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Vaccine coverage for children is an important indicator of the performance of national health and immunization systems. Most of the existing literature has targeted mothers’ low educational level, living in underserved districts and/or remote rural areas and economic poverty that are correlated with low immunization coverage but the supply- and demand-side constraints to immunization in low- and middle- income countries (LMICs) are not well understood. The reliability of claimed administrative immunization coverage in these contexts is questionable. To address these barriers within the present Expanded Programme on Immunization (EPI), the difficulties related to inadequate vaccination uptake must be addressed in more depth. Building on already produced literature, this study aims to determine the extent of immunization coverage among children in LMICs, as well as to fill in the gaps in awareness about system-level obstacles that currently hinder the effective delivery and uptake of immunization services through EPI. By two reviewers, a literature search using PubMed and Google Scholar along with targeted grey literature was conducted on the 2nd of June 2021 by following PRISMA guidelines. The search techniques for electronic databases used both Medical Subject Headings (Mesh) and free-text words were tailored to each database's specific needs using a controlled vocabulary that was limited to the English language from 2000 and 2020. Of the 689 records, eleven articles were included in this review meeting the inclusion criteria. In total, five articles related to vaccination coverage, four studies on components of the routine immunization system, one article on the implementation of new and under-utilized vaccines and one were on vaccines financing. We evaluated the quality of the included studies and extracted into tables created by one investigator and double-checked by another. Review findings suggest that specific strategies to reduce inequality may be required. Vaccine procurement and pricing strategies, as well as vaccine customization to meet the needs of LMICs, are all critical components in strengthening immunization systems. Our findings could be used to establish practical strategies for countries and development partners to address coverage gaps and improve vaccination system effectiveness. Supplementary Information The online version contains supplementary material available at 10.1007/s40267-021-00890-7.

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To help readers determine whether an author's relationships and activities might inappropriately influence a paper's content, health economics and outcomes research (HEOR) journals implement conflict of interest (COI) disclosure policies. This study examines the characteristics of COI disclosure policies in HEOR journals and its association with HEOR SCImago Journal Rank score (SJR), a proxy of journal prestige. Methods: We reviewed disclosure policies from 23 HEOR journals with a 2018 SJR score greater than one. After reviewing International Committee of Medical Journal Editors (ICMJE) guidelines, journal policies, and author disclosure forms, we identified six main author reporting characteristics (yes/no): disclosure of nonfinancial associations, personal associations, nonprofit associations, financial support for all the author's work (not restricted to the submitted work), financial ties for 36 months prior to the publication or earlier, and required disclosure of all author financial relationships (not restricted to those the author deems relevant). Descriptive statistics summarized the variation across journals of each reporting characteristic. A multiple linear regression tested the association between SJR and reporting characteristics. Results: Of 23 journals, 12 (52%) claimed to use ICMJE COI guidelines, though 2 of these had author instructions contradicting ICMJE COI guidelines. HEOR journals, on average, requested that authors satisfy four of the six evaluated reporting characteristics (range: 0 to 6). The most common requested characteristic was disclosure of both financial and nonfinancial associations (20/23) and the least common was the disclosure of all financial relationships versus selective reporting dependent on author's judgement (4/23). The regression analysis did not provide evidence of an association between SJR and the six evaluated characteristics (p-value = 0.99). Conclusions: There is considerable variability in COI disclosure policies among HEOR journals, with many asking authors to judge whether to disclose some relationships. HEOR journals should standardize COI disclosure policies and minimize author judgement to achieve COI disclosure goals.