Examining evidence use in vaccine policymaking in Kenya: A qualitative case study

Although evidence-informed health policymaking is widely promoted, evidence use in vaccine policymaking and the institutional and actor dynamics shaping it remain poorly understood. This study investigates what types of evidence were used and how they were used in vaccine policymaking in Kenya. Using a qualitative case study design, we focused on the introduction and roll-out of HPV and malaria vaccines. Data collection included 34 in-depth interviews with national Ministry of Health officials, Kenya National Immunization Technical Advisory Group members, County Expanded Programme of Immunization logisticians, international partners, and local civil society organizations; 417 hours of observation of vaccine-related policy and planning meetings; and a review of relevant policy and planning documents. Framework analysis was used to analyse the data, guided by two analytical frameworks: (1) a spectrum approach for categorizing evidence along two dimensions - scientific to tacit and global to local - and (2) Weiss's models of research use, which interpret patterns of evidence utilization in policymaking. The findings show that international actors, through their financial and technical authority, substantially influenced national policymakers' adoption of global guidance and scientific evidence. Local programmatic expertise played a crucial role in validation and contextualization of global guidance and scientific evidence to fit local contexts. The dominance of medical and public health professionals in decision-making spaces led to the prioritisation of evidence on vaccines' public health benefits over socio-political considerations. Local civil society's influence in vaccine policymaking was limited, with their community-based experiential knowledge primarily informing advocacy, communication, and social mobilization, rather than vaccine prioritisation and policy decisions. We conclude that strengthening evidence-informed policymaking requires more inclusive approaches that value diverse evidence types. Addressing power imbalances that shape what counts as credible evidence and integrating local civil society perspectives throughout the policymaking process can enhance the legitimacy, acceptability, and effectiveness of policy decisions.