In 2008, both the World Health Organization’s (WHO) World Health Assembly and the Strategic Advisory Group of Experts on Immunization noted that little had been documented concerning the obstacles faced by Lower-middle-income countries (LMICs) in new vaccine adoption. LMICs receive little external support for their vaccination programs, despite a birth cohort of nearly 80 million and the burden of disease from vaccine-preventable diseases. The GAVI Alliance (Global Alliance for Vaccines and Immunization) assists 41 low-income countries (LIC), as well as some (31) countries at the lower-income end of the LMIC category. Lack of assistance has already led some LMICs to fall behind in introducing and requiring children to be vaccinated from vaccine-preventable diseases. This study analyzes decision making concerning new vaccines, identifies and classifies factors that influence the decision-making process, and gathers information from vaccine manufacturers and global experts in immunization programs. The findings identify practical interventions at three levels—global, regional, and country—to address the issues uncovered.