Supporting Countries with Vaccine Prioritization and Optimization

GLOBAL — As national health ministries and public health leaders grapple with an increasingly volatile global health landscape, the process of shaping robust immunization portfolios has grown profoundly complex. Deciding which vaccines to introduce, determining the optimal rollout sequence, and balancing finite public health budgets against mounting disease burdens require sophisticated decision-making tools.

For more than three decades, JSI has stood at the forefront of global vaccine guidance, supporting over 20 countries in strengthening their national immunization programs. Building upon this rich legacy of technical assistance, JSI spearheaded the CHOICES 2.0 initiative. This landmark project has provided critical support to National Immunization Technical Advisory Groups (NITAGs) and Expanded/National Programs for Immunization (EPI or NIP), helping them navigate the intricacies of new vaccine introduction (NVI) prioritization. By leveraging advanced analytical tools, fostering cross-border collaboration, and engaging key stakeholders across global and regional platforms, CHOICES 2.0 is transforming how nations protect their populations against preventable infectious diseases.

Main Facts: The Core of the CHOICES 2.0 Initiative

At its heart, the CHOICES 2.0 project addresses a fundamental dilemma faced by low- and middle-income countries (LMICs): how to maximize health impact when resources are scarce. With an influx of new vaccine innovations—ranging from improved pneumococcal conjugate vaccines to emerging prophylactics for malaria and RSV—health authorities must make evidence-based choices about investment priorities.

The cornerstone of this initiative is the New Vaccine Introduction Prioritization and Sequencing Toolkit (NVI-PST). Developed through a multi-institutional collaboration using a Multi-Criteria Decision Analysis (MCDA) framework, the NVI-PST equips decision-makers with a structured, transparent methodology to evaluate competing public health interventions.

Key Pillars of the Initiative:

• The NVI-PST Framework: A sophisticated decision-support tool rooted in MCDA principles, designed to help countries systematically rank and sequence new vaccine introductions.
• Targeted Country Support: Direct engagement with Gavi-eligible countries through in-person and virtual workshops, facilitating evidence-based decision-making led by NITAGs.
• Global and Regional Partnerships: Close coordination with the World Health Organization (WHO), UNICEF, the National Immunization Technical Advisory Group Support Hub (NISH) at the University of Cape Town, and the Global NITAG Network.
• Capacity Building and Knowledge Sharing: A comprehensive five-part global webinar series that reached participants across 19 countries, fostering peer-to-peer learning and technical competence.

Chronology: The Evolution of Vaccine Prioritization and CHOICES 2.0

The journey toward systematic vaccine prioritization did not happen overnight. It represents the culmination of years of iterative development, field testing, and global consensus-building.

Phase I: Laying the Groundwork (The Original CHOICES Project)

The conceptual foundation of the NVI-PST was forged during the original CHOICES project. Led by the International Vaccine Access Center (IVAC) in collaboration with JSI, the U.S. Centers for Disease Control and Prevention (CDC), and Development Catalysts—and working alongside the WHO and Global NITAG Network partners—the initial phase focused on developing a prototype tool based on country-level learning and MCDA methodology. This early phase proved that structured decision-making could significantly improve the transparency and acceptance of immunization policy recommendations.

Phase II: Expanding Access and Refining Tools (2025–2026)

Building upon the successes and lessons of the pilot phase, the CHOICES 2.0 project was launched to scale up access to the NVI-PST and the newly developed Optimization Module. Throughout 2025 and 2026, the project rolled out a series of intensive country-level workshops. These sessions were specifically designed for Gavi-eligible nations that requested assistance or accepted invitations from project leadership.

Concurrently, recognizing the need to reach a wider audience beyond the footprint of in-person workshops, CHOICES 2.0 partnered with NISH and the WHO. Together, they launched a sprawling virtual educational campaign in late 2025, culminating in a five-part webinar series that democratized access to the prioritization methodologies for practitioners across nearly two dozen nations.

Supporting Data and Methodological Framework

The effectiveness of the CHOICES 2.0 intervention lies in the robustness of its tools and the depth of its collaborative network. Decision-making in public health is frequently complicated by competing stakeholder interests, political pressures, and incomplete epidemiological data. The NVI-PST cuts through this noise by introducing a mathematical and consultative framework.

Understanding the NVI-PST and Optimization Module

The Multi-Criteria Decision Analysis approach embedded within the NVI-PST allows NITAGs to evaluate potential vaccine candidates against a customized suite of criteria. These criteria typically include:

• Disease Burden: Morbidity, mortality, and severity of the target pathogen within the specific country context.
• Vaccine Characteristics: Efficacy, safety profile, dosage schedules, and delivery requirements (e.g., cold chain sensitivities).
• Programmatic Feasibility: Alignment with existing immunization schedules, healthcare worker capacity, and supply chain readiness.
• Economic Evaluation: Cost-effectiveness, affordability, projected financial sustainability, and co-financing implications (particularly for Gavi-transitioning countries).

By scoring candidate vaccines across these weighted dimensions, NITAGs can generate defensible, objective rankings. Furthermore, the newly integrated Optimization Module allows countries to move beyond simple linear prioritization, enabling them to model optimal multi-vaccine introduction schedules over a multi-year horizon under varying budget constraints.

Broad Reach and Engagement

The quantitative impact of these efforts is reflected in the sheer volume of engagement achieved by JSI and its partners. Across both the initial CHOICES and CHOICES 2.0 projects:

• Over 20 countries received direct, hands-on technical support to hone their national prioritization and optimization plans.
• 19 countries were actively represented by their NITAG members in the specialized virtual webinar series.
• Multiple global health agencies, including WHO, UNICEF, and academic institutions like the University of Cape Town, collaborated to ensure technical alignment and regional applicability.

Official Responses and Stakeholder Perspectives

The implementation of sophisticated decision-support tools requires more than just software or academic frameworks; it demands political buy-in, institutional commitment, and active dialogue among global health stakeholders.

The Challenge of Volunteer-Led Advisory Groups

A recurring theme emphasized by project leaders and public health experts is the unique structural vulnerability of NITAGs. In many low- and middle-income countries, NITAG members serve on a strictly voluntary basis. These are eminent pediatricians, epidemiologists, immunologists, and public health officials who juggle their advisory responsibilities alongside demanding full-time clinical, academic, or administrative roles.

Without dedicated administrative support, protected time, and institutional recognition, expecting volunteer experts to conduct exhaustive literature reviews, cost-effectiveness analyses, and multi-criteria evaluations is a formidable challenge.

Bridging the Gap Through CHOICES 2.0

Recognizing these human resource and funding limitations, the CHOICES 2.0 project stepped in to provide critical operational scaffolding. By offering administrative coordination, technical facilitation, and complementary financial support, the project alleviated the logistical burdens that often stall NITAG deliberations.

Global health authorities and regional networks have universally lauded this holistic approach. By cultivating political buy-in from Ministries of Health, CHOICES 2.0 helped elevate the status of NITAG recommendations, ensuring that national policymakers view advisory group outputs not as academic exercises, but as essential inputs for national budget allocation and strategic planning.

Implications for the Future of Global Immunization

As the international community looks toward the remainder of the decade and beyond, the lessons learned from CHOICES 2.0 offer a vital roadmap for sustainable public health governance. The global health environment is currently defined by a convergence of crises—often referred to as a polycrisis—characterized by severe economic pressures, shifting donor priorities, lingering post-pandemic disruptions, and the constant threat of emerging and re-emerging infectious diseases.

Navigating Funding Constraints and Innovations

In an era of tightening fiscal space, countries can no longer afford inefficiencies or uncoordinated vaccine introductions. Every dollar invested in immunization must yield the highest possible return in terms of lives saved and disability averted. The methodologies championed by JSI and its partners ensure that national immunization programs remain agile, data-driven, and resilient.

However, the journey does not end with a single workshop or a one-off prioritization exercise. Project leaders emphasize that routine updating of prioritization and optimization plans is essential. As new epidemiological data emerges, vaccine prices fluctuate, and disease patterns shift due to climate change and urbanization, countries must continuously revisit their roadmaps.

The Need for Enhanced Local Data Systems

A critical takeaway from the CHOICES 2.0 engagement is the persistent hunger among LMICs for localized data. While global evidence and regional estimates are invaluable, countries increasingly require robust, granular local epidemiological data, disease burden statistics, and context-specific vaccine performance metrics to feed into the NVI-PST. Strengthening national health information systems and surveillance networks must therefore go hand in hand with decision-support capacity building.

A Call for Sustained Enabling Environments

Ultimately, the long-term success of vaccine prioritization and optimization rests upon the creation and maintenance of an enabling environment. This requires a concerted, multi-stakeholder commitment involving:

1. Ministries of Health: Providing institutional backing, statutory recognition, and protected time for NITAG members.
2. Global Technical Working Groups (such as VPOP): Ensuring that global guidance remains responsive to country-level realities and operational constraints.
3. The Global NITAG Network: Serving as a conduit for South-to-South cooperation, peer learning, and the dissemination of best practices.
4. Resource Partners and Donors: Maintaining flexible, long-term financial and technical investments in national advisory systems rather than relying solely on short-term project funding.

Through the visionary leadership of JSI, the dedication of national technical advisors, and the collaborative spirit of global health institutions, initiatives like CHOICES 2.0 have laid a resilient foundation. By equipping countries with the tools to choose wisely, sequence strategically, and optimize boldly, the global health community is taking a decisive step toward a healthier, more equitable future where every vaccine reaches the arm that needs it most, exactly when it is needed.