Factors Influencing the Prioritization of Vaccines by Policymakers in Low- and Middle-income Countries: A Scoping Review


Understanding the factors  involved in governments’ decision-making processes when deciding whether to integrate new vaccines into their national immunisation programmes.


Governments deciding whether to integrate new vaccines into their national immunisation programmes can use these findings to understand new vaccine introduction decision-making processes and factors, including actors, programmatic considerations, vaccine price, communication and advocacy, and more.


Low- and Middle-income Countries (LMICs) have to make difficult choices on which vaccines to prioritize for introduction while considering a wide range of factors such as disease burden, vaccine impact, vaccine characteristics, financing and health care infrastructures, whilst adapting to each country’s specific contexts. This scoping review examined the factors that influence decision-making among policymakers for the introduction of new vaccines in LMICs. The review identified the specific data points that are factored into the decision-making process for new vaccine introduction, whilst also documenting whether there have been any changes in decision-making criteria in new vaccine introduction over the last two decades.

Key Messages:

  • The decision-making environment for new vaccine introduction in low- and middle-income countries (LMICs) is complex in the face of competing health priorities. Numerous criteria must be considered in the decision-making process which can pose as facilitators or barriers to new vaccine introduction.
  • The importance of the disease, including disease burden, costs of disease and political prioritization, coupled with economic factors such as vaccine price, affordability and financing, were the most common criteria considered for new vaccine introduction.
  • Communication efforts and sociocultural considerations pertaining to vaccines may have a more relevant role in the decision-making process in LMICs.
  • The combination of numerous criteria results in a decision-point leading to a window of opportunity for policy makers to decide whether to move forward with vaccine implementation.

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