ABSTRACT
These are unprecedented times while the world weathers the highly infectious respiratory pandemic caused by coronavirus disease-19 (COVID-19). Humanity has experienced other cataclysmic events, but something as novel as this pandemic cannot be easily described. A safe COVID-19 vaccine is often hailed as the only effective public health method to prevent the further spread of this virus. New vaccines' cost has increased even as policymakers struggle with limited resources and budget constraints. Thus, more decision-support tools are needed to facilitate the selection of vaccine manufacturers as part of a global immunization strategy against COVID-19 or other epidemics and pandemics. This study sought to address this issue by combining three well-established operational research methods (i.e., cognitive mapping, decision-making trial and evaluation laboratory, and the Choquet integral). Based on the insights provided by a panel of experts on vaccination and infectious diseases, a vaccine manufacturer selection mechanism was developed that incorporates the World Health Organization's guidelines. This approach facilitated the identification of multiple selection criteria regarding vaccine manufacturers, their allocation into six major clusters (i.e., soundness of scientific approach and technology used; speed of delivery; cost; liability and risk sharing; ability to supply sufficient quantities through production capacity development; and global solidarity), and subsequent analysis of the respective cause-and-effect relationships. The results of a real-life application of the proposed selection system were further consolidated by a member of Saint Francisco Xavier Hospital Infectious Diseases Unit in Lisbon, Portugal. The mechanism's advantages and limitations are also discussed.