Assessment of the comprehensiveness of paediatric national immunisation programmes in Europe: expert validation and future perspectives

Figures & data

Table 1. Geographical distribution of recruited experts, by clusters outlined in Laigle et al., (2021) [6].

	Cluster 1	Cluster 2	Cluster 3	Cluster 4*	Cluster 5
Cluster	National and regional decision-making and mandatory funding	National decision-making and national tendering	Individual reimbursement	National decision-making and mandatory funding (GDP higher)	National decision-making and mandatory funding (GDP lower)
Experts	N=3 from Spain N=2 from Italy	N=5 from the UK	N=2 from France N=2 from Greece	N=3 from the Netherlands N=1 from Austria	N=4 from Portugal N=1 from Poland
Total (N=23)	5	5	4	4	5

Table 2. Overview of all statements which reached consensus across the two Delphi surveys and consensus meeting.

Area of survey	Consensus statement
Key concepts for consideration of the comprehensiveness of pediatric NIPs in Europe	The number of preventable diseases covered by an NIP is an important element when considering the comprehensiveness of a pediatric NIP.*
	Simplification of the calendar (combination vaccines vs. single shots) is an important element when considering the comprehensiveness of a pediatric NIP.*
	Strengthened protection by using the vaccine with incremental benefit (vaccines with broadest serotype coverage) is an important element when considering the comprehensiveness of a pediatric NIP.
	The degree of funding (fully funded/partially funded/out of pocket) is an important element when considering the comprehensiveness of a pediatric NIP.
	Funding (recommended not funded vs. recommended and funded vaccines) is an important element when considering the comprehensiveness of a pediatric NIP.
	It is crucial that epidemiological factors should be considered when assessing the comprehensiveness of a pediatric vaccination calendar.
Overview and recap on PEDVAC assessment	Human papillomavirus (HPV) should be included within the baseline antigen bucket.
	Adolescent vaccines (for example for HPV, tetanus, diphtheria, and pertussis or meningococcal vaccines) should be included in the baseline antigen bucket.
	The PEDVAC assessment should be extended to consider populations up to 18 years, to provide a more reliable overview of the comprehensiveness of a NIP.
	Meningococcal disease should be included in the baseline bucket.
	Rotavirus should be included within the baseline bucket.
	Varicella should remain in the extended bucket.
	Influenza should remain in the extended bucket.
Exploration of the PEDVAC scoring system for assessing the comprehensiveness of a NIP	The values assigned for absence, recommendation and recommendations and funding were appropriate for the baseline bucket.*
	The weighting of the extended bucket should not be equal to the baseline bucket.^†
Enhancement score assignment	The suggested enhancement score of 20% for adding antigens together in combination vaccines, is appropriate.
	The suggested enhancement score of 25% for strengthening protection by increasing valencies, is appropriate.
	The suggested enhancement score of 50% for extension of an NIP to universal populations, is appropriate.
	A model “ideal vaccination calendar” should be developed for the EU. Countries with NIPs that follow the calendar, or adhere to it closely, would have a greater score.
	The assigned enhancement scores would not need to be re-validated if enhancement scores were altered because of elements which experts agreed were important/not important were added/removed from the PEDVAC assessment.
Dividing NIPs	The ranges presented in the tiers were appropriate/did not require changes.*
	The values assigned for tier 1 (25 to 33.525) are appropriate.*
	The values assigned for tier 2 (16.5 to <25) are appropriate.
	The values assigned for tier 3 (<16.5) are appropriate.
	The number of tiers presented are appropriate.

*Consensus reached in the first-round.

^†While there was no consensus that the values assigned for the extended bucket were “appropriate,” the panel did reach consensus that the extended scores should not be equal to the baseline bucket.

HPV: Human papillomavirus; NIP: National Immunization Program.

Table 3. Updated assignment of antigens in baseline and extended buckets.

Bucket	Disease	Score per individual antigen (recommended in NIP)	Score per individual antigen (recommended and funded in the NIP)
Baseline	Poliomyelitis, Tetanus, Diphtheria, Measles, Pertussis, Rubella, Hepatitis B, Mumps, Haemophilus Influenzae Type B, Pneumococcal disease, Tuberculosis, Rotavirus infection*, Meningococcal disease (subtypes C/B/ACWY)*, Human Papilloma Virus*	0.5	1.5
Extended	Varicella, Influenza	1.5	3

*Antigens which moved from the extended bucket to the baseline bucket following attainment of consensus through early survey rounds and discussions within the consensus meeting.

NIP: National Immunization Program.

Table 4. Updated assignment of enhancement scores.

Criteria	%	Scope	Bucket and scoring impact
Extension of NIP to universal population	+50%	Varicella (universal vs at-risk)	+50% of extended score = 1.5pts
		Rotavirus (universal vs at-risk)	+50% of baseline score = 0.75pts
		HPV (gender-neutral vs female only)	+50% of baseline score = 0.75pts
Schedule simplification by combination usage	+20%	Hexa vs Penta	+20% of HepB baseline score = 0.30pts
Strengthening protection by increasing serotypes/serogroups	+25%	MenACWY = MenB vs MenC + MenB	+25% of baseline score = 0.375pts
		QIV vs TIV	+25% of baseline score = 0.375pts
		PCV15 vs PCV10 9vHPV vs 2vHPV	+25% of baseline score = 0.375pts

HepB: Hepatitis B; HPV: Human Papillomavirus; MenACWY: Meningococcal Conjugate (serotypes A, C, W and Y); MenB: Meningococcal Serotypes B; MenC: Meningococcal Serotypes C; PCV: Pneumococcal Conjugate Vaccine; QIV: Quadrivalent Influenza Vaccine; TIV: Trivalent Influenza Vaccine.

Table 5. The total baseline, extended and enhancement scores for each country, used to inform the tiering within the PEDVAC framework of the assessment of the comprehensiveness of NIPs.

Country	Total baseline score	Total extended score	Total enhancement score	Total score	Tier
Albania	19.50	0.00	1.43	20.93	3.00
Austria	19.50	3.00	3.30	25.80	2.00
Belgium	19.50	0.00	2.55	22.05	2.00
Bulgaria	19.50	1.00	1.43	21.93	2.00
Croatia	18.00	0.00	1.43	19.43	3.00
Cyprus	18.00	3.00	3.30	24.30	2.00
Czech Republic	18.50	0.00	1.68	20.18	3.00
Denmark	15.00	3.00	2.25	20.25	3.00
Estonia	18.00	0.00	1.43	19.43	3.00
Finland	16.50	6.00	3.75	26.25	2.00
France	21.00	3.00	3.68	27.68	1.00
Germany	19.50	3.00	3.68	26.18	2.00
Greece	19.50	3.00	4.05	26.55	2.00
Hungary	19.50	4.00	3.00	26.50	2.00
Ireland	19.50	3.00	3.68	26.18	2.00
Italy	19.50	3.00	4.43	26.93	1.00
Latvia	19.50	6.00	4.05	29.55	1.00
Lithuania	21.00	0.00	2.55	23.55	2.00
Malta	18.00	0.00	1.80	19.80	3.00
Netherlands	19.50	0.00	1.80	21.30	2.00
Norway	18.00	0.00	2.18	20.18	3.00
Poland	20.00	2.00	1.63	23.63	2.00
Portugal	18.00	0.00	1.50	19.50	3.00
Romania	18.00	0.00	1.05	19.05	3.00
Serbia	18.00	0.00	1.50	19.50	3.00
Slovakia	16.50	0.00	1.05	17.55	3.00
Slovenia	18.00	3.00	1.80	22.80	2.00
Spain	18.00	6.00	4.43	28.43	1.00
Sweden	18.00	0.00	2.55	20.55	3.00
Switzerland	18.00	3.00	3.30	24.30	2.00
United Kingdom	19.50	3.00	3.68	26.18	2.00

Figure 1. Updated PEDVAC map.

Figure 2. PEDVAC map after the removal of HPV antigen.

Laigle V, Postma MJ, Pavlovic M, et al. Vaccine market access pathways in the EU27 and the United Kingdom− analysis and recommendations for improvements. Vaccine. 2021;39(39):5706–5718. doi: 10.1016/j.vaccine.2021.07.040

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Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.