Proposal of a vaccination needs index to prioritize municipal interventions in Brazil

Introduction To address the health needs of a population, it is essential to integrate several indicators that are expressed on non-comparable scales. Vaccination is a crucial aspect of public health, and prioritizing vaccination needs through immunization registries can help allocate resources and funding to integral approaches. Objective To propose and implement an index of vaccination needs (VNI) based on national administrative data on tracer vaccines for children, born between 2019 and 2022, to help prioritize Brazilian municipalities. Methodology We analyzed data from 5,570 municipalities in Brazil. The VNI integrated indicators of vaccination coverage and the number of susceptible children regarding tracer vaccines for children including DTP – Diphtheria-Tetanus-Pertussis (third dose), polio (third dose), and MMR – Measles-Mumps and Rubella (second dose). We assessed how the VNI could identify a group of municipalities in challenging situations to improve vaccination. Results Compared with criteria based only on the absolute number of unvaccinated children (susceptible children) or the vaccination coverage, the group prioritized for having high VNI exhibited more similar proportions of large, medium, and small municipalities. Additionally, this group included more municipalities located in the Legal Amazon region and Special Sanitary Indigenous Districts than groups prioritized with the other criteria. The VNI also outperformed the other criteria to prioritize municipalities that differed from the rest regarding the Gini coefficient. Conclusion The proposed VNI can facilitate the identification of populations that need differentiated interventions to prevent the resurgence of eliminated or controlled vaccine-preventable diseases. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any specific funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Data were openly available before the initiation of the study and in the manuscript was described how they can be located. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.