Journal Articles Recommendation
01
Global market landscape of vaccine manufacturing and procurement
On December 16, 2025, the World Health Organization (WHO) released the report Global Vaccine Manufacturing and Procurement Market Landscape. Drawing on 2023 data from 204 countries and 98 vaccine manufacturers, the report presents a comprehensive picture of the global vaccine ecosystem from both the demand side (countries) and the supply side (manufacturers), helping global, regional, and national stakeholders understand the current distribution of vaccine manufacturing and procurement across markets, technologies, and regions.
Key findings show that all WHO regions are interdependent for vaccine supply. At the country level, no nation meets its vaccine needs solely through production within its own region; countries in all regions procure vaccines whose production stages span multiple regions. In the WHO African Region, fewer than 5% of vaccines are supplied by companies headquartered in the region, reflecting a heavy reliance on manufacturers based in the WHO South-East Asia Region. By contrast, the South-East Asia Region is the most self-sufficient, sourcing 89% of vaccines from within the region, followed by the Western Pacific (67%) and European Regions (54%).
The report notes that domestic manufacturing capacity can strengthen national supply security, and regional manufacturing can be an important source for countries within a region. However, having domestic production does not guarantee supply security during emergencies. Vaccine production is typically concentrated within a single region across all stages, indicating manufacturers’ preference for vertically integrated, single-site operations. High-income countries (HICs) tend to procure vaccines from manufacturers headquartered in HICs, while low-income countries (LICs) rely on manufacturers based in HICs and middle-income countries (MICs). When supply is constrained, prioritization of higher-profit markets may pose access risks for LICs.
Vaccine manufacturing is highly skewed: a small number of large companies sell more than 400 million doses with revenues exceeding USD 5 billion, while 75–85% of manufacturers are small or medium-sized. Production capacity for innovative vaccines—such as mRNA and viral-vector vaccines—remains concentrated in a few countries with advanced biomanufacturing capabilities, with technology transfer and localized production still at an early stage.
The report concludes that achieving equitable access to vaccines requires strengthening regional manufacturing capacity, optimizing market structures, and overcoming technical and regulatory barriers. Continued global monitoring of regional manufacturing capacity is essential to inform decisions toward a more resilient, equitable, and sustainable global vaccine system.
Original Report: https://www.who.int/publications/i/item/9789240118249
02
Expert consensus on the implementation and evaluation process of free influenza vaccination project for students
This article was published in the Chinese Journal of Preventive Medicine and developed by the Expert Group on the Implementation and Evaluation of the Free Influenza Vaccination Program for Students. The consensus addresses the importance and feasibility of implementing free influenza vaccination programs for students, as well as program organization and implementation, supervision and management, and outcome evaluation. Nine key questions were systematically identified, and the GRADE approach was used to assess the quality of evidence and strength of recommendations. Taking into account China’s national context and practical experience, a total of 13 recommendations were formulated to provide scientific and actionable policy guidance for health authorities, CDCs, medical institutions, community health service centers, and schools that have implemented or plan to implement such programs.
The consensus highlights that primary and secondary school students are a key population for influenza transmission. Implementing free vaccination programs for students has significant public health value in reducing influenza-related disease and economic burden. Experts recommend setting a target influenza vaccination coverage of 70% among primary and secondary school students, to be achieved through policy support, centralized vaccination, and strengthened health education.
Regarding program organization and implementation, the consensus recommends assessing funding sources, vaccine supply security, vaccination service capacity, and parental acceptance during the planning stage. A multi-sectoral coordination mechanism led by health authorities, CDCs, and education departments should be established, with clear roles and standardized procedures for vaccine procurement, storage, distribution, and informed consent. Vaccination should begin at least one month before the local influenza season, and vaccine type and formulation should be selected based on epidemiological characteristics, budget, and vaccine availability. Health education is identified as a key strategy to improve coverage and should target students, parents, and teachers, covering influenza epidemiology, clinical manifestations, benefits of vaccination, precautions, and adverse reactions, using both traditional and new media channels.
For supervision and evaluation, the consensus recommends that CDCs, together with health and education departments, conduct full-process oversight of program planning, implementation, and completion in accordance with regulations. Feasibility and social risk assessments should be conducted when programs are first introduced or when major changes are made. Program evaluation should cover vaccination coverage, vaccine effectiveness, safety, satisfaction, health economics, and health benefits. Program reports should include implementation and evaluation findings, methods, outcomes, recommendations for future actions, and supporting documentation.
Overall, this consensus establishes a systematic and standardized framework for the implementation and evaluation of free influenza vaccination programs for students, providing an important foundation for the institutionalized and evidence-based advancement of influenza prevention and control in schools in China.
DOI：10.3760/cma.j.cn112150-20250210-00096
03
Immunogenicity and safety of inactivated quadrivalent influenza vaccines in children aged 6–35 months: A multi-center, randomized, double-blind, active-controlled clinical trial
This study was published in Vaccine. It aimed to systematically evaluate the immunogenicity and safety of full-dose and half-dose quadrivalent inactivated influenza vaccines (QIV) in children aged 6–35 months, compared with licensed half-dose trivalent inactivated influenza vaccines (TIV). A multicenter, randomized, double-blind, active-controlled phase III clinical trial was conducted in Hubei and Anhui provinces. Eligible healthy children aged 6–35 months were randomized in a 2:2:1:1 ratio to receive full-dose QIV, half-dose QIV, half-dose TIV containing the B/Victoria lineage, or half-dose TIV containing the B/Yamagata lineage, administered as a two-dose regimen at days 0 and 28.
Blood samples were collected before vaccination and 28 days after the second dose to measure hemagglutination inhibition (HI) antibody responses. The primary endpoints were seroconversion rates (SCRs) and geometric mean titers (GMTs) 28 days after the second dose. Non-inferiority was defined as a lower bound of the 95% confidence interval of the SCR difference of no less than −10% and a lower bound of the 95% confidence interval of the GMT ratio of no less than 2/3. Safety was monitored for six months after the final vaccination.
Between September 16 and October 13, 2023, a total of 3,468 children were screened, and 3,300 were enrolled, of whom 3,289 received at least one dose. Immunogenicity analyses showed that both full-dose and half-dose QIV were non-inferior to half-dose TIV for all shared strains in terms of SCRs and GMTs. Notably, full-dose QIV induced significantly higher immune responses than half-dose QIV and half-dose TIV. Safety profiles were comparable across groups, and no vaccine-related serious adverse events or febrile seizures were observed.
In conclusion, both full-dose and half-dose QIV demonstrated immunogenicity non-inferior to licensed half-dose TIV in children aged 6–35 months. Importantly, full-dose QIV elicited stronger immune responses without new safety concerns, suggesting the potential to provide enhanced protection for this age group.
https://doi.org/10.1016/j.vaccine.2025.128113
04
Informing the development of transmission modelling guidance for global immunization decision-making: A qualitative needs assessment
This study was published in Vaccine and aimed to inform the development of World Health Organization (WHO) guidance on mathematical modeling to support global immunization policy decisions through a qualitative needs assessment. The objective was to clarify end users’ specific needs regarding both the content and format of such guidance. In-depth interviews were conducted with 15 immunization decision-makers and mathematical modeling experts from all six WHO regions, representing high-, middle-, and low-income countries. Interviews focused on: (1) understanding and use of modeling evidence; (2) challenges in applying modeling evidence; and (3) types of guidance that could facilitate effective use of modeling evidence.
The study found that participants with modeling expertise were able to apply modeling evidence directly and systematically, often serving as consultants to support decision-making. In contrast, less experienced users—typically policy advisors—reported low confidence in interpreting models, with some avoiding modeling evidence altogether. Decision-makers without modeling backgrounds expressed a need for more information to understand the value of models in specific contexts, although most acknowledged their potential usefulness. All participants agreed on the importance of capacity building and localization of modeling evidence to enhance trust, with less experienced users emphasizing the need for ongoing engagement with knowledge brokers and targeted training.
Multiple challenges to the use of modeling evidence were identified. At the decision-making level, limited meeting time (e.g., model briefings restricted to 20 minutes) and insufficient understanding of complex modeling processes and inherent uncertainties were major barriers. Participants from some low- and middle-income countries highlighted additional constraints, including limited local data, inadequate technical resources, and delayed access to non-English technical materials. Concerns were also raised about the transferability of models across contexts; for example, COVID-19 models based on epidemiological parameters from high-income countries could produce substantial bias when applied in low-income settings, leading some decision-makers to rely more heavily on recommendations from authoritative bodies such as WHO rather than on models themselves.
Based on these findings, the study recommends developing user-friendly guidance with clear navigation to help decision-makers assess model quality, understand added value, and integrate modeling evidence into localized decision processes. Participants also emphasized that combining online training with practice-oriented communities of practice could substantially improve understanding, confidence, and effective use of modeling evidence. Insights from this study have been incorporated into the development of relevant WHO guidance.
https://doi.org/10.1016/j.vaccine.2025.126800
05
Vaccine Hesitancy and Immunization Patterns in Central and Eastern Europe: Sociocultural, Economic, Political, and Digital Influences Across Seven Countries
This study was published in Risk Management and Healthcare Policy and applied qualitative comparative analysis to examine national policy documents, vaccination coverage data, determinants of vaccine hesitancy, and stakeholder perspectives across seven Central and Eastern European countries (Hungary, Slovakia, Romania, Czech Republic, Poland, Ukraine, and Lithuania). The study aimed to identify the underlying sociocultural, economic-political, and digital factors shaping vaccine hesitancy and immunization patterns in the region, thereby informing the optimization of regional immunization strategies.
The findings revealed substantial cross-country variation and temporal dynamics in vaccination coverage. Hungary and the Czech Republic maintained near-universal coverage within routine immunization programs, whereas measles–mumps–rubella (MMR) coverage in Slovakia, Romania, and Poland fell below the WHO-recommended 95% herd immunity threshold, contributing to recurrent measles outbreaks. Influenza vaccination coverage rose briefly during the early COVID-19 period but subsequently declined across countries; Slovakia reported coverage below 5%, among the lowest in the EU, alongside persistently low acceptance of COVID-19 vaccines. In Poland, the number of officially registered vaccine refusals more than doubled between 2017 and 2022, with the strongest resistance observed for MMR vaccination. In contrast, Lithuania achieved notable increases in influenza and pneumococcal vaccine coverage through integrated measures such as vaccination certificates and strengthened public health communication. These differences were driven by interacting factors including health system structures, public trust in institutions, exposure to misinformation, and the effectiveness of digital communication strategies.
Based on these findings, the study recommends a comprehensive approach to improving vaccination uptake in Central and Eastern Europe. Key measures include strengthening digital and mobile health infrastructure to improve access for rural and socioeconomically disadvantaged populations; enhancing digital health literacy, particularly among younger and marginalized groups, to counter online misinformation; implementing culturally adapted, value-oriented communication strategies aligned with local religious and social norms; and providing healthcare workers with training in empathetic counseling and motivational interviewing. In addition, the authors emphasize the importance of real-time monitoring systems integrating digital surveillance and social sentiment analysis, enhanced cross-border and intersectoral collaboration, and inclusive governance mechanisms that actively engage community leaders, educators, and patient organizations.
The study concludes that cross-border cooperation and context-specific public health communication tailored to cultural and socioeconomic conditions are critical for strengthening regional immunization resilience and achieving the elimination of vaccine-preventable diseases.
https://doi.org/10.2147/RMHP.S519479
06
Effectiveness of a targeted infant RSV immunization strategy (2024–2025): A multicenter matched case-control study in a high-surveillance setting
This study was published in the Journal of Infection. It aimed to evaluate the real-world effectiveness of the long-acting monoclonal antibody nirsevimab in preventing respiratory syncytial virus (RSV)–associated hospitalizations among infants younger than 12 months within a seasonal immunization program.
A prospective, multicenter, matched case–control design was used across seven hospitals in Italy during the 2024–2025 RSV season. Infants hospitalized with PCR-confirmed RSV bronchiolitis (cases) were matched 1:2 by age and admission date to infants hospitalized for non-respiratory conditions (controls). A total of 138 infants were included, comprising 46 RSV cases and 92 controls.
After adjustment for potential confounders such as sex and gestational age, the estimated effectiveness of nirsevimab against RSV-related hospitalization was 89.5% (95% CI: 60.3%–97.2%). Stratified analyses showed consistent protection across subgroups, with an effectiveness of 88.4% (95% CI: 56.5%–96.9%) among infants born after April 1, and 88.1% (95% CI: 45.7%–97.4%) among infants without clinical risk factors. Sensitivity analysis using inverse probability of treatment weighting confirmed a significant protective effect (effectiveness 79.6%, 95% CI: 53.5%–91.0%). In addition, none of the immunized infants required intensive care, and oxygen requirements were significantly reduced.
The study provides robust real-world evidence supporting the high effectiveness of nirsevimab within a targeted seasonal immunization strategy, offering critical empirical support for the phased implementation of RSV prevention policies across diverse healthcare settings.
https://doi.org/10.1016/j.jinf.2025.106600
Content Editor: Tianyi Deng
Page Editor: Ruitong Li
