The Finnish decision-making process to recommend a new vaccine: From vaccine research to vaccination policy

Abstract

Aim: This article takes a closer look at the decision-making process to recommend a new vaccine in the light of the Finnish experience. Subject and methods: The criteria for evidence-based knowledge are examined in order to consider how public health decision-making in the area of immunisation evolves over time and from one context to the other on the basis of three of the more recent childhood vaccines (Haemophilus influenzae type b (Hib), seven-valent pneumococcal conjugate (PCV-7), and Human Papilloma Virus (HPV)). Results: In the case of Hib vaccine, epidemiological research concerning both direct and indirect population protection was the driving force for implementation. By contrast, PCV-7 universal vaccination was not implemented on the basis of unfavourable cost-effectiveness evaluation. However, as this evaluation took place very early on, the cost-effectiveness analysis did not consider any indirect herd effects. Regarding the HPV vaccine, it is at present considered that cervical cancer will be better prevented by enhancing the already successful PAP smear screening programme. Conclusion: Surveillance and research are valuable tools for modern vaccine programme design. Market forces and advocacy groups strongly drive the development and implementation of new vaccines, meaning that impartial and evidence-based decision-making is essential to vaccine introduction into national programmes. At the same time, economic analyses are occupying an increasingly important place in this decision-making. Vaccine costs are not necessarily compared to government expenditure on illness and disease. From a moral point of view, it should not be forgotten that children ought to have the right to best available health. © 2008 The Author(s).