TY - JOUR
T1 - A systems map of the economic considerations for vaccination
T2 - Application to hard-to-reach populations
AU - Cox, Sarah N.
AU - Wedlock, Patrick T.
AU - Pallas, Sarah W.
AU - Mitgang, Elizabeth A.
AU - Yemeke, Tatenda T.
AU - Bartsch, Sarah M.
AU - Abimbola, Taiwo
AU - Sigemund, Sheryl S.
AU - Wallace, Aaron
AU - Ozawa, Sachiko
AU - Lee, Bruce Y.
N1 - Funding Information:
Research reported in this publication was supported by the Centers for Disease Control and Prevention (CDC) via contract 5 NU2GGH002000-02-00, the Agency for Healthcare Research and Quality (AHRQ) via grant R01HS023317 and R01HS028165, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Office of Behavioral and Social Sciences Research (OBSSR) via grant U01HD086861, and by National Institute of General Medical Sciences (NIGMS) as part of the Models of Infectious Disease Agent Study (MIDAS) network under grant R01 GM127512. While CDC staff contributed in their individual capacity as authors, the funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/11/5
Y1 - 2021/11/5
N2 - Background: Understanding the economics of vaccination is essential to developing immunization strategies that can be employed successfully with limited resources, especially when vaccinating populations that are hard-to-reach. Methods: Based on the input from interviews with 24 global experts on immunization economics, we developed a systems map of the mechanisms (i.e., necessary steps or components) involved in vaccination, and associated costs and benefits, focused at the service delivery level. We used this to identify the mechanisms that may be different for hard-to-reach populations. Results: The systems map shows different mechanisms that determine whether a person may or may not get vaccinated and the potential health and economic impacts of doing so. The map is divided into two parts: 1) the costs of vaccination, representing each of the mechanisms involved in getting vaccinated (n = 23 vaccination mechanisms), their associated direct vaccination costs (n = 18 vaccination costs), and opportunity costs (n = 5 opportunity costs), 2) the impact of vaccination, representing mechanisms after vaccine delivery (n = 13 impact mechanisms), their associated health effects (n = 10 health effects for beneficiary and others), and economic benefits (n = 13 immediate and secondary economic benefits and costs). Mechanisms that, when interrupted or delayed, can result in populations becoming hard-to-reach include getting vaccines and key stakeholders (e.g., beneficiaries/caregivers, vaccinators) to a vaccination site, as well as vaccine administration at the site. Conclusion: Decision-makers can use this systems map to understand where steps in the vaccination process may be interrupted or weak and identify where gaps exist in the understanding of the economics of vaccination. With improved understanding of system-wide effects, this map can help decision-makers inform targeted interventions and policies to increase vaccination coverage in hard-to-reach populations.
AB - Background: Understanding the economics of vaccination is essential to developing immunization strategies that can be employed successfully with limited resources, especially when vaccinating populations that are hard-to-reach. Methods: Based on the input from interviews with 24 global experts on immunization economics, we developed a systems map of the mechanisms (i.e., necessary steps or components) involved in vaccination, and associated costs and benefits, focused at the service delivery level. We used this to identify the mechanisms that may be different for hard-to-reach populations. Results: The systems map shows different mechanisms that determine whether a person may or may not get vaccinated and the potential health and economic impacts of doing so. The map is divided into two parts: 1) the costs of vaccination, representing each of the mechanisms involved in getting vaccinated (n = 23 vaccination mechanisms), their associated direct vaccination costs (n = 18 vaccination costs), and opportunity costs (n = 5 opportunity costs), 2) the impact of vaccination, representing mechanisms after vaccine delivery (n = 13 impact mechanisms), their associated health effects (n = 10 health effects for beneficiary and others), and economic benefits (n = 13 immediate and secondary economic benefits and costs). Mechanisms that, when interrupted or delayed, can result in populations becoming hard-to-reach include getting vaccines and key stakeholders (e.g., beneficiaries/caregivers, vaccinators) to a vaccination site, as well as vaccine administration at the site. Conclusion: Decision-makers can use this systems map to understand where steps in the vaccination process may be interrupted or weak and identify where gaps exist in the understanding of the economics of vaccination. With improved understanding of system-wide effects, this map can help decision-makers inform targeted interventions and policies to increase vaccination coverage in hard-to-reach populations.
KW - Economic benefits
KW - Hard-to-reach
KW - Systems map
KW - Vaccination costs
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U2 - 10.1016/j.vaccine.2021.05.033
DO - 10.1016/j.vaccine.2021.05.033
M3 - Article
C2 - 34045101
AN - SCOPUS:85107042292
SN - 0264-410X
VL - 39
SP - 6796
EP - 6804
JO - Vaccine
JF - Vaccine
IS - 46
ER -