Enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO's ProVac Initiative

Introduction

New life-saving vaccines being introduced, such as Human Papillomavirus (HPV), Pneumococcal, Rotavirus and Influenza, have significantly higher prices than previous vaccines. As health sector budgets grow slowly, resources have to be allocated more prudently and consider competing options. Decision makers in Latin America and the Caribbean (LAC) increasingly require economic analysis to support decision-making for new vaccines, in addition to demographic, epidemiologic, and management data. Making evidence-based vaccine introduction decisions now requires competencies beyond those traditionally found in many National Immunization Programs. The ProVac Initiative, launched with the September 2006 workshop, will provide technical cooperation and strengthen national capacity to make evidence-based, informed decisions in the context of the introduction of new and underutilized vaccines.

To ensure that future decisions for new vaccine introductions achieve the greatest sustainable impact, ProVac will focus on three essential factors:

• Decisions should be nationally based. Recognizing the variation in disease burden and program resources and capacity from country to country, immunization policy must be set nationally in order to meet national priorities. Accordingly, the paradigm must be changed from primarily Regional decisions to national-based decisions. These decisions must be supported by national or sub-Regional evidence. While the end-products will be distinctly national approaches for new vaccines, Regional technical cooperation will continue to play a critical role in producing the essential evidence and developing sustainable immunization policies.
• Evidence used to support decisions must be broad-based. Regional immunization policy decisions have historically relied primarily on the burden of disease and vaccine efficacy; however, the higher cost of new vaccines will require a much broader evidence base ranging from cost effectiveness and financial sustainability to health systems concerns.
• Infrastructure must be in place to support nationally based process. In the transition to primarily country-based decisions, national decision making bodies must have the necessary technical capacity to ensure decisions are reached through rigorous and informed deliberations, drawing on the expertise of national advisory boards. To that end, the ProVac Initiative will work with Ministries of Health to establish or strengthen advisory boards in the countries were such capacity building is needed.

ProVac Models

A key component of the ProVac Initiative is the strengthening of national capacity to perform or coordinate economic evaluations of new vaccine introductions. The September 2006 workshop focused on developing the competencies in National Immunization Programs to manage and interpret economic evidence. In support of national economic evaluations, the ProVac Initiative has collaborated with leading academic researchers to develop simplified models in Excel for estimating the health and economic Burdens of Disease, the incremental Cost of Programs of new vaccine introduction, and the Cost-Effectiveness of new vaccines.

Models are currently available for Rotavirus, Pneumococcus and Influenza; a model for HPV is under development. As well, the Vaccine Introduction Costing (VIC) Tool is available for estimating the incremental program costs of new vaccines.