Issues to be considered for the introduction of new vaccines into national vaccination programmes

Abstract

In 1974, the World Health Organization (WHO) recommended six vaccines for worldwide routine use within the Expanded Programme on Immunization (EPI), namely vaccines against tuberculosis (BCG), poliomyelitis (OPV), diphtheria-tetanus-pertussis (DTP) and measles[1]. In 1988, WHO recommended yellow fever (YF) vaccination of all infants in countries endemic for this disease and in 1992 hepatitis B (HepB) vaccine was added to the EPI list. In 1997, the scientific advisory group of the WHO global immunization programme endorsed use of the conjugated vaccine against Haemophilus influenzae type b (Hib), according to national capacities and priorities, in countries where Hib disease is recognized as a public health problem. Since 1998, the WHO policy concerning the use of novel vaccines has been published in the Weekly Epidemiological Record (http://www.who.int/wer). Whereas the initial six vaccines cover approximately 80% of the annual global birth cohort, introduction of the vaccines against YF and HepB into the national immunization programmes (NIPs) has been relatively slow. As of August 2004, 33 of the 44 at-risk countries in Africa and Latin America have included the YF vaccine in their national programmes, but in many high-risk areas less than 50% of the young children were covered by this vaccination. Of the 214 countries and territories reporting to the WHO, about 160 had adopted infant vaccination against HepB. By 2003, the Hib vaccine had been introduced into the programmes of 88 of the 192 WHO member states, most of which belong to the industrialised world. Several other vaccines, such as the rubella, typhoid, and pneumococcal vaccines, are of documented public health value, but are clearly underused so far. It is therefore important to identify common hurdles to the introduction of new vaccines and to search for mechanisms that may facilitate world-wide acceptance of essential childhood immunization. This chapter reviews some of the issues to be considered before appropriately licensed, new vaccines may be introduced into the NIPs. Some Issues to be considered for the introduction of new vaccines into national vaccination programmes