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Pneumococcal conjugate vaccine implementation in middle-income countries

Pneumococcal conjugate vaccine implementation in middle-income countries
Pneumococcal conjugate vaccine implementation in middle-income countries

Background
Since 2000, the widespread adoption of pneumococcal conjugate vaccines (PCVs) has had a major impact in the prevention of pneumonia. Limited access to international financial support means some middle-income countries (MICs) are trailing in the widespread use of PCVs. We review the status of PCV implementation, and discuss any needs and gaps related to low levels of PCV implementation in MICs, with analysis of possible solutions to strengthen the PCV implementation process in MICs.

Main body
We searched PubMed, PubMed Central, Ovid MEDLINE, and SCOPUS databases using search terms related to pneumococcal immunization, governmental health policy or programmes, and MICs. Two authors independently reviewed the full text of the references, which were assessed for eligibility using pre-defined inclusion and exclusion criteria. The search terms identified 1,165 articles and the full texts of 21 were assessed for suitability, with eight articles included in the systematic review. MICs are implementing PCVs at a slower rate than donor-funded low-income countries and wealthier developed countries. A significant difference in the uptake of PCV in lower middle-income countries (LMICs) (71%) and upper middle-income countries (UMICs) (48%) is largely due to an unsuccessful process of “graduation” of MICs from GAVI assistance, an issue that arises as countries cross the income eligibility threshold and are no longer eligible to receive the same levels of financial assistance. A lack of country-specific data on disease burden, a lack of local expertise in economic evaluation, and the cost of PCV were identified as the leading causes of the slow uptake of PCVs in MICs. Potential solutions mentioned in the reviewed papers include the use of vaccine cost-effectiveness analysis and the provision of economic evidence to strengthen decision-making, the evaluation of the burden of disease, and post-introduction surveillance to monitor vaccine impact.

Conclusion
The global community needs to recognise the impediments to vaccine introduction into MICs. Improving PCV access could help decrease the incidence of pneumonia and reduce the selection pressure for pneumococcal antimicrobial resistance.
2200-6133
1-15
Tricarico, Serena
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McNeil, Hannah C.
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Cleary, David W.
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Head, Michael
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Lim, Victor
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Kok Seng Yap, Ivan
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Chun Wie, Chong
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Siang Tan, Cheng
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Norazmi, Mohd Nor
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Ismail, Aziah
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Seong Guan Cheah, Eddy
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Faust, Saul N.
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Jefferies, Johanna M.C.
9468e292-0b41-412d-9470-944e257c7bcf
Roderick, Paul J.
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Moore, Michael
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Yuen, Ho Ming
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Newell, Marie-Louise
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McGrath, Nuala
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Webb, Jeremy
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Doncaster, C. Patrick
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Kraaijeveld, Alex R.
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Clarke, Stuart C.
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Tricarico, Serena
e026a1aa-d584-4295-8097-a8724d67ea60
McNeil, Hannah C.
bb418c14-1ab7-45bc-9946-88bd5524f09c
Cleary, David W.
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Head, Michael
67ce0afc-2fc3-47f4-acf2-8794d27ce69c
Lim, Victor
fcefcaba-1a83-4ace-8b3f-2d094b2404bf
Kok Seng Yap, Ivan
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Chun Wie, Chong
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Siang Tan, Cheng
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Norazmi, Mohd Nor
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Ismail, Aziah
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Seong Guan Cheah, Eddy
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Faust, Saul N.
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Jefferies, Johanna M.C.
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Roderick, Paul J.
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Moore, Michael
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Yuen, Ho Ming
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Newell, Marie-Louise
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McGrath, Nuala
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Webb, Jeremy
ec0a5c4e-86cc-4ae9-b390-7298f5d65f8d
Doncaster, C. Patrick
0eff2f42-fa0a-4e35-b6ac-475ad3482047
Kraaijeveld, Alex R.
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Clarke, Stuart C.
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Tricarico, Serena, McNeil, Hannah C., Cleary, David W., Head, Michael, Lim, Victor, Kok Seng Yap, Ivan, Chun Wie, Chong, Siang Tan, Cheng, Norazmi, Mohd Nor, Ismail, Aziah, Seong Guan Cheah, Eddy, Faust, Saul N., Jefferies, Johanna M.C., Roderick, Paul J., Moore, Michael, Yuen, Ho Ming, Newell, Marie-Louise, McGrath, Nuala, Webb, Jeremy, Doncaster, C. Patrick, Kraaijeveld, Alex R. and Clarke, Stuart C. (2017) Pneumococcal conjugate vaccine implementation in middle-income countries. Pneumonia, 9 (6), 1-15, [6 (2017)]. (doi:10.1186/s41479-017-0030-5).

Record type: Article

Abstract


Background
Since 2000, the widespread adoption of pneumococcal conjugate vaccines (PCVs) has had a major impact in the prevention of pneumonia. Limited access to international financial support means some middle-income countries (MICs) are trailing in the widespread use of PCVs. We review the status of PCV implementation, and discuss any needs and gaps related to low levels of PCV implementation in MICs, with analysis of possible solutions to strengthen the PCV implementation process in MICs.

Main body
We searched PubMed, PubMed Central, Ovid MEDLINE, and SCOPUS databases using search terms related to pneumococcal immunization, governmental health policy or programmes, and MICs. Two authors independently reviewed the full text of the references, which were assessed for eligibility using pre-defined inclusion and exclusion criteria. The search terms identified 1,165 articles and the full texts of 21 were assessed for suitability, with eight articles included in the systematic review. MICs are implementing PCVs at a slower rate than donor-funded low-income countries and wealthier developed countries. A significant difference in the uptake of PCV in lower middle-income countries (LMICs) (71%) and upper middle-income countries (UMICs) (48%) is largely due to an unsuccessful process of “graduation” of MICs from GAVI assistance, an issue that arises as countries cross the income eligibility threshold and are no longer eligible to receive the same levels of financial assistance. A lack of country-specific data on disease burden, a lack of local expertise in economic evaluation, and the cost of PCV were identified as the leading causes of the slow uptake of PCVs in MICs. Potential solutions mentioned in the reviewed papers include the use of vaccine cost-effectiveness analysis and the provision of economic evidence to strengthen decision-making, the evaluation of the burden of disease, and post-introduction surveillance to monitor vaccine impact.

Conclusion
The global community needs to recognise the impediments to vaccine introduction into MICs. Improving PCV access could help decrease the incidence of pneumonia and reduce the selection pressure for pneumococcal antimicrobial resistance.

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Accepted/In Press date: 15 February 2017
e-pub ahead of print date: 25 March 2017
Published date: 2017
Organisations: Faculty of Medicine, CES General

Identifiers

Local EPrints ID: 403018
URI: http://eprints.soton.ac.uk/id/eprint/403018
ISSN: 2200-6133
PURE UUID: 43777240-b2b3-49c3-a8bd-aaf7514dc44c
ORCID for Serena Tricarico: ORCID iD orcid.org/0000-0002-1737-8697
ORCID for David W. Cleary: ORCID iD orcid.org/0000-0003-4533-0700
ORCID for Michael Head: ORCID iD orcid.org/0000-0003-1189-0531
ORCID for Saul N. Faust: ORCID iD orcid.org/0000-0003-3410-7642
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Marie-Louise Newell: ORCID iD orcid.org/0000-0002-1074-7699
ORCID for Nuala McGrath: ORCID iD orcid.org/0000-0002-1039-0159
ORCID for Jeremy Webb: ORCID iD orcid.org/0000-0003-2068-8589
ORCID for C. Patrick Doncaster: ORCID iD orcid.org/0000-0001-9406-0693
ORCID for Alex R. Kraaijeveld: ORCID iD orcid.org/0000-0002-8543-2640
ORCID for Stuart C. Clarke: ORCID iD orcid.org/0000-0002-7009-1548

Catalogue record

Date deposited: 17 Nov 2016 09:39
Last modified: 18 Feb 2021 17:25

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Contributors

Author: Serena Tricarico ORCID iD
Author: Hannah C. McNeil
Author: David W. Cleary ORCID iD
Author: Michael Head ORCID iD
Author: Victor Lim
Author: Ivan Kok Seng Yap
Author: Chong Chun Wie
Author: Cheng Siang Tan
Author: Mohd Nor Norazmi
Author: Aziah Ismail
Author: Eddy Seong Guan Cheah
Author: Saul N. Faust ORCID iD
Author: Johanna M.C. Jefferies
Author: Michael Moore ORCID iD
Author: Ho Ming Yuen
Author: Nuala McGrath ORCID iD
Author: Jeremy Webb ORCID iD

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