A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations
A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations
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DOI：
10.1016/j.vaccine.2020.05.051
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发表时间：
2020-08-10
期刊：
影响因子：
5.5
通讯作者：
Quach, Caroline
中科院分区：
文献类型：
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作者：
Ismail, Shainoor J.;Hardy, Kendra;Quach, Caroline
为了成功执行人口层面的建议，必须全面考虑公共卫生科学，包括临床和规划因素。目前的框架可能会确定在提出循证疫苗相关建议时应审查的各种因素。然而，虽然大多数免疫指南系统地评估临床因素，如疫苗的有效性和安全性，但没有公布的框架概述如何系统地评估规划因素，如建议的伦理、公平性、可行性和可接受性。我们通过开发EEFA（伦理、公平可行性、可接受性）框架解决了这一差距，该框架由证据支持的工具提供支持，包括伦理综合过滤器、公平矩阵、可行性矩阵和可接受性矩阵。该框架和工具是基于五年的环境扫描、系统审查和调查，并通过专家和利益相关者的咨询和反馈进行完善的。对于每个规划因素，EEFA框架总结了需要考虑的最低阈值，以及何时可能需要进一步深入分析，应该考虑因素的哪些方面，如何使用支持性循证工具评估因素，以及应该咨询谁来完成评估。研究，特别是在疫苗可接受性和公平性领域的研究，证实了这些工具的效用和全面性。该框架已在加拿大成功地用于明确、及时、透明的疫苗指导，利益攸关方对其全面性、相关性和适当性有积极反馈。应用EEFA框架可以系统地考虑公共卫生科学的范围，而不会延迟提出建议，补充现有的决策框架。因此，该框架将有助于世界各地的咨询小组整合可能影响成功和及时实施全面、透明建议的关键因素，并将促进制定实用和循证免疫政策的全球目标。(C) 2020作者。Elsevier Ltd.出版。
For the successful implementation of population-level recommendations, it is critical to consider the full spectrum of public health science, including clinical and programmatic factors. Current frameworks may identify various factors that should be examined when making evidence-informed vaccine-related recommendations. However, while most immunization guidelines systematically assess clinical factors, such as efficacy and safety of vaccines, there is no published framework outlining how to systematically assess programmatic factors, such as the ethics, equity, feasibility, and acceptability of recommendations. We have addressed this gap with the development of the EEFA (Ethics, Equity Feasibility, Acceptability) Framework, supported by evidence-informed tools, including Ethics Integrated Filters, Equity Matrix, Feasibility Matrix, and an Acceptability Matrix. The Framework and tools are based on five years of environmental scans, systematic reviews and surveys, and refined by expert and stakeholder consultations and feedback. For each programmatic factor, the EEFA Framework summarizes the minimum threshold for consideration and when further in-depth analysis may be required, which aspects of the factor should be considered, how to assess the factor using the supporting evidence-informed tools, and who should be consulted to complete the assessment. Research, particularly in the fields of vaccine acceptability and equity, has validated the utility and comprehensiveness of the tools. The Framework has been successfully used in Canada for clear, timely, transparent vaccine guidance with positive stakeholder feedback on its comprehensiveness, relevance and appropriateness. Applying the EEFA Framework allows for the systematic consideration of the spectrum of public health science without a delay in recommendations, complementing existing decision-making frameworks. This Framework will therefore be useful for advisory groups worldwide to integrate critical factors that could impact the successful and timely implementation of comprehensive, transparent recommendations, and will further the global objective of developing practical and evidence-informed immunization policies. (C) 2020 The Authors. Published by Elsevier Ltd.