Vaccination program evaluation with a Multi-Criteria Decision Analysis (MCDA) tool in China: from evidence to policy

As the World Health Organization (WHO) recommends more vaccines and the proportion of domestic funding for immunization programs continues to grow, China requires a transparent and context-specific approach to support vaccine prioritization decisions for its national immunization program (NIP). This study aimed to develop an MCDA framework for vaccine evaluation and prioritization and to apply the framework to evaluate six candidate vaccines for potential inclusion in China’s NIP. A Multi-Criteria Decision Making (MCDA) framework was constructed to evaluate which vaccines should be included in the NIP. The weights for the decision-making indicators were derived using the analytic hierarchy process (AHP), the Delphi method and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method. The response rate, the authority coefficient (Cr), and Kendall’s coefficient of concordance (W) were used to evaluate expert engagement, credibility, and agreement of the Delphi process. The evaluation focused on vaccines including the Haemophilus influenzae type B (Hib) vaccine, pneumococcal conjugate vaccine (PCV), human papillomavirus (HPV) vaccine, rotavirus (RV) vaccine, influenza vaccine and varicella vaccine. While the first four are recommended by the WHO, none of these vaccines are included in China’s NIP. Eighteen experts were invited to participate in the Delphi process, and 12 completed both rounds of the survey (response rate: 66.7%). An MCDA framework was created with five first-level indicators and 13 s-level indicators. These indicators include disease burden, disease cost, vaccine characteristics, vaccine cost and vaccine feasibility. Based on AHP-derived weights, the vaccines were ranked as follows: Hib vaccine (4.251), HPV vaccine (4.152), influenza vaccine (3.263), PCV vaccine (3.231), RV vaccine (3.211) and varicella vaccine (2.852). The rankings obtained from the Delphi and TOPSIS methods yielded similar results. The MCDA tool developed in this study provides a structured and transparent approach to support vaccine prioritization discussions in China. However, the results should be interpreted considering potential variations in priorities when different epidemiological, economic, or policy contexts are considered. Future evaluations incorporating additional evidence and broader stakeholder perspectives may further improve the applicability of this framework for immunization policy decision-making.