Bridging the gap in pneumonia prevention: Qualitative insights on vaccine implementation from health leaders in middle-income countries

• DOI: 10.1371/journal.pgph.0004473
• Publication Date: 2025-04-23T17:23:24Z
• Authors: Rose Weeks; Baldeep K. Dhaliwal; Jasmine Huber; Sarah Nabia; Ala’a F. Al-Shaikh; Kulkanya Chokepha...; LaKKumar Fernando; Ehssan Baghagho; Anita Shet
• Keywords: Thematic Analysis

Despite the well-documented life-saving potential of pneumococcal conjugate vaccines (PCV) and global efforts to widen vaccine availability, access PCV in middle-income countries (MICs) has remained suboptimal due, part, pricing limited external funding opportunities. To understand gaps opportunities for improving equality, this qualitative study engaged leaders from governments, medical institutions, health agencies who were based MICs that did not currently have their national immunization programs explore perspectives on decision-making contexts constraints related introduction. In-depth interviews with 17 participants Egypt, Jordan, Sri Lanka, Thailand 2023 documented that, despite high coverage commitment toward equitable systems, implementing new such as challenging. Among six thematic areas emerged, two strong enablers implementation: 1) existence primary healthcare systems; 2) established policy processes decision-making. Three themes emerged hindered introduction, including; information disease burden available products; competing country priorities; 3) financing challenges. The interplay these a paradox unique MICs, further contributing inequalities access. While subset recently became eligible support Gavi, Vaccine Alliance introducing vaccines, marketplace historically lacked tiered could sustain long term. This is great need existing inequities substantial proportion world’s low-income displaced populations. Finally, said barriers may be alleviated regional actors providing technical capacity-strengthening, advocacy, strategic financial support. These findings are informative strengthening equality developing strategies introduce including PCV.