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U of T researchers call for greater transparency in vaccine decision-making

February 4, 2015

TORONTO, ON – A group of Uni­ver­si­ty of Toron­to researchers is urg­ing the world’s health author­i­ties to over­haul the way vac­cine deci­sions are made and com­mu­ni­cat­ed, say­ing such deci­sions should no longer be made behind closed doors.

The deci­sion by gov­ern­ment author­i­ties to include new vac­cines on their coun­tries’ sched­ules should be open to pub­lic con­sul­ta­tion and input, and the process should allow greater promi­nence to eth­i­cal con­sid­er­a­tions, they argue.

Babies today receive far more pro­tec­tion from dis­ease through vac­ci­na­tion than chil­dren in pre­vi­ous gen­er­a­tions, and the dis­eases that are tar­get­ed by new­er vac­cines are now rel­a­tive­ly rare said Natasha Crow­croft, Asso­ciate Pro­fes­sor in the Depart­ment of Lab­o­ra­to­ry Med­i­cine and Patho­bi­ol­o­gy. As a result, deci­sions about whether to sched­ule addi­tion­al vac­cines are more dif­fi­cult and require more than just sci­en­tif­ic input – and the tra­di­tion­al, closed-door method of decid­ing whether a new vac­cine should be used is out­mod­ed.

“Any­thing that under­mines con­fi­dence in immu­niza­tion is a bad idea,” says Crow­croft, who is also Chief of Infec­tious Dis­eases at Pub­lic Health Ontario. “We can’t just have a group of clever peo­ple go off into a room and make a deci­sion. That process doesn’t work any­more.”

In a paper pub­lished Jan. 30 in the British Med­ical Jour­nal , Crow­croft, along with Pro­fes­sors Ross Upshur and Shel­ley Deeks of the Dal­la Lana School of Pub­lic Health, calls for an inter­na­tion­al­ly agreed-upon frame­work to pro­vide clar­i­ty about the pros and cons of adding new vac­cines to the sched­ule.

“Every coun­try is fac­ing the same deci­sion,” says Crow­croft. “It has to be inter­na­tion­al because we’re all in this togeth­er. Dis­ease cn’t be turned back at the bor­der. And every coun­try is strug­gling with the same issue – there’s a cru­cial chunk miss­ing from the deci­sion-mak­ing process which under­mines pub­lic con­fi­dence.”

The way in which British health author­i­ties han­dled the deci­sion against intro­duc­ing a new vac­cine in 2013 under­scores the need for change, accord­ing to the authors. Author­i­ties announced they were declin­ing the vac­cine for menin­gi­tis B, a rare but harsh dis­ease affect­ing babies, because it was not cost effec­tive – trig­ger­ing a pub­lic out­cry.

While it may have seemed eas­i­est to put it in strict­ly eco­nom­ic terms, in real­i­ty, the ini­tial deci­sion to turn down the vac­cine was far more com­plex, involv­ing safe­ty and effec­tive­ness con­sid­er­a­tions, says Crow­croft. But the pub­lic nev­er under­stood the nuances because such deci­sions are made behind closed doors. In the British case, this lack of trans­paren­cy led to con­spir­a­cy the­o­ries, includ­ing the idea that indus­try had undu­ly influ­enced the pro­ceed­ings.

The authors also believe that bio-ethi­cists should be involved in the deci­sion-mak­ing process ear­ly on, when the risks and ben­e­fits of a new vac­cine are being weighed. Eth­i­cal con­sid­er­a­tions, such as the oppor­tu­ni­ty cost of spend­ing health care dol­lars on vac­ci­na­tions, should be inte­gral to the assess­ment of the med­ical evi­dence and eco­nom­ic ben­e­fit of an immu­niza­tion, they argue.

The paper can be viewed at


Media con­tact

Hei­di Singer
Com­mu­ni­ca­tions and Media Rela­tions Spe­cial­ist
Office of Strat­e­gy, Com­mu­ni­ca­tions and Exter­nal Rela­tions
Temer­ty Temer­ty Fac­ul­ty of Med­i­cine
Uni­ver­si­ty of Toron­to
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