title: Influenza vaccination policy-making processes in France and The Netherlands: Framework and determinants.
abstract: OBJECTIVE
  Target groups for seasonal influenza vaccination are nationally defined based on several factors. However, few studies have explored the policy-making processes at the country-level. We investigated key differences in the policy-making process for the development of vaccination recommendations between France (FR) and The Netherlands (NL). This paper presents preliminary results on the evidence used in the decision-making process and focuses on the interactions between the experts and stakeholders.
  
  
  METHODS
  A documentary analysis identified the stakeholders of this process as governmental authorities, research institutions, associations, and manufacturers. This qualitative study included at least one expert from each stakeholder group. Thirty-three semi-structured interviews were performed in 2013 (16 FR, 17 NL). We used NVivo10® to perform a thematic content analysis on the data.
  
  
  RESULTS
  National Immunization Technical Advisory Groups (NITAGs) were the key stakeholders in the development of recommendations. There was no systematic standard evaluation of evidence during the decision-making process in both countries. Likewise, voting was not systematic, although it did occur more often in FR. A declaration of interests was obligatory in both countries. Experts with no conflicts of interest were rare because many depend on private funding for their research on influenza vaccination.
  
  
  CONCLUSIONS
  The transparency of the NITAGs' procedures for the development of recommendations should be improved. We believe improvements might be achieved by the systematic standard evaluation of evidence, consistent voting, clear declarations of interest, and increased public funding for vaccination research.
authors.affiliation: University of Lyon, Lyon, France; University of Bordeaux; Research Center Bordeaux Population HealthU1219 Inserm, Bordeaux, France; University Lumière Lyon 2; CNRS, GATELSEUMR 5824, Ecully, France. Electronic address: maria-laura.silva@univ-lyon2.fr.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Silva
authors.affiliation: University of Lyon, Lyon, France; University Lumière Lyon 2; CNRS, GATELSEUMR 5824, Ecully, France; Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Perrier
authors.affiliation: Netherlands Institute For Health Services Research (NIVEL), Utrecht, The Netherlands.
authors.forename: John W
authors.initials: JW
authors.lastname: Paget
authors.affiliation: Open Rome, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Mosnier
authors.affiliation: University of Lyon, Lyon, France; University Lumière Lyon 2 COACTIS, EA 4161, Lyon, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Buthion
authors.affiliation: Open Rome, Paris, France.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Cohen
authors.affiliation: University of Lyon, Lyon, France; University Claude Bernard Lyon 1, EAM 4128, Lyon, France.
authors.forename: Hans Martin
authors.initials: HM
authors.lastname: Späth
mesh_terms: D000288:Administrative Personnel; D005602:France; D006291:Health Policy; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control; D007407:Interviews as Topic; D009426:Netherlands; D011050:Policy Making
chemical_list: D007252:Influenza Vaccines
keywords: Health policy; Human influenza; Interviews; NITAG; Policy-making; Qualitative research; Vaccination recommendations