title: Conceptual frameworks and key dimensions to support coverage decisions for vaccines.
abstract: BACKGROUND
  Health policy makers often have to face decisions on whether and how to incorporate new vaccines into immunisation plans. This study aims to review and catalogue the relevant current frameworks and taxonomies on vaccines and connect these to the DECIDE Evidence to Decision framework (EtD), a general framework based on evidence-based criteria to guide decision-making on intervention adoption.
  
  
  METHODS
  We systematically searched MEDLINE, EMBASE, Cochrane Library and funding agency websites from 1990 to 2013. We included systematic reviews and primary studies presenting decision-making tools for community vaccine adoption. We qualitatively summarised the reports by purpose, targeted country, principal results, and decisional models. We then extracted and compared the dimensions adopted by vaccine frameworks across studies.
  
  
  RESULTS
  Fourteen studies (five systematic reviews and nine primary studies) were included. Several factors frequently influenced decision-makers' views on vaccines: the most frequent political-context factors considered were Importance of illness or problem, Vaccine characteristics, Resource use, and Feasibility. Others such as Values and preferences and Acceptability were less consistently reported. We did not find evidence on the reasons why a framework for vaccine adoption differs from that for decisions on the adoption of an intervention in general, such as the EtD. There are limited data on how dimensions are explained in practical factors and directly linked to coverage decisions.
  
  
  CONCLUSIONS
  This review summarises conceptual models and taxonomy of a heterogeneous and evolving area in health policy decisions. A shared and comprehensive framework on vaccine coverage remains to be achieved with its single dimensions (epidemiologic, effectiveness, economic, and social) valued differently across studies. A generic tool such as the EtD conceptualises all relevant dimensions, and might reduce inconsistencies.
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy. Electronic address: marien.gonzalez@unimi.it.
authors.forename: Marien
authors.initials: M
authors.lastname: González-Lorenzo
authors.affiliation: Direzione Generale Salute, UO Governo della Prevenzione e Tutela Sanitaria, Regione Lombardia, Milano, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Piatti
authors.affiliation: Direzione Generale Salute, UO Governo della Prevenzione e Tutela Sanitaria, Regione Lombardia, Milano, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Coppola
authors.affiliation: Direzione Generale Salute, UO Governo della Prevenzione e Tutela Sanitaria, Regione Lombardia, Milano, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Gramegna
authors.affiliation: Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - CochraneVaccines Field, Azienda Sanitaria Locale ASL AL, Alessandria, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Demicheli
authors.affiliation: Dipartimento di Analisi delle Politiche e Management Pubblico & Centro Dondena per la ricerca sulle Dinamiche Sociali e Politiche Pubbliche, Università Bocconi, Milano, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Melegaro
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tirani
authors.affiliation: Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Roma, Italy; Centro Cochrane Italiano, Università degli Studi di Modena e Reggio Emilia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Parmelli
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Auxilia
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy; Unità di Epidemiologia Clinica, IRCCS Istituto ortopedico Galeazzi, Milano, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
mesh_terms: D003661:Decision Support Techniques; D006291:Health Policy; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines
keywords: Decision aid; Decision-making; Framework; Health policy; Immunisation programmes; Model; Vaccination