In resource-constrained environments, priority setting is critical to making sustainable decisions for introducing new and underused vaccines and choosing among vaccine products. Donor organisations and national governments in low-income and middle-income countries (LMICs) recognise the need to support prioritisation of vaccine decisions driven by local health system capacity, epidemiology and financial sustainability. Successful efforts have supported the establishment of National Immunisation Technical Advisory Groups (NITAGs) to undertake evidence-informed decision making (EIDM) in LMICs. Now, attention is increasingly focused on supporting their function to leverage local expertise and priorities. EIDM and priority-setting functions are complex and dynamic processes. Here, we report a pilot of a web-based decision-support tool. Applying tenets of multicriteria decision analysis, SMART Vaccines 2.0 supported transparent, reproducible and evidence-informed priority setting with an easy-to-use interface and shareable outputs. The pilot was run by the Uganda NITAG who were requested by the Ministry of Health (MOH) in 2016 to produce recommendations on the prioritised introduction of five new vaccines. The tool was acceptable to the NITAG and supported their recommendations to the MOH. The tool highlighted sensitivity in the prioritisation process to the inherent biases of different stakeholders. This feature also enabled examination of the implications of data uncertainty. Feedback from users identified areas where the tool could more explicitly support evidence-to-recommendation frameworks, ultimately informing the next generation of the platform, PriorityVax. Country ownership and priority setting in vaccine decisions are central to sustainability. PriorityVax promotes auditable and rigorous deliberations; enables and captures the decision matrix of users; and generates shareable documentation of the process.
Bibliographical noteFunding Information:
Supported by Gavi and the Bill and Melinda Gates Foundation, a number of international organisations have offered capacity-building support to establish NITAGs. While greater emphasis was initially placed on fulfilling process indicators for establishing NITAGs, more recent efforts have sought to advance functional capabilities associated with EIDM, most notably by Agence de Médecine Préventive (AMP), the International Vaccine Institute and The Sabin Vaccine Institute.13 14 These programmes have additionally leveraged technical assistance from WHO and its regional offices, PATH and the US Centers for Disease Control and Prevention.15 16
The UNITAG sought technical assistance from AMP’s Supporting Independent Vaccine Advisory Committees (SIVAC) Initiative,14and engaged in piloting the SMART Vaccines 2.0 platform supported by the Fogarty International Center at the US National Institutes of Health (NIH). A description of the NITAG process is given elsewhere.24 33
Funding This work was supported by the Fogarty International Center, National Institutes of Health, USA.
© 2020 Author(s). Published by BMJ.
- health policy
- public health