The World Health Organization (WHO) has developed the Total System Effectiveness (TSE) framework to
assist national policy-makers in prioritizing vaccines. The pilot was launched in Thailand to explore the potential use of
TSE in a country with established governance structures and accountable decision-making processes for immunization
policy. While the existing literature informs vaccine adoption decisions in GAVI-eligible countries, this study attempts
to address a gap in the literature by examining the policy process of a non-GAVI eligible country.


A rotavirus vaccine (RVV) test case was used to compare the decision criteria made by the existing processes
(Expanded Program on Immunization [EPI], and National List of Essential Medicines [NLEM]) for vaccine prioritization
and the TSE-pilot model, using Thailand specific data.
Results: The existing decision-making processes in Thailand and TSE were found to offer similar recommendations on
the selection of a RVV product.


The authors believe that TSE can provide a well-reasoned and step by step approach for countries, especially
low- and middle-income countries (LMICs), to develop a systematic and transparent decision-making process for
immunization policy.


Vaccine, Universal Health Coverage, Health Technology Assessment, Priority Setting, Thailand

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