Journal Article

Prioritization of future new vaccines introduction: The experience of the Ethiopian National Immunization Technical Advisory Group

Memirie, Solomon Tessema, Mohamed, Nassor, Mekasha, Amha, Senouci, Kamel, Kokobie, Melkamu Ayalew, Kaba, Mirgissa, Tefera, Yohannes Lakew, Abebe, Workeabeba, Teka, Telahun, Guiod, Florian, Alemayehu, Tewodros

2025

Overview

As Ethiopia faces growing demands to introduce new vaccines amid constrained resources and declining donor support, evidence-based prioritization is essential. This paper describes the experience of Ethiopian National Immunization Technical Advisory Group's (ENITAG) in using a structured, multi-criteria decision analysis (MCDA) approach—the New Vaccine Introduction Prioritization and Sequencing Tool (NVI-PST)—to guide new vaccine introduction and sequencing for the 2026–2030 period. ENITAG, in collaboration with the Federal Ministry of Health (FMoH) and partners, adapted the NVI-PST to Ethiopia's context. Six candidate vaccines were shortlisted—hexavalent, rubella (MR), multivalent meningococcal conjugate (MMCV), typhoid (TCV), cholera (OCV), and respiratory syncytial virus (RSV) vaccines. Thirteen criteria across importance and feasibility domains were selected and weighted. Data were gathered by thematic working groups and used to score and rank each vaccine through a participatory process involving ENITAG members and stakeholders. The hexavalent and rubella vaccines were prioritized the highest for early introduction due to their combined public health importance and programmatic feasibility. RSV and MMCV were ranked as medium priorities, while TCV and OCV were deemed lower priorities for routine immunization. The recommendations considered existing programmatic constraints, such as upcoming introductions (e.g., malaria, yellow fever, hepatitis B birth dose) and supplementary campaigns. ENITAG also emphasized strengthening its secretariat, improving data systems, and integrating community perspectives in future prioritization efforts. This exercise marks a pivotal shift in Ethiopia's immunization decision-making—from reactive, one-off vaccine assessments to a strategic, systematic approach aligned with national priorities and health system capacity. Despite challenges related to data quality and resource limitations, the process offers a replicable model for other low-income countries seeking to optimize immunization investments in a transparent, evidence-informed manner. •Ethiopia faces growing demand for new vaccines while donor support declines, making evidence-based prioritization crucial.•The ENITAG applied MCDA tool (NVI-PST), adapted to the national context, to rank six candidate vaccines for 2026–2030.•Hexavalent and rubella vaccines emerged as top priorities while RSV and MMCV as medium priorities for routine introduction.•Recommendations factored in vaccines in the pipeline, health system constraints, and the need for stronger data systems.•It marks a shift to strategic, transparent, and replicable decision-making in Ethiopia's EPI, offering a model for other LIC.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Advisory Committees / Allergy and Immunology / Antigens / Cholera / Combined vaccines / COVID-19 vaccines / Data systems / Decision analysis / Decision making / Ethiopia / Feasibility / Fever / Foreign aid / Funding / Global health / Health care / Health Priorities / Hepatitis B / Human papillomavirus / Humans / Immunization / Immunization Programs - organization & administration / Low income areas / Malaria / Measles / Mortality / Multiple criterion / National Immunization Technical Advisory Group / New vaccine introduction and sequencing / New vaccine introduction and sequencing prioritization tool / Planning / Priorities / Public health / Respiratory syncytial virus / Rotavirus / Rubella / Streptococcus infections / Tetanus / Tropical diseases / Typhoid / Vaccination / Vaccines / Vaccines - administration & dosage / Vector-borne diseases / Viruses / Waterborne diseases / Yellow fever