Application of the WHO new vaccine introduction prioritisation and sequencing framework to guide evidence-based vaccine introduction decisions in Iran, 2025-2030

This peer-reviewed article describes the first documented application of the WHO New Vaccine Introduction Prioritization and Sequencing Toolkit (NVI-PST) in the WHO Eastern Mediterranean Region, using Iran as a case study to guide vaccine introduction decisions for 2025–2030. The study applied a structured multicriteria decision analysis-informed framework through stakeholder workshops, evidence synthesis, weighted ranking and sequencing exercises. The process aimed to support transparent and evidence-based prioritization of candidate vaccines by balancing public health importance with implementation feasibility, including financial and programmatic considerations. The study also highlights practical challenges related to evidence gaps, cost-effectiveness data availability and long-term budget impact estimation under macroeconomic uncertainty.

Key findings and insights

• Human papillomavirus (HPV) vaccine ranked highest overall across both importance and feasibility criteria, making it the top candidate for introduction within Iran’s 2025–2030 roadmap.
• Pneumococcal conjugate vaccine (PCV) for high-risk groups and seasonal influenza vaccine for high-risk populations were also identified as high-priority candidates, although feasibility considerations affected sequencing decisions.
• The framework explicitly separated “importance” (public health impact) from “feasibility” (financial, operational and market considerations), allowing policymakers to visualize trade-offs between health impact and implementation complexity.
• Economic and programmatic considerations were integrated into the prioritization process through criteria such as vaccine price, sustainability of funding, healthcare cost reductions, productivity gains, market availability and affordability.
• The authors identified major evidence constraints affecting prioritization decisions, including limited locally generated cost-effectiveness analyses, insufficient adult disease burden data for RSV and pneumococcal disease, and uncertainty in long-term budget impact projections.
• Two sequencing scenarios were proposed, both introducing HPV first, while RSV and varicella vaccines were considered low priority for introduction during the five-year horizon.
• The study found that structured prioritization approaches can improve transparency, reduce dominance bias in decision-making and support more reproducible vaccine introduction planning processes.

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