Abstract
Background: The World Health Organization (WHO) has developed the Total System Effectiveness (TSE) framework to assist national policy-makers in prioritizing vaccines. The pilot was launched in Thailand to explore the potential use of TSE in a country with established governance structures and accountable decision-making processes for immunization policy. While the existing literature informs vaccine adoption decisions in GAVI-eligible countries, this study attempts to address a gap in the literature by examining the policy process of a non-GAVI eligible country. Methods: A rotavirus vaccine (RVV) test case was used to compare the decision criteria made by the existing processes (Expanded Program on Immunization [EPI], and National List of Essential Medicines [NLEM]) for vaccine prioritization and the TSE-pilot model, using Thailand specific data. Results: The existing decision-making processes in Thailand and TSE were found to offer similar recommendations on the selection of a RVV product. Conclusion: The authors believe that TSE can provide a well-reasoned and step by step approach for countries, especially low- and middle-income countries (LMICs), to develop a systematic and transparent decision-making process for immunization policy.
Highlights
Ministries or departments of health had sole responsibility for health service policy at the national level
Social Insurance Administration Organization in Indonesia, National Health Agency in India, PhilHealth in the Philippines, and Vietnam Social Security Office in Vietnam. These institutional changes introduce new challenges for Rattanavipapong et al vaccine policy, since the responsibility for vaccine priority setting is often shared by multiple bodies which may have different interests. These challenges are in addition to other contextual and process factors that limit national priority setting for vaccines in low- and middle-income countries (LMICs), including political power, financial constraints, the influence of donor and industry priorities, a lack of explicit frameworks and participation of key stakeholders, and the inappropriate use of priority setting criteria.[1,2,3,4,5]
For vaccines considered by the National List of Essential Medicines (NLEM), the Advisory Committee on Immunization Practices (ACIP) serves as a platform for information exchange, and submits evidence on disease prevalence, diseases burden, safety and efficacy of vaccine to the NLEM subcommittee as inputs for their consideration
Summary
Ministries or departments of health had sole responsibility for health service policy at the national level. These institutional changes introduce new challenges for Rattanavipapong et al vaccine policy, since the responsibility for vaccine priority setting is often shared by multiple bodies which may have different interests These challenges are in addition to other contextual and process factors that limit national priority setting for vaccines in low- and middle-income countries (LMICs), including political power, financial constraints, the influence of donor and industry priorities, a lack of explicit frameworks and participation of key stakeholders, and the inappropriate use of priority setting criteria.[1,2,3,4,5] One way of addressing some of the above mentioned challenges is to develop a framework for supporting successful priority setting. To this end we piloted a new priority setting framework for vaccines, Total System Effectiveness (TSE), which has been renamed to Capacity-led Assessment for Priority-setting of Immunization, in Thailand, where the vertical vaccination program, previously part of the Ministry of Public Health (MOPH), has been reclassified to be part of the newly established and autonomous public health authority called the National Health Security Office (NHSO)
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