Global Public Health Master's Program, New York University, New York, New York, United States of America.
PLoS One. 2010 Nov 2;5(11):e13802. doi: 10.1371/journal.pone.0013802.
A major effort to introduce new vaccines into poor nations of the world was initiated in recent years with the help of the GAVI alliance. The first vaccines introduced have been the Haemophilus influenzae type B (Hib) and the hepatitis B (Hep B) vaccines. The introduction of these vaccines during the first phase of GAVI's operations demonstrated considerable variability. We set out to study the factors affecting the introduction of these vaccines. The African Region (AFRO), where new vaccines were introduced to a substantial number of countries during the first phase of GAVI's funding, was selected for this study.
METHODOLOGY/PRINCIPAL FINDINGS: GAVI-eligible AFRO countries with a population of 0.5 million or more were included in the study. Countries were analyzed and compared for new vaccine introduction, healthcare indicators, financial indicators related to healthcare and country-level Governance Indicators, using One Way ANOVA, correlation analysis and Qualitative Comparative Analysis (QCA). Introduction of new vaccines into AFRO nations was associated primarily with high country-level Governance Indicator scores. The use of individual Governance Indicator scores, as well as a combined Governance Indicator score we developed, demonstrated similar results.
CONCLUSIONS/SIGNIFICANCE: Our study results indicate that good country-level governance is an imperative pre-requisite for the successful early introduction of new vaccines into poor African nations. Enhanced support measures may be required to effectively introduce new vaccines to countries with low governance scores. The combined governance score we developed may thus constitute a useful tool for helping philanthropic organizations make decisions regarding the type of support needed by different countries to achieve success.
近年来，在 GAVI 联盟的帮助下，世界上贫穷国家发起了一项将新疫苗引入的重大努力。引入的第一批疫苗是乙型流感嗜血杆菌（Hib）疫苗和乙型肝炎（Hep B）疫苗。在 GAVI 运营的第一阶段引入这些疫苗证明了相当大的可变性。我们着手研究影响这些疫苗引入的因素。非洲区域（AFRO）在 GAVI 资助的第一阶段向大量国家引入了新疫苗，因此选择该区域进行这项研究。
方法/主要发现：本研究纳入了符合 GAVI 资格的、人口在 50 万或以上的 AFRO 国家。使用 One Way ANOVA、相关性分析和定性比较分析（QCA），对新疫苗引入、医疗保健指标、与医疗保健相关的财务指标以及国家层面的治理指标进行了分析和比较。新疫苗引入到 AFRO 国家主要与高国家层面的治理指标得分相关。使用个别治理指标得分以及我们开发的综合治理指标得分，均得出了类似的结果。
结论/意义：我们的研究结果表明，良好的国家层面治理是将新疫苗成功早期引入贫穷非洲国家的必要前提。可能需要增强支持措施，以便有效地向治理得分较低的国家引入新疫苗。我们开发的综合治理评分可能因此构成了一个有用的工具，帮助慈善组织就不同国家所需的支持类型做出决策，以实现成功。
