Abstract
Global inequities in vaccine access remain a major barrier to the control of epidemic-prone and endemic infectious diseases, particularly in low- and middle-income countries. High vaccine costs, limited manufacturing capacity, and cold-chain requirements constrain rapid and equitable deployment during outbreaks and routine immunisation alike. Dose-sparing strategies using intradermal (ID) administration offer a promising approach to expand vaccine coverage by reducing the amount of antigen required per dose. While ID vaccination has been used for decades, its wider implementation has been limited by the technical difficulty and variability of the traditional Mantoux technique.
Recent advances in ID delivery devices, such as Vax-ID, enable precise and reproducible delivery of reduced vaccine doses into the dermis with minimal training requirements. This creates new opportunities to revisit reduced-dose vaccination strategies for outbreak response and routine immunisation in settings where vaccine supply, costs, and cold-chain logistics remain key constraints. The relevance of reduced-dose intradermal vaccination extends to high-cost vaccines with major access gaps, such as HPV, for which intradermal administration has shown promising safety and immunogenicity but still requires robust non-inferiority trials in low-resource settings. Preliminary evidence from IDEVAX, supports the feasibility of Vax-ID–based ID vaccination for selected vaccines. However, robust clinical evidence in low-resource settings is lacking, and the potential of reduced-dose ID vaccination for multivalent childhood vaccines has not been systematically assessed.
Building on the highly ranked but unfunded M-PACT EDCTP proposal, this SEP project will broaden the scientific and strategic basis for reduced-dose ID vaccination using Vax-ID in populations where the public health benefit is expected to be greatest. The project will (i) produce a comprehensive state of the art review paper synthesising the evidence on dose-sparing ID vaccination, delivery devices, and implications for vaccine access, costs, and cold-chain requirements; (ii) refine and broaden the existing proposal to position reduced-dose ID vaccination as a cross-cutting strategy relevant not only for outbreak preparedness but also for routine childhood immunisation and multivalent vaccines; and (iii) support targeted networking and engagement with key global health stakeholders and funders (e.g. EDCTP, CEPI, UNICEF, GAVI) to align future proposals with policy and implementation needs in low-resource settings.
By combining scientific synthesis with strategic proposal development and partnership building, this SEP project will strengthen the evidence base and readiness for resubmission of competitive international grant applications. Ultimately, it aims to accelerate the development and evaluation of practical dose-sparing vaccination strategies that can contribute to more affordable, scalable, and equitable vaccine access.
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