Factors influencing the prioritization of vaccines by policymakers in low- and middle-income countries: a scoping review

Abstract

Vaccination decision making in low-and-middle-income countries (LMICs) has become increasingly complex, particularly in the context of numerous competing health challenges. LMICs have to make difficult choices on which vaccines to prioritize for introduction while considering a wide range of factors such as disease burden, vaccine impact, vaccine characteristics, financing, health care infrastructures, whilst being adapted to each country’s specific contexts. Our scoping review reviewed the factors that influence decision-making among policymakers for the introduction of new vaccines in LMICs. We identified the specific data points that are factored into the decision-making process for new vaccine introduction, while also documenting whether there have been any changes in decision-making criteria in new vaccine introduction over the last two decades. A comprehensive data-base search was conducted using a search strategy consisting of key terms and MeSH phrases related to policy, decision-making, vaccine introduction, immunization programs, and low-and-middle-income countries. Articles were screened following PRIMSA guidelines. A total of 843 articles were identified, with 34 articles retained after abstract screening, full-text screening, and grading with the mixed methods appraisal tool (MMAT). The Burchett et al. (2012) framework for new vaccine introduction was used to identify indicators for vaccine-decision making and guided data extraction. Articles in our study represented a diverse range of perspectives and methodologies. Across articles, the importance of the disease which included disease burden, costs of disease, and political prioritization, coupled with economic factors related to vaccine price, affordability, and financing were the most common criteria considered for new vaccine introduction. Our review identified two additional criteria in the decision-making process for vaccine introduction that was not included in the Burchett et al (2012) framework: communications and sociocultural considerations. Data from this review can support informed decision-making for vaccine introduction amongst policymakers and stakeholders in LMICs.

Vaccine Inequity: A Threat to Africa’s Recovery from COVID-19

“…Through a data-driven, age-strati ed epidemic model to evaluate the effects of Covid-19 vaccine inequities focused on 20 LMICs from all WHO regions, it has been revealed that as of October 1, 2022, 77% of individuals in high and upper middle income countries completed the initial vaccination course, with its equivalent in LMICs being 50% [49]. In this same study, the vaccine coverage by October 1, 2021 in HICs was more than 1 dose per person while that of lower middle income countries was 40 doses per 100 and low income countries stood at 3.6 doses per 100, with these inequalities further discussed in several other studies [50,51,52,54,55]. In HICs, challenges related to vaccine hesitancy and dose scarcity have been anticipated, with governments implementing potential solutions like mass media interventions and population groups prioritization to increase uptake.…”

National Immunization Program Decision Making Using the CAPACITI Decision-Support Tool: User Feedback from Indonesia and Ethiopia

“…The decision-making environment for new vaccine introduction in LMICs is complex given the range of immunization strategies and activities available to countries, combined with economic and financial constraints many LMICs face [ 9 ]. Decision-making about new vaccine introductions, including strategic decisions about medium- to short-term priority vaccines for introduction, requires the simultaneous consideration of multiple criteria that collectively capture the broader value of vaccines in terms of benefits and impact across the vaccine life cycle, referred to by WHO as the “full value of vaccines” [ 9 , 10 ].…”

“…The decision-making environment for new vaccine introduction in LMICs is complex given the range of immunization strategies and activities available to countries, combined with economic and financial constraints many LMICs face [ 9 ]. Decision-making about new vaccine introductions, including strategic decisions about medium- to short-term priority vaccines for introduction, requires the simultaneous consideration of multiple criteria that collectively capture the broader value of vaccines in terms of benefits and impact across the vaccine life cycle, referred to by WHO as the “full value of vaccines” [ 9 , 10 ]. A recent systematic review of criteria considered in national decision-making for the introduction of new vaccines showed that, indeed, many criteria are considered, noting that programmatic and acceptability aspects were not as often considered and that NITAGs increasingly take into consideration economic evaluations [ 11 ].…”

Sustainable Dengue Prevention and Management: Integrating Dengue Vaccination Strategies with Population Perspectives

“…Consistently monitoring dengue epidemiology before and after introducing the dengue vaccine on a large scale can help demonstrate its effectiveness, especially on the dengue burden and prevalence across serotypes [ 18 ]. Furthermore, economic evidence showcasing the cost-effectiveness and societal impact of consistently implementing dengue vector control and vaccination programs is crucial for gaining government buy-in [ 19 ]. To complete the evidence requirements, emphasizing patient voices with real-life stories can shed light on the individual-level burden of dengue.…”