Vaccination decision making in low- and middle-income countries (LMICs) has become increasingly complex, particularly in the context of numerous competing health challenges. LMICs have to make difficult choices on which vaccines to prioritize for introduction while considering a wide range of factors such as disease burden, vaccine impact, vaccine characteristics, financing and health care infrastructures, whilst adapting to each country's specific contexts. Our scoping review reviewed the factors that influence decision-making among policymakers for the introduction of new vaccines in LMICs. We identified the specific data points that are factored into the decision-making process for new vaccine introduction, whilst also documenting whether there have been any changes in decision-making criteria in new vaccine introduction over the last two decades. A comprehensive database search was conducted using a search strategy consisting of key terms and Medical Subject Headings (MeSH) phrases related to policy, decision-making, vaccine introduction, immunization programmes and LMICs. Articles were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 843 articles were identified, with 34 articles retained after abstract screening, full-text screening and grading with the mixed methods appraisal tool (MMAT). The Burchett framework for new vaccine introduction was used to identify indicators for vaccine-decision making and guided data extraction. Articles in our study represented a diverse range of perspectives and methodologies. Across articles, the importance of the disease, which included disease burden, costs of disease and political prioritization, coupled with economic factors related to vaccine price, affordability and financing were the most common criteria considered for new vaccine introduction. Our review identified two additional criteria in the decision-making process for vaccine introduction that were not included in the Burchett framework: communication and sociocultural considerations. Data from this review can support informed decision-making for vaccine introduction amongst policymakers and stakeholders in LMICs.

The number of scientific climate advisory bodies is growing rapidly across European countries, including the establishment of one at the EU-level. Under the right conditions, such expert councils can help governments not only make the right climate policy decisions but also hold them accountable by boosting transparency and tracking the success (or failures) of national actions. Governments across Europe have their own specific systems for climate policy-making. Some are laid down in law with significant detail on procedures, institutional arrangements and mechanisms for both monitoring and outside input. Dedicated national advisory bodies, especially in the form of independent scientific climate councils, are both a sign of and an important enabler for more robust climate governance. They tend to operate in highly formalized and specific governance systems, but also require regular and specific governance mechanisms in order to function effectively. Download full report | EEA summary briefing An analysis of these institutions and their underlying governance contexts suggests that the effectiveness of any advisory body depends strongly on the quality of the system it is working in. In addition, a detailed look at scientific expert councils revealed that their composition, their mandate and the resources they have available all influence the extent to which they can inform policy-making. This report by Ecologic Institute and IDDRI, commissioned by the European Environment Agency (EEA), provides a comprehensive mapping of climate advisory bodies in European countries and the national governance systems in which they operate. It proposes a typology to account for the diversity of advisory bodies and a three-tiered frame by which to evaluate national climate policy-making systems. The research was based on an in-depth investigation of national policy documents and structured interviews with country experts. Key insights: National climate policy systems in Europe differ in terms of their degree of formality, specificity and accountability. The analysis identified three main tiers into which existing systems fall. The first tier countries only include essential elements required by EU or international law ('EU/UN Baseline'); while the second and third tier countries have additional functionality specific to national policy cycles, increasing the windows of opportunity for expert and stakeholder involvement ('light framework' and 'robust framework'). Increasingly, European countries have turned to national framework laws to organize climate actions, often establishing supporting advisory institutions. In total, the research found 57 advisory bodies operating in 27 European countries. These can be categorized based on their composition and degree of autonomy into four different groups: (1) 'independent, scientific councils', (2) 'in-house scientific advisory bodies', (3) 'stakeholder engagement platforms' and (4) 'stakeholder and/or inter-ministerial roundtables'. Ten countries have established independent scientific councils dedicated specifically to climate (i.e., Type 1a advisory bodies). Each council's ability to influence policy formulation is a function of their mandate (specific responsibilities and windows to be involved) and the capacity they are given (through staff and means to create visibility). Without a clear and visible role and proper resources, impact is low. Despite capacity and contextual limitations, they play a unique role, exercising a combination of watchdog, reliable information provider and convener/stakeholder outreach functions. Experience from across Europe suggests that they can be positioned to enhance the accountability of a national governance system. A preliminary version of the report was used as input for a two-day virtual workshop with representatives of national climate advisory bodies that took place on 12 and 19 November 2020. Workshop participants were invited to comment on the ongoing research and the virtual discussions provided invaluable insight into how advisory bodies operate on the ground to influence national policy-making. Most importantly, the dialogue uncovered an appetite for further exchange and the need for coordinated and cross-boundary solutions to unlock effective solutions for the transition to a climate neutral Europe. more...3 / 3Figure: Development of national climate advisory bodies in Europe 2000-2020 Ecologic Institute 20211 / 3Map: Three 'tiers' of climate governance in Europe EEA / Ecologic Institute 20212 / 3Map: Landscape of climate change advisory bodies in Europe EEA / Ecologic Institute 2021

Unsustainable growth in healthcare expenditure demands effective cost-containment policies. We review policy effectiveness using total payer expenditure as primary outcome measure. We included all OECD member states from 1970 onward. After a rigorous quality appraisal, we included 43 original studies and 18 systematic reviews that cover 341 studies. Policies most often evaluated were payment reforms (10 studies), managed care (8 studies) and cost sharing (6 studies). Despite the importance of this topic, for many widely-used policies very limited evidence is available on their effectiveness in containing healthcare costs. We found no evidence for 21 of 41 major groups of cost-containment policies. Furthermore, many evaluations displayed a high risk of bias. Therefore, policies should be more routinely and rigorously evaluated after implementation. The available high-quality evidence suggests that the cost curve may best be bent using a combination of cost sharing, managed care competition, reference pricing, generic substitution and tort reform.