communication needs at user and provider levels, and vaccine use including supply issues.

The health infrastructures in many low- and middle-income countries do not adequately support use of needed vaccines. Causes include inability to pay for vaccines, inadequate infrastructure (ranging from public health laboratories to refrigerators), lack of providers or paraprofessionals to administer vaccines safely, and lack of systems to monitor vaccine use and potential adverse events. Without adequate infrastructure, funding for vaccines alone will not get vaccines to those who need them most.

Recommendation 5-1: The National Vaccine Plan should call for the engagement of U.S. federal agencies and partners to support immunization capacity-building to implement new vaccines in low- and middle-income countries through the provision of expertise and financial resources necessary to incorporate new vaccines, strengthen immunization infrastructure, and achieve higher levels of vaccination. One infrastructure component requiring specific attention is the development and implementation of surveillance systems for vaccination, disease burden, and vaccine safety that are innovative and appropriate for developing countries.

Differential pricing—that is, matching prices to a nation’s ability to pay—can increase global access to vaccines while providing incentives for innovation.

Recommendation 5-2: The National Vaccine Plan should endorse active U.S. engagement in the development of global policy frameworks to further global adherence to differential pricing in order to ensure access to needed vaccines in all countries.


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Gross, C.P., G.F. Anderson, and N.R. Powe. 1999. The relation between funding by the National Institutes of Health and the burden of disease. NEJM 340(24):1881-1887.

HHS (Department of Health and Human Services). 1994. 1994 National Vaccine Plan. Available: [accessed January 2008].

HHS. 2008 (November). Draft Strategic National Vaccine Plan. Available: [accessed December, 2008].

HHS, Federal Immunization Safety Task Force. 2009. Federal Plans to Monitor Immunization Safety for the Pandemic 2009 H1N1 Influenza Vaccination Program. Washington, DC: HHS.

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