No abstract

als in 14 countries to access unpublished information and assess the acceptability of different MEA types across Europe. Outputs were developed into a vaccines specific MEA framework and guidance for implementation. Results: To date, there is very little experience with vaccine MEAs in Europe; however, interesting value-added service examples were identified (e. g. educational campaign support). The vaccine-specific MEA framework developed (aligned with current taxonomy) focused on financial schemes (e. g. staggered entry approaches, volume-based discounts, price-volume agreements), coverage with evidence development and value-added services (e. g. vaccination implementation support). Pay-for-performance MEAs were less applicable. Budget holder feedback in selected countries confirmed their interest in co-creating such MEA/service approaches with vaccine companies. ConClusions: To enable decision makers to continue investing in innovative vaccines that address public health needs, a shift towards new value-based acquisition models is key. A broader, more flexible approach to vaccines access, including MEAs, can address the needs of budget holders and other external stakeholders as well as manufacturers.