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Immunization governance: Mandatory immunization in 28 Global NITAG Network countries.

ABSTRACT: International trends currently favour greater use of mandatory immunization. There has been little academic consideration or comparison of the existence and scope of mandatory immunization internationally. In this paper, we examine mandatory immunization in 28 Global NITAG (National Immunization Technical Advisory Group) Network (GNN) countries, including countries from every WHO region and World Bank income level classification. We found that although mandatory immunization programs, or mandatory elements within broader immunization programs, are relatively common, jurisdictions vary significantly with respect to the immunizations required, population groups affected, grounds for exemptions, and penalties for non-compliance. We also observed some loose associations with geography and income level. Based on these data, we categorized policies into a spectrum ranging from Narrow to Broad scope.

SUBMITTER: Harmon SHE

PROVIDER: S-EPMC7519394 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Immunization governance: Mandatory immunization in 28 Global NITAG Network countries.

Harmon Shawn H E SHE Faour David E DE MacDonald Noni E NE Graham Janice E JE Steffen Christoph C Henaff Louise L Shendale Stephanie S

Vaccine 20200926 46

International trends currently favour greater use of mandatory immunization. There has been little academic consideration or comparison of the existence and scope of mandatory immunization internationally. In this paper, we examine mandatory immunization in 28 Global NITAG (National Immunization Technical Advisory Group) Network (GNN) countries, including countries from every WHO region and World Bank income level classification. We found that although mandatory immunization programs, or mandato ...[more]

PMID: 32988691

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Project description:Since the declaration of the COVID-19 pandemic, the promotion of health equity including the health of various population sub-groups has been compromised, human rights jeopardised, and social inequities further exacerbated. Citizens worldwide, including in the Group of 20 (G20) countries, were affected by both global health governance (GHG) processes and decisions and public health measures taken by governments to respond to COVID-19. While it is critical to swiftly respond to COVID-19, little is known about how and to what extent the GHG is affecting population health priorities for health equity in global economies such as the G20 countries. This scoping review synthesised and identified knowledge gaps on how the COVID-19-related GHG is affecting population health priorities for policy, programme, and research in G20 countries. We followed the five-stage scoping review methodology promoted by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews guidelines. We searched four bibliographic databases for references conducted in G20 countries and regions and published in English and French, between January 2020 and April 2023. Out of 4,625 references and after two phases of screening, 14 studies met the inclusion criteria. G20 countries included in the review were Australia, Brazil, Canada, China, France, India, Italy, Japan, Russia, South Africa, the United Kingdom, the United States of America, and the European Union. We found insufficient collaboration and coordination and misalignment among governance actors at multiple levels. In most cases, equity considerations were not prioritised while unequal consequences of COVID-19 public health measures on population groups were widely reported. COVID-19-related population health priorities mainly focused on upstream and midstream determinants of health. Our scoping review showed the stark inequities of COVID-19 public health outcomes, coupled with a prevalent lack of coherent collaboration and coordination among governance actors. Moreover, governance as an object of empirical study is still emerging when examining its intersection with global health and population health policy, programme, and research. An urgent shift is required to effectively act upon structural health determinants that include transformative and comprehensive policies for prevention, equity, resilience, and sustainable health.

Project description:ObjectivesDespite increases in global health actors and funding levels, health inequities persist. We empirically tested whether global health governance (GHG) operates under the rational actor model (RAM) and characterised GHG power dynamics.DesignWe collected approximately 75 000 tweets of 20 key global health actors, between 2016 and 2020, using Twitter API. We generated priorities from tweets collected using topic modelling. Priorities from tweets were compared with stated priorities from content analyses of policy documents and with revealed priorities from network analyses of development assistance for health funding data. Comparing priorities derived from Twitter, policy documents and funding data, we can test whether GHG operates under RAM and characterise power dynamics in GHG.Participants20 global health actors were identified based on a consensus of three peer-reviewed articles mapping global health networks. All tweets of each actor were collected in 3-month intervals from November 2016 to May 2020. Policy documents and developmental assistance for health (DAH) financial data for each actor were collected for the same period.ResultsWe find all 20 actors and the global health system collectively fulfil the three conditions of RAM based on stated and revealed priorities. We also find compulsory and institutional power asymmetries in GHG. Funding organisations have compulsory power over channels of DAH and implementing institutions they directly fund. Funding organisations also have transitive influence over implementing institutions receiving DAH funding.ConclusionsWe find that there is a correlation between the priorities of large funders and the priorities of health actors. This correlation in conjunction with GHG operating under the RAM and the asymmetric power held by funders raises issues. GHG under the RAM grants large funders majority of the power to determine global health priorities and ultimately influencing outcomes while implementing organisations, especially those that work closest with populations, have little to limited influence in priority-setting.

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Immunization governance: Mandatory immunization in 28 Global NITAG Network countries.

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Immunization governance: Mandatory immunization in 28 Global NITAG Network countries.

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