The study delves into the persistent challenge of pneumonia as a major cause of childhood mortality globally, “accounting for 14% of deaths among children under five years”, despite the availability and proven effectiveness of pneumococcal conjugate vaccines (PCVs). The main objective was to assess the landscape of countries (39 as of January 2023, 33 low- and middle-income countries; 6 high-income countries) that have not fully incorporated PCVs into their National Immunization Programs. Through an archetype analysis focusing on health characteristics, immunization factors, and policy frameworks, the researchers identified key indicators “that could influence countries’ decision-making ability and readiness to introduce PCV.”
“Focused on three key domains—health characteristics, immunization factors, and policy framework,” three team members independently conducted online searches for domains and indicators from published literature about vaccine introduction in the 33 low- and middle-income countries (LMICs). Each country received a score between 0 and 4, aligning with a sliding scale for each indicator within its respective domain. The higher scores denoted “stronger evidence for PCV introduction need, value, and readiness,” potentially fostering favorable conditions for PCV implementation.
The findings revealed that many countries, including 33 low- and middle-income countries and 6 high-income countries, have yet to integrate PCVs. Among LMICs, “fifteen out of the 18 (83%) countries classified as moderate- to high-barrier”, indicating favorable conditions for PCV introduction. This is likely due to lower disease burden, lower external support, and cost and product visibility barriers, such as “high immunization coverage of common childhood vaccines, supportive governments, and substantial disease burden and eligibility for Gavi support.” However, when compared to low-income countries, middle-income countries together have a higher total number of vulnerable populations and consequently reported “67% of global vaccine-preventable deaths.” The study identified countries falling into the “moderate-barrier” (12) and ‘high-barrier’ (6) archetypes, which exhibited immunization capacity but faced challenges like “competing national priorities and cost barriers that impeded policy decision-making on PCV introduction.”
The classification of the study based on policy and health variables provides a strategic approach to tailor advocacy campaigns for PCV uptake in these remaining nations. By tailoring policy approaches informed by this framework, there is potential to enhance decision-making processes regarding vaccine introduction and ensure sustained access to vaccines, ultimately “increasing political, scientific, logistical, and financial ownership by countries and global agencies” to improve child survival worldwide.
Relevant Links/Information resources
Banerjee, P., Huber, J., Denti, V., Sauer, M., Weeks, R., Dhaliwal, B. K., & Shet, A. (2023). Closing the pneumococcal conjugate vaccine (PCV) introduction gap: an archetype analysis of last-mile countries. Global Health Action, 16(1). https://doi.org/10.1080/16549716.2023.2281065
