Closing the pneumococcal conjugate vaccine (PCV) introduction gap: an archetype analysis of last-mile countries

ABSTRACT

Background

Pneumonia remains the leading infectious cause of global childhood deaths, despite the availability of pneumococcal conjugate vaccine (PCV) products and widespread evidence of their safety and efficacy.

Objective

To map the landscape of countries that are yet to fully include PCV in their National Immunization Programs, we conducted an archetype analysis of country indicators related to barriers and facilitators for PCV decision-making.

Methods

We created a country matrix focused on three key domains – health characteristics, immunisation factors, and policy framework, and identified ten related indicators. We scored countries based on indicator performance and subsequently ranked and grouped them into three archetypes of low-, moderate-, and high-barrier countries with regard to PCV introduction.

Results

Our results indicated 39 countries (33 low- and middle-income countries [LMICs] and 6 high-income countries) that are yet to introduce PCV. Among LMICs, 15 countries were classified as ‘low-barrier,’ indicating factors favourable for PCV introduction such as high immunisation coverage of common childhood vaccines, supportive governments, and substantial disease burden and eligibility for Gavi support. Countries classified in the ‘moderate-barrier’ (12) and ‘high-barrier’ (6) archetypes demonstrated adequate capacity in immunisation systems but had competing national priorities and cost barriers that impeded policy decision-making on PCV introduction.

Conclusions

The current health and policy indicator-based categorisation provides an actionable framework to design tailored PCV advocacy within these last-mile countries. Policy approaches emerging from this framework can lead to strengthened decision-making on vaccine introduction and sustained vaccine access that can enhance child survival worldwide.

KEYWORDS:

• Pneumococcal conjugate vaccine
• child mortality
• child health
• immunization
• vaccines

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Author contributions

• Initial conceptualisation: A.S.

• Design of the work: A.S., P.B. and J.H.

• Data collection: P.B. and J.H.

• Data analysis and interpretation: P.B., J.H., and A.S.

• Drafting of the article: P.B., J.H., and A.S.

• Critical revision of the article: R.W, B.D., V.D., and M.S.

• Final approval of the version to be submitted: All authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

Ethical approval for this type of study which does not involve human subjects research is not required by our institute.

Paper context

Main findings: Despite the availability of Pneumoccoal Conjugate Vaccine (PCV) products and technical and financial support, there are 33 Low- and Middle-Income Countries that are yet to introduce PCV into their National Immunization Programs. There are three overarching archetypes amongst the countries analysed: low-barrier (15 countries), moderate-barrier (12 countries) and high-barrier (6 countries). Based on indicator performance-based archetype analysis, we found three overarching archetypes: low-barrier (15 countries), moderate-barrier (12 countries) and high-barrier (6 countries).

Added knowledge: These archetypes provide a framework to guide policies to ensure that PCV is accessible to countries most in need and best prepared to facilitate a sustainable rollout.

Global health impact for policy and action: Actionable approaches include increased international support pathways through existing schemes together with in-country commitment (low-barrier countries); National Immunization Technical Advisory Group (NITAG) strengthening, vaccine delivery enhancement, and appropriate vaccine-related public health messaging (moderate-barrier countries); and greater engagement and inclusivity within the international community for decision-making support for new vaccine introduction (high-barrier countries).

Data availability statement

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2281065

Additional information

Funding

This work was supported by The Bill & Melinda Gates Foundation under grant number [INV-006046].