The Importance of Engaging Policy-Makers at the Outset to Guide Research on and Introduction of Vaccines: The Use of Policy-Maker Surveys

By DeRoeck, Denise | Journal of Health Population and Nutrition, September 2004 | Go to article overview

The Importance of Engaging Policy-Makers at the Outset to Guide Research on and Introduction of Vaccines: The Use of Policy-Maker Surveys


DeRoeck, Denise, Journal of Health Population and Nutrition


INTRODUCTION

Why conduct policy-maker surveys?

Increasingly, the public sector is creating large research programmes to accelerate the introduction of new vaccines in developing countries. In recent years, multi-million dollar programmes have been created to develop and introduce a variety of vaccines. Examples include a meningococcal conjugate vaccine targeted for children in sub-Saharan Africa (1), a paediatric dengue vaccine (2), rotavirus and pneumococcal conjugate vaccines geared towards children in developing countries (3), a malaria vaccine (4), improved vaccines against Japanese encephalitis, and new-generation vaccines against cholera, typhoid fever, and shigellosis (5).

These research efforts should lead to the availability of a greater number of safe, effective, and presumably reasonably-priced vaccines in the marketplace in the coming years. However, as more vaccines become available and as each research programme tries to convince countries to introduce its target vaccine, resource-constrained governments will not be able to take up all desired or presumably needed vaccines. The past two or three decades have seen the development of a number of vaccines sorely needed in developing countries, including vaccines against hepatitis B, Haemophilus influenzae type b (Hib), and Japanese encephalitis (for Asia). However, many national immunization programmes have not introduced these vaccines because of their perceived high cost, uncertain disease burden in their country, or other factors. As more vaccines enter the international market, countries will be forced to set priorities for vaccines and disease-control activities based on sound data and financial realities.

However, just what are the disease-control priorities of policy-makers in developing countries and how do various upcoming vaccines fit in with these priorities? How do policy-makers determine these priorities and what specific information do they use to do so? Is, for instance, disease burden always the major determinant in setting priorities? What other factors or data influence decisions to introduce a new vaccine? What is the decision-making process that different countries use regarding the introduction of new vaccines and who makes and influences these decisions? What are the major barriers to the introduction of vaccine and how can they be overcome? Are there criteria for cost and performance of different vaccines that decision-makers consider critical or even a pre-condition to considering their use? And if they do decide to introduce a certain vaccine, what introduction and financing strategies are they considering, if not full-scale introduction of free vaccine through the national immunization programme?

While policy-making is not always a rational process, answering these questions early in the formulation of vaccine-research programmes may improve the odds that a research programme will actually lead to the introduction of a vaccine in a country, that the people most in need of the vaccine will receive it, and that its use and financing will be sustainable over the long term.

One way to begin answering these questions is to conduct face-to-face surveys with key policy-makers and other opinion leaders in the target countries during the design or early implementation phase of the research programme. By initially surveying the opinions and beliefs of those who will actually make decisions on whether to introduce a new vaccine, these studies can help ensure that the research activities, including vaccine development, respond to the needs of end-users of data--that is, policy-makers in countries endemic for the target disease. Policy-maker surveys can provide valuable data to inform the research agenda, advocacy plans, and actual introduction of vaccine by determining the likelihood of a new vaccine being introduced in a country, identifying key decision-makers and centres of influence, identifying obstacles to the introduction of vaccine, determining the data and other requirements needed to overcome these obstacles, and identifying vaccine-introduction strategies that are most likely to succeed in a sustainable fashion. …

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