The aim of the thesis was to asses whether global strategies to introduce new vaccines result in new practices at country level and to find out whether implementation of the new vaccine requires changes in the existing immunization programme in Malawi. Malawi’s decision making process leading to the application for support GAVI is seen as an important part of these objectives. The participation of the actors and their relative influence, the information flow including access to data on long and short term costs and benefits, and the main topics for discussion for the actors taking part in the process, were at the outset central topics in order to answer the main objectives illustrated above, with the use of semi-structured interviews, and available documents as a research method. Malawi is one of the poorest countries in the world, with high HIV/AIDS prevalence and a substantial amount of the population being undernourished. They started their EPI programme in 1976, and they introduced Hep B and Hib in 2002. The EPI programme now contains measles, DPT, HepB, Hib, polio, and BCG. According to the Financial Sustainability Plan from Malawi from 2004, the total programme cost increased significantly by over 200%, the initiation of the GAVI support (including the measles campaign carried out that year). An article reviewing hospital surveillance data for acute bacterial meningitis from Blantyre district, published in 2006, concludes that there is an urgent future need now for a sustainable routine infant immunization programme including a less expensive vaccine and new financing strategies. Despite the meager resources, the Malawian Ministry of Health has, according to this report, recognized the importance of infant Hib immunization and applied for bridge funding from the Vaccine Fund to allow it to continue routine infant Hib and Hep B vaccination. The government will during 2006 contribute to approximately 20% of the total cost of pentavalent vaccine. Given the tremendous number of other health priorities the country is facing it is unlikely that the Ministry of Health will be able to afford these costs despite the recognition of the vaccine benefits. This study traced the factors affecting the implementation of new vaccines and the effect of the introduction on the existing immunization programme. Like environmental problems, many health problems are international, their causes and consequences cross political borders. This is evident when it comes to infectious diseases, and in order to lift focus, and set the results in a greater perspective, the analytical framework of regime studies was applied. The study indicates that the decision to introduce the new vaccines was not based on cost-effective data and data on disease burden, but rather on the fact that Malawi was eligible for support, and the vaccine was available for free. The introduction of SWAp seems to influence the policy context to a larger degree than the introduction of GAVI, as the donor community and the UN agencies already had a substantial funding responsibility in the health sector also before the introduction of the new vaccines. A somewhat unexpected finding was that the discussions concerning the new vaccines are still going on, and the challenge of the financial sustainability and the remaining high price of the pentavalent vaccine is substantial for the EPI programme.