A literature review to identify factors that determine policies for influenza vaccination

- We analyse 111 articles related to decision-making on influenza vaccination policy.
- We assess stakeholders' interactions, information used and factors of influence.
- The complex interaction between stakeholders is presented in a holistic scheme.
- The most relevant evidence for policy-making is clinical and epidemiological studies.
- Models, economic studies and ethics have greater importance since the 2009 pandemic.

ObjectivesTo conduct a literature review of influenza vaccination policy, describing roles and interactions between stakeholders and the factors influencing policy-making.MethodsMajor databases were searched using keywords related to influenza vaccination, decision-making and healthpolicy. Titles and abstracts were screened according to defined criteria using independent reviewers. Selected articles were analysed and compared against a checklist.Results342 papers were identified, but only 111 included. A wide range of countries was represented in articles published in 1994-2012. We identified numerous stakeholders at the national and international level and found a variety of interactions between them. Using these data, we suggest a scheme for the most important stakeholders and their interactions. Determinants of policy-making were mainly related to the vaccine/disease, political-economic context, and stakeholders communication. The most relevant evidence was clinical/epidemiological studies. After the 2009 pandemic: the importance of mathematical modelling and ethical issues was greater; and the need for better communication between stakeholders was emphasised.ConclusionsThe relevance of evidence and factors influencing policy-making varied between countries, according to complex interactions between the stakeholders involved at different levels of decision-making process. These interactions remain unclear, especially at national level, where the most important influenza policy decisions are made. To better define and understand the exact interactions and use of evidence, we recommend undertaking future qualitative studies at national level using small number of countries.