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Measles is a highly infectious disease leading to high morbidity and mortality impacting people's lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality. [ABSTRACT FROM AUTHOR]

As of November 2023, 140 World Health Organization (WHO) member states had introduced human papillomavirus (HPV) vaccination in their routine immunization schedules. Despite a continuously increasing demand from countries across all income groups, supply constraints, COVID-19 pandemic disruptions, and other factors have slowed the pace of introduction, particularly in low-resource settings. Using a population-based forecasting methodology and leveraging the WHO's yearly vaccine supply data collection, we updated global demand and supply projections for the HPV vaccine for the period of 2022–2031. The analysis aimed at clarifying the magnitude of the challenges to bringing in equitable access to HPV vaccines, which can hinder the achievement of the Global Strategy for the Elimination of Cervical Cancer. The results of this analysis show that the risk of HPV shortages has significantly decreased, and global supply is now, under normal circumstances, sufficient to meet global demand. In the long term, HPV supply will be more than sufficient to meet the Global Strategy's goal of 90% of girls fully vaccinated with the HPV vaccine by the age of 15 years. Nonetheless, paying attention to the formulation of policies and carefully managing demand and supply will be required to ensure the long-term sustainability of the HPV vaccine program. [ABSTRACT FROM AUTHOR]

Many countries with the highest burdens of cervical cancer have not yet offered HPV vaccines to the majority of their age-eligible girls, who as adults also have limited or no access to effective cervical cancer screening or treatment. There are now two complementary developments that could make HPV vaccines more accessible and affordable: 1) the current and projected increases in HPV vaccine supply and 2) the permissive recommendation for single-dose HPV vaccination schedules. This change in policy paired with the healthier HPV vaccine supply is an incredible opportunity to facilitate rapid access and expansion of HPV vaccination. Female adolescent vaccination including multi-age cohorts must be prioritized. In the coming decades this is the most cost-effective approach to avert millions of projected cervical cancer cases, which account for the majority of HPV-related cancers globally. [ABSTRACT FROM AUTHOR]

Markets for life-saving vaccines do not often generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability for use in the lowest income countries. The perceived risks and uncertainties about sustainably funded demand from developing countries often leads to underinvestment in development and manufacturing of appropriate products. The pilot initiative Advance Market Commitment (AMC) for pneumococcal vaccines, launched in 2009, aims to remove some of these market risks by providing a legally binding forward commitment to purchase vaccines according to predetermined terms. To date, 14 countries have already introduced pneumococcal vaccines through the AMC with a further 39 countries expected to introduce before the end of 2013. This paper describes early lessons learnt on the selection of a target disease and the core design choices for the pilot AMC. It highlights the challenges faced with tailoring the AMC design to the specific supply situation of pneumococcal vaccines. It points to the difficulty- and the AMC's apparent early success--in establishing a long-term, credible commitment in a constantly changing unpredictable environment. It highlights one of-the inherent challenges of the AMC: its dependence on continuous donor funding to ensure long-term purchases of products. The paper examines alternative design choices and aims to provide a starting point to inform discussions and encourage debate about the potential application of the AMC concept to other fields. Les marches des vaccins salvateurs ne generent souvent pas les resultats desires du point de vue de la sante publique, en termes de quantite, de qualite et de fiabilite des produits, mais aussi d'adequation et/ou de durabilite des programmes pour l'utilisation dans les pays aux plus faibles revenus. Les risques percus et les incertitudes concernant une demande durablement financee, de la part des pays en voie de developpement, conduisent souvent a un sous-investissement dans le developpement et la fabrication des produits appropries. L'initiative pilote Garantie de marche (AMC) pour le vaccin antipneumococcique, lancee en 2009, vise a eliminer certains de ces risques du marche en offrant un engagement prealable, juridiquement contraignant, d'acheter des vaccins selon ales conditions predefinies. A ce jour, 14 pays ont deja introduit les vaccins contre le pneumocoque par le biais de l'AMC. Il est prevu que 39 autres pays les introduisent avant la fin de 2013. Cet article decrit les premieres lecons tirees de la selection d'une maladie cible et des choix du concept de base de l'AMC pilote. Il souligne les defis que suppose l'adaptation du concept d'AMC a la situation specifique d'approvisionnement des vaccins contre le pneumocoque. Il met en exergue la difficulte--et l'apparent succes initial de l'AMC--d'etablir un engagement credible a long terme dans un environnement imprevisible, en constante evolution. Il met l'accent sur l'un des defis inherents de l'AMC: sa dependance vis-a-vis du financement continu des donateurs pour garantir les achats a long terme de produits. L'article examine les choix de concept alternatifs et vise a fournir un point de depart pour preparer les discussions et encourager le debat sur l'application potentielle du concept AMC a d'autres domaines. Los mercados de vacunas que salvan vidas no suelen generar los resultados mas deseados desde una perspectiva de salud publica, en terminos de cantidad, calidad, viabilidad del producto, asi como de idoneidad y/o sostenibilidad programatica para su uso en los paises con menores ingresos. Es frecuente que los riesgos e incertidumbres percibidos sobre la demanda financiada sostenible de paises en desarrollo conlleven a la desinversion en el desarrollo y fabricacion de los productos adecuados. La iniciativa piloto Compromiso de mercado anticipado (CAM) para vacunas neumococicas, que se lanzo en 2009, pretende eliminar algunos de estos riesgos de mercado mediante la creacion de un compromiso legalmente vinculante para la compra de vacunas de acuerdo con condiciones predeterminadas. Hasta la fecha, ya son 14 los paises que han introducido vacunas neumococicas a traves del CAM y se espera que otros 39 paises las introduzcan antes de finales del 2013. Este documento describe las lecciones anteriormente aprendidas sobre la seleccion de una enfermedad objetivo y las elecciones de diseno principales para el CAM piloto. Destaca los retos a los que hay que enfrentarse para adaptar el diseno CAMa la situacion de suministro de vacunas neumococicas especifica. Senala la dificultad--y al aparentemente temprano exito del CAM--de establecer un compromiso creible, a largo plazo, en un entorno impredecible y constantemente cambiante. Destaca uno de los desafios inherentes del CAM: su dependencia de la financiacion donante continua para asegurar compras de productos a largo plazo. El documento examina las opciones de diseno alternativas y pretende proporcionar un punto inicial para informar las discusiones y promover los debates sobre la aplicacion potencial del concepto CAM a otros campos., Introduction The prevention of disease through vaccination with efficacious and safe vaccines is one of the most cost-effective public health interventions. (1) However, often the markets for vaccines do not [...]

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests. SG is a consultant providing services to public and private sector personnel involved in the development of vaccination policy. He does not own stock or shares or have any other interest in any company developing vaccines. MM is a consultant providing services to public and private sector personnel involved in the development of vaccines and vaccination policy. She does not directly own stock or shares or have any other financial interest in any vaccine-related company.

Background: Human papillomavirus (HPV) vaccines to prevent cervical cancer have become available in recent years and presented a new challenge to health systems, since they prevent a sexually transmitted virus and are most effective if they are delivered to young adolescent girls, a group not widely served by other health programs. Demonstration and pilot HPV vaccination programs undertaken in the past 7-8 years in low-resource settings have produced lessons that may be more broadly applied to other adolescent health interventions, particularly to those that attempt to reduce human immunodeficiency virus (HIV) infection., Methods: A systematic literature review was undertaken to identify formal and informal evaluations of HPV vaccine use in low- and middle-income countries. Special attention was devoted to the detailed evaluations carried out on large demonstration projects in India, Peru, Uganda, and Vietnam., Results: These lessons fall into 2 main categories: service delivery operations and community outreach and mobilization. Operational issues included venue and timing of vaccinations, definition of target population, micro-planning and coordination, integration with other services, and training. Community issues included consent, messages and channels, endorsement and support, and timing of mobilization efforts., Discussion: Careful planning, good coordination across sectors and levels, and sensitive attention to the expressed needs for information and preferences for communication channels among youth, parents, and communities more broadly were among the key lessons that are relevant for HIV interventions, but many of the smaller details were also important., Conclusions: Applying or adapting these lessons to adolescent HIV services could accelerate effective program design and enhance success.