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

Addressing conflicts of interest regarding the vaccine in infectious disease outbreaks based on good governance for health approach: a policy brief

BACKGROUND

Infectious disease outbreaks pose a significant threat to public health, and achieving herd immunity highlights the importance of addressing conflicts of interest (COI) in vaccine development and policy-making. This policy brief aims to present policy options that address COI regarding vaccines in infectious disease outbreaks, based on good governance for health approach.

METHODS

Our study used a scoping review methodology. We conducted a systematic search, which led to identifying 43 eligible articles. A qualitative approach (i.e., content analysis) was employed for data analysis, using "ATLAS.ti 9" software. The primary results underwent a process of cleaning, categorisation, and subsequent discussion in three sessions with the research team.

RESULTS

Relationships between theindustry and "government/policymakers" as well as "academic institutions/researchers" are prominent origins of COI regarding the vaccine in infectious disease outbreaks. To address this issue, we present nine policy options that target both the root cause of the problem and the adoption of good governance for health approach.

CONCLUSIONS

The key principles of good governance for health, including, "Transparency", "The Rule of Law", "Effectiveness", "Efficiency", "Participation", "Consensus Orientation", "Equality", "Responsibility", "Responsiveness" and "Accountability" must be taken into account when formulating policy options to address COI regarding the vaccine in infectious disease outbreaks. The effectiveness of the policy options outlined in this policy brief should be assessed in practical contexts, as this evaluation may uncover the need for revisions.

Vaccine market access pathways in the EU27 and the United Kingdom - analysis and recommendations for improvements

BACKGROUND

Vaccine market access (VMA) pathways across the European Union (EU) and the United Kingdom (UK) are complex, lengthy, and heterogeneous, particularly when compared with pharmaceuticals. The knowledge base to inform recommendations for optimization of VMA is lacking. We therefore conducted a comprehensive evaluation of EU VMA pathways.

METHODS

Research in two phases included: (1) mapping VMA pathways in each EU member state (including the UK) based on a literature review, expert interviews, and mathematical archetyping; and (2) interviews with vaccine experts to identify barriers, drivers, and recommendations for regional VMA alignments.

RESULTS

Key steps in VMA across the EU include horizon scanning, early advice, National Immunization Technical Advisory Group (NITAG) recommendation for inclusion in national immunization programs, health technology assessment (HTA), final decision and procurement. We found significant complexity and heterogeneity, particularly for early advice, and in the roles, decision-making criteria, and transparency of NITAGs and HTA bodies. The most important drivers for rapid VMA included demonstration of disease burden and vaccine benefit (e.g., efficacy, safety, economic). Key barriers were budget limitations and complexity/clarity of VMA processes (e.g., need for national-regional consensus, clarity on process initiation, and clarity on the role of HTA). Recommendations for alignment at EU and member-state levels include information sharing, joint clinical assessment, initiatives to address funding and political barriers, and improved transparency by decision-making bodies. Early engagement with vaccine stakeholders was a key recommendation for manufacturers.

CONCLUSIONS

There is significant potential for alignment, collaboration, and improvement of VMA across the EU. Roles, responsibilities, and transparency of key bodies can be clarified. The COVID-19 pandemic response should stimulate policies to improve access to all vaccines, including routine ones, and form the foundation upon which a consistent vaccine ecosystem can be created for the EU, one that is resilient, consistent between member states, and fit for purpose.

Stakeholder analysis in health innovation planning processes: A systematic scoping review

Integrating health innovations into the health system is a complex endeavour that requires a well-designed planning process engaging key stakeholders. Stakeholder analyses lay the foundations to inform appropriate planning processes and undertake strategic actions. A systematic scoping review was performed to explore how stakeholder analyses are applied in health innovation planning processes and a guideline to report stakeholder analyses was developed. The literature search was conducted in PubMed, Scopus and DOAJ; grey literature was sought using Google. Articles reporting stakeholder analyses during the planning process of health policies, systems, products and technologies, and services and delivery methods were included. Fifty-one records were incorporated in the qualitative synthesis. Stakeholder analyses were conducted worldwide, used in all types of health innovations, applied in all phases of the planning process and conducted both prospectively and retrospectively. The steps followed to perform stakeholder analysis, the methods used, the stakeholder attributes analysed and how authors reported the analyses were heterogeneous. Forty-one studies reported the identification of stakeholders, 50 differentiated/categorised them and 25 analysed stakeholder relationships. Only some authors proposed future actions based on the results obtained in their stakeholder analysis. A list of Reporting Items for Stakeholder Analysis (i.e., the RISA tool) is proposed to contribute to the reporting guidelines to enhancing the quality and transparency of health research.

Determining Factors for Pertussis Vaccination Policy: A Study in Five EU Countries

Pertussis vaccination policy varies across Europe, not only in the type of vaccine-whole cell (wP) vs. acellular (aP1/2/3/5)-but also in the schedule and recommendation for parents. This study aims to investigate the determining factors for the type of vaccine, immunization schedule and maternal immunization recommendation. From March to May 2019, experts in national health agencies and major academic or research institutions from Denmark, France, Poland, Sweden and the UK were invited to a semi-structured interview. Thematic analysis was performed on the transcripts using a codebook formulated by three coders. Inter-coder agreement was assessed. Fifteen expert interviews were conducted. The identified driving factors for pertussis vaccine policy were classified into three domains: scientific factors, sociological factors, and pragmatic factors. The determining factors for the type of vaccine were prescriber's preference, concern of adverse events following immunization (AEFI), effectiveness, and consideration of other vaccine components in combined vaccines. The determining factors for infant schedule were immunity response and the potential to improve coverage and timeliness. The determining factors for maternal immunization were infant mortality and public acceptability. To conclude, socio-political and pragmatic factors were, besides scientific factors, important in determining the pertussis vaccine type, schedule of childhood immunization and recommendations for parents.

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.