Ma Chao, Li Junhong, Wang Nan, Wang Yamin, Song Yudan, Zeng Xiang, Zheng Canjun, An Zhijie, Rodewald Lance, Yin Zundong
National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Shanghai Municipal Center for Disease Control and Prevention, Shanghai 201204, China.
Vaccines (Basel). 2022 Jun 24;10(7):1010. doi: 10.3390/vaccines10071010.
Vaccine developers in China have made an increasing number of infectious diseases preventable through vaccination. An appropriate decision-making procedure is necessary for making wise decisions on whether to introduce new vaccines into the Expanded Program on Immunization (EPI). When there are several vaccines that could potentially be considered, a scientifically justifiable mechanism is needed for prioritizing and sequencing vaccines for consideration.
We used a modified Delphi technique (MDT) to develop and refine an indicator system to prioritize vaccines and make policy recommendations concerning their introduction into China's EPI system. From January through May 2021, thirty-nine experts were recruited and participated in a two-round Delphi survey that was based on a set of candidate indicators obtained through a literature review and reference to the WHO vaccine introduction recommendations. Using the resulting indicator system, we conducted a third consultation with a multi-disciplinary group of experts who scored five program-eligible candidate vaccines to determine prioritization and sequencing for consideration of inclusion into the EPI.
Response rates of the thirty-nine experts were 100% and 97.4% across the two rounds. Authority coefficients from rounds one to three were over 0.70, reflecting the high accuracy and reliability of the consultation. Coordination coefficients of importance scores for primary, secondary, and tertiary indicators were 0.486, 0.356, 0.275 in round one, and 0.405, 0.340, and 0.236 in round two. According to the scores from 30 experts using our indicator system, the sequence and scores (1-10 scale, 10 highest) of 5 candidate vaccines were varicella (6.91), meningococcal conjugate AC (6.83), Hib (6.74), influenza (6.56), and EV71 (6.17) vaccines.
A modified Delphi technique effectively built a scientific, rational, comprehensive, and systematic indicator system for prioritizing vaccine candidates for consideration of inclusion into the EPI. The rank order will be used by the technical working groups of China's National Immunization Advisory Committee to sequentially develop and present Evidence-to-Recommendation tables for making policy recommendations.
中国的疫苗研发人员已通过疫苗接种使越来越多的传染病得以预防。对于是否将新疫苗纳入扩大免疫规划（EPI）做出明智决策，需要一个合适的决策程序。当有几种疫苗可能被考虑时，需要一种科学合理的机制来对疫苗进行优先排序并确定审议顺序。
我们使用改良德尔菲技术（MDT）来开发和完善一个指标体系，以对疫苗进行优先排序，并就将其纳入中国EPI系统提出政策建议。2021年1月至5月，招募了39名专家，他们参与了两轮德尔菲调查，该调查基于通过文献综述和参考世界卫生组织疫苗引入建议获得的一组候选指标。利用最终的指标体系，我们与一个多学科专家小组进行了第三次咨询，该小组对五种符合项目要求的候选疫苗进行评分，以确定纳入EPI审议的优先顺序和排序。
两轮调查中39名专家的回复率分别为100%和97.4%。第一轮至第三轮的权威系数均超过0.70，反映出咨询的高准确性和可靠性。第一轮中一级、二级和三级指标重要性得分的协调系数分别为0.486、0.356、0.275，第二轮中分别为0.405、0.340和0.236。根据30名专家使用我们的指标体系给出的评分，5种候选疫苗的顺序和评分（1 - 10分制，10分为最高分）分别为水痘疫苗（6.91）、A群C群脑膜炎球菌结合疫苗（6.83）、b型流感嗜血杆菌结合疫苗（6.74）、流感疫苗（6.56）和肠道病毒71型疫苗（6.17）。
改良德尔菲技术有效地构建了一个科学、合理、全面且系统的指标体系，用于对候选疫苗进行优先排序，以考虑纳入EPI。该排名顺序将由中国国家免疫咨询委员会的技术工作组用于依次制定和呈现证据到建议表，以提出政策建议。
