{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T08:05:50Z","timestamp":1785571550274,"version":"3.56.0"},"reference-count":10,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"name":"WHO Office of Iran","award":["203643963"],"award-info":[{"award-number":["203643963"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,16]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To document the first application of the WHO New Vaccine Introduction Prioritization and Sequencing Toolkit (NVI-PST) in the WHO Eastern Mediterranean Region and to describe how Iran\u2019s National Immunization Technical Advisory Group (NITAG) adapted and implemented the framework to develop a prioritised roadmap for vaccine introduction during 2025\u20132030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Policy implementation case study applying a structured multicriteria decision analysis-informed prioritisation framework through a three-phase process including framework adaptation, evidence synthesis, ordinal ranking of candidate vaccines, weighted aggregation and development of sequencing scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>National immunisation governance process in Iran, coordinated by the Ministry of Health and Medical Education and Iran\u2019s NITAG, with technical support from the WHO Country Office.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Core and non-core members of Iran\u2019s NITAG and key immunisation stakeholders involved in the deliberative prioritisation process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Human papillomavirus (HPV) vaccine ranked highest in both importance and feasibility, followed by pneumococcal conjugate vaccine (PCV) for high-risk adults and seasonal influenza vaccine for high-risk groups. Two sequencing scenarios were proposed: both placed HPV first, with either PCV or influenza third after the already-approved hexavalent vaccine. Respiratory syncytial virus (RSV) and varicella vaccines were classified as low priority for the 5-year horizon. The toolkit enabled structured multistakeholder deliberation, improved the transparency and reproducibility of prioritisation, and supported systematic integration of epidemiological, economic and programme evidence. The main implementation challenges arose from national evidence constraints, particularly gaps in adult RSV and pneumococcal disease burden, limited locally generated cost-effectiveness analyses and uncertainty in long-term budget impact estimation under macroeconomic instability, rather than from limitations of the toolkit itself.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The NVI-PST proved feasible under national leadership and generated credible, consensus-based recommendations aligned with Iran\u2019s public health priorities and programme constraints. Minor refinements (streamlined evidence compendium, simpler weighting, stronger secretariat support) would make the toolkit lighter and more sustainable, especially for resource-constrained settings. This Iranian experience provides a replicable model for structured multi-vaccine prioritisation in the Eastern Mediterranean Region and beyond.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115580","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:55Z","timestamp":1776271255000},"page":"e115580","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Application of the WHO new vaccine introduction prioritisation and sequencing framework to guide evidence-based vaccine introduction decisions in Iran, 2025\u20132030"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6438-6833","authenticated-orcid":false,"given":"Akbar","family":"Fotouhi","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1124-3311","authenticated-orcid":false,"given":"Sobhan","family":"Younesian","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3618-1451","authenticated-orcid":false,"given":"Seyede Maryam","family":"Mousavi","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Mohsen","family":"Zahraei","sequence":"additional","affiliation":[{"name":"Department of Vaccine Preventable Diseases, Center for Communicable Diseases Control, Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sussan","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"Department of Vaccine Preventable Diseases, Center for Communicable Diseases Control, Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3832-4564","authenticated-orcid":false,"given":"Farid","family":"Fotouhi","sequence":"additional","affiliation":[{"name":"ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzieh","family":"Nojomi","sequence":"additional","affiliation":[{"name":"Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Alavi","sequence":"additional","affiliation":[{"name":"Department of Communicable Diseases, World Health Organization Country Office for Iran, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Zamani","sequence":"additional","affiliation":[{"name":"Department of Communicable Diseases, World Health Organization Country Office for Iran, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraj","family":"Sedighi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Nateghian","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7755-7665","authenticated-orcid":false,"given":"Ali","family":"Akbari Sari","sequence":"additional","affiliation":[{"name":"Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoud","family":"Movahedi","sequence":"additional","affiliation":[{"name":"Department of Allergy and Clinical Immunology, Children\u2019s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Gharagozlou","sequence":"additional","affiliation":[{"name":"Department of Allergy and Clinical Immunology, Children\u2019s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setareh","family":"Mamishi","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"},{"name":"Department of Infectious Disease, Children\u2019s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1987-5929","authenticated-orcid":false,"given":"Mohammadreza","family":"Salehi","sequence":"additional","affiliation":[{"name":"Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Department of infectious diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Biglari","sequence":"additional","affiliation":[{"name":"Department of Medical Genetics, Children\u2019s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Es-Haghi","sequence":"additional","affiliation":[{"name":"Department of Physico Chemistry, Agricultural Research, Education and Extension Organization, Razi Vaccine and Serum Research Institute, Karaj, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghobad","family":"Moradi","sequence":"additional","affiliation":[{"name":"Health Metrics and Evaluation Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran (the Islamic Republic of)"},{"name":"Center for Communicable Disease Control, Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Mehdi","family":"Gouya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026041509403823000_16.4.e115580.1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiab284"},{"key":"2026041509403823000_16.4.e115580.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00850-X"},{"key":"2026041509403823000_16.4.e115580.3","doi-asserted-by":"crossref","first-page":"e214","DOI":"10.1016\/S1473-3099(24)00078-1","article-title":"The role of NITAGs in government decisions on vaccine use: insights from the Fifth Global NITAG Network meeting","volume":"24","author":"Henaff","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"2026041509403823000_16.4.e115580.4","first-page":"219","article-title":"Meeting of the Strategic Advisory Group of Experts on Immunization, March 2025: Conclusions and recommendations","volume":"100","year":"2025","journal-title":"Wkly Epidemiol Rec"},{"key":"2026041509403823000_16.4.e115580.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054219","article-title":"Priority setting of vaccine introduction in Bangladesh: a multicriteria decision analysis study","volume":"12","author":"Haider","year":"2022","journal-title":"BMJ Open"},{"key":"2026041509403823000_16.4.e115580.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-21013-7","article-title":"Prioritizing vaccine introduction to China\u2019s National Immunization Program: a multi-criteria decision analysis","volume":"24","author":"Guo","year":"2024","journal-title":"BMC Public Health"},{"key":"2026041509403823000_16.4.e115580.7","doi-asserted-by":"crossref","first-page":"886","DOI":"10.3390\/vaccines12080886","article-title":"Prioritization of Vaccines for Introduction in the National Immunization Program in the Republic of Korea","volume":"12","author":"Choi","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"2026041509403823000_16.4.e115580.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-016-3382-5","article-title":"What criteria do decision makers in Thailand use to set priorities for vaccine introduction?","volume":"16","author":"Pooripussarakul","year":"2016","journal-title":"BMC Public Health"},{"key":"2026041509403823000_16.4.e115580.9","unstructured":"Development C . New vaccine introduction prioritization and sequencing toolkit (NVI-PST). 2025."},{"key":"2026041509403823000_16.4.e115580.10","unstructured":"Fotouhi A , Mahmoudi S , Zahraei SM , et al . Iran\u2019s immunization program: gaps, challenges, and ways forward. East Mediterr Health J 2025."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-115580","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:58Z","timestamp":1776271258000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-115580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,15]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2025-115580"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-115580","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}