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BMC Public Health

, 12:683

Global health


BackgroundIt is unclear how long it takes for health interventions to transition from research and development RandD to being used against diseases prevalent in resource-poor countries. We undertook an analysis of the time required to begin implementation of four vaccines and three malaria interventions. We evaluated five milestones for each intervention, and assessed if the milestones were associated with beginning implementation.

MethodsThe authors screened World Health Organization WHO databases to determine the number of years between first regulatory approval of interventions, and countries beginning implementation. Descriptive analyses of temporal patterns and statistical analyses using logistic regression and Cox proportional hazard models were used to evaluate associations between five milestones and the beginning of implementation for each intervention. The milestones were: A presence of a coordinating group focused on the intervention; B availability of an intervention tailored to developing country health systems; C international financing commitment, and; D initial and E comprehensive WHO recommendations. Countries were categorized by World Bank income criteria.

ResultsFive years after regulatory approval, no low-income countries LICs had begun implementing any of the vaccines, increasing to an average of only 4% of LICs after 10 years. Each malaria intervention was used by an average of 7% of LICs after five years and 37% after 10 years. Four of the interventions had similar implementation rates to hepatitis B vaccine HepB, while one was slower and one was faster than HepB. A financing commitment and initial WHO recommendation appeared to be temporally associated with the beginning of implementation. The initial recommendation from WHO was the only milestone associated in all statistical analyses with countries beginning implementation relative rate = 1.97, P < 0.001.

ConclusionsAlthough possible that four milestones were not associated with countries beginning implementation, we propose an alternative interpretation; that the milestones were not realized early enough in each intervention’s development to shorten the time to beginning implementation. We discuss a framework built upon existing literature for consideration during the development of future interventions. Identifying critical milestones and their timing relative to RandD, promises to help new interventions realize their intended public health impact more rapidly.

KeywordsVaccine Malaria Intervention Research and development Implement Access Developing country AbbreviationsACTArtemisinin-based combination therapies for treating malaria

ArYear of establishment of a group providing coordination i.e. architecture

DCDeveloping country

EMAEuropean Medicines Agency

FiYear of a global financing commitment, such as through GAVI or GFATM


GFATMGlobal Fund to Fight AIDS, Tuberculosis and Malaria

CRYear of comprehensive i.e. global WHO recommendation

HepBHepatitis B vaccine

HibHaemophilus influenzae type b vaccine

HICHigh-income country World Bank defined

IPTiIntermittent preventive treatment for malaria in infants

IIYear of availability of an improved intervention better aligned with the needs of developing countries

IRYear of initial WHO recommendation

ITNInsecticide treated net

LICLow-income country World Bank defined

LLINLong-lasting insecticidal nets

LMICLower-middle-income country World Bank defined

PCPneumococcal conjugate vaccine

PDPProduct development partnership

RVRotavirus vaccine

RandDResearch and development

RDTRapid diagnostic test

UMICUpper-middle-income country World Bank defined

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-12-683 contains supplementary material, which is available to authorized users.

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Autor: Alan Brooks - Thomas A Smith - Don de Savigny - Christian Lengeler


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