{
  "abstract": "Objectives 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’s National Immunization Technical Advisory Group (NITAG) adapted and implemented the framework to develop a prioritised roadmap for vaccine introduction during 2025–2030.Design 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.Setting National immunisation governance process in Iran, coordinated by the Ministry of Health and Medical Education and Iran’s NITAG, with technical support from the WHO Country Office.Participants Core and non-core members of Iran’s NITAG and key immunisation stakeholders involved in the deliberative prioritisation process.Results 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.Conclusion The NVI-PST proved feasible under national leadership and generated credible, consensus-based recommendations aligned with Iran’s 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.",
  "authors": [
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Akbar Fotouhi"
    },
    {
      "affiliations": [
        "School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Sobhan Younesian"
    },
    {
      "affiliations": [
        "School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Seyede Maryam Mousavi"
    },
    {
      "affiliations": [
        "Department of Vaccine Preventable Diseases, Center for Communicable Diseases Control, Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Seyed Mohsen Zahraei"
    },
    {
      "affiliations": [
        "Department of Vaccine Preventable Diseases, Center for Communicable Diseases Control, Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Sussan Mahmoudi"
    },
    {
      "affiliations": [
        "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)"
      ],
      "name": "Farid Fotouhi"
    },
    {
      "affiliations": [
        "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)"
      ],
      "name": "Marzieh Nojomi"
    },
    {
      "affiliations": [
        "Department of Communicable Diseases, World Health Organization Country Office for Iran, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Maryam Alavi"
    },
    {
      "affiliations": [
        "Department of Communicable Diseases, World Health Organization Country Office for Iran, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Omid Zamani"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran (the Islamic Republic of)"
      ],
      "name": "Iraj Sedighi"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Alireza Nateghian"
    },
    {
      "affiliations": [
        "Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Ali Akbari Sari"
    },
    {
      "affiliations": [
        "Department of Allergy and Clinical Immunology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Masoud Movahedi"
    },
    {
      "affiliations": [
        "Department of Allergy and Clinical Immunology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Mohamad Gharagozlou"
    },
    {
      "affiliations": [
        "Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)",
        "Department of Infectious Disease, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Setareh Mamishi"
    },
    {
      "affiliations": [
        "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)"
      ],
      "name": "Mohammadreza Salehi"
    },
    {
      "affiliations": [
        "Department of Medical Genetics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Alireza Biglari"
    },
    {
      "affiliations": [
        "Department of Physico Chemistry, Agricultural Research, Education and Extension Organization, Razi Vaccine and Serum Research Institute, Karaj, Iran (the Islamic Republic of)"
      ],
      "name": "Ali Es-Haghi"
    },
    {
      "affiliations": [
        "Health Metrics and Evaluation Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran (the Islamic Republic of)",
        "Center for Communicable Disease Control, Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Ghobad Moradi"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Mohammad Mehdi Gouya"
    }
  ],
  "title": "Application of the WHO new vaccine introduction prioritisation and sequencing framework to guide evidence-based vaccine introduction decisions in Iran, 2025–2030",
  "uid": "9e9babad-1ecd-597d-a5cd-1aa36fd392e9"
}