Strengthening the Evidence-Based Approach to Guiding Effective Influenza Vaccination Policies

Abstract

The availability of several effective and safe vaccines enables health systems to counteract annual influenza epidemics. However, the criteria of appropriateness and sustainability require that each citizen should receive the right vaccine. The value of each vaccine can be assessed within well-known frameworks, such as the Health Technology Assessment (HTA), a step that is fundamental to the process of allocating resources to vaccination strategies. The paper describes how HTA has been incorporated as an evidence-based tool to support the definition of Italian vaccination strategies, reports the results of the HTA report on the most recently available influenza vaccine in Italy (cell-based quadrivalent vaccine (QIVc)—Flucelvax® Tetra) and elaborates on current and future recommendations in the field of influenza vaccination. Recommendations issued by the Italian Ministry of Health foster the appropriate use of influenza vaccines from 2018–2019 onwards. Evidence of the value of newly available vaccines will hopefully support future decisions and promote the appropriate use of these vaccines on the basis of the characteristics of the target population. However, the success of influenza vaccination will also depend on citizens’ empowerment and engagement in the decision-making process.

Attitudes and Beliefs on Influenza Vaccination during the COVID-19 Pandemic: Results from a Representative Italian Survey

“…Public health values would be vital, in particular in disease prevention and health management [ 46 ]. In this regard, the criteria of appropriateness and sustainability seem particularly attractive: each citizen should receive the most appropriate vaccine in order to achieve adequate protection [ 47 ].…”

Influenza Vaccination Assessment according to a Value-Based Health Care Approach

“…Of the 40 studies included in our systematic review [ 3 , 4 , 5 , 8 , 10 , 11 , 12 , 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], seven (17.5%) had a non-European perspective and were conducted in Canada ( n = 1) [ 18 ], the USA ( n = 3) [ 19 , 21 , 42 ], China ( n = 1) [ 36 ], Iran ( n = 1) [ 49 ], and low-income countries (LICs) ( n = 1) [ 32 ]; ten (25%) had a global perspective [ 5 , 10 , 12 , 20 , 22 , 24 …”

“…Among the European studies, eight (36.4%) were conducted specifically in Italy [ 3 , 4 , 13 , 31 , 38 , 39 , 43 , 47 ]. In addition, of the 40 articles included in our work, 17 (42.5%) were systematic reviews or literature reviews [ 3 , 5 , 10 , 11 , 12 , 22 , 24 , 25 , 28 , 29 , 30 , 31 , 32 , 37 , 41 , 47 , 48 ], ten (25%) were economic evaluations [ 8 , 13 , 19 , 21 , 23 , 26 , 27 , 34 , 44 , 45 ], seven (17.5%) were cross-sectional studies [ 18 , 35 , 36 , 38 , 42 , 43 , 49 ], two studies (5%) were HTA reports [ 4 , 39 ], one study (2.5%) was a nonlinear regression model [ 33 ], and three studies (7.5%) were expert opinions [ 20 , 40 , 46 ]. The main features of the studies are shown in Table 1 .…”

“…Regarding the influenza vaccination target population investigated in the studies included in our systematic review, 11 studies (27.5%) focused on vaccination in the general population [ 5 , 12 , 18 , 20 , 25 , 37 , 39 , 40 , 44 , 46 , 48 ], five (12.5%) on vaccination in the pediatric population [ 3 , 19 , 29 , 33 , 45 ], three (7.5%) on vaccination in the population aged 6 months to over 85 [ 21 , 27 , 28 ], seven (17.5%) on vaccination in elderly individuals (over 65) [ 4 , 11 , 24 , 30 , 31 , 41 , 47 ], two (5%) specifically on adults over 18 [ 38 ] and over 50 [ 26 ], one study (2.5%) specifically on influenza vaccination in elderly individuals and at risk groups [ 22 ], one (2.5%) on the target population for which the WHO recommends flu vaccination [ 8 ], one (2.5%) on customs officers [ 23 ], four (10%) on HCWs [ 10 , 34 , 35 , 36 ], one (2.5%) on workers in general [ 13 ], two (5%) on health care students [ 42 , 43 ], one (2.5%) on pregnant women [ 32 ], and another study (2.5%) on influenza vaccination in the cancer population [ 49 ].…”

Comparative effectiveness of adjuvanted versus high-dose seasonal influenza vaccines for older adults: a systematic review and meta-analysis

“…In other words, older adults aged ≥ 65 years could be administered either aQIV, hdQIV, standard-dose egg-based, cell-based, or recombinant SIVs (Italian Ministry of Health, 2022). Although this approach may be justified from the point of view of the vaccine procurement, it may lead to significant between-region differences in vaccination policies 6 (Bonanni et al, 2018;Calabrò et al, 2020). The use of both aQIV (Calabrò et al, 2022) and hdQIV (Cicchetti et al, 2021) in the Italian elderly has recently undergone the process of full health technology assessment (HTA).…”