Background: The framing of any health policy at the global or national level should be based on recommendations generated through evidence. The addition of a new vaccine to any immunization programs is no exception since a new antigen could be both expensive and have adverse events, though rare. In India the National Technical Advisory Group on Immunization (NTAGI) has recommended the introduction of Rubella vaccine. Rubella is a mild viral infection of children and adults. Partial immunization coverage results in shift of age at infection and rubella in older age groups during pregnancy could have a devastating influence on the fetus causing congenital rubella syndrome. There is a lack of data from India that could help estimate this risk. In order to strengthen one such a recommendation for the introduction of Rubella vaccine in combination with the Measles vaccine, the South Asian Cochrane Center has suggested steps to generate concrete and reliable evidence.

Objectives: Generate evidence to formulate health policy for Rubella vaccines in low and middle income countries.

Strategy: The first step would be to quantify the burden of rubella through a sero-survey of residual antenatal blood samples, quantify the burden of CRS in a cohort of children born through home visits and reviewing documentation, survey the existing rubella vaccine coverage in the community, carry out a Cochrane systematic review on the efficacy and safety of the rubella vaccine. Based on the information, develop a mathematical model to predict the dynamics of the disease with respect to different vaccination strategies. The final step would be to use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach by a panel of stakeholders (including consumer activists) for formulating recommendations to frame a health policy.

Conclusion: These steps advocated can be used to generate evidence, to guide decision making for different vaccine strategies.