Understanding Public Vaccine Policymaking Through the Lens of Political Economy Analysis—Using Taiwan as an Example

Abstract

Despite the epidemiological transition from the era of communicable disease to the era of non-communicable disease (the COVID-19 pandemic notwithstanding), dengue remains a growing threat to the public health of the world. Lack of effective treatment and scalable vector control measures justify the need for investments in the development of a dengue vaccine. The thesis documents an eight-month project with Takeda Vaccine Business Unit, using political economy analysis to understand public vaccine policymaking. The field assignment experience consisted of four steps: the first step involved becoming familiar with the goals, functions, and culture of the host organization, Takeda Vaccines; this step was necessary in order to scope and adjust the focus of the deliverables appropriately. The second step focused on data collection, with Taiwan selected as the primary country for in-depth analysis of public vaccine policymaking. Several public vaccine introductions in the United States, Canada, Indonesia, and Malaysia were chosen from the literature to provide a broader context for comparison and analysis. The third step was to match the data collected on Kingdon’s multiple stream framework to demonstrate the usefulness of the framework in understanding the vaccine adoption processes. The fourth and final step, based on the aforementioned analysis, was to generate hypotheses that informed the development of a toolkit for Takeda’s branch offices to prepare for the launch of a dengue vaccine in prioritized countries. Although industry involvement in public vaccine policymaking has not been viewed as ethically appropriate by everyone, this project demonstrated that the industry plays an indispensable role in bringing a healthcare solution to a population in need. In this sense, the power of the market and its resources would be beneficial to public health. Technocrats and scientists involved in public vaccine policymaking explicitly adopt values of objective utilitarianism, while politicians adopt those of liberal egalitarianism; the combination of these two belief systems inform real-world decision-making. However, political considerations are able to trump the effects of different value principles and affect the final results of the policy decision, which would result in the decrease of transparency and consistency of the principles for vaccine policies. Existing analytical frameworks of public vaccines fall short in explaining how public vaccine policies were introduced. The combination of political science, behavioral science, and lessons from environmental health can add value to the study of public vaccine policymaking, and health agenda setting.