Navigating the intricacies of public health policy in an increasingly volatile global environment has never been more demanding for Ministries of Health and immunization planners. As the landscape of infectious disease threats continually evolves alongside constrained economic resources, the decision of how to optimize national immunization portfolios—specifically determining which vaccines to introduce, and in what precise sequence—represents a monumental challenge. For more than three decades, JSI has served as a foundational pillar in shaping global vaccine guidance, lending critical technical assistance to more than 20 countries to fortify their national immunization programs. In response to post-pandemic fiscal realities and shifting epidemiological patterns, JSI spearheaded the CHOICES 2.0 initiative. This vital project has provided comprehensive support to National Immunization Technical Advisory Groups (NITAGs) and Expanded or National Programs for Immunization (EPI or NIP), empowering them to conduct rigorous new vaccine introduction prioritization through the deployment of advanced methodological tools.
The Imperative of Strategic Vaccine Prioritization
Modern public health frameworks require robust, transparent, and evidence-based decision-making processes. Historically, the introduction of new vaccines into low- and middle-income countries often relied on fragmented data, donor-driven priorities, or immediate availability rather than a comprehensive assessment of long-term public health impact and cost-effectiveness. In an era marked by competing healthcare demands, climate-induced disease shifts, and dwindling international assistance, countries can no longer afford inefficiencies in their immunization pipelines.
To combat these systemic vulnerabilities, the CHOICES 2.0 project functioned as a catalyst for structured decision-making. By channeling decades of institutional experience alongside deep partnerships with international immunization experts and specialized working groups, the initiative sought to institutionalize systematic prioritization. The project actively engaged with relevant stakeholders at both the global and Africa regional levels to inform and guide the evolution of Vaccine Prioritization and Optimization (VPOP) processes, working in close tandem with networks such as the Global NITAG Network to ensure that country-level decisions were underpinned by solid technical consensus and peer-reviewed methodologies.
The Genesis and Evolution of the NVI-PST
At the heart of this transformative technical assistance is the New Vaccine Introduction Prioritization and Sequencing Toolkit, commonly known as the NVI-PST. Developed through a sophisticated Multi-Criteria Decision Analysis (MCDA) approach paired with extensive country learning, the toolkit provides a quantitative and qualitative framework for evaluating competing vaccine candidates. The NVI-PST was originally designed by Development Catalysts in close collaboration with the initial CHOICES project—an enterprise led by the International Vaccine Access Center (IVAC) and backed by JSI, the U.S. Centers for Disease Control and Prevention (CDC), and Development Catalysts, alongside vital contributions from the World Health Organization (WHO) and Global NITAG partners.
The MCDA methodology utilized within the NVI-PST allows advisory committees to weigh a multitude of variables simultaneously. These criteria typically include disease burden, vaccine efficacy and safety, programmatic feasibility, cold chain requirements, economic costs, and cost-effectiveness ratios. By standardizing these variables, the toolkit minimizes subjective bias and political interference, enabling NITAGs to present Ministries of Health with defensible, transparent, and objective recommendations. The evolution of the toolkit under CHOICES 2.0 also saw the integration of the newly developed Optimization Module, which addresses the sequencing of vaccine introductions over multi-year strategic plans to maximize health gains under tight budgetary ceilings.
Chronology of Engagement: Workshops and Capacity Building
The operationalization of the NVI-PST occurred primarily through a targeted series of country-level engagements spanning 2025 and 2026. Recognizing that technical tools are only as effective as the capacity of the professionals wielding them, CHOICES 2.0 prioritized direct, hands-on workshops with Gavi-eligible nations. These countries were selected based on formal requests for engagement or through affirmative responses to invitations issued by the CHOICES 2.0 leadership team.
Convened directly by national NITAGs, these workshops served as intensive training and analytical grounds where local experts could apply the NVI-PST to their specific domestic contexts. Across the lifespan of the original CHOICES initiative and its successor, JSI and its consortium partners successfully supported seven countries through bespoke, in-person and virtual workshops. These sessions were not merely academic exercises; they resulted in concrete roadmap drafts for national immunization schedules, aligning local stakeholders around unified immunization priorities.
Expanding Reach Through Virtual Innovation and the NISH Webinar Series
While in-person workshops yielded profound localized results, the sheer demand for prioritization support far outstripped the physical capacity of project teams to visit every requesting nation. To bridge this gap and democratize access to these critical decision-support resources, CHOICES 2.0 forged a strategic partnership with the National Immunization Technical Advisory Group Support Hub (NISH) at the University of Cape Town and the World Health Organization (WHO).
This collaboration materialized as a comprehensive five-part webinar series entitled Applying Vaccine Prioritization Strategies for Optimized Public Health Outcomes. Designed to transcend geographical barriers, the series drew upon the specialized expertise of representatives from NISH, JSI, WHO, UNICEF, and various active NITAGs. The curriculum was meticulously structured to provide NITAG members and EPI representatives with an exhaustive orientation to the new vaccine prioritization process, an in-depth introduction to the NVI-PST and its novel Optimization Module, practical tutorials on underlying methodologies, and real-world case studies illustrating successful application.
Crucially, the webinar series fostered vital discussions on how the NVI-PST and optimization frameworks complement existing decision-support resources, such as WHO position papers and comprehensive multi-year plans (cMYPs). By engaging participants representing NITAG members across 19 distinct countries, the virtual format achieved a dual objective: it dramatically widened the dissemination of technical competencies while concurrently cultivating a vibrant ecosystem for cross-country learning, peer networking, and the sharing of best practices across diverse healthcare systems.
Addressing Systemic Hurdles: Data Deficits and Human Resource Constraints
Despite the technical triumphs of the CHOICES 2.0 project and the widespread enthusiasm for the NVI-PST, the broader landscape of national vaccine planning remains fraught with systemic impediments. Through both on-the-ground convenings and virtual training environments, JSI has extended advisory and technical support to more than 20 countries over the combined operational periods of CHOICES and CHOICES 2.0, helping them refine their strategic plans.
However, significant operational bottlenecks persist. While a select group of nations has managed to allocate dedicated domestic resources to sustain these prioritization exercises independently, the vast majority continue to grapple with critical structural deficits. Foremost among these is a pronounced scarcity of granular epidemiological data, accurate local disease burden metrics, and up-to-date vaccine market and performance intelligence—both from domestic sources and from comparable socioeconomic settings. Without reliable data inputs, even the most sophisticated prioritization tools face analytical limitations.
Furthermore, human resource constraints present a continuous vulnerability. The vast majority of NITAG members serve on a strictly voluntary, part-time basis, balancing their demanding advisory roles with full-time clinical, academic, or administrative positions within their home healthcare systems. Expecting these dedicated professionals to independently manage the rigorous evidence gathering, data synthesis, modeling exercises, and stakeholder consultations required for advanced vaccine prioritization is an unsustainable proposition, particularly when compounded by broader economic polycrises and tightening public sector budgets.
The Role of Administrative Support and Institutional Buy-In
Recognizing these human capital limitations, the CHOICES 2.0 project actively stepped in to bridge the gap by providing vital administrative scaffolding, rigorous technical support, and expert facilitation. By shouldering the heavy lifting of data organization and workshop logistics, the project helped cultivate essential political buy-in from high-level health authorities. This administrative backing ensured that national experts were granted the institutional space and time required to dedicate themselves to this complex, high-stakes work. In select instances, complementary financial support was also mobilized to offset operational hurdles.
Industry experts and global health economists emphasize that sustainable vaccine prioritization cannot rely solely on short-term project interventions. Moving forward, an enabling environment must be continuously nurtured and maintained by Ministries of Health, national immunization programs, global VPOP technical working groups, the Global NITAG Network, and international resource partners. If countries are expected to maintain living, routinely updated prioritization and optimization plans in the face of emerging pathogens and shifting funding architectures, institutional structures must evolve to provide permanent staffing and budgetary allocations for NITAG secretariats.
The Broader Implications for Global Health Security
The implications of the work accomplished by JSI, CHOICES 2.0, and their global partners extend far beyond individual country borders. As the international community confronts the lingering socioeconomic scars of pandemic disruptions, escalating climate-driven health emergencies, and a complex matrix of circulating vaccine-preventable diseases, the margin for error in public health expenditure has narrowed to near zero.
Optimizing immunization portfolios through transparent, criteria-based frameworks like the NVI-PST is no longer merely a technical exercise in administrative efficiency; it is an essential component of national security and sustainable development. By ensuring that every scarce public health dollar is directed toward the vaccines that offer the greatest epidemiological impact and economic return, countries can protect their populations more equitably and build resilience against future health shocks.
As the formal chapters of CHOICES 2.0 conclude, the methodologies, partnerships, and digital tools established over the past several years leave a lasting legacy. The democratization of prioritization frameworks, the strengthening of regional support networks like NISH and the Global NITAG Network, and the empowerment of local decision-makers collectively mark a paradigm shift in how global health resources are managed. For Ministries of Health willing to commit to evidence-based planning, the path forward is clearer, supported by a proven architecture designed to withstand the uncertainties of the 21st-century health landscape.
