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COMMENTARY

The future of routine immunization in the developing world: challenges and opportunities

Angela K Shen, Rebecca Fields and Mike McQuestion
Global Health: Science and Practice December 2014, 2(4):381-394; https://doi.org/10.9745/GHSP-D-14-00137
Angela K Shen
aUnited States Agency for International Development and United States Department of Health and Human Services, Washington, DC, USA
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  • For correspondence: ashen@usaid.gov
Rebecca Fields
bMaternal and Child Survival Program, Washington, DC, USA
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Mike McQuestion
cSabin Vaccine Institute, Washington, DC, USA
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    Figure 1.

    Critical Elements of Routine Immunization Programs

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    Figure 2.

    DTP3 Coverage for Lowest and Highest Wealth Quintiles in 14 African Countries, 2007–2012

    Abbreviations: DRC, Democratic Republic of the Congo; DTP3, third dose of the diphtheria, tetanus, and pertussis vaccine.

    Source: Demographic and Health Surveys.30

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    Figure 3.

    Vaccine Costs per Child (US$) for Routinely Recommended Vaccinesa From Birth Through Age 18, 2001, 2005, 2014

    Abbreviation: HPV, human papilloma virus.

    Source: UNICEF contract prices as of May 8, 2014.7 Costs based on lowest-available price to UNICEF.

    a The 2001 WHO-recommended vaccination schedule comprised 4 vaccines containing 6 antigens: diphtheria, tetanus, pertussis (DTP); measles; polio; and bacille Calmette-Guérin (BCG). In 2005, 2 more antigens were added: hepatitis B (Hep B) and Haemophilus influenzae type b (Hib). In 2014, rotavirus, pneumococcal conjugate, rubella, and HPV were added to the schedule, bringing the total number of WHO-recommended antigens to 12. Notes: The WHO-recommended target group for HPV vaccination is girls ages 9–13 years. HPV vaccination of boys is optional but not recommended in resource-constrained settings. WHO recommends all countries introduce at least 1 dose of inactivated polio virus (IPV) into their immunization schedules by the end of 2015, which will add an additional $1.26 to the schedule.

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    Figure 4.

    GNI per Capita and Government Expenditures on Health per Capita and on Routine Immunization per Surviving Infant Among Reporting Gavi-Eligible Countries

    Abbreviations: GNI, Gross National Income; N/A, not available.

    Source: Routine immunization expenditures extracted from the WHO/UNICEF Joint Reporting Form, Immunization Financing Database,53 Indicator 6500. Expenditures reported in local currency were converted to US$ using the midyear exchange rate. Surviving infant populations derived from the UN Population Division Online Database.54 GNI per capita (Atlas method) expressed in US$ and extracted from the World Bank.55 Government expenditures on health extracted from the WHO National Health Account Database.56

    All values in population-weighted constant (2013) US$. The following country-years were excluded from the analysis: Bhutan 2007, Uganda 2011, and Uzbekistan 2006, 2009.

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Global Health: Science and Practice: 2 (4)
Global Health: Science and Practice
Vol. 2, No. 4
December 01, 2014
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The future of routine immunization in the developing world: challenges and opportunities
Angela K Shen, Rebecca Fields, Mike McQuestion
Global Health: Science and Practice Dec 2014, 2 (4) 381-394; DOI: 10.9745/GHSP-D-14-00137

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The future of routine immunization in the developing world: challenges and opportunities
Angela K Shen, Rebecca Fields, Mike McQuestion
Global Health: Science and Practice Dec 2014, 2 (4) 381-394; DOI: 10.9745/GHSP-D-14-00137
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  • Article
    • BACKGROUND
    • WHAT IS ROUTINE IMMUNIZATION?
    • CHALLENGES TO ROUTINE IMMUNIZATION AND LESSONS LEARNED
    • GAVI AND GRADUATION
    • WHERE DO WE GO FROM HERE?
    • Acknowledgments
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