Table 1. Previous findings on factors that influence national vaccine decision-making.
Author | Important Variables | Methods | Vaccine |
Widdus (1999) [31] | • Local burden of disease and vaccine effectiveness studies• Cost-effectiveness studies• Cost reduction and knowledge sharing platforms for poorer countries• International recommendations• Private sector use• Social/behavioral research to understand local barriers to acceptance• Advocacy for economic benefit of vaccine• Emerging market technology licensing• Coordinating approval process of vaccines in all countries• Donor financing | Conceptual framework of suggested actions to accelerate vaccine introduction in low-income countries | New vaccines |
Wenger et al. (2000) [11] | • Published burden of disease and effectiveness studies• Local experience with vaccine• Support from pediatrician association• Price• Public interest (political will)• Surveillance data | Case study of four early adopting, nonindustrialized countries | Hib |
Miller and Flanders (2000) [9] | • DTP3 coverage• GDP per capita• Vaccine cost (price per dose)• Treatment cost per unit• Years of life lost• Years of life lost• Treatment cost prevented• Years of life saved | Univariate logistic analysis | HBV |
Gauri and Khaleghian (2002) [15] | • Democracy score• GDP per capita• DTP3 coverage• Presence of UNICEF financing• PAHO revolving fund membership• Institutional quality score | Longitudinal multivariable analysis | HBV |
DeRoeck et al. (2005) [12] | • Burden of disease studies• Cost-effectiveness studies• Vaccine price• Vaccine safety and immunogenicity• Feasibility of local production• WHO recommendation• Ease of inclusion in current EPI | Qualitative interviews with country-level policy makers and immunization professionals | Cholera, typhoid fever, shigellosis |
Munira and Fritzen (2007) [13] | • External pressures and advocacy• Burden of disease studies• Scientific support on benefit of vaccine• Feasibility of adoption into current EPI• Local vaccine pilot studies | Case studies of two early adopting countries (Taiwan, Thailand) | HBV |
Rossi et al. (2007) [14] | • Geographical region• DTP3 coverage• Previous introduction of HBV• GNI per capita | Cross-sectional, descriptive comparison | Hib |
Danovaro-Holliday et al. (2008) [10] | • Political will• Burden of disease and impact studies• “Experience exchange” between countries• PAHO Revolving Fund membership | Descriptive analysis and case studies from the Americas | Hib |
Studies were identified by searching for keyword combinations of “Hib,” “new vaccine,” or “immunization” and “policy,” “adoption,” or “government factors” in PubMed, SCOPUS, PAIS International, EconLit, and WorldCat. Additional articles were identified by reviewing references of retrieved studies.