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This paper reviews the key design features, accomplishments of and lessons learned from two regional group procurement mechanisms dealing with vaccines that have been in operation for more than 25 years. The Pan American Health Organization (PAHO) EPI Revolving Fund purchases vaccines and immunization supplies on behalf of more than 35 countries in the Latin American and Caribbean region. Based on a 'central contracting' model, the program handles most aspects of procurement-from tendering to contracting with and paying producers--using a common fund to pay producers before being reimbursed by countries once goods are received in-country. The Gulf Cooperation Council (GCC) Group Purchasing Program among seven Persian Gulf States issues joint tenders for vaccines, as well as drugs and other medical goods. Through this 'group contracting' program, countries are responsible for contracting with and paying producers on their own, once the group has selected winning bids. Both programs have experienced substantial growth in the past two decades and are considered to have contributed to or accelerated achievements of immunization programs in both regions, including the introduction of new vaccines. The paper identifies several features of both programs--both those designed to attract country participation and those designed to ensure the programs' financial viability--which help explain their success and longevity.

The WHO has recently issued updated recommendations for the programmatic use of new-generation typhoid vaccines in high-risk areas of countries where typhoid fever is still endemic. Countries have subsequently been instructed to discuss how these recommendations can be implemented and to develop plans for targeted typhoid vaccination. These plans can be informed by the experiences with typhoid vaccination that several Asian countries have had. This article reviews past and current typhoid vaccination programs that have taken place in Thailand (using the old whole-cell vaccine) and in China, Vietnam and India (using the new-generation injectable Vi polysaccharide vaccine). This review also describes recent typhoid Vi vaccine demonstration projects that were conducted in five Asian countries.

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