Priority setting for older adult vaccines in Indonesia: a multi-criteria decision analysis using SMART vaccines

BACKGROUND: Indonesia's aging population faces substantial vaccine-preventable disease burdens, while vaccine introduction decisions remain constrained by limited resources and the absence of a prioritization framework. This study prioritized vaccines for older adults in Indonesia using a structured prioritization approach. RESEARCH DESIGN AND METHODS: A multi-criteria decision analysis was conducted using the Strategic Multi-Attribute Ranking Tool for Vaccines. Influenza vaccine (IV), pneumococcal conjugate vaccine (PCV), recombinant zoster vaccine (RZV), and respiratory syncytial virus vaccine (RSVV) were assessed across 10 attributes. Stakeholders confirmed vaccine candidates, validated criteria, assigned weights, and scored vaccines. One-way sensitivity analyses and an exploratory proxy uncertainty analysis were performed to assess ranking robustness. RESULTS: Seventeen representatives from ten stakeholder institutions participated. The highest weighted attributes were quality-adjusted life years gained/disability-adjusted life years averted (14.44%), relevance to older adult public health priorities (12.78%), premature deaths averted (11.89%), net budget impact (11.44%), and cost-effectiveness (11.22%). Composite scores ranked IV first (858.25), followed by PCV (809.24), RSVV (569.39), and RZV (558.03). Rankings remained unchanged across all sensitivity and proxy uncertainty analyses. CONCLUSIONS: IV was the highest-priority vaccine for older adults in Indonesia, followed by PCV, RSVV, and RZV. This framework provides an evidence-informed basis for vaccine policy and healthy aging strategies.