Vaccine – Volume 33, Issue 1, Pages 1-276 (1 January 2015)

Volume 33, Issue 1, Pages 1-276 (1 January 2015)

Recommendations for strengthening NITAG policies in developed countries
Pages 1-2
G.W. Ricciardi, M. Toumi, G. Poland
Vaccination constitutes one of the most significant public health advancements protecting millions of people from infectious diseases worldwide and contributing to the socio-economic development of nations on a global scale. Preventative in nature, vaccines have been traditionally used with the aim of directly avoiding or reducing overall incidence, morbidity, and mortality in healthy individuals, proving vaccination is a highly cost-effective public health intervention [1]. Yet, time to effective populations’ access to new vaccines is heterogeneous and lengthy in developed countries, with an average of 6.4 years between European Marketing Authorization and effective populations’ access to new vaccines [2]. The delay in access is mainly driven by the time taken by National Immunization Technical Advisory Groups (NITAG) to issue vaccination recommendations guiding the executive policy-decisions [2]. Ricciardi et al. reported the heterogeneity in NITAG terms of reference and analytical decision frameworks that may contribute to the disparity in access to vaccination and immunization programs across developed countries [3]:
:: In a study of 13 countries, publicly available information on NITAGs’ policies and processes was very limited in most countries, but more documented in the UK, US and Germany.
:: The decision analysis frameworks that are critical for transparent, structured, reproducible and reliable decision-making, were available for a limited number of NITAGs with only two countries (Germany and the US) using a detailed and standardized methodology for reliable, robust, and reproducible assessments (the Grades of Recommendation, Assessment, Development and Evaluation – GRADE) [4], [5], [6] and [7].
:: The lack of transparency in NITAGs’ interaction with the general public and healthcare professionals deserves improvement. Few NITAGs published their meeting agendas and minutes and only the US had open meetings.

Development of a quality framework for models of cervical screening and its application to evaluations of the cost-effectiveness of HPV vaccination in developed countries
Review Article
Pages 34-51
Leonardo Simonella, Karen Canfell
HPV vaccination has now been introduced in most developed countries, but this has occurred in the context of established cervical cancer screening mechanisms which provide population-level protection against the most common HPV-related cancer. Therefore, estimating the cost-effectiveness of HPV vaccination to further reduce HPV-related disease depends in large part on the estimation of the effectiveness of the cervical screening ‘background’. The aim of this study was to systematically review and assess methods for simulating cervical screening in decision analytic models used for evaluation of HPV vaccination.
Existing quality frameworks for economic models were extended to develop a specific quality framework for models of cervical screening. This involved domains for model structure, parameterisation (data sources) and validation (consistency). A systematic review of economic evaluations of HPV vaccination was then conducted, and assessment of cervical screening model components was then performed via application of the new quality framework.
Generally, models took into account population-level cervical screening participation, but were inconsistent in their approach to modelling abnormal smear management, diagnostic evaluation and treatment of precancerous disease. There was also considerable variability in the accuracy of modelling clinical pathways and the scope of validation performed for screening-related outcomes, with focus directed towards cervical cancer targets. Only a few models comprehensively validated against observed pre-cancerous abnormalities.
Models of HPV vaccination in developed countries can be improved by further attention to the ‘background’ modelling of secondary protection via cervical screening. The quality framework developed for this review can be used to inform future HPV vaccination evaluations, including evaluations of the cost-effectiveness of male vaccination and next generation HPV vaccines, and to assess models used to evaluate new cervical screening technologies and recommendations.

Twenty-five years of the WHO vaccines prequalification programme (1987–2012): Lessons learned and future perspectives
Review Article
Pages 52-61
Nora Dellepiane, David Wood
The World Health Organization (WHO) vaccines prequalification programme was established in 1987. It is a service provided to United Nations procurement agencies to ensure that the vaccines supplied through these agencies are consistently safe and effective under conditions of use in national immunization programmes. This review describes the purpose and aims of the programme, its evolution during 25 years of existence, its added value, and its role in the context of the WHO strategy to ensure the global availability of vaccines of assured quality. The rationale for changes introduced during the implementation of the programme is provided. The paper also discusses the resources involved, both human and financial, its performance, strengths and weaknesses and steps taken to maximize its efficiency. This historical perspective is used to inform proposed future changes to the service.

What predicts postpartum pertussis booster vaccination? A controlled intervention trial
Original Research Article
Pages 228-236
Elizabeth Helen Hayles, Spring Chenoa Cooper, Nicholas Wood, John Sinn, S. Rachel Skinner
:: We immunised 70% of susceptible postpartum mothers, demonstrating that information, using either gain or loss-framing or standard factsheet, is effective at increasing uptake.
:: Perceived vaccine benefits, a vaccine recommendation and pre-existing vaccine intentions independently predicted pertussis vaccine uptake.
:: Postpartum pertussis booster vaccination can achieve high coverage (from 23% to 77%) when implemented in the hospital setting.