title: New vaccine adoption in lower-middle-income countries.
abstract: OBJECTIVE
  Lower-middle-income countries (LMICs) are lagging behind both high-income and low-income countries in new vaccine adoption. Our study involved the following objectives: (1) understand the decision-making processes of LMICs on new vaccine adoption, (2) identify the factors influencing LMIC decisions, (3) obtain the views of vaccine manufacturers about LMIC markets for new vaccines, and (4) make recommendations concerning how to speed up and improve decision making, including proposing mechanisms for implementation of the recommendations.
  
  
  METHODS
  Collect and analyse qualitative data from participants in decision making in 15 case study countries [12 LMICs and three upper-middle-income countries (UMICs)] and multinational and developing country vaccine manufacturers.
  
  
  RESULTS
  Interviews of actors in decision making indicate that the aspects deemed most important for adoption are: World Health Organization (WHO) recommendations, the existence of local epidemiological data and a set of factors comprising affordability, cost-effectiveness and overall cost of the new vaccine for the programme. National Immunization Technical Advisory Groups (NITAG) have a key role in advising decision-makers, although their resources and capacity vary. Country decision-makers and manufacturers both see advantages in pooled procurement mechanisms for vaccine purchasing. Recommendations for countries and the international community involve assisting with making epidemiological data and vaccine market information accessible to countries, building and reinforcing related analysis capacity, and assisting with purchasing mechanisms and practices such as pooled procurement.
authors.affiliation: Results for Development Institute, Washington, DC 20005, USA. mmakinen@resultsfordevelopment.org
authors.forename: Marty
authors.initials: M
authors.lastname: Makinen
authors.forename: Miloud
authors.initials: M
authors.lastname: Kaddar
authors.forename: Vivikka
authors.initials: V
authors.lastname: Molldrem
authors.forename: Lara
authors.initials: L
authors.lastname: Wilson
mesh_terms: D026683:Advisory Committees; D003659:Decision Making, Organizational; D003906:Developing Countries; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration*; D011050:Policy Making; D014612:Vaccines / Q000191:economics / Q000627:therapeutic use*
chemical_list: D014612:Vaccines