Vaccines save millions of lives every year, yet uptake and coverage of many potentially life saving immunizations remain sub-optimal throughout much of the developing world. Most of the work that has been done to date to better understand why vaccines don’t get into the mouths or arms of those who need them most focus on operational level aspects but little research has been conducted at the global level to understand why some countries adopt particular vaccine policies while others do not.

Despite the availability of an effective vaccines against Haemophilus influenza type b (Hib) – a bacteria that is responsible for causing almost 400,000 deaths in children and significant morbidity globally – over a decade after its introduction only 13 low-income countries were using the vaccine. A few years later over 60 were. What factors influence a country’s decision to adopt a national vaccination policy?

That is the question that is explored in a new PLoS Medicine research article by researchers at the Johns Hopkins School of Public Health and the Hib Initiative. Using a hazard model, they explore the determinants of national level adoption of the Hib vaccine in recent years. They find:

“The receipt of GAVI support speeded the decision to adopt vaccination by 63%, for example, and sharing borders with two or more countries that had adopted the vaccine speeded the decision by 50%. By contrast, for each 1% increase in vaccine costs, the time to decision to adopt vaccination was delayed by 2%. The 1998 and 2006 World Health Organization recommendations on routine Hib vaccination and the existence of local studies on Hib disease had no influence on the time to decision.”

National policies, therefore, seem to be heavily dependent on whether or not an outside organization is willing to fund such introductions – and not just advocate for them. More evidence of how the new Global Health Initiatives – here GAVI – are radically transforming the way in which health care is delivered around the world.

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