What We Do

Constraints to Vaccine Adoption in Lower and Middle Income Countries

The Challenge
The large birth cohorts of lower middle income countries (LMICs) face a heavy burden of disease, yet they receive little international support for their vaccine programs, in large part due to their ascending economic status. As a consequence, LMICs have fallen behind other income categories in adopting new vaccines.

The Opportunity                                         
The Bill and Melinda Gates Foundation funded and co-chaired, along with the World Health Organization, a study on the constraints that lower middle income countries (LMICs) face in adopting new vaccines. The study examines the major factors in LMIC decisions about adoption, identifies obstacles and offers recommendations for future action at the global, regional and country levels.

Our Work

  • The 18-month study found that the inspiring success of the Global Alliance for Vaccines and Immunisation (GAVI) in LICs has made LMICs, as a group, the slowest adopters of the new Hib vaccine. The relative number of unvaccinated children in LMICs compared to other income groups is likely to become more pronounced as GAVI tightens its eligibility requirements to exclude more LMICs and prepares to support the introduction of more vaccines (e.g. pneumococcal and rotavirus).
  • The study closely examined the vaccine decision-making process in LMICs in order to identify key factors and obstruction points. It found that the processes are generally deliberate and rational, though face constraints from incomplete burden of disease information, lack of access to vaccine market information, and human capacity in terms of skills to analyze epidemiological and financial and economic information.
  • The report provides a number of prioritized recommendations to speed vaccine adoption in LMICs. Most notably, the report recommends developing inter-country and regional processes for achieving pooled procurement (where desired by countries). It also recommends creating a technical and reliable source for global vaccine market information, and, at the country level, improving procurement and vaccine regulation to promote competition, quality and sustainability.

The R4D team that conducted the work was led by Study Director Marty Makinen, and included consultant Piers Whitehead and R4D staff members Robert Hecht, Lara Wilson, Maria Belenky, Amrita Palriwala, and Kira Thorien. The study team benefitted from input provided by an Advisory Group co-chaired by Violaine Mitchell (Bill & Melinda Gates Foundation) and Miloud Kaddar (World Health Organization) with representatives from WHO regional offices, GAVI, UNICEF, vaccine manufacturers and other experts. The advisory group provided critical feedback on all aspects of the study, including the development and implementation of the work plan, and recommendations resulting from the project. The study began in October 2009 and was completed in March 2011.