title: The impact of new vaccine introduction on the coverage of existing vaccines: a cross-national, multivariable analysis.
abstract: BACKGROUND
  A surge of new and underutilized vaccine introductions into national immunization programmes has called into question the effect of new vaccine introduction on immunization and health systems. In particular, countries deciding whether to introduce a new or underutilized vaccine into their routine immunization programme may query possible effects on the delivery and coverage of existing vaccines. Using coverage of diphtheria-tetanus-pertussis (DTP) vaccine as a proxy for immunization system performance, this study aims to test whether new vaccine introduction into national immunization programs was associated with changes in coverage of three doses of DTP vaccine among infants.
  
  
  RESULTS
  DTP3 vaccine coverage was analyzed in 187 countries during 1999-2009 using multivariable cross-national mixed-effect longitudinal models. Controlling for other possible determinants of DTP3 coverage at the national level these models found minimal association between the introduction of Hepatitis-, Haemophilus influenzae type b-, and rotavirus-containing vaccines and DTP3 coverage. Instead, frequent and sometimes large fluctuations in coverage are associated with other development and health systems variables, including the presence of armed conflict, coverage of antenatal care services, infant mortality, the percent of health expenditures that are private and total health expenditures per capita.
  
  
  CONCLUSIONS
  Introductions of new vaccines did not affect national coverage of DTP3 vaccine in the countries studied. Introductions of other new vaccines and multiple vaccine introductions should be monitored for immunization and health systems impacts.
authors.affiliation: Centre for Health Economics and Policy Analysis, McMaster University, Canada. shearejc@mcmaster.ca
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Shearer
authors.forename: Damian G
authors.initials: DG
authors.lastname: Walker
authors.forename: Nicholas
authors.initials: N
authors.lastname: Risko
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
mesh_terms: D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D022243:Rotavirus Vaccines / Q000008:administration & dosage; D014611:Vaccination / Q000706:statistics & numerical data*; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D022243:Rotavirus Vaccines; D014761:Viral Hepatitis Vaccines