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The incidence of dengue fever (DF) is steadily increasing in Mexico [1], [2], as it is in the rest of Latin America [3], burdening health systems with the consequent morbidity and mortality [4]–[6]. The incidence of DF in Mexico has increased from 1.7 cases per 100,000 inhabitants in 2000 to 43.03 cases per 100,000 inhabitants in 2012 (Table 1) [1], [2]. Growing urbanization, human migration, climate change, and ecological disruption have facilitated the expansion of dengue's vectors, Aedes aegypti and A. albopictus [3], [4]. This increase, which could be solely attributed to an improvement in epidemiological surveillance, in reality has a much more complex explanation. According to reports from the Mexican Secretariat of Health, DF in Mexico follows a cyclical pattern of approximately five years per cycle, characterized by a sudden and dramatic rise in cases subsequently followed by a period of decrement that ultimately results in years with a low number of cases. This pattern seems to have its origin in the introduction/reintroduction of new serotypes among the population [2].    Table 1  Evolution of the incidence of dengue fever cases in Mexico between 2000 and 2012.    Globally, an estimated 2,500,000,000 to 3,000,000,000 individuals are at risk of infection. Each year 50 million people fall ill, and 20,000 people die as a result of dengue [5]–[7]. These trends will continue to worsen in the foreseeable future [3], [7].  Even at its current level, dengue overloads healthcare systems, particularly in developing countries in which resources are scarce [4]. The direct and indirect costs of dengue are high and impose a considerable financial burden on those affected [2], [8]. The most commonly used dengue control measure—vector control programs—have had poor effects on dengue incidence and are difficult to implement in a sustainable fashion [9]–[11]. Also, these programs are costly and have limited effect because of the difficulty of destroying all mosquitoes in an area [9]. Additionally, there are no effective antivirals available to treat the disease. However, as a result of much progress in research and development over the last decade [12], there is a prospect of a safe and effective preventive vaccine becoming available soon [13]–[16].  In 2012, Sanofi-Pasteur (SP) published the results of a Phase IIB clinical trial carried out in Thailand to test the efficacy of its recombinant, live-attenuated, tetravalent dengue vaccine. The authors reported that although the vaccine showed less efficacy than projected, this was not significant, and the vaccine resulted immunogenic for the four dengue serotypes and protected against serotypes 1, 3, and 4 [17]. Irregardless of the results, the authors of the present report consider that this exercise has been successful and a step forward in the process towards obtaining a much-needed dengue vaccine. Nevertheless, it will be important to assess further data, particularly from the ongoing Phase III studies in Latin America and Asia, in which Mexico is participating with several clinical sites [18].  A dengue vaccine would change the paradigm of dengue control by providing invaluable support to currently available prevention and control measures. Importantly, as a disease most prevalent in developing regions, a dengue vaccine would be primarily aimed at low- and middle-income countries (LMICs) [2], [16], a reversal of the traditional situation. Historically, LMICs wait for vaccines to become available and licensed in developed countries before adopting it themselves once an evidence base is generated and prices have come down to affordable levels [19], [20].  The prospect of a dengue vaccine presents LMICs, like Mexico, with an opportunity to strengthen their decision-making capacity in order to make timely and well-informed decisions about the introduction of new interventions for disease prevention and control. Improving the decision-making process will help LMICs become early adopters of public health interventions [21] and help close the time gap between innovation and access to new vaccines in such countries [22].  For early access to the dengue vaccine, countries will need to be proactive, since early access entails the timely development of adoption plans with active involvement of all sectors of society, including academic institutions, nonprofit organizations, ministries of health and finance, and health service providers [21]. Consequently, LMICs will need to prepare early and engage with all stakeholders to accelerate the process of making the vaccine available to their populations.

Introducing a Dengue Vaccine to Mexico: Development of a System for Evidence-Based Public Policy Recommendations