title: New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries.
abstract: As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed.
authors.affiliation: Department of Global Health & Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. helen.burchett@lshtm.ac.uk
authors.forename: H E D
authors.initials: HE
authors.lastname: Burchett
authors.forename: S
authors.initials: S
authors.lastname: Mounier-Jack
authors.forename: U K
authors.initials: UK
authors.lastname: Griffiths
authors.forename: R
authors.initials: R
authors.lastname: Biellik
authors.forename: P
authors.initials: P
authors.lastname: Ongolo-Zogo
authors.forename: E
authors.initials: E
authors.lastname: Chavez
authors.forename: H
authors.initials: H
authors.lastname: Sarma
authors.forename: J
authors.initials: J
authors.lastname: Uddin
authors.forename: M
authors.initials: M
authors.lastname: Konate
authors.forename: Y
authors.initials: Y
authors.lastname: Kitaw
authors.forename: M
authors.initials: M
authors.lastname: Molla
authors.forename: S
authors.initials: S
authors.lastname: Wakasiaka
authors.forename: L
authors.initials: L
authors.lastname: Gilson
authors.forename: A
authors.initials: A
authors.lastname: Mills
mesh_terms: D001459:Bangladesh; D002163:Cameroon; D003659:Decision Making, Organizational; D003906:Developing Countries; D005002:Ethiopia; D006166:Guatemala; D006292:Health Priorities; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration; D007630:Kenya; D008302:Mali; D011050:Policy Making; D011057:Politics; D013019:South Africa; D014612:Vaccines / Q000191:economics / Q000627:therapeutic use*
chemical_list: D014612:Vaccines