A literature review to identify factors that determine policies for influenza vaccination.
OBJECTIVE
To conduct a literature review of influenza vaccination policy, describing roles and interactions between stakeholders and the factors influencing policy-making.


METHODS
Major databases were searched using keywords related to influenza vaccination, decision-making and health policy. Titles and abstracts were screened according to defined criteria using independent reviewers. Selected articles were analysed and compared against a checklist.


RESULTS
342 papers were identified, but only 111 included. A wide range of countries was represented in articles published in 1994-2012. We identified numerous stakeholders at the national and international level and found a variety of interactions between them. Using these data, we suggest a scheme for the most important stakeholders and their interactions. Determinants of policy-making were mainly related to the vaccine/disease, political-economic context, and stakeholders communication. The most relevant evidence was clinical/epidemiological studies. After the 2009 pandemic: the importance of mathematical modelling and ethical issues was greater; and the need for better communication between stakeholders was emphasised.


CONCLUSIONS
The relevance of evidence and factors influencing policy-making varied between countries, according to complex interactions between the stakeholders involved at different levels of decision-making process. These interactions remain unclear, especially at national level, where the most important influenza policy decisions are made. To better define and understand the exact interactions and use of evidence, we recommend undertaking future qualitative studies at national level using small number of countries.
Université Lumière Lyon 2, Lyon F-69007, France; CNRS, GATE Lyon Saint-Etienne, Ecully F-69130, France. Electronic address: maria-laura.silva@univ-lyon2.fr.
Maria Laura
ML
Silva
Université Lumière Lyon 2, Lyon F-69007, France; CNRS, GATE Lyon Saint-Etienne, Ecully F-69130, France; Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France.
Lionel
L
Perrier
Open Rome; Coordination Nationale des Groupes Régionaux d'Observation de la Grippe, Réseau des GROG, Paris, France.
Jean Marie
JM
Cohen
Netherlands Institute For Health Services Research (NIVEL), Utrecht, The Netherlands.
William John
WJ
Paget
Open Rome; Coordination Nationale des Groupes Régionaux d'Observation de la Grippe, Réseau des GROG, Paris, France.
Anne
A
Mosnier
University Claude Bernard, Lyon 1, EAM 4128 Lyon, France.
Hans Martin
HM
Späth
D003659:Decision Making, Organizational; D006291:Health Policy; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human; D011050:Policy Making; D036301:Qualitative Research; D014611:Vaccination
D007252:Influenza Vaccines
Policy-making, Influenza vaccination, Health policy, Decision-making