The Path to Vaccine Introduction Prioritization in Ethiopia

Participants of the Ethiopia E-NITAG workshop on new vaccine assessment, prioritization, and sequencing. Photo courtesy: JSI Ethiopia

With many newly developed vaccines entering the market and the availability of Gavi’s support for selected new programs, the Ethiopian Ministry of Health (MOH) must decide which vaccines should be introduced through its Expanded Programme on Immunization (EPI). The MOH is currently preparing to develop its National Immunization Strategy for 2026–2030, which will include the plan for new vaccine introductions.

The Ethiopian National Immunization Technical Advisory Group (E-NITAG), an independent and voluntary advisory body established in 2016, was created to assist the MOH by offering expert guidance on various aspects of the national immunization program, including the introduction of new vaccines. To fulfill its mandate, E-NITAG conducts assessments of emerging health needs, identifies gaps, and formulates actionable, evidence-based recommendations for the MOH. This process ensures that Ethiopia’s immunization programs are effective and adaptable to evolving public health demands.

Since its inception, E-NITAG has evaluated various new vaccine introduction requests from the MOH on a case-by-case basis. While this approach has resulted in recommendations for the introduction of multiple vaccines in a short timeframe, it has often lacked preliminary prioritization processes. This has led to delays in implementing the recommended vaccines due to programmatic challenges. However, with support from CHOICES 2.0, a multi-country, Gates Foundation-funded project led by JSI, the E-NITAG is implementing a new approach to vaccine introduction prioritization for the country. In March 2025, E-NITAG identified the measles rubella and hexavalent vaccines as high priority for introduction and set a course for the MOH to plan for vaccine introductions over the next five years based on Ethiopia’s needs.

Shifting Gears

To fulfill its founding objective to “provide unbiased and evidence-based recommendations,” E-NITAG had to shift from reviewing individual new vaccine introduction requests to a streamlined proactive approach that informs a 5 years plan for new vaccine introduction. To support this change, CHOICES 2.0, a multi-country, Gates Foundation-funded project led by JSI, worked with the MOH and other project partners, including Development Catalysts, guided E-NITAG to use the New Vaccine Introduction Prioritization and Sequencing Framework Toolkit.

During an initial six month period, E-NITAG staff participated in virtual and in-person workshops to adapt and implement the toolkit (See graphic). The Expanded Programme on Immunisation (EPI) led by the MOH was aligned with this approach from the start, ensuring programmatic considerations and incorporation in strategy development.

In March 2025, E-NITAG members convened to vote on the shortlisted vaccines based on the information collected as per agreed criteria. The voting resulted in recommendations to introduce two high-priority vaccines (measles rubella and hexavalent) between 2026-2030 and identified two additional vaccines as medium-priority (multivalent meningococcal conjugate vaccine and respiratory syncytial virus vaccine).

E-NITAG advised revisiting these recommendations every two years to account for new evidence and evolving circumstances in the country. The MOH is expected to incorporate the high-priority vaccines into the National Immunization Strategy for 2026–2030.

A Key Win and the Road Ahead

For the first time in its history, E-NITAG successfully conducted multilayered consultative workshops, meetings, and iterative processes to present the vaccines it recommends for introduction in Ethiopia. This approach marks a departure from the previous practice of recommending new vaccine introduction on a case-by-case basis. Building on the success of this initiative, E-NITAG plans to apply these skills in future prioritization exercises as other vaccines become available.

This model enables E-NITAG to provide proactive, independent, and expert recommendations on new vaccine introductions that reflect the country’s realities. It also strengthens the MOH’s capacity for planning, coordination, and resource mobilization for timely and effective implementation of the recommendations. More broadly, a strong, capable E-NITAG will remain a critical advisor to the MOH, helping shape strategic, evidence-based public health policies that improve the nation’s resilience to emerging health threats and result, ultimately, in better health outcomes.

“In a resource-limited setting like Ethiopia, implementing an evidence-based vaccine prioritization process is critical to ensuring the most effective and equitable use of scarce health resources,” says Dr. Solomon, Chair, E-NITAG. “Such a process enables the health system to maximize population-level health impact by targeting groups at the highest risk of severe disease or transmission. It also promotes fairness by prioritizing vulnerable and underserved populations. Furthermore, a transparent and well- communicated prioritization strategy helps build public trust and acceptance of vaccination efforts. Lastly, it allows for the efficient use of limited logistical and healthcare infrastructure, ensuring that vaccine delivery is both strategic and sustainable.”

The CHOICES 2.0 project aims to strengthen the capacity of countries to make informed decisions on prioritizing new vaccine introduction and optimizing vaccine programs by enhancing the decision-making capacities of immunization NITAGs to provide evidence-based recommendations to national immunization programs using the New Vaccine Introduction Prioritization and Sequencing Framework Toolkit. The prioritization process does not replace the need for review of each vaccine program and use of Evidence To Recommendations (EtR) which support the NITAG in making recommendations on whether and how individual vaccines should be introduced.