Construction of the indicator framework for vaccine inclusion of routine immunization program: A Delphi-entropy method study

Abstract Background With more and more new vaccines being developed and flooding the market, governments must decide which priority to include in public health programs. Many WHO-recommended vaccines were slow to be included into national and local routine immunization in China. We aimed to construct a comprehensive vaccine evaluation indicator framework to provide a basis for more WHO-recommended vaccines to be included in public health program. Methods We developed an indicator pool for vaccine inclusion in routine immunization through experts' consultation, literature review, and group discussion. The modified Delphi method was applied to consult 22 experts in the field of vaccines with different specialties twice to optimize the systems for inclusion at the national, provincial, municipal, and county administrative levels, each containing three-level indicator. The indicator weights at the hierarchical levels were determined subjectively and objectively through the multiplication of experts' scores and entropy weighting method. Results A total of 4 primary indicators, 17 secondary indicators, and 45 tertiary indicators were selected, which covered vaccine-preventable diseases, candidate vaccines, and social drivers on the supply and demand sides. From a subjective perspective, there was no significant difference in the weight shares of primary and secondary indicators at national, provincial, municipal, and county levels. Vaccine-preventable diseases were the priority primary indicators for inclusion. The consideration of health burden had a greater weight in the secondary indicators. From the objective perspective, the social drivers on the supply and demand sides of the primary indicators accounted for a total weighting of 65% and above. Among the secondary indicators, the candidate vaccine characteristics and vaccine-related policies on the supply side carried weights of 8% or more at both national and provincial levels. Regional demographic characteristics (13.495) and vaccine price (8.292) have prominent weights at the municipal level. The inclusion experience in other regions (10.850) held top weight as well at the county level. Conclusions The study indicates that China needs to have a different focus when considering the inclusion of WHO-recommended vaccines at the national, provincial, municipal, and county levels, and that social drivers are emerging as important indicators to be concerned about. The system will provide a tool for subsequent policy makers to determine the inclusion priority of candidate vaccines.