McCormick Benjamin J J, Waiswa Peter, Nalwadda Celia, Sewankambo Nelson K, Knobler Stacey L
Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, Maryland, USA.
School of Public Health, Makerere University, Kampala, Uganda.
BMJ Glob Health. 2020 Nov;5(11). doi: 10.1136/bmjgh-2020-003587.
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.
在资源有限的环境中，确定优先次序对于就引入新的和未充分使用的疫苗以及在疫苗产品之间进行选择做出可持续决策至关重要。低收入和中等收入国家（LMICs）的捐助组织和国家政府认识到，需要支持根据当地卫生系统能力、流行病学和财政可持续性来确定疫苗决策的优先次序。成功的努力支持建立了国家免疫技术咨询小组（NITAGs），以便在LMICs中进行基于证据的决策（EIDM）。现在，注意力越来越集中在支持它们发挥作用，以利用当地的专业知识和优先事项。EIDM和确定优先次序的功能是复杂且动态的过程。在此，我们报告了一个基于网络的决策支持工具的试点情况。应用多标准决策分析原则，SMART Vaccines 2.0通过易于使用的界面和可共享的输出，支持透明、可重复且基于证据的优先次序确定。该试点由乌干达NITAG开展，2016年卫生部（MOH）要求他们就优先引入五种新疫苗提出建议。该工具为NITAG所接受，并支持他们向卫生部提出的建议。该工具突出了优先次序确定过程中对不同利益相关者固有偏差的敏感性。这一特性还使得能够审视数据不确定性的影响。用户的反馈确定了该工具可以更明确地支持从证据到建议框架的领域，最终为该平台的下一代产品PriorityVax提供信息。疫苗决策中的国家自主权和确定优先次序对于可持续性至关重要。PriorityVax促进可审计且严谨的审议；启用并记录用户的决策矩阵；并生成该过程的可共享文档。
