Dear Craig and Narayana,

Thank you. I am glad that you found the guidelines helpful.

Craig, you may find some answers to your first comment in the dicument'Principles and considerations for adding a vaccine to a national immunization programme' published in April 2014, available at

http://apps.who.int/iris/bitstream/10665/111548/1/9789241506892_eng.pdf. Regarding your second observation a new document titled "Global Routine Immunization Strategies and Practices (GRISP) a companion document to the Global Vaccine Action Plan (GVAP)" is under development currently.

Kaushik

Thanks Kaushik,

Congratulations to the whole team - really clear guidance for countries. Thank you.

I had two obervations, which may be beyond the scope of the individual new vaccine guidelines:

1. Acknowledging the financial trade offs between each new vaccine and how this compares with other RMNCH interventions: Many countries have to make choices between the new vaccines on offer and between new vaccine introductions and other interventions they can invest in long term (ie. often using domestic resources after graduating from GAVI support for example). I wonder if each new vaccine intro guideline may benefit from acknowledging this and how an extra spend on rubella may compare with rota / pneumo / HPV and even broader with key essential components of RMNCH programmes. This menu approach or highlighting different interventions have different cost effectiveness (yes I know less than perfect!) may help inform decision makers.

2. Are there any references to how countries can sustainably continue to maintain coverage >80% or >95%:This is a major constraint and any links to key guidelines (eg. Reach Every Community or others) may help make linkages between the new vaccine and RI / systems communities. Good that the document acknowledges the risk of introducing rubella vaccine into weaker systems delivering <80%DTP3 coverage - there are risks. For example it will be interesting to see (and hope!) that PNG, who are introducing MR vaccine this year will be able to reach and surpass 80% coverage.

Thanks,

Craig

Sir

Thank you very much sharing detailed document on Rubella vaccination.