Criteria for inclusion of vaccinations in public programmes
Introduction
As more and more new vaccines are developed and brought to the market, governments have to make decisions about which vaccinations to include in public programmes. The expansion of public vaccination programmes will meet constraints due to limited financial resources and practical scope, but also because the public may be reluctant to accept new vaccinations. Public vaccination programmes are collective interventions, aiming to protect the health of the public through vaccination of the whole population or of large subgroups [1]. Such public protection is only feasible if there is a high level of trust and acceptance of the programme. This requires a trustworthy, transparent and accountable process of decision-making about inclusion of new vaccinations. This paper describes the experience in the Netherlands in developing a framework for assessing whether a new vaccination should be included in the National Immunisation Programme (NIP) [2].
The NIP Review Committee of the Health Council of the Netherlands started the work presented in this paper in 2001, when it was asked to advise the minister of health on potential inclusion of vaccination against serogroup C meningococcal disease [3]. At that same time vaccination against pneumococcal disease was at the horizon, and several other new vaccinations were expected. With respect to priority setting, it was felt an explicit assessment framework and inclusion criteria were needed. At the time no national or international standard for the assessment of public vaccination options was available.
Since then several steps towards the development of such a method were taken. The World Health Organization developed guidance for the decision to add a new vaccination to a NIP [4], but this document does not propose a method to compare options and prioritise between them. National immunisation committees published methods for knowledge retrieval and synthesis in order to reach evidence-based immunisation recommendations [5]. Erickson and colleagues published an analytical framework for comprehensive and systematic evaluation of all factors which should be considered before making decisions regarding the pertinence of new immunisation programmes. Their framework includes 58 criteria classified into 13 categories. In Quebec this framework was used to structure reports on the pertinence of vaccination against varicella, pneumococcal and serogroup C meningococcal disease. The framework was also used in consensus-building and prioritisation conferences [6].
Section snippets
Assessment framework to support informed decision-making and prioritisation
By exploring the ethical principles underlying collective immunisation programmes Verweij and Dawson performed a finger exercise for our work presented here [1], [7]. The framework and criteria were further developed in the context of an evaluation of the effectiveness and the future of the Dutch NIP at the occasion of its 50th anniversary in 2007 [2]. Part of that evaluation was an assessment of current and future candidate vaccinations, presented in this paper.
Bearing in mind the public
Assessment of current and potential future vaccinations in the NIP in the Netherlands
In the following section the vaccinations currently provided in the Netherlands through public programmes as well as 23 ‘candidate’ vaccinations are assessed against the seven criteria.
The NIP in the Netherlands was started in 1957, following a polio epidemic in 1956 that invalidated 2200 people and caused more than 70 deaths. Since 1962, various other vaccinations have been added to the NIP. In 2007, the programme included 12 vaccinations against 11 diseases (Table 2). Delivery takes place at
Discussion
Our method provides a systematic framework for the scientific assessment of arguments for and against the inclusion and prioritisation of particular vaccinations within public programmes. It proved useful in assessing the vaccinations currently provided in the Netherlands through public programmes and provided guidance when assessing 23 ‘candidate’ vaccinations, including revised indications for influenza vaccination [30], vaccination against cervical cancer [19], general vaccination programmes
Acknowledgements
The authors thank Nico (JND) de Neeling PhD, Pauline Slot PhD, and Wim A. van Veen MD PhD for useful comments on a previous version of this article.
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The NIP Review Committee consists of the following persons (all members with a right to vote unless stated ‘advisor’): E.J. Ruitenberg, PhD, Prof. of International Public Health, VU University, Amsterdam, Chairman; J.J. Roord, MD, PhD, Prof. of Paediatrics, VU University, Amsterdam, Vice Chairman; M.A.E. Conyn-van Spaendonck, MD, PhD, epidemiologist, NIP Manager, Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, Advisor; P.J. van Dalen, PhD, Ministry of Health, Welfare and Sport, Den Haag, Advisor; W. van Eden, MD, PhD, microbiologist, Prof. of Veterinary Immunology, Utrecht University; R. de Groot, MD, PhD, Prof. of Paediatrics, Radboud University Nijmegen; H.E. de Melker, PhD, epidemiologist, RIVM, Bilthoven, Advisor; T.G.W.M. Paulussen, PhD, Sector Head Health Promotion, TNO Quality of Life, Leiden; M.J. Postma, PhD, Prof. of Health Economics, University of Groningen; H.C. Rümke, MD, PhD, paediatrician and epidemiologist, University Vaccine Centre, Rotterdam/Nijmegen; J.L. Severens, PhD, Prof. of Evaluation in Health Care, Erasmus University Rotterdam; B.H. Stricker, PhD, Prof. of Pharmaco-epidemiology, Erasmus University Rotterdam; S.P. Verloove-Vanhorick, MD, PhD, Em. Prof. of Child Health, Leiden University, Leiden; H.J. Vermeulen-Schakel, MD, health centre physician, Municipal Health Service Kennemerland, Hoofddorp; M. Verweij, PhD, ethicist, Utrecht University; A.C.G. Voordouw, MD, MPH, PhD, Medicines Evaluation Board (CBG), Den Haag, Advisor; H.L. Zaaijer, MD, PhD, Professor of Microbiology, Academic Medical Center (AMC), Amsterdam; H. Houweling, MD, PhD, epidemiologist, Health Council, Den Haag, Senior Scientific Officer.