Kingdon’s Multiple Streams Framework and the Analysis of Decision-Making Processes Regarding Publicly-Funded Immunization Programs.

ABSTRACT

Introduction: The implementation of a publicly-funded immunization program results from a complex decision-making process. John Kingdon’s ‘Multiple Streams Framework’ has been extensively used to analyze how and why governmental policies were adopted.

Area covered: Ideas that will ultimately end up in a proposal for a new immunization program develop gradually along three main streams: (i) the problem stream, which focuses on a particular vaccine-preventable disease and its perception by stakeholders; (ii) the policy stream, which is centered on experts’ views on the optimal use of available vaccines; and (iii) the politics stream, which consists of socio-political factors, including budgetary constraints. Ideas are progressively shaped by policy entrepreneurs into a proposal with concrete implementation strategies. The three streams then converge within a policy window, during which adoption is especially likely to occur. To survive, the proposed program should be operationally feasible, consistent with mainstream social values, and financially affordable. The timing of the policy window is usually unpredictable and of short duration.

Expert opinion: Analytical frameworks traditionally used to assess immunization programs focus on the technical aspects of the disease, the vaccine, and the program. The ‘Multiple Streams Framework’ brings added analytical value by enlarging the scope of the analysis into the political arena.

KEYWORDS:

• Decision-making
• immunization programs
• John Kingdon
• multiple streams framework
• public health policy

Article highlights

• Publicly-funded immunization programs are by definition governmental health policies.

• Their adoption is the end result of a complex process involving different actors and institutions in a particular social, political, and economic context.

• The ‘Multiple Streams Framework’ proposed by John W. Kingdon may be a useful tool to better understand their genesis.

• Ideas on new immunization programs develop along three main streams: (i) the problem: the disease; (ii) the solution: the vaccine and a program; and (iii) the politics: socio-political factors including budgetary constraints.

• The streams may converge within a policy window, during which policy adoption is especially likely to occur.

• Policy entrepreneurs play an important role in shaping ideas and setting the agenda.

Acknowledgments

The idea for the writing of this paper was provided by Yann LeBodo, Quebec Heart and Lung Institute Research Centre. Rachel Hatcher contributed significantly to the editing of the manuscript. Daniel Béland acknowledges support from the Canada Research Chairs Program.

Declaration of interest

P De Wals has received research grant and reimbursements of travel expenses from vaccine manufacturers including GlaxoSmithKline, Novartis, Pfizer, and Sanofi Pasteur. M E Espinoza-Moya has received reimbursement of travel expenses from Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was performed thanks to research funds provided by the Sherbrooke University Hospital Clinical Research Centre and Laval University, and unrestricted research grants from GlaxoSmithKline Biologicals SA, Pfizer, and Sanofi. Grants were administered by the Québec Heart and Lung Institute Research Centre. Sponsors had no role in the design of the study, in the collection, analysis and interpretation of data. Sponsors were provided the opportunity to review a preliminary version of this manuscript for factual accuracy but the authors are solely responsible for final content and approval.