Applying the RE-AIM framework to policy: The example of vaccine policy

Vaccines have been acknowledged as one of the most significant contributions to public health in the past century. Through mandatory vaccine policy in the United States, many vaccine-preventable diseases, such as smallpox and poliomyelitis, have resulted in a significant decline in infectious disease mortality and morbidity. However, there have been recent increases in rates of exempting out of vaccines, causing concerns for individual and community health. Maintaining this successful public health infrastructure is an important strategy for policy makers, medical providers, school officials, and parent groups. Additionally, there have been few health policy planning and evaluation frameworks developed to assess the public health impact of policy design and development, policy implementation, and policy change. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to evaluate the relative impact of changes in vaccine policy, we can assess short-term and long-term outcomes of population public health relative to a variety of infectious disease and policy scenarios. This expansion of the RE-AIM framework into the policy analysis process allows for an improved communication tool in demonstrating the impact of policy change to a wider audience. Using the example of Colorado vaccine policy, we demonstrate the application of RE-AIM framework to inform public health policy. The case study validates, through example, the applicability of the RE-AIM framework to inform the potential impact of various policy scenarios. Future application of the RE-AIM framework to vaccine policy may include the comparative effectiveness and integration of public health strategies designed to improve vaccine coverage rates.