Despite high pneumococcal disease and economic burden in Indonesia and interest to introduce pneumococcal conjugate vaccine (PCV), there were challenges in establishing a comprehensive strategy to accelerate and enable the introduction in country in the early 2010s. Starting in 2017, Clinton Health Access Initiative and partners supported the government of Indonesia with evidence-based decision-making and implementation support for introducing PCV into the routine immunization program. Indonesia has since accelerated PCV roll out, with nationwide reach achieved in 2022. On the path to PCV introduction, several challenges were observed that impacted decision making on whether and on how to optimally roll out PCV, resulting in significant introduction delays; including (1) a complex country context with a devolved government structure, fragmented domestic funding streams, and an imminent transition out of major immunization donor (Gavi) support; (2) strong preference to use domestically sourced products, with limited experience accessing global pooled procurement mechanism including for vaccines; and (3) concerns around programmatic feasibility and sustainability. This case study documents key insights into the challenges experienced and how those were systematically addressed to accelerate new vaccine introduction in Indonesia, with support from local and global stakeholders over time. The learnings would be beneficial for other countries yet to introduce critical new vaccines, in particular those with similar archetype as Indonesia e.g., middle-income countries with domestic manufacturing capacity and/or countries recently transitioning out of Gavi support.

中文翻译：

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加速印度尼西亚肺炎球菌结合疫苗的推广：2017 年至 2022 年的主要经验教训

尽管印度尼西亚肺炎球菌疾病和经济负担较高，并且有兴趣引入肺炎球菌结合疫苗 (PCV)，但在制定全面战略以加速和实现 2010 年代初在该国的引入方面仍面临挑战。从 2017 年开始，克林顿健康计划和合作伙伴为印度尼西亚政府提供循证决策和实施支持，将 PCV 纳入常规免疫计划。此后，印度尼西亚加速了 PCV 的推广，并于 2022 年在全国范围内实现了覆盖。在 PCV 的推广过程中，我们发现了一些挑战，这些挑战影响了是否以及如何最佳地推广 PCV 的决策，从而导致了推广的严重延迟；包括 (1) 复杂的国家背景、权力下放的政府结构、分散的国内资金流以及即将停止主要免疫捐助国 (Gavi) 支持的情况；(2) 强烈倾向于使用国内产品，但参与疫苗等全球联合采购机制的经验有限；(3) 对计划可行性和可持续性的担忧。本案例研究记录了对所经历的挑战的重要见解，以及如何在当地和全球利益相关者长期的支持下系统地解决这些挑战，以加速印度尼西亚新疫苗的推出。这些经验教训对于尚未推出关键新疫苗的其他国家将是有益的，特别是那些与印度尼西亚类似的国家，例如具有国内制造能力的中等收入国家和/或最近摆脱全球疫苗免疫联盟支持的国家。