Prioritization of future new vaccines introduction: The experience of the Ethiopian National Immunization Technical Advisory Group

BACKGROUND: As Ethiopia faces growing demands to introduce new vaccines amid constrained resources and declining donor support, evidence-based prioritization is essential. This paper describes the experience of Ethiopian National Immunization Technical Advisory Group's (ENITAG) in using a structured, multi-criteria decision analysis (MCDA) approach-the New Vaccine Introduction Prioritization and Sequencing Tool (NVI-PST)-to guide new vaccine introduction and sequencing for the 2026-2030 period. METHODS: ENITAG, in collaboration with the Federal Ministry of Health (FMoH) and partners, adapted the NVI-PST to Ethiopia's context. Six candidate vaccines were shortlisted-hexavalent, rubella (MR), multivalent meningococcal conjugate (MMCV), typhoid (TCV), cholera (OCV), and respiratory syncytial virus (RSV) vaccines. Thirteen criteria across importance and feasibility domains were selected and weighted. Data were gathered by thematic working groups and used to score and rank each vaccine through a participatory process involving ENITAG members and stakeholders. RESULTS: The hexavalent and rubella vaccines were prioritized the highest for early introduction due to their combined public health importance and programmatic feasibility. RSV and MMCV were ranked as medium priorities, while TCV and OCV were deemed lower priorities for routine immunization. The recommendations considered existing programmatic constraints, such as upcoming introductions (e.g., malaria, yellow fever, hepatitis B birth dose) and supplementary campaigns. ENITAG also emphasized strengthening its secretariat, improving data systems, and integrating community perspectives in future prioritization efforts. CONCLUSION: This exercise marks a pivotal shift in Ethiopia's immunization decision-making-from reactive, one-off vaccine assessments to a strategic, systematic approach aligned with national priorities and health system capacity. Despite challenges related to data quality and resource limitations, the process offers a replicable model for other low-income countries seeking to optimize immunization investments in a transparent, evidence-informed manner.