A Calculated Risk? Making Decisions on Stockpiling of Influenza Vaccines for Pre-Pandemic Use Open Access

Humans have been affected by periodic pandemics, or global outbreaks, of influenza for centuries. Severe influenza pandemics can lead to millions of deaths and social and economic disruption worldwide. The purpose of this dissertation was to adapt and test a decision support tool to inform the decision whether to build and maintain a stockpile of pre-pandemic influenza vaccines as part of a nation’s pandemic preparedness. This dissertation addresses the following objectives: 1) assess the role, if any, that pre-pandemic vaccine stockpiles have as a part of pandemic influenza preparedness; 2) assess the tools are available to assist decision-makers in determining whether to stockpile pre-pandemic influenza vaccines; 3) determine the critical factors decision-makers use to consider stockpiling pre-pandemic influenza vaccines; 4) assess the performance of a decision support tool for stockpiling pre-pandemic vaccine; and 5) evaluate alternatives for pandemic influenza preparedness.I explored the context of influenza, influenza vaccines and pandemic preparedness and review existing decision support tools related to vaccines. I reviewed theoretical frameworks that inform pandemic preparedness, including the precautionary principle. I surveyed subject matter experts for the most important attributes in considering pre-pandemic vaccine stockpiling. I used these findings to adapt and test a decision support tool, using the United States as the test case. Based on the attributes chosen by subject matter experts, the results strongly favored stockpiling pre-pandemic influenza vaccine for 20% of the population. In multiple pandemic scenarios, this largest option of pre-pandemic stockpiling consistently scored highest. This is likely due to the emphasis on health-related attributes and de-emphasis of costs by the subject matter experts in choosing important attributes to consider when making decisions about pre-pandemic vaccines. Based on these findings, I provided recommendations for improving decision support tools and how decision support tools are used – by decisionmakers, by the subject matter experts who advise them, and by stakeholders and members of the public. In considering this policy decision, I provided additional recommendations on areas of research to improve the pandemic preparedness and response options that decisionmakers have to consider. Since the purpose of pre-pandemic vaccines is to have more immediate response capability than a well-matched vaccine, I provided recommendations for other ways that response objective could be met.

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