Conceptual frameworks and key dimensions to support coverage decisions for vaccines

Area of Science:

• Health Policy
• Vaccinology
• Decision Science

Background:

• Health policy makers face challenges incorporating new vaccines into immunization plans.
• Existing frameworks for vaccine adoption are heterogeneous and evolving.
• There is a need to connect vaccine-specific decision tools to general evidence-based frameworks.

Purpose of the Study:

• To review and catalogue current frameworks and taxonomies for vaccine adoption.
• To connect these vaccine frameworks to the DECIDE Evidence to Decision (EtD) framework.
• To identify gaps in decision-making tools for vaccine adoption.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, Cochrane Library, and funding agency websites (1990-2013).
• Inclusion of systematic reviews and primary studies on community vaccine adoption decision-making tools.
• Qualitative summarization and comparison of decision dimensions across studies.

Main Results:

• Fourteen studies (5 systematic reviews, 9 primary studies) were included.
• Key factors influencing decisions included illness importance, vaccine characteristics, resource use, and feasibility.
• Less consistent reporting was found for values, preferences, and acceptability.
• No evidence was found explaining differences between vaccine adoption and general intervention adoption frameworks.
• Limited data exists on linking decision dimensions to practical factors and coverage decisions.

Conclusions:

• A shared, comprehensive framework for vaccine coverage decisions is needed.
• Current frameworks are heterogeneous, with dimensions (epidemiologic, effectiveness, economic, social) valued differently.
• A generic tool like the DECIDE Evidence to Decision (EtD) framework could potentially reduce inconsistencies by conceptualizing all relevant dimensions.