Influenza vaccine programs for children in low- and middle-income countries: current status and way forward

ABSTRACT

Introduction: Influenza vaccines are safe and effective, yet they are infrequently used in low- and middle-income countries (LMICs).

Areas covered: We examine influenza vaccine programs for children from within a framework of new vaccine adoption in LMICs. We review the available evidence on disease burden and vaccine introduction, the current global and financing policies, and the current status of vaccine availability, and country readiness for implementation.

Expert commentary: Access to appropriate formulations of influenza vaccines and existing immunization infrastructures must be strengthened if influenza vaccine programs are to be expanded in LMICs. While WHO recommends that implementation of influenza vaccine programs should be a country decision based on national goals, capacities, and data review, vaccine decision makers from many LMICs will likely need more evidence to inform the value proposition of program investment for pediatric vaccination, particularly related to alternative immunization strategies that align with current vaccine delivery platforms, anticipated program impact on severe illness endpoints, and program costs and economic benefits. Targeted research and development to address the specific needs of LMICs may be needed to demonstrate the value proposition of influenza vaccines and to expand influenza vaccine programs in these settings.

KEYWORDS:

• Influenza
• influenza vaccine
• low-resource country
• immunization
• pediatrics

Article highlights

• The World Health Organization (WHO) recommends that countries immunize high-risk individuals to prevent severe influenza disease, with national policy decisions based on national capacities, resources, and review of the most relevant data.

• Despite the WHO recommendations, influenza vaccines are under-utilized in low- and middle-income countries (LMICs).

• While causes of under-utilization of influenza vaccines in LMICs are multifactorial and likely differ among countries, some notably obstacles include vaccine costs, the need for annual revaccination, up to twice annual vaccine formulation changes, and weak vaccine delivery platforms beyond traditional childhood immunization age groups.

• Immunization experts have proposed three major categories of activities and evidence in order to advance vaccines into LMICs: 1) establishment and organization of evidence, including vaccine performance, disease burden, and health economics; 2) establishment of supportive global policies, including recommendations, financing policies, procurement mechanisms, and adequate, affordable supply of prequalified vaccine; and 3) translation of policies into local action, including ensuring political will and country readiness to implement programs and development of systems to deliver and monitor the vaccines. While these activities have been accomplished for influenza vaccines in many high-income countries, there are still gaps in LMICs.

• In 2018, Gavi, the Vaccine Alliance, committed to supporting influenza vaccine use in eligible LMICs to strengthen health systems and pandemic preparedness.

• Much can be done to improve the feasibility of influenza vaccination in LMICs, but there is a risk that global focus on pandemic preparedness and new product development will not generate the data or products most needed by LMICs to address their national highest public health priorities.

Declaration of interest

J Ortiz’s current and previous institutions have conducted influenza vaccine-related research funded by the CDC, NIH, the Bill and Melinda Gates Foundation and WHO. K Neuzil’s current and previous institutions have conducted influenza vaccine-related research funded by the CDC, NIH, the Bill and Melinda Gates Foundation WHO, and the Biomedical Advanced Research and Development Authority. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.