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"A novel approach to estimate the local population denominator to calculate disease incidence for hospital-based health events in England". Epidemiol Infect 2022; 150:e150. [PMID: 35811424 PMCID: PMC9386789 DOI: 10.1017/s0950268822000917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
While incidence studies based on hospitalisation counts are commonly used for public health decision-making, no standard methodology to define hospitals' catchment population exists. We conducted a review of all published community-acquired pneumonia studies in England indexed in PubMed and assessed methods for determining denominators when calculating incidence in hospital-based surveillance studies. Denominators primarily were derived from census-based population estimates of local geographic boundaries and none attempted to determine denominators based on actual hospital access patterns in the community. We describe a new approach to accurately define population denominators based on historical patient healthcare utilisation data. This offers benefits over the more established methodologies which are dependent on assumptions regarding healthcare-seeking behaviour. Our new approach may be applicable to a wide range of health conditions and provides a framework to more accurately determine hospital catchment. This should increase the accuracy of disease incidence estimates based on hospitalised events, improving information available for public health decision making and service delivery planning.
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Haider MS, Youngkong S, Thavorncharoensap M, Thokala P. Priority setting of vaccine introduction in Bangladesh: a multicriteria decision analysis study. BMJ Open 2022; 12:e054219. [PMID: 35228286 PMCID: PMC8886403 DOI: 10.1136/bmjopen-2021-054219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To prioritise vaccines for introduction in Bangladesh. METHODS Multicriteria decision analysis (MCDA) process was used to prioritise potential vaccines for introduction in Bangladesh. A set of criteria were identified, weighted and assigned scores by relevant stakeholders (n=14) during workshop A. The performance matrix of the data of vaccines against the criteria set was constructed and validated with the experts (n=6) in workshop B. The vaccines were ranked and appraised by another group of stakeholders (n=10) in workshop C, and the final workshop D involved the dissemination of the findings to decision-makers (n=28). RESULTS Five criteria including incidence rate, case fatality rate, vaccine efficacy, size of the population at risk and type of population at risk were used quantitatively to evaluate and to score the vaccines. Two other criteria, cost-effectiveness and outbreak potentiality, were considered qualitatively. On deliberation, the Japanese encephalitis (JE) vaccine was ranked top to be recommended for introduction in Bangladesh. CONCLUSIONS Based on the MCDA results, JE vaccine is planned to be recommended to the decision-makers for introduction into the national vaccine benefit package. The policymakers support the use of systematic evidence-based decision-making processes such as MCDA for vaccine introduction in Bangladesh, and to prioritise health interventions in the country.
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Affiliation(s)
- Mohammad Sabbir Haider
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Directorate General of Health Services, Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Praveen Thokala
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Suwantika AA, Supadmi W, Ali M, Abdulah R. Cost-effectiveness and budget impact analyses of dengue vaccination in Indonesia. PLoS Negl Trop Dis 2021; 15:e0009664. [PMID: 34383764 PMCID: PMC8384188 DOI: 10.1371/journal.pntd.0009664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/24/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Despite the fact that the incidence and mortality rates due to dengue virus (DENV) infection in Indonesia are relatively high, dengue vaccination has not yet been introduced. This study aimed to analyse the cost-effectiveness and the budget impact of dengue vaccination in Indonesia by taking the potential of pre-vaccination screening into account. An age-structured decision tree model was developed to assess the cost-effectiveness value by applying a single cohort of 4,710,100 children that was followed-up in a 10-year time horizon within a 1-year analytical cycle. The budget impact was analysed in a 5-year period (2020-2024) by considering provinces' readiness to introduce dengue vaccine and their incidence rate of DENV infection in the last 10 years. Vaccination that was coupled with pre-vaccination screening would reduce dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) by 188,142, 148,089 and 426 cases, respectively. It would save treatment cost at $23,433,695 and $14,091,642 from the healthcare and payer perspective, respectively. The incremental cost-effectiveness ratios (ICERs) would be $5,733 and $5,791 per quality-adjusted-life-year (QALY) gained from both perspectives. The most influential parameters affecting the ICERs were probability of DENV infection, vaccine efficacy, under-reporting factor, vaccine price, case fatality rate and screening cost. It can be concluded that dengue vaccination and pre-vaccination screening would be cost-effective to be implemented in Indonesia. Nevertheless, it seems unaffordable to be implemented since the total required cost for the nationwide vaccination would be 94.44% of routine immunization budget.
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Affiliation(s)
- Auliya Abdurrohim Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
| | - Woro Supadmi
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Mohammad Ali
- Faculty of Educational Sciences, Universitas Pendidikan Indonesia, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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Suwantika AA, Purwadi FV, Zakiyah N, Puspitasari IM, Abdulah R, Diantini A, Boersma C, Postma MJ. Multi-criteria decision analysis to prioritize the introduction of new vaccines in Indonesia by using the framework of the strategic multi-attribute ranking tool for vaccines (SMART vaccines). Expert Rev Vaccines 2021; 20:83-91. [PMID: 33428502 DOI: 10.1080/14760584.2021.1874926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Decision-making processes regarding new vaccine prioritizations are complex. The objective of this study was to prioritize the introduction of new vaccines in Indonesia.Methods: A multi-criteria decision analysis (MCDA) was applied in this study. A preliminary data collection form was developed to collect country-specific data in relation to 30 pre-defined attributes. In particular, an open-ended questionnaire was conducted among targeted respondents from global level, national level and vaccine manufacturers, which were involved in the financial flows of new vaccine procurement in Indonesia. For setting new vaccines priorities, targeted respondents were asked to assign weight on 10 selected criteria.Results: Top 3 attributes with the highest weight from respondents were premature deaths averted per year, incident cases prevented per year, and cost-effectiveness. Applying criteria scores and weight assessment, the result showed that PCV, rotavirus, HPV, and JE would be on the 1st, 2nd, 3rd, and 4th rank for setting new vaccine priority in Indonesia. There was a significant difference score (p value <0.05) between all these vaccines.Conclusions: PCV, rotavirus and HPV vaccines should be more prioritized than JE vaccine. This ranking is in line with the WHO's priority list, which potentially illustrates the validity and usefulness of our MCDA-approach.
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Affiliation(s)
- Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.,Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
| | - Febby V Purwadi
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Cornelis Boersma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.,Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands.,Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
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Panero MS, Khuri-Bulos N, Biscayart C, Bonvehí P, Hayajneh W, Madhi SA. The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries-Argentina, Jordan, and South Africa (2017-2018). Vaccine 2020; 38:7118-7128. [PMID: 32950303 PMCID: PMC10783979 DOI: 10.1016/j.vaccine.2020.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance. METHODS In 2017-2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC). RESULTS Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation. CONCLUSIONS Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.
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Affiliation(s)
- Maria S Panero
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Cristián Biscayart
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Argentina
| | - Pablo Bonvehí
- Sociedad Argentina de Infectología, Buenos Aires, Argentina
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rodrigues CMC, Plotkin SA. Impact of Vaccines; Health, Economic and Social Perspectives. Front Microbiol 2020; 11:1526. [PMID: 32760367 PMCID: PMC7371956 DOI: 10.3389/fmicb.2020.01526] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022] Open
Abstract
In the 20th century, the development, licensing and implementation of vaccines as part of large, systematic immunization programs started to address health inequities that existed globally. However, at the time of writing, access to vaccines that prevent life-threatening infectious diseases remains unequal to all infants, children and adults in the world. This is a problem that many individuals and agencies are working hard to address globally. As clinicians and biomedical scientists we often focus on the health benefits that vaccines provide, in the prevention of ill-health and death from infectious pathogens. Here we discuss the health, economic and social benefits of vaccines that have been identified and studied in recent years, impacting all regions and all age groups. After learning of the emergence of SARS-CoV-2 virus in December 2019, and its potential for global dissemination to cause COVID-19 disease was realized, there was an urgent need to develop vaccines at an unprecedented rate and scale. As we appreciate and quantify the health, economic and social benefits of vaccines and immunization programs to individuals and society, we should endeavor to communicate this to the public and policy makers, for the benefit of endemic, epidemic, and pandemic diseases.
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Affiliation(s)
- Charlene M. C. Rodrigues
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Department of Paediatric Infectious Diseases, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stanley A. Plotkin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States
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De Wals P, Espinoza-Moya ME, Béland D. Kingdon's Multiple Streams Framework and the Analysis of Decision-Making Processes Regarding Publicly-Funded Immunization Programs. Expert Rev Vaccines 2019; 18:575-585. [PMID: 31216187 DOI: 10.1080/14760584.2019.1627208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction: The implementation of a publicly-funded immunization program results from a complex decision-making process. John Kingdon's 'Multiple Streams Framework' has been extensively used to analyze how and why governmental policies were adopted. Area covered: Ideas that will ultimately end up in a proposal for a new immunization program develop gradually along three main streams: (i) the problem stream, which focuses on a particular vaccine-preventable disease and its perception by stakeholders; (ii) the policy stream, which is centered on experts' views on the optimal use of available vaccines; and (iii) the politics stream, which consists of socio-political factors, including budgetary constraints. Ideas are progressively shaped by policy entrepreneurs into a proposal with concrete implementation strategies. The three streams then converge within a policy window, during which adoption is especially likely to occur. To survive, the proposed program should be operationally feasible, consistent with mainstream social values, and financially affordable. The timing of the policy window is usually unpredictable and of short duration. Expert opinion: Analytical frameworks traditionally used to assess immunization programs focus on the technical aspects of the disease, the vaccine, and the program. The 'Multiple Streams Framework' brings added analytical value by enlarging the scope of the analysis into the political arena.
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Affiliation(s)
- Philippe De Wals
- a Department of Social and Preventive Medicine , Laval University , Québec City , Canada
| | - Maria-Eugenia Espinoza-Moya
- b Health Services Research, Institute of Health Policy, Management and Evaluation , University of Toronto , Toronto , Canada
| | - Daniel Béland
- c Department of Political Science , McGill University , Montréal , Canada
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Jamka LP, Simiyu KW, Bentsi-Enchill AD, Mwisongo AJ, Matzger H, Marfin AA, Pollard AJ, Neuzil KM. Accelerating Typhoid Conjugate Vaccine Introduction: What Can Be Learned From Prior New Vaccine Introduction Initiatives? Clin Infect Dis 2019; 68:S171-S176. [PMID: 30845328 PMCID: PMC6405264 DOI: 10.1093/cid/ciy1118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The health consequences of typhoid, including increasing prevalence of drug-resistant strains, can stress healthcare systems. While vaccination is one of the most successful and cost-effective health interventions, vaccine introduction can take years and require considerable effort. The Typhoid Vaccine Acceleration Consortium (TyVAC) employs an integrated, proactive approach to accelerate the introduction of a new typhoid conjugate vaccine to reduce the burden of typhoid in countries eligible for support from Gavi, the Vaccine Alliance. TyVAC and its partners are executing a plan, informed by prior successful vaccine introductions, and tailored to the nuances of typhoid disease and the typhoid conjugate vaccine. The iterative process detailed herein summarizes the strategy and experience gained from the first 2 years of the project.
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Affiliation(s)
- Leslie P Jamka
- Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, Baltimore, MD
| | - Kenneth W Simiyu
- Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, Baltimore, MD
| | - Adwoa D Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Aziza J Mwisongo
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington
| | - Helen Matzger
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anthony A Marfin
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, Baltimore, MD
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Hoe C, Rodriguez DC, Üzümcüoğlu Y, Hyder AA. Understanding political priority development for public health issues in Turkey: lessons from tobacco control and road safety. Health Res Policy Syst 2019; 17:13. [PMID: 30728038 PMCID: PMC6364388 DOI: 10.1186/s12961-019-0412-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use and road traffic injuries are major public health problems in Turkey. During the last decade, the former issue received political priority in the country, while the latter did not despite the immense health and economic burden that road traffic injuries pose on the Turkish population. Political priority can facilitate the attainment of public health goals. Unfortunately, however, limited cross-case analyses exist to help us understand why it emerges for certain public health issues but fails to develop for others in low- and middle-income countries. METHODS This study utilised Kingdon's Multiple Streams Framework to explore the political priority development process in Turkey. A cross-case analysis was conducted, using data gathered from three different sources, namely key informant interviews (n = 42), documents (n = 307) and online self-administered surveys (n = 153). The Wilcoxon-Mann-Whitney test was also employed to examine whether the relationships within the tobacco control and road safety networks differed significantly. RESULTS In Turkey, political priority emerges when four streams - problem, policy, political and global - converge while a policy window is open. While these findings are largely consistent with the Multiple Streams Framework, this study also shed light on (1) the need to consider global health treaties for urgent public health issues as these instruments can accentuate global norms and standards, (2) the disproportionate strength of the political stream, (3) the need to develop in-depth understanding of national political context, (4) the importance of fostering meaningful ties between global and domestic health networks, and (5) the need for policy network cohesion. CONCLUSIONS Findings from this study can be used by advocates striving to promote public health issues in other similar contexts.
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Affiliation(s)
- Connie Hoe
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America.
| | - Daniela C Rodriguez
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America
| | - Yeşim Üzümcüoğlu
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America
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The social network of international health aid. Soc Sci Med 2018; 206:67-74. [DOI: 10.1016/j.socscimed.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 02/22/2018] [Accepted: 04/04/2018] [Indexed: 11/23/2022]
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Sieleunou I, Turcotte-Tremblay AM, Fotso JCT, Tamga DM, Yumo HA, Kouokam E, Ridde V. Setting performance-based financing in the health sector agenda: a case study in Cameroon. Global Health 2017; 13:52. [PMID: 28764720 PMCID: PMC5540528 DOI: 10.1186/s12992-017-0278-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/16/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND More than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon. METHODS The research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis. RESULTS By 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change. CONCLUSION The policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers' actions and choices.
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Affiliation(s)
- Isidore Sieleunou
- University of Montreal, 7101, avenue du Parc, Montréal, Québec H3N 1X9 Canada
- Research for Development International, 30883 Yaoundé, Cameroon
| | | | | | | | | | - Estelle Kouokam
- Université Catholique d’Afrique Centrale, 11628 Nkolbisson, Yaoundé, Cameroon
| | - Valery Ridde
- University of Montreal, 7101, avenue du Parc, Montréal, Québec H3N 1X9 Canada
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Hsiao A, Desai SN, Mogasale V, Excler JL, Digilio L. Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings. Bull World Health Organ 2017; 95:303-312. [PMID: 28479625 PMCID: PMC5407249 DOI: 10.2471/blt.16.175166] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 11/28/2022] Open
Abstract
Improving water and sanitation is the preferred choice for cholera control in the long-term. Nevertheless, vaccination is an available tool that has been shown to be a cost-effective option for cholera prevention in endemic countries or during outbreaks. In 2011 the first low-cost oral cholera vaccine for international use was given prequalification by the World Health Organization (WHO). To increase and prioritize use of the vaccine, WHO created a global stockpile in 2013 from which countries may request oral cholera vaccine for reactive campaigns. WHO has issued specific guidelines for applying for the vaccine, which was previously in short supply (despite prequalification for a second oral vaccine in 2015). The addition of a third WHO-prequalified oral cholera vaccine in 2016 is expected to increase the global stockpile considerably and alleviate supply issues. However, prioritization and best use of the vaccine (e.g. how, when and where to use) will remain challenges. We describe 12 past oral cholera vaccine campaigns, conducted in settings with varying burdens of cholera. These case studies illustrate three key challenges faced in the use of the oral cholera vaccines: regulatory hurdles, cold chain logistics and vaccine coverage and uptake. To pave the way for the introduction of current and future oral cholera vaccines, we discuss operational challenges and make recommendations for future research with respect to each of these challenges.
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Affiliation(s)
- Amber Hsiao
- Development and Delivery Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Sachin N Desai
- Development and Delivery Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Vittal Mogasale
- Department of Policy and Economic Research, International Vaccine Institute, Seoul, Republic of Korea
| | - Jean-Louis Excler
- Department of Clinical Development and Regulatory, International Vaccine Institute, Seoul, Republic of Korea
| | - Laura Digilio
- Development and Delivery Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
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Berlan D, Buse K, Shiffman J, Tanaka S. The bit in the middle: a synthesis of global health literature on policy formulation and adoption. Health Policy Plan 2016; 29 Suppl 3:iii23-34. [PMID: 25435534 DOI: 10.1093/heapol/czu060] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Policy formulation and adoption are poorly understood phases of the health policy process. We conducted a narrative synthesis of 28 articles on health policy in low- and middle-income countries to provide insight on what kinds of activities take place in these phases, the actors crafting policies and the institutions in which policy making occurs. The narrative synthesis involved an inductive process to identify relevant articles, extract relevant data from text and reach new understandings. We find that actors exercising decision-making power include not just various governmental entities, but also civil society, commissioners, nongovernmental organizations and even clergy. We also find that most articles identified two or more distinct institutions in which policy formulation and adoption occurred. Finally, we identify seven distinct activities inherent in policy formulation and adoption: generation of policy alternatives, deliberation and/or consultation, advocacy of specific policy alternatives, lobbying for specific alternatives, negotiation of policy decisions, drafting or enacting policy and guidance/influence on implementation development. Health policy researchers can draw on these categories to deepen their understanding of how policy formulation and adoption unfolds.
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Affiliation(s)
- David Berlan
- Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA
| | - Kent Buse
- Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA
| | - Jeremy Shiffman
- Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA
| | - Sonja Tanaka
- Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA
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Walt G, Gilson L. Can frameworks inform knowledge about health policy processes? Reviewing health policy papers on agenda setting and testing them against a specific priority-setting framework. Health Policy Plan 2016; 29 Suppl 3:iii6-22. [PMID: 25435537 DOI: 10.1093/heapol/czu081] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This article systematically reviews a set of health policy papers on agenda setting and tests them against a specific priority-setting framework. The article applies the Shiffman and Smith framework in extracting and synthesizing data from an existing set of papers, purposively identified for their relevance and systematically reviewed. Its primary aim is to assess how far the component parts of the framework help to identify the factors that influence the agenda setting stage of the policy process at global and national levels. It seeks to advance the field and inform the development of theory in health policy by examining the extent to which the framework offers a useful approach for organizing and analysing data. Applying the framework retrospectively to the selected set of papers, it aims to explore influences on priority setting and to assess how far the framework might gain from further refinement or adaptation, if used prospectively. In pursuing its primary aim, the article also demonstrates how the approach of framework synthesis can be used in health policy analysis research.
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Affiliation(s)
- Gill Walt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 9SH, UK and Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 9SH, UK and Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 9SH, UK and Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 9SH, UK and Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town
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Hadisoemarto PF, Reich MR, Castro MC. Introduction of pentavalent vaccine in Indonesia: a policy analysis. Health Policy Plan 2016; 31:1079-88. [PMID: 27107293 PMCID: PMC5013783 DOI: 10.1093/heapol/czw038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
The introduction of pentavalent vaccine containing Haemophilus influenzae type b antigen in Indonesia's National Immunization Program occurred nearly three decades after the vaccine was first available in the United States and 16 years after Indonesia added hepatitis B vaccine into the program. In this study, we analyzed the process that led to the decision to introduce pentavalent vaccine in Indonesia. Using process tracing and case comparison, we used qualitative data gathered through interviews with key informants and data extracted from written sources to identify four distinct but interrelated processes that were involved in the decision making: (a) pentavalent vaccine use policy process, (b) financing process, (c) domestic vaccine development process and (d) political process. We hypothesized that each process is associated with four necessary conditions that are jointly sufficient for the successful introduction of pentavalent vaccine in Indonesia, namely (a) an evidence-based vaccine use recommendation, (b) sufficient domestic financing capacity, (c) sufficient domestic vaccine manufacturing capacity and (d) political support for introduction. This analysis of four processes that led to the decision to introduce a new vaccine in Indonesia may help policy makers and other stakeholders understand and manage activities that can accelerate vaccine introduction in the future.
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Affiliation(s)
- Panji F Hadisoemarto
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115, USA Faculty of Medicine, Department of Public Health, Padjadjaran University, Jl. Eyckman 38, West Java, Bandung 40161 Indonesia
| | - Michael R Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115, USA
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Gessner BD, Wilder-Smith A. Estimating the public health importance of the CYD-tetravalent dengue vaccine: Vaccine preventable disease incidence and numbers needed to vaccinate. Vaccine 2016; 34:2397-401. [PMID: 27055020 DOI: 10.1016/j.vaccine.2016.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND To evaluate the potential public health impact of the live attenuated tetravalent Sanofi Pasteur dengue vaccine (CYD-TDV) we analyzed data from the reported clinical trials to calculate vaccine preventable disease incidence (VPDI) and number needed to vaccinate (NNV) based on the licensure indication for persons age 9 years and above. METHODS VPDI is defined as incidence in an unvaccinated population X vaccine efficacy (VE), and thus incorporates both VE and the underlying burden of disease. NNV was calculated as 100,000 divided by VPDI divided by 2-year length of study. We compared these values to data for three newer vaccines that are currently integrated into some national immunization programs in Asia and Latin America, namely pneumococcal conjugate, Haemophilus influenzae type b, and rotavirus vaccines. RESULTS In the Asian-Pacific trial, in the first 25 months after the first dose of the dengue vaccine, CYD-TDV prevented annually 2639 cases of virologically confirmed dengue for every 100,000 persons vaccinated, for an NNV of 18. In the Latin American trial, given the overall lower annual dengue incidence compared to Asia, VPDI was 1707, and NNV 28. For the Asian-Pacific and Latin American studies, the VPDIs for hospitalized virologically confirmed disease at the trials' end were 638 and 239 per 100,000 population per year, respectively, with NNVs of 75 and 201. VPDI for confirmed dengue hospitalization was higher than that for Hib vaccine against Hib meningitis or all cause severe pneumonia while lower than that for rotavirus vaccine against severe rotavirus gastroenteritis. CONCLUSIONS Our analysis found that the CYD-TDV dengue vaccine had favorable VPDI and NNV, also when compared to existing vaccines used in Latin America and Asia. VPDI and NNV varied by serotype distribution, extent of prior dengue exposure (baseline seroprevalence) and country. These findings will help policy-makers decide where and how to introduce this vaccine post-licensure.
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Affiliation(s)
| | - Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Institute of Public Health, University of Heidelberg, Germany.
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17
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Williams BA, Kidane T, Chirwa G, Tesfaye N, Prescott MR, Scotney ST, Valle M, Abebe S, Tambuli A, Malewezi B, Mohammed T, Kobayashi E, Wootton E, Wong R, Dosani R, Subramaniam H, Joseph J, Yavuz E, Apple A, Le Tallec Y, Kang'ethe A. The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi. Health Policy Plan 2016; 31:563-72. [PMID: 26856361 PMCID: PMC4857484 DOI: 10.1093/heapol/czv103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 01/03/2023] Open
Abstract
Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the ‘backlog cohort’, comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries’ plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction.
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Affiliation(s)
- B Adam Williams
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA,
| | - Teklay Kidane
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Geoffrey Chirwa
- Ministry of Health, Maternal and Child Health Division, P.O. Box 30377, Lilongwe 3 Malawi and
| | - Neghist Tesfaye
- Ministry of Health, Maternal and Child Health Division, Lideta Subcity Addis Ababa, Ethiopia P.O. Box 1234
| | - Marta R Prescott
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Soleine T Scotney
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA,
| | - Moussa Valle
- Ministry of Health, Maternal and Child Health Division, P.O. Box 30377, Lilongwe 3 Malawi and
| | - Sintayehu Abebe
- Ministry of Health, Maternal and Child Health Division, Lideta Subcity Addis Ababa, Ethiopia P.O. Box 1234
| | - Adija Tambuli
- Ministry of Health, Maternal and Child Health Division, P.O. Box 30377, Lilongwe 3 Malawi and
| | - Bridget Malewezi
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Tahir Mohammed
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Emily Kobayashi
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Emily Wootton
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Renee Wong
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Rahima Dosani
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Hamsa Subramaniam
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Jessica Joseph
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | | | - Aliza Apple
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Yann Le Tallec
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
| | - Alice Kang'ethe
- Clinton Health Access Initiative (CHAI) the global headquarters: 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
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Choe YJ, Han OP, Cho H, Bae GR, Chun BC, Kim JH, Kim KH, Lee HJ, Choi EH. Prioritization of the introduction of new vaccines to the national immunization program in the Republic of Korea. Vaccine 2014; 32:6049-53. [PMID: 25239482 DOI: 10.1016/j.vaccine.2014.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/03/2014] [Accepted: 09/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was performed to determine the priority of vaccine introduction for five vaccine-preventable diseases (VPDs) caused by Haemophilus influenzae type b (Hib), pneumococcus (Spn), hepatitis A virus (HepA), rotavirus (RV), and human papillomavirus (HPV) to the future Korean National Immunization Program (NIP) and to suggest framework programs to assist decision makers on implementation of the NIP. METHODS Following analysis of the disease burden and economics of the five VPDs by the core team and Korean Advisory Committee on Immunization Practices sub-committee members, a Delphi survey was administered to 94 Korean experts using structured questionnaires that provided the reference data. The two evaluation frameworks for NIP prioritization were (1) a disease-related framework and (2) a vaccine-related framework. After analyzing the responses, a meeting of experts was held to build a consensus for determining how to prioritize NIP implementation. RESULTS The average scores for relative importance were 63.29 for the disease-related framework and 36.71 for the vaccine-related framework. Within the disease-related framework, the mortality and case fatality rate was the highest scored factor (8.97), whereas within the vaccine-related framework, efficacy of the vaccine was considered the most important factor (9.56). On average, Spn, Hib, and HepA had the highest priority scores. CONCLUSION The Korean experts suggested that the main factors influencing the decision to adopt new vaccines in the Korean NIP should be disease mortality, case fatality, and the efficacy and effectiveness of the vaccine. Among the five selected VPDs, Spn, Hib, and HepA were considered to be of higher priority than RV and HPV.
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Affiliation(s)
- Young June Choe
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Ok Pil Han
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Heeyeon Cho
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea; Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Geun-Ryang Bae
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Byung-Chul Chun
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Hyo Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Suwantika AA, Zakiyah N, Lestari K, Postma MJ. Accelerating the introduction of rotavirus immunization in Indonesia. Expert Rev Vaccines 2014; 13:463-72. [DOI: 10.1586/14760584.2014.891940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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20
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Vaccines to promote and protect sexual health: Policy challenges and opportunities. Vaccine 2014; 32:1610-5. [DOI: 10.1016/j.vaccine.2013.09.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/09/2013] [Accepted: 09/23/2013] [Indexed: 11/22/2022]
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21
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Rentmeester CA, Dasgupta R, Feemster KA, Packard RM. Coercion and polio eradication efforts in Moradabad. Hum Vaccin Immunother 2014; 10:1122-25. [PMID: 24401293 DOI: 10.4161/hv.27667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We introduce the problem of vaccine coercion as reported in Moradabad, India. We offer commentary and critical analysis on ethical complexities at the intersection of global public health and regional political strife and relate them to broader vaccine goals. We draw upon a historical example from malaria vaccine efforts, focusing specifically on ethical and health justice issues expressed through the use of coercion in vaccine administration. We suggest how coercion is indicative of failed leadership in public health and consider community-based collaborations as models for cultivating local investment and trust in vaccination campaigns and for success in global public health initiatives.
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Affiliation(s)
- Christy A Rentmeester
- Center for Health Policy and Ethics; Creighton University School of Medicine; Omaha, NE USA
| | - Rajib Dasgupta
- Center of Social Medicine and Community Health; Jawaharlal Nehru University; New Delhi, India
| | - Kristen A Feemster
- Department of Pediatrics; Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA USA; Division of Infectious Diseases and the Vaccine Education Center; The Children's Hospital of Philadelphia; Philadelphia, PA USA; Leonard Davis Institute of Health Economics at the University of Pennsylvania; Philadelphia, PA USA
| | - Randall M Packard
- Institute of the History of Medicine; Johns Hopkins School of Medicine; Baltimore, MD USA
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Suwantika AA, Yegenoglu S, Riewpaiboon A, Tu HAT, Postma MJ. Economic evaluations of hepatitis A vaccination in middle-income countries. Expert Rev Vaccines 2013; 12:1479-94. [PMID: 24168129 DOI: 10.1586/14760584.2013.851008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Economic evaluations of hepatitis A vaccination are important to assist national and international policy makers in different jurisdictions on making effective decisions. Up to now, a comprehensive review of the potential health and economic benefits on hepatitis A vaccination in middle-income countries (MICs) has not been performed yet. In this study, we reviewed the literature on the cost-effectiveness of hepatitis A vaccination in MICs. Most of the studies confirmed that hepatitis A vaccination was cost effective or even cost saving under certain conditions. We found that vaccine price, medical costs, incidence and discount rate were the most influential parameters on the sensitivity analyses. Vaccine price has been shown as a barrier for MICs in implementing universal vaccination of hepatitis A. Given their relatively limited financial resources, implementation of single-dose vaccination could be considered. Despite our findings, we argue that further economic evaluations in MICs are still required in the near future.
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Affiliation(s)
- Auliya A Suwantika
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
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Abstract
At the World Economic Forum in 2010, The Gates Foundation announced the “Decade of Vaccines,” a $10 billion commitment to increase access to existing and new childhood vaccines. It is estimated that this effort could save 6.4 million lives and avert 426 million illnesses [1, 2] Achieving these goals will require a significant effort among global health agencies, non-governmental organizations, industry and national governments to support vaccine development and ensure a strong infrastructure for sustainable vaccine delivery. Vaccines are one of the most important public health achievements in history, resulting in significant decreases in the prevalence of many childhood diseases. However, persistent disparities exist in the adoption of new vaccines and sustained vaccination rates in both developed and developing countries. Decreasing vaccination rates in some communities have resulted in outbreaks of vaccine-preventable diseases. Disparities may be due to vaccine supply, poor infrastructure, or low prioritization of vaccines for public health spending. However, another crucial contributor to the success of vaccination programs is vaccine acceptance.
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Douglas DL, DeRoeck DA, Mahoney RT, Wichmann O. Will dengue vaccines be used in the public sector and if so, how? Findings from an 8-country survey of policymakers and opinion leaders. PLoS Negl Trop Dis 2013; 7:e2127. [PMID: 23516658 PMCID: PMC3597493 DOI: 10.1371/journal.pntd.0002127] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 02/08/2013] [Indexed: 11/24/2022] Open
Abstract
Background A face-to-face survey of 158 policymakers and other influential professionals was conducted in eight dengue-endemic countries in Asia (India, Sri Lanka, Thailand, Vietnam) and Latin America (Brazil, Colombia, Mexico, Nicaragua) to provide an indication of the potential demand for dengue vaccination in endemic countries, and to anticipate their research and other requirements in order to make decisions about the introduction of dengue vaccines. The study took place in anticipation of the licensure of the first dengue vaccine in the next several years. Methods/Principal Findings Semi-structured interviews were conducted on an individual or small group basis with government health officials, research scientists, medical association officers, vaccine producers, local-level health authorities, and others considered to have a role in influencing decisions about dengue control and vaccines. Most informants across countries considered dengue a priority disease and expressed interest in the public sector use of dengue vaccines, with a major driver being the political pressure from the public and the medical community to control the disease. There was interest in a vaccine that protects children as young as possible and that can fit into existing childhood immunization schedules. Dengue vaccination in most countries surveyed will likely be targeted to high-risk areas and begin with routine immunization of infants and young children, followed by catch-up campaigns for older age groups, as funding permits. Key data requirements for decision-making were additional local dengue surveillance data, vaccine cost-effectiveness estimates, post-marketing safety surveillance data and, in some countries vaccine safety and immunogenicity data in the local population. Conclusions/Significance The lookout for the public sector use of dengue vaccines in the eight countries appears quite favorable. Major determinants of whether and when countries will introduce dengue vaccines include whether WHO recommends the vaccines, their price, the availability of external financing for lower income countries, and whether they can be incorporated into countries' routine immunization schedules. Information gleaned from surveys of country-level policymakers and other opinion leaders can assist in planning the development, production and introduction of new or upcoming vaccines into public sector immunization programs. In the case of dengue vaccines, prevailing views among these leaders about the importance of the disease, their expressed level of interest in the government's use of the vaccine, and preferred strategies for vaccine introduction (e.g., geographically-targeted vs. nation-wide vaccination, specific age groups to target) can help to identify “early adopter” countries and indicate the level of demand for the vaccine. This information can be critical to current producers of the vaccine in planning their production capacity and to potential future producers in deciding whether to pursue development of the vaccine. This information also helps donors and international technical agencies, such as WHO and UNICEF, in setting their priorities and determining their level of technical and financial support to countries for the introduction of dengue vaccines. In addition, these surveys can provide crucial information to national governments and the above stakeholders about potential barriers to introducing dengue vaccines into national immunization programs, and what additional studies and data countries will require in order to make decisions about use of the vaccines in the public sector.
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Affiliation(s)
- Don L. Douglas
- DKT Janani, Reshmi Complex, P&T Colony, Kidwaipuri, Patna, India
| | - Denise A. DeRoeck
- International Vaccine Institute, Kwanak-gu, Seoul, South Korea
- * E-mail:
| | | | - Ole Wichmann
- Robert Koch Institute, Immunization Unit, DGZ-Ring1, Berlin, Germany
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Bartolini RM, Winkler JL, Penny ME, LaMontagne DS. Parental acceptance of HPV vaccine in Peru: a decision framework. PLoS One 2012; 7:e48017. [PMID: 23144719 PMCID: PMC3483308 DOI: 10.1371/journal.pone.0048017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/20/2012] [Indexed: 12/02/2022] Open
Abstract
Objective and Method Cervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008 Peru’s Ministry of Health implemented a demonstration project involving 5th grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developed a conceptual model describing the process of HPV vaccine acceptance. Results We found a nonlinear HPV decision-making process that evolved over time. Initially, the vaccine’s newness, the requirement of written consent, and provision of information were important. If information was sufficient and provided by credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel, and other trusted sources, more parents accepted vaccination. An understanding of the issues surrounding the vaccine developed, parents overcome fears and rumors, and engaged in family negotiations–including hearing the girl’s voice in the decision-making process. The concept of prevention (cancer as danger, future health, and trust in vaccines) combined with pragmatic factors (no cost, available at school) and the credibility of the offer (information in the media, recommendation of respected authority figure) were central to motivations that led parents to decide to vaccinate their daughters. A lack of confidence in the health system was the primary inhibitor of vaccine acceptance. Conclusions Health personnel and teachers are credible sources of information and can provide important support to HPV vaccination campaigns.
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Affiliation(s)
| | | | - Mary E. Penny
- Instituto de Investigación Nutricional, La Molina, Lima, Peru
| | - D. Scott LaMontagne
- PATH, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Harborview Medical Center, Seattle, Washington, United States of America
- * E-mail:
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Burchett HED, Mounier-Jack S, Griffiths UK, Biellik R, Ongolo-Zogo P, Chavez E, Sarma H, Uddin J, Konate M, Kitaw Y, Molla M, Wakasiaka S, Gilson L, Mills A. New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries. Health Policy Plan 2012; 27 Suppl 2:ii5-16. [PMID: 22513732 DOI: 10.1093/heapol/czs035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed.
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Affiliation(s)
- H E D Burchett
- Department of Global Health & Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Brooks A, Smith TA, de Savigny D, Lengeler C. Implementing new health interventions in developing countries: why do we lose a decade or more? BMC Public Health 2012; 12:683. [PMID: 22908877 PMCID: PMC3495221 DOI: 10.1186/1471-2458-12-683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/06/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is unclear how long it takes for health interventions to transition from research and development (R&D) to being used against diseases prevalent in resource-poor countries. We undertook an analysis of the time required to begin implementation of four vaccines and three malaria interventions. We evaluated five milestones for each intervention, and assessed if the milestones were associated with beginning implementation. METHODS The authors screened World Health Organization (WHO) databases to determine the number of years between first regulatory approval of interventions, and countries beginning implementation. Descriptive analyses of temporal patterns and statistical analyses using logistic regression and Cox proportional hazard models were used to evaluate associations between five milestones and the beginning of implementation for each intervention. The milestones were: (A) presence of a coordinating group focused on the intervention; (B) availability of an intervention tailored to developing country health systems; (C) international financing commitment, and; (D) initial and (E) comprehensive WHO recommendations. Countries were categorized by World Bank income criteria. RESULTS Five years after regulatory approval, no low-income countries (LICs) had begun implementing any of the vaccines, increasing to an average of only 4% of LICs after 10 years. Each malaria intervention was used by an average of 7% of LICs after five years and 37% after 10 years. Four of the interventions had similar implementation rates to hepatitis B vaccine (HepB), while one was slower and one was faster than HepB. A financing commitment and initial WHO recommendation appeared to be temporally associated with the beginning of implementation. The initial recommendation from WHO was the only milestone associated in all statistical analyses with countries beginning implementation (relative rate = 1.97, P < 0.001). CONCLUSIONS Although possible that four milestones were not associated with countries beginning implementation, we propose an alternative interpretation; that the milestones were not realized early enough in each intervention's development to shorten the time to beginning implementation. We discuss a framework built upon existing literature for consideration during the development of future interventions. Identifying critical milestones and their timing relative to R&D, promises to help new interventions realize their intended public health impact more rapidly.
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Affiliation(s)
- Alan Brooks
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland
- University of Basel, Petersplatz 1, Basel, CH-4003, Switzerland
| | - Thomas A Smith
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland
- University of Basel, Petersplatz 1, Basel, CH-4003, Switzerland
| | - Don de Savigny
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland
- University of Basel, Petersplatz 1, Basel, CH-4003, Switzerland
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland
- University of Basel, Petersplatz 1, Basel, CH-4003, Switzerland
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Makinen M, Kaddar M, Molldrem V, Wilson L. New vaccine adoption in lower-middle-income countries. Health Policy Plan 2012; 27 Suppl 2:ii39-49. [DOI: 10.1093/heapol/czs036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Mishra A, Graham JE. Risk, choice and the ‘girl vaccine’: Unpacking human papillomavirus (HPV) immunisation. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2011.641524] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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30
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Schaetti C, Chaignat CL, Hutubessy R, Khatib AM, Ali SM, Schindler C, Weiss MG. Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar. HUMAN VACCINES 2011; 7:1299-308. [PMID: 22108036 DOI: 10.4161/hv.7.12.18012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite improvements in sanitation and water supply, cholera remains a serious public health burden. Vaccination is included among recommendations for cholera control. Cultural concepts of illness are likely to affect vaccine acceptance. This study examined social and cultural determinants of anticipated acceptance of an oral cholera vaccine (OCV) prior to a mass vaccination campaign in Zanzibar. Using a cultural epidemiological approach, 356 unaffected adult residents were studied with vignette-based semi-structured interviews. Anticipated acceptance was high for a free OCV (94%), but declined with increasing price. Logistic regression models examined social and cultural determinants of anticipated acceptance at low (USD 0.9), medium (USD 4.5) and high (USD 9) price. Models including somatic symptoms (low and high price), social impact (low and medium) and perceived causes (medium and high) explained anticipated OCV acceptance better than models containing only socio-demographic characteristics. Identifying thirst with cholera was positively associated with anticipated acceptance of the low-priced OCV, but acknowledging the value of home-based rehydration was negatively associated. Concern about spreading the infection to others was positively associated at low price among rural respondents. Confidence in the health system response to cholera outbreaks was negatively associated at medium price among peri-urban respondents. Identifying witchcraft as cause of cholera was negatively associated at medium and high price. Anticipated acceptance of free OCVs is nearly universal in cholera-endemic areas of Zanzibar; pre-intervention assessments of community demand for OCV should not only consider the social epidemiology, but also examine local socio-cultural features of cholera-like illness that explain vaccine acceptance.
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Affiliation(s)
- Christian Schaetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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31
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Hajjeh R. Accelerating introduction of new vaccines: barriers to introduction and lessons learned from the recent Haemophilus influenzae type B vaccine experience. Philos Trans R Soc Lond B Biol Sci 2011; 366:2827-32. [PMID: 21893547 PMCID: PMC3146773 DOI: 10.1098/rstb.2011.0046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adoption of new vaccines in developing countries is critical to reducing child mortality and meeting Millennium Development Goal 4. However, such introduction has historically suffered from significant delays that can be attributed to various factors including (i) lack of recognition of the value of a vaccine, (ii) factors related to weak health systems, and (iii) policy considerations. Recently, the Global Alliance for Vaccines and Immunization (GAVI) supported efforts to accelerate the introduction of Haemophilus influenzae type b (Hib) vaccines in developing countries, which resulted in a significant surge in vaccine adoption by these countries. The experience with Hib vaccines, as well as similar efforts by GAVI to support the introduction of new pneumococcal and rotavirus vaccines, provides a strategy for new vaccine adoption that is reviewed in this paper, providing a useful model to help accelerate the uptake of other life-saving vaccines. This strategy addresses barriers for vaccine adoption by focusing on three major areas: (i) communications to increase awareness about the various factors needed for evidence-based decisions that meet a country's health goals; (ii) research activities to answer key questions that support vaccine introduction and long-term programme sustainability; and (iii) coordination with the various stakeholders at global, regional and country levels to ensure successful programme implementation.
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Affiliation(s)
- Rana Hajjeh
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30333, USA.
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32
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Burchett HED, Mounier-Jack S, Griffiths UK, Mills AJ. National decision-making on adopting new vaccines: a systematic review. Health Policy Plan 2011; 27 Suppl 2:ii62-76. [DOI: 10.1093/heapol/czr049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Wells WA, Brooks A. Adoption of new health products in low and middle income settings: how product development partnerships can support country decision making. Health Res Policy Syst 2011; 9:15. [PMID: 21453529 PMCID: PMC3079693 DOI: 10.1186/1478-4505-9-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 03/31/2011] [Indexed: 11/10/2022] Open
Abstract
When a new health product becomes available, countries have a choice to adopt the product into their national health systems or to pursue an alternate strategy to address the public health problem. Here, we describe the role for product development partnerships (PDPs) in supporting this decision-making process. PDPs are focused on developing new products to respond to health problems prevalent in low and middle income settings. The impact of these products within public sector health systems can only be realized after a country policy process. PDPs may be the organizations most familiar with the evidence which assists decision making, and this generally translates into involvement in international policy development, but PDPs have limited reach into endemic countries. In a few individual countries, there may be more extensive involvement in tracking adoption activities and generating local evidence. This local PDP involvement begins with geographical prioritization based on disease burden, relationships established during clinical trials, PDP in-country resources, and other factors. Strategies adopted by PDPs to establish a presence in endemic countries vary from the opening of country offices to engagement of part-time consultants or with long-term or ad hoc committees. Once a PDP commits to support country decision making, the approaches vary, but include country consultations, regional meetings, formation of regional, product-specific committees, support of in-country advocates, development of decision-making frameworks, provision of technical assistance to aid therapeutic or diagnostic guideline revision, and conduct of stakeholder and Phase 4 studies. To reach large numbers of countries, the formation of partnerships, particularly with WHO, are essential. At this early stage, impact data are limited. But available evidence suggests PDPs can and do play an important catalytic role in their support of country decision making in a number of target countries.
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Affiliation(s)
- William A Wells
- Global Alliance for TB Drug Development, 40 Wall St, New York NY 10005 USA.
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A new approach to global health institutions? A case study of new vaccine introduction and the formation of the GAVI Alliance. Soc Sci Med 2010; 71:1349-1356. [DOI: 10.1016/j.socscimed.2010.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 05/22/2010] [Accepted: 06/08/2010] [Indexed: 11/23/2022]
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Blume S, Tump J. Evidence and policymaking: The introduction of MMR vaccine in the Netherlands. Soc Sci Med 2010; 71:1049-55. [PMID: 20667640 PMCID: PMC2941041 DOI: 10.1016/j.socscimed.2010.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 06/14/2010] [Accepted: 06/20/2010] [Indexed: 11/24/2022]
Abstract
Based on a case-study of the introduction of measles-mumps-rubella (MMR) vaccine in the Netherlands two decades ago, using documentary and archival sources, this paper examines the way evidence is used in policymaking. Starting from the question of 'what counts as evidence', two central claims are developed. First, the decision to introduce MMR was not one but a series of decisions going back at least seven years, over the course of which the significance attached to various forms of evidence changed. Second, results of international studies were coming gradually to be of greater significance than evidence gathered from within the Netherlands itself. These developments had, and continue to have, major consequences for national scientific competences.
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Affiliation(s)
- Stuart Blume
- Department of Sociology and Anthropology, University of Amsterdam, 1012 DK Amsterdam, Netherlands.
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36
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Bryson M, Duclos P, Jolly A. Global immunization policy making processes. Health Policy 2010; 96:154-9. [DOI: 10.1016/j.healthpol.2010.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/25/2022]
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37
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Piñeros M, Wiesner C, Cortés C, Trujillo LM. HPV vaccine introduction at the local level in a developing country: attitudes and criteria among key actors. CAD SAUDE PUBLICA 2010; 26:900-8. [DOI: 10.1590/s0102-311x2010000500012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/24/2010] [Indexed: 11/22/2022] Open
Abstract
In most developing countries, HPV vaccines have been licensed but there are no national policy recommendations, nor is it clear how decisions on the introduction of this new vaccine are made. Decentralization processes in many Latin American countries favor decision-making at the local level. Through a qualitative study we explored knowledge regarding the HPV vaccine and the criteria that influence decision-making among local health actors in four regions of Colombia. We conducted a total of 14 in-depths interviews with different actors; for the analysis we performed content analysis. Results indicate that decision-making on the HPV vaccine at the local level has mainly been driven by pressure from local political actors, in a setting where there is low technical knowledge of the vaccine. This increases the risk of initiatives that may foster inequity. Local decisions and initiatives need to be strengthened technically and supported by national-level decisions, guidelines and follow-up.
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39
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Shearer JC, Stack ML, Richmond MR, Bear AP, Hajjeh RA, Bishai DM. Accelerating policy decisions to adopt haemophilus influenzae type B vaccine: a global, multivariable analysis. PLoS Med 2010; 7:e1000249. [PMID: 20305714 PMCID: PMC2838745 DOI: 10.1371/journal.pmed.1000249] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 02/11/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Adoption of new and underutilized vaccines by national immunization programs is an essential step towards reducing child mortality. Policy decisions to adopt new vaccines in high mortality countries often lag behind decisions in high-income countries. Using the case of Haemophilus influenzae type b (Hib) vaccine, this paper endeavors to explain these delays through the analysis of country-level economic, epidemiological, programmatic and policy-related factors, as well as the role of the Global Alliance for Vaccines and Immunisation (GAVI Alliance). METHODS AND FINDINGS Data for 147 countries from 1990 to 2007 were analyzed in accelerated failure time models to identify factors that are associated with the time to decision to adopt Hib vaccine. In multivariable models that control for Gross National Income, region, and burden of Hib disease, the receipt of GAVI support speeded the time to decision by a factor of 0.37 (95% CI 0.18-0.76), or 63%. The presence of two or more neighboring country adopters accelerated decisions to adopt by a factor of 0.50 (95% CI 0.33-0.75). For each 1% increase in vaccine price, decisions to adopt are delayed by a factor of 1.02 (95% CI 1.00-1.04). Global recommendations and local studies were not associated with time to decision. CONCLUSIONS This study substantiates previous findings related to vaccine price and presents new evidence to suggest that GAVI eligibility is associated with accelerated decisions to adopt Hib vaccine. The influence of neighboring country decisions was also highly significant, suggesting that approaches to support the adoption of new vaccines should consider supply- and demand-side factors.
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Affiliation(s)
- Jessica C Shearer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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40
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Winkler JL, Wittet S, Bartolini RM, Creed-Kanashiro HM, Lazcano-Ponce E, Lewis-Bell K, Lewis MJ, Penny ME. Determinants of human papillomavirus vaccine acceptability in Latin America and the Caribbean. Vaccine 2008; 26 Suppl 11:L73-9. [PMID: 18945404 DOI: 10.1016/j.vaccine.2008.05.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Prophylactic human papillomavirus (HPV) vaccines provide promise as a key component of future cervical cancer prevention programs in the Latin America and the Caribbean region. The successful introduction and acceptance of these vaccines will depend on a range of factors including awareness of cervical cancer as a problem, affordability of the vaccine, political will, competition with other vaccines, feasibility of vaccine delivery and acceptability of the vaccine among the range of groups who will influence uptake. While existing data about acceptability from Latin America and the Caribbean is scarce, it is clear that health policymakers, providers and the general public lack knowledge about HPV and cervical cancer. Furthermore, they would value more local epidemiologic data related to cervical cancer. Price is currently a major barrier to vaccine acceptability and a priority for advocacy. More research is required in Latin America and the Caribbean to determine what messages and strategies will work in these communities.
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