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Haemophilus influenzae type B (Hib) is a bacterium that causes a range of clinical syndromes including bacteraemia, pneumonia, and acute bacterial meningitis. It is predominantly a childhood disease, with >80% of cases in children aged less than 5 years. Hib vaccines have been available in developed countries since the early 1990s. Prior to vaccine availability, Hib was the most common cause of pneumonia and meningitis in children aged <5 years. For many reasons, including the cost of the vaccine and a lack of local disease burden data, the introduction of Hib-containing vaccines in low income country immunisation programs has lagged behind that of high income countries. The GAVI application requirements include evidence that national DTP3 (Diphtheria-tetanus-pertussis) coverage is >70% and estimates of the burden of Hib disease (including regional data) as well as a national commitment to long-term funding of the program. Despite commencement of funding availability in 2000 through the GAVI Alliance, uptake remained low. In 2005, only 19/75 (25%) of GAVI-eligible countries had introduced Hib vaccine using the pentavalent DTP-HepB-Hib vaccine. Assessment by GAVI and the WHO led to the Hib Initiative – a global push to implement Hib vaccine programs. It also led to the revision of the requirements countries needed to fulfil in order to be able to apply for GAVI funding. By the end of 2014, all 73 GAVI eligible countries had introduced the pentavalent vaccine. I’d like to start the discussion by asking: 1- Why did the WHO and GAVI change their position to fund countries unable to provide evidence of the burden of disease? 2- What are some of the obstacles to replacing the EPI trivalent DTwP vaccine with the pentavalent DTwP-HepB-Hib in resource-poor settings?

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