The Vaccine Decision-Making Process in the UK

Where are decisions about vaccination policy being made in the UK?

Since the beginning of the COVID-19 pandemic, the topic of vaccination has become a focal point of public and political debate. Due to its presence and relevance, FASresearch has turned its attention to the question of where decisions about vaccination policy are being made: Which are the crucial institutions regarding the issue of vaccination? Who are the relevant stakeholders here, and what is their environment like?

FASresearch has already conducted several such network analyses on the German health care system, and in 2022, took a closer look at decision-making institutions in the United Kingdom. The network-analytical perspective makes it possible to advance from a mere list of actors to a map of relationships and key players and enables evidence-based conclusions.

To do this, FASresearch used a combination of desktop research, expert recommendations, and internal databases to create a network of 535 institutions relevant to immunization and vaccination policy in the United Kingdom. The institution-based and therefore anonymous network of vaccination decision-makers can be explained in terms of three playing fields that operate according to the logic of different "currencies": The playing field of scientific and clinical advisors, the playing field of decision-makers, and the playing field of implementers.

Playing field 1: Who are the key players in the clinical and scientific field?

First, there is the tightly-knit environment of scientific and clinical advisors, with the Joint Committee on Vaccination and Immunisation (JCVI) at its heart. The JCVI advises health departments of the UK and the devolved nations on immunisation based on consideration of scientific evidence. It is largely made up of scientists, academics, and clinical experts, and is therefore strongly embedded in the UK’s scientific community with actors such as the National Institute for Health and Care Excellence (NICE). In this realm, the currency that players bargain with is that of scientific impact – publications, collaborations, co-development of products and clinical expertise. Accordingly, a co-publishing analysis was conducted that looked into scientific publications on vaccination and immunisation between 2017 and 2022. The Oxford Vaccine Group, the Vaccine Institute at St George’s University, and the Bristol Children's Vaccine Centre employ the top three scientists, with the latter and the first also employing JCVI members (as of March 2022).

Playing field 2: Who are the decision-makers on the policy field?

On the policy side, the UK Health Security Agency (UKHSA; the executive agency for public health that replaced Public Health England in 2021), the Scientific Advisory Group for Emergencies (SAGE), and the Department of Health and Social Care lead the list of decision-makers. Their environment consists of UKHSA sub-departments and affiliated government agencies such as the Government Office for Science or the Medicines and the Healthcare products Regulatory Agency (MHRA) on the one hand and important institutions of British politics such as the House of Commons, the House of Lords, and vaccine-relevant All-Party Parliamentary Groups (APPGs) on the other. Since the decision-making power is institutionally endowed, they are much less reliant on collaboration and networking compared to the scientific playing field and are more loosely connected. Their currency is the opportunity to be present at the negotiating table and to influence debates and decisions.

Playing field 3: Who are the implementers?

In the area of implementation, institutions such as NHS England & Improvement (NHSE&I) and their counterparts in Northern Ireland, Wales and Scotland are the key players. They set implementation standards, seek to secure resources, and put decision into practice.

The playing fields can be distinguished from one another in the network map, but they also overlap. Certain institutions also find themselves simultaneously in two or more playing fields. The Ministry of Health, for example, acts both as a decision maker and as an implementer. One crucial space of multiple currencies at the intersection of the playing fields is the JCVI meetings: Here, decision-makers engage, interact and exchange information with the scientific advisors and implementers. Anyone who engages with these fields should thus be aware of the currencies the different players bargain with.

Recommendation

Stakeholders interested in vaccination policy are therefore well advised to follow these institutional and personnel changes closely. This is because the network of vaccine decision-makers is a network in flux:

• The UKHSA did not replace Public Health England until 2021
• The NHS has recently been restructured and reshuffled,
• There is a lot of personnel movement in both the Department of Health and the JCVI, which is due to have a new chair next year (2023).