A literature review to identify factors that determine policies for influenza vaccination

Demand planning for vaccinations using the example of seasonal influenza vaccination - country comparison and implications for Germany

BACKGROUND

Annual vaccination is the most important measure to prevent influenza infection. However, demand planning of influenza vaccines is challenging due to seasonal adaptations of virus strains and long production times. The aim was to analyze how other countries manage the demand planning of seasonal influenza vaccines and to draw implications for the German demand planning system for seasonal (influenza) vaccines.

METHODS

A two-stage approach has been adopted. As a first step, an analysis of the German demand planning system was carried out to identify key challenges. Second, an analysis of comparable countries with regard to solution strategies was conducted. For this, six comparator countries were selected based on different healthcare systems and structures (Australia, Canada, Great Britain, Singapore, Switzerland, USA). Targeted searches in PubMed, Google Scholar and on websites of agencies and organizations were performed. Further information was requested through e-mail correspondence with the ministries of health and other relevant institutions. In addition, experts from the pharmaceutical industry in the selected countries were approached via written survey.

RESULTS

Identified challenges in the demand planning of influenza vaccines in Germany include a lack of reliability of the current demand planning system, bureaucratic burden, lack of binding orders, financial liability of GPs, vaccine discard and limited possibilities of reordering. Various approaches have been identified in six comparator countries. Some of them are already implemented in the German system, others could address the challenges in the German demand planning for influenza vaccines. These include vaccine forecast methods, monitoring systems/vaccination registers, a central platform for orders, (earlier) preorders, centralized purchase system, reimbursement of a surplus and reallocation and return systems. The different approaches are discussed and linked to address the challenges of the German system.

CONCLUSIONS

Several approaches have been identified that may be suitable to address the challenges of the German system of (influenza) vaccine demand planning. In the future, further investigation is necessary to assess the potential feasibility and implementation on a health policy level.

A LAG-based framework to overcome the challenges of the sustainable vaccine supply chain: an integrated BWM–MARCOS approach

Purpose

Each individual needs to be vaccinated to control the spread of the COVID-19 pandemic in the shortest possible time. However, the vaccine distribution with an already strained supply chain in low- and middle-income countries (LMICs) will not be effective enough to vaccinate all the population in stipulated time. The purpose of this paper is to show that there is a need to revolutionize the vaccine supply chain (VSC) by overcoming the challenges of sustainable vaccine distribution.

Design/methodology/approach

An integrated lean, agile and green (LAG) framework is proposed to overcome the challenges of the sustainable vaccine supply chain (SVSC). A hybrid best worst method (BWM)–Measurement of Alternatives and Ranking According to COmpromise Solution (MARCOS) methodology is designed to analyze the challenges and solutions.

Findings

The analysis shows that vaccine wastage is the most critical challenge for SVSC, and the coordination among stakeholders is the most significant solution followed by effective management support.

Social implications

The result of the analysis can help the health care organizations (HCOs) to manage the VSC. The effective vaccination in stipulated time will help control the further spread of the virus, which will result in the normalcy of business and availability of livelihood for millions of people.

Originality/value

To the best of the author's knowledge, this is the first study to explore sustainability in VSC by considering the environmental and social impact of vaccination. The LAG-based framework is also a new approach in VSC to find the solution for existing challenges.

Trust, but customize: federalism's impact on the Canadian COVID-19 response

This article explores how Canadian federalism, with its complex mix of competencies, and the country's punctuated gradualism policy style interface with urgent, complex decision-making like the COVID-19 pandemic. We find that while punctuated gradualism favors tailored responses to pandemic management it is weaker when coordination and resourcing are to be undertaken during non-crisis situations and that, while the level of cooperation among Canadian jurisdictions has progressively increased over the years, policy is still almost exclusively handled at the federal, provincial and territorial levels. Furthermore, the model appears to have critical 'blind spots' in terms of vulnerable communities that do not emerge as such until after a crisis hits.

One Health and Zoonotic Uncertainty in Singapore and Australia: Examining Different Regimes of Precaution in Outbreak Decision-Making

A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases (EIDs) in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary approaches to EID decision-making—which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice.

Interdependency in vaccination policies among Japanese municipalities

Economic theory predicts that vaccination policies at the local level can be negatively affected by the policies of neighboring regions because of free-riding motives, whereas positive dependency may exist due to policy diffusions among localities. By using the unique variations in the provision of vaccination subsidies in Japan, we assess how vaccination policies in a local government are affected by the decisions of neighboring governments. We find that the provision of vaccination subsidies is positively correlated with the decisions of neighboring localities. Moreover, a correlation is found with neighboring municipalities within the same prefecture but not with those in surrounding prefectures, indicating that the correlations are likely to arise because of mimicking behavior among localities within a prefecture. Our results show that vaccination policies tend to be formed following neighboring municipalities and do not necessarily aim to optimize community health, thus questioning the autonomy of local government authorities regarding vaccination policies.

Development of Seasonal Influenza Vaccination Recommendations: Relevance and Influence of the Evidence on the Decision-Making Process in France and the Netherlands

BACKGROUND

Target groups for seasonal influenza vaccination are defined at the country level and are based on several factors. However, little is known about the national decision-making procedures.

OBJECTIVE

The purpose of this study was to compare the evidence used for the development of recommendations and its impact on the choice of target groups in France and the Netherlands.

METHODS

A preliminary documentary analysis identified institutions to include in the assessment: governmental authorities, research institutions, associations, and manufacturers. At least one expert from each group was invited to our study. Thirty-three semi-structured interviews were conducted in 2013 (16 France, 17 the Netherlands). We used NVivo10® to perform a thematic content analysis.

RESULTS

Clinical/epidemiological studies were the evidence most used in both countries. Economic models were increasingly being used; these had greater influence on the decision making in the Netherlands than in France, probably because of the presence of a modeler. Generally, the quality of the evidence used was poor, although no systematic use of standard protocol for its assessment was observed. A general protocol was sometimes used in France; however, the personal judgment of the experts was crucial for the assessment in both countries.

CONCLUSIONS

There were differences in the target groups, for example, pregnant women, recommended only in France. France and the Netherlands use similar evidence for developing vaccination recommendations, although different decisions are sometimes made regarding target groups. This could be associated with the lack of systematic standard appraisals, increasing the influence of the experts' judgment on decision making. The development of standards for the appraisal of evidence is recommended.

Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes

BACKGROUND

Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking.

OBJECTIVE

To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health.

DESIGN

The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection.

RESULTS

Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel.

CONCLUSIONS

This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity.

Influenza vaccination policy-making processes in France and The Netherlands: Framework and determinants

OBJECTIVES

Target groups for seasonal influenza vaccination are nationally defined based on several factors. However, few studies have explored the policy-making processes at the country-level. We investigated key differences in the policy-making process for the development of vaccination recommendations between France (FR) and The Netherlands (NL). This paper presents preliminary results on the evidence used in the decision-making process and focuses on the interactions between the experts and stakeholders.

METHODS

A documentary analysis identified the stakeholders of this process as governmental authorities, research institutions, associations, and manufacturers. This qualitative study included at least one expert from each stakeholder group. Thirty-three semi-structured interviews were performed in 2013 (16 FR, 17 NL). We used NVivo10® to perform a thematic content analysis on the data.

RESULTS

National Immunization Technical Advisory Groups (NITAGs) were the key stakeholders in the development of recommendations. There was no systematic standard evaluation of evidence during the decision-making process in both countries. Likewise, voting was not systematic, although it did occur more often in FR. A declaration of interests was obligatory in both countries. Experts with no conflicts of interest were rare because many depend on private funding for their research on influenza vaccination.

CONCLUSIONS

The transparency of the NITAGs' procedures for the development of recommendations should be improved. We believe improvements might be achieved by the systematic standard evaluation of evidence, consistent voting, clear declarations of interest, and increased public funding for vaccination research.