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Harnessing the Power of Vaccines in Jordan: Steps in introducing the pneumococcal conjugate vaccine (PCV)

Authors: Dr. Ala’a Al-Shaikh is an Expanded Programme on Immunization Officer with the World Health Organization who led this work in Jordan. Baldeep K. Dhaliwal, Jasmine Huber, and Dr. Anita Shet of the Global Advocacy for PCV Project of Johns Hopkins International Vaccine Access Center supported the development of this piece.   

As a prominent regional leader in health services, Jordan continues making investments in healthcare delivery and in preventative programs such as prioritizing vaccine introductions to protect their population from infectious diseases. The National Immunization Programme was established in 1979 with antigens against five diseases, , and Jordan’s vaccine coverage rate of 95% has potentially contributed to the decline in the rates of child under-5 deaths and vaccine-preventable diseases (VPDs).

In 2015, Jordans’ National Immunization Technical Advisory Group (NITAG) recommended the introduction of four new vaccines to the National Immunization schedule, including Pneumococcal Conjugate Vaccine (PCV), Rotavirus, Hepatitis A and Varicella. Despite a range of difficulties, including the growing population and influx of refugees, Jordan succeeded in the introduction of rotavirus vaccine in 2015, as well as the Hepatitis A vaccine in 2020. Due to the COVID-19 pandemic and the associated disruption in essential health services, the country faced resource constraints that led to the de-prioritization of the introduction of new routine vaccinations into the national schedule, such as PCV. 

The results of such delays can be dire. In the Eastern Mediterranean region, of which Jordan is a part, an estimated 923,000 children under-5 die, with pneumonia accounting for over 20% of deaths among this age group. As Jordan is one of the five countries in the region that have yet to introduce  PCV in their national immunization schedule (alongside Egypt, Somalia, Syrian Arab Republic, and Islamic Republic of Iran), stakeholders have been pushing for change to save the lives of children.

At Jordan’s NITAG meeting in January 2023, the country had another chance to re-visit the initiation of introducing the lifesaving PCV. In preparation for this meeting, the International Vaccine Access Center, in collaboration with the World Health Organization (WHO), prepared an evidence-based brief which provided data on the burden of pneumonia, the PCV cost-effectiveness, global status of PCV introduction and use, and available PCV products. Subsequently, the NITAG agreed that there was an urgent need to introduce PCV into the immunization schedule and agreed to provide their recommendations to the Ministry of Health.

Dr. Nizar Maswada, a manager in the Expanded Program on Immunizations (EPI) and a member of Jordans’  NITAG, shared his excitement about this recommendation: “Introducing PCV has been amid the main goals of the National Immunization Programme for years”. With this recommendation to introduce, Jordan is in the process of closing the global PCV introduction gap and preventing the needless suffering of children. In examining the steps that facilitated Jordan’s decision, three unique factors merit highlighting.

The first is that stakeholders took an unconventional approach to advocacy efforts. In this NITAG meeting, presenters advocating for the introduction of PCV went beyond the traditional methods of discussing mortality, morbidity, and deaths averted with the introduction of PCV. Stakeholders instead focused the discussion on where Jordan stood in comparison with their neighboring countries. Despite being a leader in health services in the region, Jordan lagged with regards to PCV introduction. Jordan’s neighbors – Palestine, Lebanon, Iraq, and Saudi Arabia – have introduced PCV in the national schedule, resulting in decreases in the incidence of invasive pneumococcal disease and disappearance of some vaccine serotypes. Showcasing the progress of Jordans’ neighbors was a unique, and effective, approach.

A second effective approach was leveraging voices from multiple sources. As opposed to previous meetings, where the same voices were advocating for vaccines, this NITAG meeting had voices from a range of global stakeholders, simultaneously advocating for them to recommend the introduction of PCV. Involving various advocates including from academic institutions, the World Health Organization (WHO), and nongovernmental agencies, was a beneficial approach, demonstrating that multiple entities were willing to come together to collectively advocate for the introduction of PCV. 

The last, and most practical, strategy that contributed was ensuring there were existing support structures in place. During the COVID-19 pandemic, Jordan was able to invest in materials, supplies, and communication strategies, as well as leverage ongoing business to procure vaccines. With the COVID-19 pandemic underway, Jordan is able to explore the possibility of leveraging unused funds associated with COVID-19 relief to implement preventative measures against other vaccine preventable diseases, such as pneumonia. This combination of factors allowed for a supportive environment to facilitate the NITAGs’ recommendation of PCV.

Children and families in Jordan, and globally, endure senseless pain and loss from a disease that can be largely prevented through vaccination. Dr. Nizar believes that the NITAG is taking a step in the right direction through their recommendation to introduce PCV, and he shared “We believe that children residing in Jordan should be protected against invasive pneumococcal infections, and I am positive about introducing it in the new future.”

Other countries can utilize similar non-traditional approaches in their advocacy efforts, so children can be protected from life-threatening pneumonia without further delay.

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