A systems map of the economic considerations for vaccination: Application to hard-to-reach populations.
A systems map of the economic considerations for vaccination: Application to hard-to-reach populations.
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DOI：
10.1016/j.vaccine.2021.05.033
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发表时间：
2021-11-05
期刊：
影响因子：
5.5
通讯作者：
Lee BY
中科院分区：
文献类型：
--
作者：
Cox SN;Wedlock PT;Pallas SW;Mitgang EA;Yemeke TT;Bartsch SM;Abimbola T;Sigemund SS;Wallace A;Ozawa S;Lee BY
了解疫苗接种的经济学对于制定可以在有限资源下成功使用的免疫策略至关重要，特别是在难以接触的人群中接种疫苗时。根据对24位全球免疫经济学专家的采访，我们开发了一个机制系统图（即，疫苗接种所涉及的必要步骤或组成部分）以及相关的成本和效益，重点放在提供服务一级。我们利用这一点来确定可能与难以接触的人群不同的机制。该系统图显示了决定一个人是否可以接种疫苗的不同机制，以及这样做的潜在健康和经济影响。地图分为两部分：1）疫苗接种的成本，代表接种疫苗所涉及的每种机制（n=23个疫苗接种机制），其相关的直接疫苗接种费用（n=18疫苗接种成本）和机会成本（n=5机会成本），2）疫苗接种的影响，代表疫苗接种后的机制（n=13种影响机制）、其相关的健康影响（n=10种对受益人和其他人的健康影响）和经济效益（n=13种直接和间接经济效益和成本）。如果中断或延迟，可能导致难以接触到人群的机制包括获得疫苗和关键利益攸关方（例如，疫苗接种的目的是将接种者（受益人/护理人员、疫苗接种者）送到疫苗接种点，以及在该点接种疫苗。决策者可以利用这一系统图来了解疫苗接种过程中哪些步骤可能中断或薄弱，并确定在理解疫苗接种经济学方面存在的差距。随着对全系统影响的进一步了解，该地图可以帮助决策者为有针对性的干预措施和政策提供信息，以增加难以接触到的人群的疫苗接种覆盖率。
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. 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. 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. 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.
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