Choice Optimization in Immunization: Country Exercises for Sustainability (CHOICES)



Bill and Melinda Gates Foundation (BMGF)



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The goal of the Choice Optimization in Immunization: Country Exercises for Sustainability (CHOICES) project is that low- and lower-middle-income country immunization programs:

  • Include and can sustain both inclusion and high coverage of pneumococcal, rotavirus, and HPV vaccines

  • Align with broad country health priorities for communicable disease prevention and control

A detailed project briefer can be found here.

JSI’s recent work under Rotavirus Accelerated Vaccine Introduction Network (RAVIN), as well as under complementary and related initiatives with global partners, has surfaced a number of gaps in the resources available to guide country immunization program decision-making, particularly for program optimization and comprehensive prioritization efforts. RAVIN consortium is a cross-disciplinary partnership between the Johns Hopkins Bloomberg School of Public Health International Vaccine Access Center (IVAC), John Snow, Inc. (JSI), and the U.S. Centers for Disease Control and Prevention (CDC). CHOICES builds upon the work done by RAVIN to fill these gaps and assist countries in making informed decisions to tailor vaccine programming to fit their current immunization landscape and future needs.

RAVIN has provided technical support to eight Gavi-eligible countries—Afghanistan, Bangladesh, Benin, Cambodia, Democratic Republic of Congo, Lao PDR, Myanmar, and Nepal—across RVV introduction and product switch decision-making, Gavi application, introduction preparation, and implementation. Our consortium partners have honed a set of common values throughout the RAVIN project, which will continue to be upheld in the CHOICES grant:

  • Promoting country self-determination, so that decisions made are locally owned and outlast this project

  • Integrating our work with relevant efforts of global partners to strengthen and support their work

  • Committing to supporting countries by embedding local staff in government offices to support project activities

  • Investing in capacity, so that countries, global partners, and the health system realize a sustained value from engaging with our project

Since 2021, CHOICES has developed a series of Vaccine Evidence Briefers used to provide guidance over COVID-19 vaccinations for

  • Booster Doses

  • Dose Intervals

  • Mixed Vaccine Schedules

  • Vaccinating Pregnant Women

CHOICES has also recently engaged with several new countries interested in introducing or switching PCV and rotavirus vaccine products. Since 2022, CHOICES has been working with the following countries to assist in Rota/PCV introductions or product switches.

  • Uganda

  • Chad

  • Somalia

To support the EPI teams of these countries, CHOICES has hired immunization technical advisors and directly linked with an existing JSIPL program that successfully rolled out rotavirus vaccine introduction in a phased approach from 2018 to 2021. The Rotavirus Vaccine Introduction (RVVI) program of India participated in the 14th Annual Rotavirus Symposium in Bali, Indonesia. During this event, CHOICES also had the opportunity to present a poster on its experience in supporting countries navigating the ever-changing rotavirus vaccine product menu.


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