ProVac Toolkit

The Pan American Health Organization (PAHO) Comprehensive Family Immunization Unit launched the ProVac Initiative in 2004 to provide technical cooperation for the promotion of evidence-based decision making prior to the introduction of new vaccines in the Americas. With PAHO, national policy makers, academics and immunization program managers have formed an extensive network of collaboration to promote data-driven decision making on new vaccines in the Americas and beyond, with the ultimate aim of ensuring that the efficient use of scarce resources leads to optimal health impact. The Bill & Melinda Gates Foundation financed the ProVac Initiative and its implementation by the Pan American Health Organization from 2009 to 2016.

Tools, Training, & ProVac Documents

ProVac’s toolkit is a web-based, open access platform on a single e-toolkit website to expand the use of ProVac tools. ProVac’s toolkit includes decision-support tools and models, methodological guidance and a technical cooperation platform. This toolkit has been tested, reviewed by expert panels and widely implemented in LAC.

Through this website, ProVac web-users will have access to guidance documents, general information and training materials. This will also include space to identify and register users, communicate with users (email), describe the models (UNIVAC, COSTVAC) and for users to download the tools.

About UNIVAC

UNIVAC is a single universal vaccine impact and cost-effectiveness decision support model with a standardized, accessible Excel-based interface and a familiar set of input steps and outputs. Input estimates of age-specific disease burden, age/dose specific vaccine coverage and effectiveness allow for a simple evaluation of direct vaccination impact on health outcomes.

Additional input parameters can be included to evaluate indirect effects, which may be important for the evaluation of several vaccines. The tool features automated calculations, options for sensitivity analysis and automatically generated results charts and figures.

Download UNIVAC

About COSTVAC

COSTVAC is an Excel-based toolkit that provides structured guidance on how to estimate the cost of routine immunization from a sample of health facilities and administrative levels of the health system. This toolkit provides guidance on sampling, survey instrument development and administration, and calculations.

It was developed to help countries more precisely document the shared resource use between the immunization program and other health service provision. Users can define the perspective and scope of the analysis.

Module 1. Introduction to the ProVac Initiative

Video
Slides

Module 2. Introduction to evidence-based decision making on immunization

Video
Slides

Module 3. Introduction to vaccine economics

Module 4. Immunization program costing

Module 5. UNIVAC – a universal model for vaccines cost-effectiveness analyses

Video
Additional resources
- DALYs explained

Module 6. COSTVAC – support for immunization program costing

Installation Instructions: Video (Password: pr0v4c)
Orientation on Data Collection Interface: Video (Password: pr0v4c)
Practice Data Collection Interface (DCI) Part 1: Video (Password: pr0v4c)
Practice Data Collection Interface (DCI) Part 2: Video (Password: pr0v4c)
Practice Data Collection Interface (DCI) Part 3: Video (Password: pr0v4c)
Aggregation of Collected Data: Video (Password: pr0v4c)

Module 7. Communicating the evidence to key stakeholders

Video

This Toolkit serves as a directory for all of the documents that were developed by or in collaboration with the ProVac Initiative. A majority of these have been published in peer-reviewed journals. A link to the published document has been provided where available. The documents have been grouped into 4 categories:

Approach and Methods
Background and Lessons Learned
Examples of Published Country Studies
Other (including perspectives from ProVac and partners)

Approach and Methods

The ProVac Approach

Andrus, J. et al. (2007). A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: Paho’s Provac Initiative. Public Health Rep, 122, 6, 811-816.

ProVac Models

Clark, A. et al. (2013). TRIVAC decision support model for evaluating cost-effectiveness of Haemophilus influenzae type b, pneumococcal and rotavirus vaccination. Vaccine, 31(Suppl 3), C19-29. doi:10.1016/j.vaccine.2013.05.04.
Castañeda-Orjuela, C. et al. (2013). Using standardized tools to improve immunization costing data for program planning: the cost of the Colombian Expanded Program on Immunization. Vaccine, 31(Suppl 3), C72-9. doi: 10.1016/j.vaccine.2013.05.038.

ProVac Methods Guidance

Sinha, A., Augustovski, F., Alcarez, A. & García Martí, S. (2013). Perspectives on the challenge of Streptococcus pneumoniae disease burden estimation for national policymakers in Latin America and the Caribbean: From theory to practice. Vaccine, 31(Suppl 3), C30-2. doi: 10.1016/j.vaccine.2013.05.052.
Sartori, A.M.C, Novaes, C.G., de Soárez, P.C., Toscano, C.M. & Novaes, H.M.D. (2013). Estimating health service utilization for treatment of pneumococcal disease: the case of Brazil. Vaccine, 31(Suppl 3),63-71. doi: 10.1016/j.vaccine.2013.05.029.

top

Background and Lessons Learned

Background and lessons learned from the ProVac Initiative

Jauregui, B. et al. (2015). ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions. Useful lessons and insights for the future of the ProVac Initiative. Vaccine, 33(Suppl 1), A21-7. doi: 10.1016/j.vaccine.2014.12.080.
Jauregui, B. et al. (2015). Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group’s experience. Vaccine, 33(Suppl 1), A28-33. doi:10.1016/j.vaccine.2014.10.090.
Blau, J. et al. (2015). Strengthening national decision-making on immunization by building capacity for economic evaluation: Implementing ProVac in Europe. Vaccine, 33(Suppl 1), A34-9. doi: 10.1016/j.vaccine.2014.12.073.
Toscano, C.M. et al. (2013). Establishing a regional network of academic centers to support decision making for new vaccine introduction in Latin America and the Caribbean: The ProVac experience. Vaccine, 33(Suppl 1), C12-8. doi: 10.1016/j.vaccine.2013.05.033.
Andrus, J.K., Jauregui, B., Oliveira, L.H. & Ruiz-Matus, C. (2011). Challenges to building capacity for evidence-based new vaccine policies. Health Affairs, 30(6), 1104-12. doi: 10.1377/hlthaff.2011.0361.
Janusz, C.B. et al. Performing Country-led Economic Evaluations to Inform Immunization Policy: ProVac Experiences in Latin America and the Caribbean. Value in Health, 1(2), 248-253. doi:10.1016/j.vhri.2012.10.003.
Jauregui, B. et al. Strengthening the technical capacity at country-level to make informed policy decisions on new vaccine introduction: lessons learned by PAHO’s ProVac Initiative. Vaccine, 29(5), 1099-106. doi: 10.1016/j.vaccine.2010.11.075.
Burns, J.E. et al. (2009). Descriptive analysis of immunization policy decision making in the Americas. Revista Panamericana de Salud Pubica, 26(5), 398-404.

top

Examples of Published Country Studies

Komakhidze, T. et al (2015). Cost-effectiveness of pneumococcal conjugate vaccination in Georgia Vaccine, 29(31), 4963-72. doi: 10.1016/j.vaccine.2014.12.070.

Country-led ProVac analyses

Janusz, C. et al. (2015). Examining the cost of delivering routine immunization in Honduras. Vaccine, 33(Suppl 1), A53-9. doi: 10.1016/j.vaccine.2015.01.016.
Valdés, W. et al. (2015). Tracking financial flows for immunization in Honduras. Vaccine, 33(Suppl 1), A85-92. doi:10.1016/j.vaccine.2015.01.012.
Sigei, C. et al. (2015). Cost-effectiveness of rotavirus vaccination in Kenya and Uganda. Vaccine(Suppl1), A109-18. doi: 10.1016/j.vaccine.2014.12.079.
Peña Kieningera, M. et al. (2015). Cost-effectiveness analysis of pneumococcal conjugate vaccine introduction in Paraguay. Vaccine, 33(Suppl 1), A143-53. doi: 10.1016/j.vaccine.2014.12.078.
Vizzotti, C. et al. (2015). Economic analysis of the single-dose immunization strategy against hepatitis A in Argentina. Vaccine, 33(Suppl 1), A227-32. doi: 10.1016/j.vaccine.2014.12.077.
Ahmeti, A. et al. (2015). Cost-effectiveness of rotavirus vaccination in Albania. Vaccine, 33(Suppl 1), A201-8. doi:10.1016/j.vaccine.2014.12.075.
Urueña, A. et al. (2015). Cost-effectiveness analysis of rotavirus vaccination in Argentina. Vaccine, 33(Suppl 1), A126-34. doi: 10.1016/j.vaccine.2014.12.074.
Molina Aguilar, I.B. et al. (2015). Cost-effectiveness analysis of the introduction of the human papillomavirus vaccine in Honduras. Vaccine, 33(Suppl 1), A167-73. doi:10.1016/j.vaccine.2014.12.067.
Visekruna Vucina, V. et al. (2015). Cost-effectiveness of pneumococcal conjugate vaccination in Croatia. Vaccine, 33(Suppl 1), A209-A218. doi: 10.1016/j.vaccine.2014.12.043.
Walwyn, L. et al. Cost-effectiveness of HPV vaccination in Belize. Vaccine, 33(Suppl 1), A174-81. doi: 10.1016/j.vaccine.2014.12.042.
Javanbakht, M. et al. (2015). Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran. Vaccine, 33(Suppl 1), A192-200. doi: 10.1016/j.vaccine.2014.12.035.
Novaes, H.M. et al. (2015). Cost-effectiveness analysis of introducing universal human papillomavirus vaccination of girls aged 11 years into the National Immunization Program in Brazil. Vaccine, 33(Suppl 1), A135-42. doi: 10.1016/j.vaccine.2014.12.031.
Mezones, E. et al. (2015). Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru. Vaccine, 33(Suppl 1), A154-66. doi: 10.1016/j.vaccine.2014.12.039.
Urueña, A. et al. (2011). Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina. Vaccine, 29(31), 4963-72. doi: 10.1016/j.vaccine.2011.04.111.

top

Other (including perspectives from ProVac and partners)

Perspectives from ProVac and partners on the use of economic evidence for decision making

Andrus, J.K. & Walker, D.G. (2015). Perspectives on expanding the evidence base to inform vaccine introductions: Program costing and cost-effectiveness. Vaccine, 33(Suppl 1), A2-3. doi: 10.1016/j.vaccine.2015.01.001.
Teerawattananon, N. (2015). A learning experience from price negotiations for vaccines. Vaccine, 33(Suppl 1), A11-2. doi: 10.1016/j.vaccine.2014.12.050.
Sanderson, C. (2015). The ProVac Initiative and evolving decision support. Vaccine, 33(Suppl 1), A8-10. doi: 10.1016/j.vaccine.2014.12.049.
Molina Aguilera, I.B. (2015). Perspectives on the development and use of economic evidence for immunization decision-making. Vaccine, 33(Suppl 1), A6-7. doi: 10.1016/j.vaccine.2014.12.048.
Sosler, S., Kallenberg, J., & Johnson, HL. (2015). Gavi’s balancing act: Accelerating access to vaccines while ensuring robust national decision-making for sustainable programmes. Vaccine, 33(Suppl 1), A4-5. doi: 10.1016/j.vaccine.2014.12.051.
Andrus, J.K & Walker, D.G. (2013). Evidence base for new vaccine introduction in Latin America and the Caribbean. Vaccine, 31(Suppl 3), C2-3. doi: 10.1016/j.vaccine.2013.05.074.
de Quadros, C. (2013). Historical perspectives on new vaccine introduction in Latin America and the Caribbean. Vaccine, 31(Suppl 3), C4-5. doi: 10.1016/j.vaccine.2013.05.058.
Whitney, C.G. & Parashar, U.D. (2013). What do policy makers need to know? Lessons from the decision to add pneumococcal conjugate and rotavirus vaccines to the US. Vaccine, 31(Suppl 3), C6-7. doi: 10.1016/j.vaccine.2013.05.051.
Hinman, A. Perspectives on sustainable vaccine introduction. Vaccine, 31(Suppl 3), C8-9. doi: 10.1016/j.vaccine.2013.05.053.
Glassman, A (2013). Beyond methods and studies: Building institutions for better public spending on vaccination. Vaccine, 31(Suppl 3), C10-1. doi: 10.1016/j.vaccine.2013.05.050.

Other references

Bahia, L., Toscano, C.M., Takemoto, M.L. & Vianna Araujo, D. (2013). Systematic review of pneumococcal disease costs and productivity loss studies in Latin America and the Caribbean. Vaccine, 31(Suppl 3), C33-44, doi:10.1016/j.vaccine.2013.05.030.
Takemoto, M.L., Bahia, L., Toscano, C.M. & Vianna Araujo, D. (2013). Systematic review of studies on rotavirus disease cost-of-illness and productivity loss in Latin America and the Caribbean. Vaccine, 31(Suppl 3), C45-57. doi:10.1016/j.vaccine.2013.05.031.
Alvis-Guzman, N. et al. (2013). Treatment costs of diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia. Vaccine, 31(Suppl 3), C58-62. doi:10.1016/j.vaccine.2013.05.035.
de la Hoz, F., Castañeda-Orjuela, C., Paternina, A. & Alvis-Guzman, N. (2013). Systematic review of incremental non-vaccine cost estimates used in cost-effectiveness analysis on the introduction of rotavirus and pneumococcal vaccines. Vaccine, 31(Suppl 3), C80-87. doi:10.1016/j.vaccine.2013.05.064.
Toscano, C.M. et al. (2013). Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica. Vaccine, 31(Suppl 3), C88-93. doi: 10.1016/j.vaccine.2013.05.036.
Oliveira, L.H. et al. (2013). Temporal trends in diarrhea-related hospitalizations and deaths in children under age 5 before and after the introduction of the rotavirus vaccine in four Latin American countries. Vaccine, 31(Suppl 3), C99-108. doi: 10.1016/j.vaccine.2013.05.065.
Picón, T. et al. (2013). Effectiveness of the 7-valent pneumococcal conjugate vaccine against vaccine-type invasive disease among children in Uruguay: An evaluation using existing data. Vaccine, 31(Suppl 3), C109-113. doi:10.1016/j.vaccine.2013.01.059.
Oliveira, L.H. et al. (2013). Systematic documentation of new vaccine introduction in selected countries of the Latin American Region. Vaccine, 31(Suppl 3), C114-22. doi: 10.1016/j.vaccine.2013.05.032.

top

Our Collaborators

PAHO collaborates with a number of academic institutions and organizations on the development of economic evaluation tools, trainings and technical assistance. These include:

London School of Hygiene and Tropical Medicine

Harvard School of Public Health’s Center for Health Decision Science

Rutgers University

Universidade Federal de Goias

Instituto de Efectividad Clinica y Sanitaria*

Universidad Nacional de Colombia*

Universidade de São Paulo*

Universidade Estatal do Rio de Janiero*

Universidad de Cartagena*

The Bill and Melinda Gates Foundation awarded PAHO with a multi-year grant to accelerate the work of ProVac in 2009. In 2010, a network of academic centers of excellence* was established to promote evidence-based vaccine policy in the Americas by bridging between research and policy. From 2011-2013, a partner collaboration named the ProVac International Working Group (IWG) was established to transfer the tools and framework of ProVac to non-PAHO Regions. Sabin Vaccine Institute (Sabin), the US Centers for Disease Control (CDC), PATH and Agence de Medecine Préventive (AMP) were members of the ProVac IWG and contributed to extending the ProVac Initiative to thirteen countries across three regions, including Africa, Asia and Europe.

Where we work

The ProVac Initiative is managed by PAHO at its Headquarters in Washington, DC. PAHO is the leading public health technical cooperation agency in Latin America and the Caribbean and serves as the WHO Regional Office of the Americas. In this capacity, PAHO’s immunization unit provides technical assistance with the ProVac Initiative to any government in the Americas that makes an official request for support.

PAHO works with the World Health Organization (WHO) and its other WHO Regional Offices as well as other leading technical agencies to promote the development and use of evidence in the vaccine decision making process outside of the Latin America and Caribbean Region. These agencies include Sabin, the US-CDC, PATH and AMP’s SIVAC Initiative.

A map of countries that have received support to conduct full economic evaluations and/or cost analyses is below.