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The Pan American Health Organization (PAHO) estimates annual mortality in Latin America and the Caribbean due to rotavirus-induced diarrhea to be 16,000; another 22,000 children die each year from invasive pneumococcal disease; and 32,000 women die prematurely each year from cervical cancer caused by human papillomavirus (HPV). Vaccines against these priority diseases present opportunities to make substantial gains in health, contributing to the achievement of the Millennium Development Goals (MDG).
The current decision-making process for new vaccine introductions has historically been driven by regional immunization priorities, despite the fact that burden of disease and resources available vary between countries and sub regions. Additionally, national policy makers in some countries are making decisions for new vaccine introduction irrespective of the evidence available. This was highlighted in two country experiences in 2006. One country introduced varicella-zoster virus vaccine despite disease burden data and preliminary economic analyses to suggest that pneumococcal and rotavirus infections may be of greater public health significance. Another, much poorer country, decided to introduce rotavirus vaccine without addressing their health system's capacity for including such a vaccine.
To ensure that future decisions for new vaccine introductions achieve the greatest sustainable impact, most experts agree that three essential factors must be addressed:
- Decisions should be nationally based;
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- Broader evidence covering cost-effectiveness and financial sustainability should be used to support decisions; and
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- Technical capacity should be enhanced to make nationally based decisions.
| Over the last three years, managers of Expanded Programs on Immunizations (EPI) in the Americas have indicated that they need expanded support with some of these components, particularly cost-effectiveness analysis and economic evaluations of interventions. To that end, with help from Partners such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), in July 2004 PAHO conducted a Prevention Effectiveness Workshop to brief national immunization managers and epidemiologists on the decision-making framework and, more specifically, on methodologies for conducting cost-effectiveness studies and interpretation of their results. In 2006, this meeting was followed up with a ProVac Workshop on Economic Analysis to Support Decision Making on Vaccine Introduction. This meeting was supported by the Bill and Melinda Gates Foundation through a donation to Pan American Health & Education Foundation (PAHEF).
In September 2006, Ministers of Health in PAHO's annual Directing Council Meeting requested PAHO to continue to provide technical assistance for evidence-based decisions. Ministers expressed that the absence of suitable economic analyses represented a weak link in the development of immunization policy.
While the ProVac initiative is intended to promote and strengthen economical analyses, the initiative will continue to promote critical assessments of all factors in the decision making framework.
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Beginnings of ProVac 
