How are mathematical models and results from mathematical models of vaccine-preventable diseases used, or not, by global health organisations?

Abstract

While epidemiological and economic evidence has the potential to provide answers to questions, guide complex programmes and inform resource allocation decisions, how this evidence is used by global health organisations who commission it and what organisational actions are generated from the evidence remains unclear. This study applies analytical tools from organisational science to understand how evidence produced by infectious disease epidemiologists and health economists is used by global health organisations. A conceptual framework that embraces evidence use typologies and relates findings to the organisational process of action generation informs and structures the research. Between March and September 2020, we conducted in-depth interviews with mathematical modellers (evidence producers) and employees at global health organisations, who are involved in decision-making processes (evidence consumers). We found that commissioned epidemiological and economic evidence is used to track progress and provides a measure of success, both in terms of health outcomes and the organisations’ mission. Global health organisations predominantly use this evidence to demonstrate accountability and solicit funding from external partners. We find common understanding and awareness across consumers and producers about the purposes and uses of these commissioned pieces of work and how they are distinct from more academic explorative research outputs. Conceptual evidence use best describes this process. Evidence is slowly integrated into organisational processes and is one of many influences on global health organisations’ actions. Relationships developed over time and trust guide the process, which may lead to quite a concentrated cluster of those producing and commissioning models. These findings raise several insights relevant to the literature of research utilisation in organisations and evidence-based management. The study extends our understanding of how evidence is used and which organisational actions are generated as a result of commissioning epidemiological and economic evidence.

Qualitative evaluation of the use of modelling in resource allocation decisions for HIV and TB

“…30 In practice, interviewees described a wide spectrum of stakeholder participation in Optima analyses These findings are consistent with the International Association for Public Participation (IAP2) spectrum, 31 which considers multiple ways to engage stakeholders in research to inform government decision making (Figure 2). This is also supported by a study looking at research translation from mathematical models of vaccine-preventable diseases, 15 suggesting these findings may be broadly applicable beyond Optima HIV and TB models. Where models are not institutionalized at a national level, additional funding may be needed to support renumeration and mobilize appropriate national consultants and teams to engage in the modelling process.…”

“…While some respondents supported the role of Optima in these decisions, other research has reported on modelling evidence being used symbolically to support existing decisions and strategy. 15 International funding organizations, government bodies, and public health researchers may have preconceived notions or agendas leading to confirmation bias. Conversely, findings that contradicted stakeholders' beliefs were, at times, rejected.…”

“…Despite the widespread use of mathematical modelling in health planning and policy, it is rarely evaluated beyond technical methods and direct outputs 14 , with limited evaluation of the mechanisms by which model findings and recommendations are adopted by countries into policy and programming. [15][16][17] Most modelling guidelines focus on technical aspects or results communication 18 and have less emphasis on how to work together with policy and decision makers. 19,20 However, existing research prescribes stakeholder engagement as one of the key principles for effective modelling, 19 and therefore assessing the use of past modelling analyses by key stakeholders may provide important insight to improve the uptake and impact of future modelling.…”

A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice

“…The articles were published between 2005 and 2022, with more than half (27, 52%) between 2018 and 2022 49 52–77. Their titles suggest a wide coverage of topics and issues in global health, among others: the accountability of international global health actors (eg, the Global Fund, World Bank),7 56 62 69 78–81 governance and corruption in global health funding,67 70 71 78 82 the promotion and realisation of health as a human right,57 83–88 accountability through rankings, countdowns and monitoring of health outcomes,53–55 60 68 72 75 76 89–94 the social accountability of schools of health professions through networking or accreditation,61 64 73 95–97 as well as litigation and legal accountability49 57 84 85 98 and ethical research and community participation 63 66 74 99 100…”

Human papillomavirus vaccination strategies for accelerating action towards cervical cancer elimination

“… 7 Model-based results have an important role in planning when triangulated against empirical epidemiological evidence from multiple contexts. 8 …”