce the new vaccine. DISCUSSION Developing countries around the world are increasingly interested in weighing the potential health impact due to new vaccine introduction against the investments required. During the two years, the ProVac approach proved valuable and timely to aid the national decision making processes, even despite the different challenges and idiosyncrasies encountered in each region. The results of this work suggest that: (1) there is great need and demand for technical support and for capacity building around economic evaluations; and (2) the ProVac method of supporting country-owned analyses is as effective in other regions as it has been in the PAHO region. CONCLUSION Decision support for new vaccine introduction in low- and middle-income countries is critical to guiding the efficient use of resources and prioritizing high impact vaccination programs.
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Affiliation(s)
| | | | | | - Julia Blau
- Agence de Médecine Préventive, Paris, France
| | | | | | | | - Rana Hajjeh
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin Lopman
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Louise Baxter
- London School of Hygiene and Tropical Medicine, London, UK
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Cost-effectiveness of rotavirus vaccination in Kenya and Uganda. Vaccine 2016; 33 Suppl 1:A109-18. [PMID: 25919149 DOI: 10.1016/j.vaccine.2014.12.079] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/11/2014] [Accepted: 12/19/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda. METHODOLOGY In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda. RESULTS Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective). CONCLUSIONS Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national capacity to undertake economic evaluations.
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Jauregui B, Janusz CB, Clark AD, Sinha A, Garcia AGF, Resch S, Toscano CM, Sanderson C, Andrus JK. ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions. Vaccine 2016; 33 Suppl 1:A21-7. [PMID: 25919164 DOI: 10.1016/j.vaccine.2014.12.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Pan American Health Organization (PAHO) created the ProVac Initiative in 2004 with the goal of strengthening national technical capacity to make evidence-based decisions on new vaccine introduction, focusing on economic evaluations. In view of the 10th anniversary of the ProVac Initiative, this article describes its progress and reflects on lessons learned to guide the next phase. METHODS We quantified the output of the Initiative's capacity-building efforts and critically assess its progress toward achieving the milestones originally proposed in 2004. Additionally, we reviewed how country studies supported by ProVac have directly informed and strengthened the deliberations around new vaccine introduction. RESULTS Since 2004, ProVac has conducted four regional workshops and supported 24 health economic analyses in 15 Latin American and Caribbean countries. Five Regional Centers of Excellence were funded, resulting in six operational research projects and nine publications. Twenty four decisions on new vaccine introductions were supported with ProVac studies. Enduring products include the TRIVAC and CERVIVAC cost-effectiveness models, the COSTVAC program costing model, methodological guides, workshop training materials and the OLIVES on-line data repository. Ten NITAGs were strengthened through ProVac activities. DISCUSSION The evidence accumulated suggests that initiatives with emphasis on sustainable training and direct support for countries to generate evidence themselves, can help accelerate the introduction of the most valuable new vaccines. International and Regional Networks of Collaborators are necessary to provide technical support and tools to national teams conducting analyses. Timeliness, integration, quality and country ownership of the process are four necessary guiding principles for national economic evaluations to have an impact on policymaking. It would be an asset to have a model that offers different levels of complexity to choose from depending on the vaccine being evaluated, the availability of data, and the time frame of the decision. CONCLUSION Decision support for new vaccine introduction in low- and middle-income countries is critical to maximizing the efficiency and impact of vaccination programs. Global technical cooperation will be required. In the future, PAHO and WHO have an opportunity to expand the reach of the ProVac philosophy, models, and methods to additional regions and countries requiring real-time support. The ProVac Global Initiative is proposed as an effective mechanism to do so.
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Affiliation(s)
- Barbara Jauregui
- Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA.
| | - Cara Bess Janusz
- Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA
| | - Andrew D Clark
- Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anushua Sinha
- Depatment of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers - The State University of New Jersey, Newark, NJ, USA
| | | | - Stephen Resch
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA
| | | | - Colin Sanderson
- Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jon Kim Andrus
- Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA
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Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru. Vaccine 2015; 33 Suppl 1:A154-66. [DOI: 10.1016/j.vaccine.2014.12.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 11/15/2022]
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12
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Betancourt-Cravioto M, Kuri-Morales P, González-Roldán JF, Tapia-Conyer R. Introducing a dengue vaccine to Mexico: development of a system for evidence-based public policy recommendations. PLoS Negl Trop Dis 2014; 8:e3009. [PMID: 25077478 PMCID: PMC4117432 DOI: 10.1371/journal.pntd.0003009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Enhancing the work of the Department of Health and Human Services national vaccine program in global immunization: recommendations of the National Vaccine Advisory Committee: approved by the National Vaccine Advisory Committee on September 12, 2013. Public Health Rep 2014; 129 Suppl 3:12-85. [PMID: 25100887 PMCID: PMC4121882 DOI: 10.1177/00333549141295s305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Glassman A. Beyond methods and studies: Building institutions for better public spending on vaccination. Vaccine 2013; 31 Suppl 3:C10-1. [DOI: 10.1016/j.vaccine.2013.05.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/28/2022]
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15
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Andrus JK, Walker DG. Evidence base for new vaccine introduction in Latin America and the Caribbean. Vaccine 2013; 31 Suppl 3:C2-3. [DOI: 10.1016/j.vaccine.2013.05.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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