New vaccine adoption and decision making in Ethiopia: Qualitative study of national decision-making processes for the introduction of PCV 10

Abstract

Abstract
Background: Although vaccines are proven to protect communities from infectious disease, in countries with several competing health problems prioritizing health interventions is important. This study assessed the decision-making process in adopting new vaccines -specifically pneumococcal conjugate vaccine (PCV 10) in Ethiopia.
Methods: We conducted in-depth interviews with 16 purposively selected key informants in Addis Ababa. Informants from Ministry of Health, Ministry of Finance, UN agencies, bilateral organizations, civic societies, universities and professional associations participated in the study. A team of researchers, two from Ethiopia and one from the London School of Hygiene and Tropical Medicine, conducted the interviews.
Findings: Few actors were involved in the decision-making process, with the then Minister, a former GAVI board member, playing a key role. Availability of GAVI funding was the most prominent cue to action although discussion about pneumococcal vaccines preceded the GAVI invitation for funding applications. The political prioritization of immunization and a desire to meet MDG 4 (reducing child mortality) were other key drivers of the decision.
The role of the Ministry of Finance was minimal although the government was committed to allocate a cost sharing approach, as requested by GAVI.
Conclusion: The decision-making process was dominated by only few actors at a central level and was mostly politically driven by the availability of GAVI funding. Though small, cost-sharing indicates the commitment of the government. The involvement of the Ministry of Finance should be encouraged for the sustainability of the program as more new vaccines are introduced into the health system. [Ethiop. J. Health Dev.2015; Special Issue 1:17-22]