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Priority setting for improved influenza vaccines: a multi-criteria decision analysis
Carlo Federici1, Sara Sá Silva2, Mitsuki Koh3
1Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Italy.
Vaccine
|July 17, 2025
Summary
Improved influenza vaccines (IIVs) are underused in low- and middle-income countries. This study identified key decision-making criteria for IIVs, highlighting efficacy and duration of protection as priorities for vaccine adoption.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Seasonal influenza vaccines significantly reduce global disease burden but face low uptake in low- and middle-income countries (LMICs).
- The World Health Organization's Full Value of Improved Influenza Vaccines Assessment (FVIVA) initiative aims to understand barriers to improved influenza vaccine (IIV) adoption.
- LMIC decision-makers' priorities for IIVs are crucial for enhancing vaccine utilization.
Purpose of the Study:
- To explore the priorities and preferences of decision-makers in LMICs regarding improved influenza vaccines (IIVs).
- To identify key criteria for evaluating and selecting IIVs to improve their adoption in national immunization programs.
- To assess the feasibility and acceptance of multi-criteria decision analysis (MCDA) for vaccine portfolio optimization.
Main Methods:
- A multi-criteria decision analysis (MCDA) framework was employed in Kenya and Thailand to evaluate improved influenza vaccines (IIVs).
- Criteria for IIV evaluation were established through literature reviews, expert consultations, and stakeholder workshops.
- A swing weighting and bisection approach were used to elicit criteria weights and scores, with results validated against current and hypothetical IIVs.
Main Results:
- Seven key criteria for IIV evaluation were identified in Kenya and Thailand, with six being common: vaccine efficacy, duration of protection, breadth of protection, safety (serious adverse events), storage requirements (temperature), and shelf life.
- Consistent scoring and weighting of these criteria were observed across both countries.
- Stakeholder workshops in 11 additional countries provided a broader understanding of IIV preferences.
Conclusions:
- A core set of decision-making criteria for improved influenza vaccines (IIVs) was identified across 13 countries.
- Multi-criteria decision analysis (MCDA) proved to be a well-accepted and feasible method for evidence-based prioritization of vaccine portfolios.
- Future development of IIVs should prioritize country-identified criteria to enhance their integration into national immunization programs.
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