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Evans-Gilbert T, Figueroa JP, Bonvehí P, Melgar M, Stecher D, Kfouri R, Munoz G, Bansie R, Valenzuela R, Verne E, Salas D, Jennifer Sanwogou N. Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean. Vaccine 2024; 42:2310-2316. [PMID: 38438288 DOI: 10.1016/j.vaccine.2024.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.
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Affiliation(s)
- Tracy Evans-Gilbert
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica.
| | - J Peter Figueroa
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston, Jamaica.
| | - Pablo Bonvehí
- Center for Medical Education and Clinical Research, Av. Las Heras 2929, 1425 Buenos Aires, Argentina.
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala 01011, Guatemala.
| | - Daniel Stecher
- Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121 ABG Buenos Aires, Argentina.
| | - Renato Kfouri
- Immunization Department, Brasilian Society of Pediatrics, R. Santa Clara, 292 - Copacabana, Rio de Janeiro, RJ 22041-012, Brazil.
| | - Greta Munoz
- Hospital Pediátrico Baca Ortiz, S/N y D.M., Avenida 6 de Diciembre & Av. Cristóbal Colón, Quito, Ecuador.
| | - Rakesh Bansie
- Academic Hospital Paramaribo, RRP8+PQ7, Flustraat, Paramaribo, Suriname.
| | | | - Eduardo Verne
- Hospital Nacional Cayetano Heredia, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru.
| | - Daniel Salas
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
| | - N Jennifer Sanwogou
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
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De Oliveira LH, Janusz CB, Da Costa MT, El Omeiri N, Bloem P, Lewis M, Luciani S. HPV vaccine introduction in the Americas: a decade of progress and lessons learned. Expert Rev Vaccines 2022; 21:1569-1580. [PMID: 36154390 DOI: 10.1080/14760584.2022.2125383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is an important public health concern due to its causative role in many cancers, especially cervical cancer, and other conditions that lead to serious health consequences in both men and women. In Latin America and the Caribbean, nearly 60,000 new cases of cervical cancer and another 7,000 HPV-associated cancers are diagnosed annually. AREAS COVERED HPV vaccination combined with comprehensive cervical cancer control programmingis paving the way for eliminating cervical cancer as a major public health problem and drastically reducing other HPV-associated diseases. To date, 44 countries and territories in the Americas have introduced HPV vaccines as part of their national immunization programs and cervical cancer control strategies. Early lessons from HPV vaccine introduction suggest that transparent and credible evidence-based decision-making, information, education and communication about HPV and cervical cancer, coordination with existing cervical cancer control initiatives, and precise planning for ensuring effective uptake of the vaccine in target groups are all critical elements of success. EXPERT OPINION There is an urgent need for strategies to increase HPV vaccine coverage, and as the integrated control programs evolve and other HPV-associated disease becomes important for public health, there will be a need for continued program and policy evaluation.
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Affiliation(s)
- Lucia H De Oliveira
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Cara B Janusz
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nathalie El Omeiri
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Paul Bloem
- Department of Immunizations, Biologicals, and Vaccines, World Health Organization, Geneva, Switzerland
| | - Merle Lewis
- Pan American Health Organization, Washington, DC, USA
| | - Silvana Luciani
- Non-communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Ozaltin A, Vaughan K, Tani K, Manzi F, Mai VQ, Van Minh H, Kosen S, Shimp L, Brenzel L, Boonstoppel L. Key Factors Influencing Use of Immunization Cost Evidence in Country Planning and Budgeting Processes: Experiences From Indonesia, Tanzania, and Vietnam. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00264. [PMID: 35294377 PMCID: PMC8885341 DOI: 10.9745/ghsp-d-21-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Soewarta Kosen
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Logan Brenzel
- Bill & Melinda Gates Foundation, Washington, DC, USA
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Evidence-informed vaccine decision making: The introduction of Human Papilloma Virus (HPV) vaccination in the Netherlands. Health Policy 2019; 123:260-266. [DOI: 10.1016/j.healthpol.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 11/21/2022]
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Health Economics and Outcomes Research Knowledge Needs Assessment for Latin America. Value Health Reg Issues 2019; 20:2-6. [PMID: 30634087 DOI: 10.1016/j.vhri.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND An increasing awareness of the importance of health economics and outcomes research (HEOR) skills has been reported in Latin America. There is, however, no published study directly assessing perceived knowledge levels and knowledge gaps on specific HEOR topics among professionals and students in the region. OBJECTIVES To assess perceived HEOR knowledge levels and identify knowledge gaps in Latin America. METHODS An online needs assessment survey was developed to quantify perceived HEOR knowledge levels and identify knowledge gaps. Members of the International Society for Pharmacoeconomics and Outcomes Research in the Latin American region, regional chapters, and student chapter presidents were invited to participate in the survey. The survey, developed using the SurveyMonkey tool, was distributed to participants electronically. Data were extracted from the survey and analyzed using Microsoft Excel. Data analysis was conducted using descriptive statistics to summarize the survey respondents' demographic information, current and desired knowledge levels, and preferred method/format for delivery of educational training. RESULTS Survey responses were collected from 106 participants. The largest knowledge gap was calculated for methods for integrating medication adherence and persistence in health economic evaluations (mean = 2.30 ± 1.48). The smallest knowledge gap was calculated for types of healthcare costs (mean = 1.01 ± 1.17). Most respondents (74% [n = 66]) preferred to receive educational materials related to HEOR topics through online learning and continuing education programs. CONCLUSIONS The knowledge gap assessment provided current knowledge gap perceptions among members of the International Society for Pharmacoeconomics and Outcomes Research in Latin America. The survey data collected support a need for developing educational programs for topics with the highest perceived knowledge gap.
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Bardach AE, Rey-Ares L, Calderon Cahua M, Ciapponi A, Cafferata ML, Cormick G, Gentile Á. Burden of Culture-Confirmed Pediatric Pneumococcal Pneumonia in Latin America and the Caribbean: A Systematic Review and Meta-Analysis. Value Health Reg Issues 2017; 14:41-52. [PMID: 29254541 DOI: 10.1016/j.vhri.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/11/2017] [Accepted: 04/09/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pneumococcal pneumonia (PP) causes almost one in five deaths in children younger than 5 years worldwide. In Latin America and the Caribbean (LAC), pneumonia causes 14% of all deaths. Although pneumococcal disease is a vaccine-preventable disease that accounts for a significant proportion of this burden, the decision-making process to introduce pneumococcal conjugate vaccines in official schedules is still complex in LAC. Confirmed PP cases and epidemiology are the basis for broader projections. OBJECTIVE To gather all the information available in the LAC region to assist decision makers. METHODS We performed a systematic review of studies of consolidating and culture-confirmed pediatric PP in LAC (2000-2016) using a generic academic Internet search and search engines without language restrictions. Pairs of reviewers independently selected and assessed the studies' methodological quality. We analyzed meta-information on pneumococcal serotypes available from the SIREVA laboratory-based surveillance system. RESULTS A total of 35 out of 750 initially identified studies were included. In the age group between 0 and 59 years, the incidence of culture-confirmed PP ranged from 10.2 to 43.0/100,000 children, with a pooled incidence of 20.4/100,000 children (95% confidence interval 0.0-123.2). Mortality ranged from 0.4 to 5.7/100,000 children, and the pooled mortality was 2.9/100,000 children (95% confidence interval 0.3-8.2). The pooled serotype distribution from surveillance data showed that serotypes 14, 1, and 6B were the most frequent serotypes in LAC, all included in licensed vaccines. CONCLUSIONS Studies on confirmed pediatric PP were scarce in LAC in 2000 to 2016. Epidemiology indicators and health resource use are still poorly defined.
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Affiliation(s)
- Ariel Esteban Bardach
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina.
| | - Lucila Rey-Ares
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - María Calderon Cahua
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - María Luisa Cafferata
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - Ángela Gentile
- Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
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Cost-effectiveness analysis of the introduction of the human papillomavirus vaccine in Honduras. Vaccine 2016; 33 Suppl 1:A167-73. [PMID: 25919157 DOI: 10.1016/j.vaccine.2014.12.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 12/13/2014] [Accepted: 12/15/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer deaths in Honduras. With the availability of a vaccine to prevent human papillomavirus (HPV), the causative agent for cervical cancer, the Honduran Secretary of Health undertook a cost-effectiveness analysis of introducing the HPV vaccine to support their national decision-making process. METHODS A national multidisciplinary team conducted this analysis with the CERVIVAC model, developed by the London School of Hygiene and Tropical Medicine in collaboration with the Pan American Health Organization's ProVac Initiative. The cumulative costs and health benefits of introducing the HPV vaccine were assessed over the lifetime of one single cohort of 11-year-old girls. We assumed a three-dose series with 95% vaccination coverage of the cohort using a mixture of school-based and facility-based delivery. To estimate national cervical cancer cases and deaths, we used United Nations demographic projections and GLOBOCAN estimates based on registry data from El Salvador, Guatemala, and Nicaragua. Based on estimates from the World Health Organization (WHO) and the Division of Intensified Cooperation with Countries (ICO), we assumed that 70% of cervical cancer would be due to vaccine types HPV16 and HPV18. We used a vaccine dose price of US$ 13.45 and evidence from the scientific literature to estimate vaccine effectiveness. National information was used to estimate health service utilization and costs of cervical cancer treatment. All costs and health benefits were discounted at 3%. RESULTS Upon fully vaccinating 86,906 11-year old girls, 2250 (undiscounted) cervical cancer cases and 1336 (undiscounted) deaths would be prevented over the lifetime of the cohort. After discounting future health benefits at 3% per year, the equivalent cases and deaths prevented were 421 and 170. HPV vaccination is estimated to cost around US$ 5 million per vaccinated cohort, but this would be offset by around US$ 1 million in avoided costs borne by the government to treat cervical cancer. Furthermore, 4349 discounted disability adjusted life years (DALYs) could be avoided at a cost of US$ 926 per DALY avoided, making HPV vaccination in Honduras a highly cost-effective intervention. DISCUSSION The net cost of HPV vaccination per DALY avoided is less than the WHO threshold for cost-effectiveness. However, at a cost of around US$ 5 million per vaccinated cohort, an important element to consider in this discussion is the budgetary implications that the introduction of the HPV vaccine would cause for the country. CONCLUSIONS When comparing the costs and benefits of HPV vaccine introduction in Honduras, it is clear that this intervention would be highly cost-effective and that the intervention would greatly reduce cervical cancer disease. For these reasons, it is in the country's best interest to explore financing opportunities that could support the vaccine's introduction.
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Berenice IM, Mendoza LO, García O, Díaz I, Figueroa J, Duarte RM, Perdomo G, Garcia AGF, Janusz CB. WITHDRAWN: Analyse coût-efficacité de l’introduction du vaccin contre le virus du papillome humain au Honduras. Vaccine 2015:S0264-410X(15)01445-0. [PMID: 26601622 DOI: 10.1016/j.vaccine.2015.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ida Molina Berenice
- Programme élargi de vaccination, secrétariat à la Santé, Tegucigalpa, Honduras.
| | | | - Odalys García
- Organisation panaméricaine de la Santé, Tegucigalpa, Honduras
| | - Iris Díaz
- Programme élargi de vaccination, secrétariat à la Santé, Tegucigalpa, Honduras
| | - Jacqueline Figueroa
- Programme national de contrôle du cancer et des maladies chroniques, secrétariat à la Santé, Tegucigalpa, Honduras
| | - Rosa María Duarte
- Programme national de contrôle du cancer et des maladies chroniques, secrétariat à la Santé, Tegucigalpa, Honduras
| | | | - Ana Gabriela Félix Garcia
- Immunisation intégrale de la famille, Organisation panaméricaine de la Santé, Washington (D.C.), États-Unis
| | - Cara Bess Janusz
- Immunisation intégrale de la famille, Organisation panaméricaine de la Santé, Washington (D.C.), États-Unis
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Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries: A Cost-effectiveness Modeling Analysis. Pediatr Infect Dis J 2015; 34:e176-84. [PMID: 25923424 DOI: 10.1097/inf.0000000000000727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The competing choices of vaccination with either RV1 or RV5, the potential budget impact of vaccines on the EPI with different prices and new evidence make important an updated analysis for health decision makers in each country. The objective of this study is to assess cost-effectiveness of the monovalent and pentavalent rotavirus vaccines and impact on children deaths, inpatient and outpatient visits in 116 low and middle income countries that represent approximately 99% of rotavirus mortality. METHODS A decision tree model followed hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year averted, comparing no vaccination with either monovalent or pentavalent mass introduction. Vaccine price was assumed fixed for all world low-income and middle-income countries. RESULTS Around 292,000 deaths, 3.34 million inpatient cases and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 54.7% of inpatient cases and 45.4% of deaths. Pentavalent vaccination would prevent 51.4% of inpatient cases and 41.1% of deaths. The vaccine was cost-effective in all world countries in the base-case scenario for both vaccines. Cost per disability-adjusted life-year averted in all selected countries was I$372 for monovalent, and I$453 for pentavalent vaccination. CONCLUSION Rotavirus vaccine is cost-effective in most analyzed countries. Despite cost-effectiveness analysis is a useful tool for decision making in middle-income countries, for low-income countries health decision makers should also assess the impact of introducing either vaccine on local resources and budget impact analysis of vaccination.
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Augustovski F, Jaime Caro J, Zárate Barahona V, Ferraz MB. Introducing the New Value in Health Regional Issues Journal: The Latin America Region Edition. Value Health Reg Issues 2014; 5:78-79. [DOI: 10.1016/j.vhri.2013.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boncz I, Kaló Z, Mohamed Ibrahim MIB, Greenberg D. Further Steps in the Development of Pharmacoeconomics, Outcomes Research, and Health Technology Assessment in Central and Eastern Europe, Western Asia, and Africa. Value Health Reg Issues 2013; 2:169-170. [DOI: 10.1016/j.vhri.2013.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Drummond M. Future Prospects for Pharmacoeconomics and Outcomes Research in the Emerging Regions. Value Health Reg Issues 2013; 2:3-4. [PMID: 29702849 DOI: 10.1016/j.vhri.2013.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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