Table 2.
Scoring.
| Decision-making | |
| Early or late adopter of adult vaccines |
0 = No or late decision-making and adoption of either pneumococcal or herpes zoster vaccine 1 = Follower in decision-making and adoption of at least one vaccine 2 = Leader in decision-making and adoption of one or more vaccines |
| Country-specific policy requirements of manufacturers |
0 = Multiple 1 = One 2 = None |
| Disease burden surveillance |
0 = No surveillance 1 = Some surveillance (mostly of flu and pneumococcal disease) 2 = National surveillance of flu, pneumococcal disease, and herpes zoster |
| NITAG’s prioritization of health security in decision-making |
0 = Small to no priority on health security, or no evidence available 1 = NITAG considers health security, but it is not a main driver of decisions 2 = NITAG considers health security as a main driver of decisions |
| NITAG’s utilization of cost-effectiveness (C-E) data in decision-making |
0 = Small to no focus on C-E, or no evidence available 1 = NITAG considers C-E data, but it is not a main driver 1.5 *= NITAG mostly considers C-E data as a main driver 2 = NITAG considers C-E data as a main driver |
| NITAG has adult vaccine working group(s) |
0 = 0 such working groups 0.5* = NITAG has 0 such working groups, but is involved in other recommending bodies where government is engaged 1 = 1 such working group 2 = Multiple such working groups (as part of a broader vaccine-specific working group or a standalone) |
| Public policy - pneumococcal vaccination for older adults |
0 = PCV or PPSV not recommend, unknown if considered by NITAG 1 = PCV or PPSV considered by NITAG, but not recommended 1.5* = PCV or PPSV was recommend by NITAG, but not yet implemented 2 = PCV recommended by NITAG |
| Public policy - herpes zoster vaccine (HZV) for older adults |
0 = HZV not recommended, unknown if considered by NITAG 1 = HZV considered, but not recommend by NITAG 1.5*= HZV recommended by NITAG, but not yet implemented 2 = HZV recommended by NITAG |
| Publication of Health Aging Strategies |
0 = No healthy aging strategy publicly available 1 = Aging strategy available at the sub-national or national level 1.5*= Sub-national or national aging strategy available that mentions adult immunization, but is over ten years old 2 = National aging strategy available that mentions adult vaccines |
| Publication of National Immunization Strategies |
0 = No immunization strategy publicly available 1 = Only pediatric immunization strategy publicly available 2 = National immunization strategy published and covers both pediatric and adult vaccines |
| Implementation | |
| Vaccine Financing – Level of public financing (for each vaccine) |
0 = Older adults must pay out of pocket 1 = Vaccine covered by private insurance, requires co-pay, or limited coverage is provided in certain geographic areas or at-risk populations 1.5*= Mixed system of payment (covered) 2 = Vaccine is fully funded by the government for all |
| Vaccine Registry (for pediatric and adult populations) |
0= No registry 1= Sub-national or by individual health systems/providers/insurers 2= Centralized |
| Availability of Public Vaccine Coverage Data (for each vaccine) |
0= No evidence of being measured 1= Some public coverage data (at sub-national level and/or by age) 2= Complete public coverage data (at national level and/or across life-course) |
| Advocacy – promotion of adult immunization |
0= No evidence of advocacy for older adult vaccines 1= Few advocacy initiatives 2= Multiple sectors promoting older adult vaccines |
| Influence of individuals or organizational leaders on how older adult immunization program is implemented |
0= No influence 1= Some influence, but data influences more 2= Significant influence of champions or organizational leaders |
| Access – Ease of getting vaccinated as an older adult |
0= Difficult to get vaccinated 1= Somewhat complicated 2= Easy to get vaccinated (multiple locations and/or providers) |
| Equity is a focus in adult vaccine program implementation |
0= No or little evidence of equity focus 1= Some evidence of equity focus 2= Multiple sources of evidence of equity focus |
| Degree of centralization of adult vaccine delivery |
0 = Decentralized 1 = Mixture 2= Centralized |
| Degree of centralization of health system delivery |
0= Decentralized 1= Mixture 2= Centralized |
*0.5 and 1.5 scores added based on feedback during validation process.
Countries were assessed on their adult vaccine implementation and decision-making. Decision-making was scored upon 10 indicators and implementation upon 9 indicators. Each indicator was ascribed a quantitative score, as described above.