New Vaccine Adoption: Qualitative Study of National Decision-Making Processes in Ethiopia

As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. This, one of the first studies conducted in low- and middle-income countries to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods, presents the findings in Ethiopia. Other countries in the study included Bangladesh, Cameroon, Guatemala, Kenya, Mali and South Africa.

Sixteen key informant interviews were conducted and framework analysis was used to explore issues and processes in deciding to introduce pneumococcal vaccine.

The underlying driver for adoption decisions in the country was the desire to seize GAVI windows of opportunity for funding. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritisation of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they have not always resulted in consideration of all relevant factors. As familiarity with GAVI procedures has increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished.

Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bear little resemblance to real-life decisions, which are dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed.