The Partnership for Influenza Vaccine Introduction (PIVI): Supporting Influenza Vaccine Program Development in Low and Middle-Income Countries through Public-Private Partnerships

"PIVI is based on the concept that solutions to global influenza disease prevention and control will require participation of both public and private entities."

In 2014, only 24% of low and low-middle income countries (LMICs) reported policies for use of influenza vaccine, compared with 94% of high-income countries. The Partnership for Influenza Vaccine Introduction (PIVI) was developed as a public-private partnership to support LMICs to develop and sustain national vaccination programmes. This article reviews the first 5 years (2013-2018) of experience with PIVI, including the concept, country progress toward sustainability, and lessons learned. This summary focuses on communication aspects of the experience.

Based at the Task Force for Global Health in the United States (US), PIVI is a partnership of 3 types of organisations: (i) national Ministries of Health, which develop influenza vaccine policies and are responsible for programme implementation and evaluation; (ii) industry partners that support the provision of appropriate vaccines, shipping, and supplies to the programme; and (iii) technical partners and collaborators (e.g., the Centers for Disease Control and Prevention (CDC) and the World Health Organization, or WHO) that provide assistance to the Ministries of Health in planning the programmes, supporting national evidence-based policy development, and conducting programme evaluations.

From 2013 to 2018, 17 countries became PIVI partners. Country selection is based on a series of engagements and discussions with the country representatives and other key stakeholders, such as the WHO Regional and Country Offices. PIVI serves as a catalyst for countries to generate data and gain experience to support the development of decisions concerning and programmes to carry out sustainable influenza vaccination programmes. Technical assistance offered to a country is tailored to address data and programme gaps expressed by local stakeholders and/or capacity improvement needs.

The article reports on issues of programme sustainability and country ownership. Partner countries identified several challenges to introducing, expanding, or sustaining influenza vaccination programmes. Some of the obstacles were related to concerns about the safety and/or value of vaccination. One way of addressing this issue is the gathering of data: Knowledge, attitude, and practices (KAP) surveys about influenza and vaccination have been conducted or are planned for 2019 in 16 countries. Data from the surveys have been used to inform appropriate intended groups for vaccine, to plan communication and educational campaigns, and to evaluate the success of these efforts.

Capacity issues have been addressed, for example, through development of an influenza resource package that includes a systematic literature review of papers relevant to national discussions about disease epidemiology and disease burden, vaccine effectiveness and safety, and programme implementation issues. Among the lessons learned: "Close coordination and communication with WHO and WHO Regional Offices and other experts has been important for development and testing of technical support tools..."

Because of the link between pandemic and seasonal preparedness, PIVI partner countries will work to update their pandemic vaccine plans in 2019-2020, building on the capacities developed for seasonal vaccination.

"With the recent Gavi decision to invest in evaluating seasonal influenza vaccination for health workers, opportunities to increase experience and develop best practices in the lowest income countries will increase in the coming years, augmenting PIVI's knowledge base."