Mapping the decision-making process
Governmental decision-making processes vary greatly from country to country, and even within countries. These are some standard structures and processes that exist in many or most countries, but it is important that you map your own. Where available, list the name of the person responsible.
CREATING POLITICAL COMMITMENT FOR IMMUNISATION
What is political commitment?
The UK’s Department of International Development, or Dfid, has defined it as,”the determination of an individual political actor to do and say things that will produce a desired outcome.”
This definition focuses on a particular decision-maker – his or her awareness, understanding, motivation and will to make a desired change happen. But there are many other factors involved in a decision. They might be competing or opposing political agendas; lack of funding; or as simple or complicated as an election being called before the decision is made.
Below you can see what some of the experts say about untangling the complex process of decision-making about immunisation and vaccines:
- “[I]t is important to acknowledge that policy decisions are shaped by an array of social, institutional, economic and political factors that may not always be in line with stringently rational decision-making but that instead reflect particular values or pressures.“
Mantel, C., and Wang, S. (WHO)
The privilege and responsibility of having choices: decision-making for new vaccines in developing countries.
- “The decision-making process to introduce new vaccines into national immunisation programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement technical information, implement programmes and garner political support. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions.”
Wonodi, CB and Privor-Dumm, L,
Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria.
Understanding the decision-making process
Here is a general example of how different groups, government departments and legislators share responsibility for making decisions around vaccines and immunisation, but you will need to map the specific and relevant roles and responsibilities in your country.
Which government bodies and departments are involved?
- The Extended Programme on Immunisation (EPI): the manager (national and regional if relevant), communications officers, other staff as relevant.
- Sub-national government departments with responsibility for or a role in immunisation delivery:
health, immunisation, EPI or other.
- District and community governments that make decisions regarding vaccines and immunisation.
- Other potentially relevant Ministries: (Add your own country’s ministries, using the correct titles)
- Finance: this is very important for financing of vaccines
- Social services
- Family and community
- Justice, etc.
What other official groups are involved in immunisation and vaccines?
The National Immunisation Technical Advisory Group (NITAG or ITAG)
- Also sometimes known as the National Advisory Committee for Immunisation Practices (NCIP or NIP).
- This is an important advisory or decision-making body for immunisation and vaccines.
The Inter-agency Coordination Committee (ICC)
- Coordinates between international donors and partners and supports funding, planning, implementation and advocacy.
The Health Sector Coordinating Committee (HSCC)
- Examines health initiatives and funding requests from across all sectors to ensure coordination and prioritisation against the national health plan.
Are there other influential organisations and bodies?
- Gavi, bilateral donors and others may have policies, guidelines or funding agreements with your government.
- United Nations agencies such as the World Health Organization, UNICEF and others may be advising your government on decisions and policies.
Medical, health and other professional groups
- Such as a paediatricians’ association, academic experts, community and religious leaders who may have a formal role (on the NITAG perhaps), or an informal role as advisors or experts.
Medias (social medias, public and private mass medias, etc.)
National and Regional Communities, Traditional, community and religious leaders, First Ladies, CSOs, etc.
Are there other organisations conducting advocacy efforts on vaccines and immunisation?
If a NITAG or similar structure does not exist, it may be an important gap in the system that needs to be addressed by your country.
How decisions are made to introduce new vaccines
- When government bodies and decision-makers are considering whether or not to introduce a new vaccine, they look at a range of issues, including how many children’s lives will be saved and how much illness can be prevented.
Is it a public health priority?
- What is the burden of this disease?
- How many children under the age of five die or fall ill?
- How many children’s lives can be saved?
What is the value of this vaccine?
- What would be the impact of the vaccine – such as reduced hospital and treatment costs, for example
– on the economy and society?
- What is the cost-effectiveness of employing the vaccine? This is the balance between the cost of the vaccines and the cost of the disease burden, known as the cost effectiveness ratio.
What are the financial considerations and impact?
- Is the vaccine affordable?
- What is the total cost of introduction?
- How will introduction of this vaccine impact the broader immunisation and health budgets?
- Is there funding?
Vaccine delivery and impact
- What does the scientific evidence show?
- What does the World Health Organization (WHO) advise for this vaccine?
The WHO advisory group on vaccines is called the Strategic Advisory Group of Experts on immunisation,
or SAGE. It reviews vaccines and their safety and issues guidance.
Are there vaccine delivery challenges?
- How will the new vaccine fit with the existing vaccine schedule?
- Can the immunisation supply chain accommodate this new vaccine?
- What are the challenges in the immunisation system?
- Are there any vaccine supply issues?
- What is the public and professional acceptance?
Will this vaccine be accepted?
- Do people – including medical/health professionals, health care workers and caregivers – accept these vaccines?
- What communication will be needed to improve awareness, acceptance and uptake?
New and upcoming vaccines
Vaccines introduced in the global market since 2000
- Rotavirus (oral)
- Pneumococcal conjugate (10 and 13 valent)
- Japanese encephalitis (improved: live, single-dose SA 14-14-2)
- Human papillomavirus (HPV)
- Meningococcal A (monovalent, tetra- and pentavalent conjugate vaccines)
- Cholera vaccine (Oral killed, whole cell only)
- Polio vaccines (oral monovalent and bivalent)
- Inactivated polio vaccine
Vaccines in late stages of clinical development
- Malaria (RTS,S)
- Typhoid Vi conjugate
- Tuberculosis (new generation)
(Source: WHO 2014)
- Human papillomavirus (HPV)
- Inactivated polio vaccine (IPV)
- Japanese encephalitis (JE)
- Measles (second dose)
- Meningitis A
- Pentavalent (5-in-one)
- Yellow fever
Gavi also supports:
- Health system strengthening (HSS)
- Civil Society Organisations (CSOs)
- Injection safety support