Evaluating Vaccines in Low- and Middle-Income Countries

The continued high burden of communicable disease globally underlines the importance of
vaccines in world health. The ever-growing range and complexity of vaccines that can meet
this challenge demand reliable evidence of vaccine efficacy and effectiveness. Such evidence is often derived from studies in high-income settings but extrapolation of efficacy and especially effectiveness of vaccines to low- and middle-income countries is often unreliable due to the many differences that exist between rich and poor worlds. However, such evidence is critically needed in resource poor settings where disease burdens are high, and vaccine programs have to compete for scarce resources.
Evaluation of vaccine impact in resource poor settings is challenged by a number of factors
including accuracy of information systems, availability and quality of laboratory support and
rapid changes in use of health services. Cost, population coverage and dosing schedules are ongoing challenges in resource poor countries.
This thesis addresses these issues and contributes to the growing body of knowledge of how best to design, implement and evaluate vaccine programs in resource poor countries using routine administrative data.