Bridging the gap in pneumonia prevention

Qualitative insights on vaccine implementation from health leaders in middle-income countries

Bibliographic Data

ID19592253
AuthorsRose Weeks (0000-0003-0171-5043, Johns Hopkins University), Baldeep K Dhaliwal (0000-0001-5021-3432, Johns Hopkins University), Jasmine Huber (0009-0008-6708-0646, Johns Hopkins University), Sarah Nabia (0009-0005-4942-2508, Johns Hopkins University), Ala’a Al-Shaikh (0000-0002-3844-7292), Kulkanya Chokephaibulkit (0000-0002-0140-4600, Mahidol University), LaKKumar Fernando (0000-0001-8645-3497, Nawaloka Hospital), Ehssan Baghagho (0000-0002-8197-6237, General Organization For Teaching Hospitals and Institutes), Anita Shet (0000-0002-7204-8164, Johns Hopkins University)
EditorsMila Shakya Mila Shakya
Year2025
Volume5
Issue4
Pagese0004473
Publication date2025-04-23
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0004473
PMID40267080
OpenAlexW4409729700
LanguageEN
References cited20

Despite the well-documented life-saving potential of pneumococcal conjugate vaccines (PCV) and global efforts to widen vaccine availability, access to PCV in middle-income countries (MICs) has remained suboptimal due, in part, to vaccine pricing and limited external funding opportunities. To understand gaps and opportunities for improving vaccine equality, this qualitative study engaged leaders from governments, medical institutions, and health agencies who were based in MICs that did not currently have PCV in their national immunization programs to explore their perspectives on decision-making contexts and constraints related to PCV introduction. In-depth interviews with 17 participants from Egypt, Jordan, Sri Lanka, and Thailand in 2023 documented that, despite high immunization coverage and commitment toward equitable health systems, implementing new vaccines such as PCV has remained challenging. Among the six thematic areas that emerged, two were strong enablers to vaccine implementation: 1) the existence of strong primary healthcare systems; and 2) established policy processes for vaccine decision-making. Three themes that emerged have hindered PCV introduction, including; 1) limited information on disease burden and available vaccine products; 2) competing country health priorities; and 3) financing challenges. The interplay of these thematic areas has documented a paradox unique to MICs, further contributing to inequalities in vaccine access. While a subset of MICs recently became eligible for support from Gavi, the Vaccine Alliance for introducing new vaccines, the marketplace has historically lacked tiered vaccine pricing that MICs could sustain for the long term. This is despite the great need with existing inequities and a substantial proportion of the world’s low-income and displaced populations. Finally, participants said barriers may be alleviated with support from global and regional actors providing technical capacity-strengthening, advocacy, and strategic financial support. These findings are informative for strengthening equality in access to vaccines and developing strategies to introduce and sustain life-saving vaccines, including PCV

Business · Developing country · Economic growth · Economics · Immunization · Political science · Qualitative research · Sociology · Thematic analysis · Vaccination · Healthcare Policy and Management · Medicine · Pneumonia and Respiratory Infections · Vaccine Coverage and Hesitancy · Immunology

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