The Pan American Health Organization (PAHO) Comprehensive Family Immunization Unit launched the ProVac Initiative in 2004 to provide technical cooperation for the promotion of evidence-based decision making prior to the introduction of new vaccines in the Americas. With PAHO, national policy makers, academics and immunization program managers have formed an extensive network of collaboration to promote data-driven decision making on new vaccines in the Americas and beyond, with the ultimate aim of ensuring that the efficient use of scare resources leads to optimal health impact.
PAHO, with modeling groups from the London School of Hygiene and Tropical Medicine, Harvard’s Center for Health Decision Science and Rutgers, has developed and launched a suite of tools to provide decision-support and build capacity for more informed decision-making on new vaccines at country-level. PAHO has supported more than 30 country-led analyses with these tools, most specifically to support decisions around Pneumococcal conjugate, Rotavirus and Human papillomavirus vaccine introduction.
The ProVac approach involves a clearly defined country-led process which can lead to increased trust and interest in the results by national authorities. PAHO Member States participate in regional trainings on decision-support methods, and follow-up with requests for technical assistance around a specific policy question. In addition to building local technical capacity, the process provides a number of important indirect benefits such as increased collaboration between national institutions, improved infrastructure and more systematic approaches for decision-making and provides a platform for wider promotion of evidence-based decision-making.
In 2011, following increasing demand for the ProVac approach, tools and methods from outside the PAHO region, an International Working Group (IWG) was formed between partners (PAHO, WHO, CDC, PATH, AMP, Sabin) to pilot test the implementation of ProVac in Africa, Eastern Europe and the Eastern Mediterranean region. Since the two-year Bill & Melinda Gates Foundation (BMGF) funded collaboration of the ProVac IWG (2011-2013), PAHO and partners have continued to extend the ProVac framework to more countries via existing collaborations and new ones.
ProVac’s excel-based tools provide country teams with a modeling framework to evaluate the costs, health impact and cost-effectiveness of vaccines. In response to demands for a diverse set of policy questions within and outside the Region of the Americas, PAHO and its modeling team has moved away from vaccine-specific tools to a more flexible framework that allow for the evaluation of multiple vaccines with its new model UNIVAC, a universal framework for evaluating the cost-effectiveness of vaccines. Additionally, other companion tools are under development to support countries in their efforts to estimate immunization program costs and other costs potentially averted by vaccines.
Tools, guidance and lessons learned from the PAHO ProVac Initiative are now available via an online toolkit at www.provac-toolkit.com. The website was designed with the purpose of centralizing access to tools and documentation for country users and their technical assistance partners. The site builds off the OLIVES database, which was developed to host the default data to ProVac models, and it adds additional documentation and functions. The main benefit of centralizing access to the ProVac toolkit is streamlining tool update releases, documentation and tool guidance for country users in PAHO Region and other users/partners in non-PAHO Regions. Additionally, non-country users may download tools for technical review and/or training purposes.
Future development of existing and new ProVac tools will respond to emerging immunization policy needs in Latin America and the Caribbean, including support around decisions about dengue, Hepatitis A, meningococcal vaccines. We look forward to you and your colleagues following the work via the e-toolkit and welcome your feedback!
PAHO is grateful for the financial and technical support from the Bill and Melinda Gates Foundation (2009-2016) and the U.S. Centers for Disease Control (2015-present). PAHO also acknowledges the important technical contributions from the ProVac Centers of Excellence to the tools, guidance and lessons learned developed over the past 10+ years supporting evidence-based immunization policy in the Region, including: Instituto de Efectividad Clinica y Sanitaria, Universidade de Sao Paulo, Universidade Estatal do Rio de Janiero, Universidad Nacional de Colombia, Universidad de Cartagena.
For more information:
Andrus et al. 2007. A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO’s ProVac Initiative. Public Health Reports, vol. 122, no. 6, pp. 811-816.
Jauregui et al. 2011. Strengthening the technical capacity at country-level to make informed policy decisions on new vaccine introduction: lessons learned by PAHO’s ProVac Initiative. Vaccine, vol. 29, no. 5, pp. 1099-106.
Jauregui et al. 2015. Evidence-based decision making for vaccine introductions: Overview of the ProVac International Working group’s experience. Vaccine, vol. 33, suppl. 1, pp. A28-33.
Images: PAHO, creative commons