Search

BackgroundPrevious studies identified factors influencing regulatory approval to introduction timelines for individual vaccines. However, introduction and uptake timelines have not been comprehensively assessed across the portfolio of Gavi-supported vaccines.MethodsWe analysed median times between introduction milestones from vaccine licensure to country introduction and uptake across six vaccine-preventable diseases (VPDs), three delivery platforms and 69 Gavi-supported countries. Data were gathered from public, partner and manufacturer records. VPDs and prequalified vaccines analysed included Haemophilus influenzae type b (DTwP-HepB-Hib, pentavalent), pneumococcal disease (pneumococcal conjugate vaccine, PCV), rotavirus diarrhoea (rotavirus vaccine, RVV), cervical cancer (human papillomavirus vaccine, HPV), polio (inactivated polio vaccine, IPV) and meningococcal meningitis (meningococcal group A conjugate vaccine, MenA).ResultsMedian time from first vaccine licensure to first Gavi-supported country introduction across VPDs at a ‘global level’ (Gavi-supported countries) was 5.4 years. Once licensed, MenA vaccines reached first introduction fastest (campaign=0.6 years; routine immunisation (RI)=1.7 years). Most introductions were delayed. Country uptake following first introduction was accelerated for more recently Gavi-supported RI vaccines compared with older ones.ConclusionFactors accelerating timelines across delivery platforms included rapid product prequalifications by WHO, strong initial recommendations by the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, achieving target product profiles on first vaccine licensure within a VPD and completing several VPD milestones at a global level prior to licensure. Milestones required for introduction in Gavi-supported countries should start prior or in parallel to licensure to accelerate uptake of vaccines delivered through diverse delivery platforms.

Household cooking and space heating with biomass and coal have adverse impacts on both indoor and outdoor air quality and are associated with a significant health burden. Though household heating with biomass and coal is common in northern China, the contribution of space heating to ambient air pollution is not well studied. We investigated the impact of space heating on ambient air pollution in a village 40 km southwest of central Beijing during the winter heating season, from January to March 2013. Ambient PM2.5 concentrations and meteorological conditions were measured continuously at rooftop sites in the village during two winter months in 2013. The use of coal- and biomass-burning cookstoves and space heating devices was measured over time with Stove Use Monitors (SUMs) in 33 households and was coupled with fuel consumption data from household surveys to estimate hourly household PM2.5 emissions from cooking and space heating over the same period. We developed a multivariate linear regression model to assess the relationship between household PM2.5 emissions and the hourly average ambient PM2.5 concentration, and a time series autoregressive integrated moving average (ARIMA) regression model to account for autocorrelation. During the heating season, the average hourly ambient PM2.5 concentration was 139 ± 107 μg/m3 (mean ± SD) with strong autocorrelation in hourly concentration. The average primary PM2.5 emission per hour from village household space heating was 0.736 ± 0.138 kg/hour. The linear multivariate regression model indicated that during the heating season – after adjusting for meteorological effects – 39% (95% CI: 26%, 54%) of hourly averaged ambient PM2.5 was associated with household space heating emissions from the previous hour. Our study suggests that a comprehensive pollution control strategy for northern China, including Beijing, should address uncontrolled emissions from household solid fuel combustion in surrounding areas, particularly during the winter heating season.