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Fox AM, Choi Y, Lin L. Substantial Disparities In COVID-19 Vaccine Uptake And Unmet Immunization Demand In Low- And Middle-Income Countries. Health Aff (Millwood) 2023; 42:1697-1705. [PMID: 38048509 DOI: 10.1377/hlthaff.2023.00729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
The two primary narratives that have emerged to explain low COVID-19 vaccine uptake in low- and middle-income countries are constrained accessibility and vaccine hesitancy. However, it is unclear how much each issue contributes to low uptake. This article examines these twin barriers to access. Using global survey data from 15,696 respondents across seventeen Western Pacific and African countries, collected between May 2022 and January 2023, we estimated the unmet demand for vaccines and examined its predictors. We found that among unvaccinated respondents, by the time of the survey, 50 percent had unmet demand-meaning they were still willing to get vaccinated. Rates of unmet demand were highest in African countries and lowest in Western Pacific countries. The perceived accessibility of vaccines and respondents' age and sex were identified as consistent predictors of unmet demand. These issues suggest that inequitable supply continues to play a substantial role in limiting vaccine access. Targeted efforts to increase vaccination rates are necessary, particularly in countries with low coverage and high unmet demand. Policy efforts should address barriers to vaccine access, ensure accessibility and distribution of mRNA vaccines, and aim to overcome vaccine hesitancy-all critical factors in reducing unmet immunization demand and achieving higher vaccination rates across regions.
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Affiliation(s)
- Ashley M Fox
- Ashley M. Fox, University at Albany, State University of New York, Albany, New York
| | - Yongjin Choi
- Yongjin Choi , London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Leesa Lin
- Leesa Lin, London School of Hygiene and Tropical Medicine; Laboratory of Data Discovery for Health Limited (D24H), Pak Shek Kok, New Territories, Hong Kong; and University of Hong Kong, Pok Fu Lam, Hong Kong
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Enhancing the environmental sustainability of emergency humanitarian medical cold chains with renewable energy sources. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2023. [DOI: 10.1108/jhlscm-09-2021-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose
Emergency humanitarian medical cold chains (HMCCs) depend heavily on their supporting energy services due to end-to-end temperature requirements in volatile disaster situations. Most energy sources powering emergency HMCCs are fossil-based due to well established processes, regardless of their environmental impact. In response to the recent energy crisis and climate change, a solution to tackle this issue relies on renewable energy sources (RES), whose use has increased to promote climate resilient development. Nevertheless, RESs’ capacity to replace conventional energy services in emergency HMCCs remains poorly understood. This study aims to investigate opportunities for, and barriers to, increasing the use of RESs in emergency HMCCs, thereby enhancing their environmental sustainability.
Design/methodology/approach
Based on a review of academic and practice literature, interviews with expert practitioners on emergency HMCCs and sustainable energy, and case study examples, this research aimed to analytically generalise the phenomenon by investigating opportunities for, and barriers to, increasing the use of RESs in emergency HMCCs. The phenomenon is illustrated in a novel framework of typical HMCC, that forms a contextual basis for future research.
Findings
A conceptual framework of typical emergency HMCC shows energy-consuming sections where RES can best be increased. This research is put forth in four propositions to manage the opportunities and barriers of the transition.
Originality/value
This research is, to the best of the author’s knowledge, the first attempt to operationalise sustainability by linking energy with HMCCs’ logistical activities in complex emergency settings. The cross-findings from literature, example cases and interviews together demonstrate the need to increase the use of RES in HMCCs, and how to do it.
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Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs. ENERGY REPORTS 2022; 8. [PMCID: PMC8706030 DOI: 10.1016/j.egyr.2021.12.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The outbreaks of infectious diseases that spread across countries have generally existed for centuries. An example is the occurrence of the COVID-19 pandemic in 2020, which led to the loss of lives and economic depreciation. One of the essential ways of handling the spread of viruses is the discovery and administration of vaccines. However, the major challenges of vaccination programs are associated with the vaccine cold chain management and cold storage facilities. This paper discusses how vaccine cold chain management and cold storage technology can address the challenges of vaccination programs. Specifically, it examines different systems for preserving vaccines in either liquid or frozen form to help ensure that they are not damaged during distribution from manufacturing facilities. Furthermore, A vaccine is likely to provide very low efficacy when it is not properly stored. According to preliminary studies, the inability to store vaccine properly is partly due to the incompetency of many stakeholders, especially in technical matters. The novelty of this study is to thoroughly explore cold storage technology for a faster and more comprehensive vaccine distribution hence it is expected to be one of the reference and inspiration for stakeholders.
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Arriaga-Lorenzo P, de Jesús Maldonado-Simán E, Ramírez-Valverde R, Martínez-Hernández PA, Tirado-González DN, Saavedra-Jiménez LA. Cold chain relevance in the food safety of perishable products. FOODS AND RAW MATERIALS 2022. [DOI: 10.21603/2308-4057-2023-1-559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The food cold chain is an effective tool that allows food markets to maintain food quality and reduce losses. Poor logistics may result in foodborne disease outbreaks and greenhouse gas emissions caused by organic matter decay. The ongoing pandemic of COVID-19 makes it necessary to study the chances of SARS-CoV-2 transmissions in food products.
This study reviews cold chain logistics as a handy tool for avoiding food safety risks, including COVID-19.
The cold chain of perishables and its proper management make it possible to maintain quality and safety at any stage of the food supply chain. The technology covers each link of the food chain to prevent microbial spoilage caused by temperature fluctuations and the contamination with SARS-CoV-2 associated with perishable foods. Given the lack of knowledge in this field in Latin America, the region needs new research to determine the impact of the cold chain on perishable foodstuffs.
The perishable cold chain is only as strong as its weakest link, and the national and international markets require new traceability protocols to minimize the effect of COVID-19.
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Cattin M, Jonnalagedda S, Makohliso S, Schönenberger K. The status of refrigeration solutions for last mile vaccine delivery in low-income settings. Vaccine X 2022; 11:100184. [PMID: 35800134 PMCID: PMC9253487 DOI: 10.1016/j.jvacx.2022.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 04/20/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022] Open
Abstract
Recommendations for storage of most vaccines imply a continuous exposure to a temperature range between 0 °C and 10 °C, from the production to the administration to beneficiaries. According to the World Health Organization, more than 50% of vaccines are wasted around the world. Discontinuities of the cold chain in low-income settings where electricity is scarce contributes to this wastage. Recently, several advances have been made in cooling technologies to store and transport vaccines. This paper presents an overview of refrigeration technologies based on scientific publications, industry white papers and other grey literature. With a focus on vaccine transport, we briefly describe each refrigeration method, its best performing available devices as well as the outstanding research challenges in order to further improve its performance.
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Leungtongkum T, Laguerre O, Flick D, Denis A, Duret S, Chaomuang N. Experimental investigation of airflow and heat transfer by natural convection in an insulated box with a Phase Change Material using a Particle Image Velocimetry technique. J FOOD ENG 2022. [DOI: 10.1016/j.jfoodeng.2022.111207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yadav AK, Kumar D. A LAG-based framework to overcome the challenges of the sustainable vaccine supply chain: an integrated BWM–MARCOS approach. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2022. [DOI: 10.1108/jhlscm-09-2021-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeEach individual needs to be vaccinated to control the spread of the COVID-19 pandemic in the shortest possible time. However, the vaccine distribution with an already strained supply chain in low- and middle-income countries (LMICs) will not be effective enough to vaccinate all the population in stipulated time. The purpose of this paper is to show that there is a need to revolutionize the vaccine supply chain (VSC) by overcoming the challenges of sustainable vaccine distribution.Design/methodology/approachAn integrated lean, agile and green (LAG) framework is proposed to overcome the challenges of the sustainable vaccine supply chain (SVSC). A hybrid best worst method (BWM)–Measurement of Alternatives and Ranking According to COmpromise Solution (MARCOS) methodology is designed to analyze the challenges and solutions.FindingsThe analysis shows that vaccine wastage is the most critical challenge for SVSC, and the coordination among stakeholders is the most significant solution followed by effective management support.Social implicationsThe result of the analysis can help the health care organizations (HCOs) to manage the VSC. The effective vaccination in stipulated time will help control the further spread of the virus, which will result in the normalcy of business and availability of livelihood for millions of people.Originality/valueTo the best of the author's knowledge, this is the first study to explore sustainability in VSC by considering the environmental and social impact of vaccination. The LAG-based framework is also a new approach in VSC to find the solution for existing challenges.
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Qrunfleh S, Vivek S, Merz R, Mathivathanan D. Mitigation themes in supply chain research during the COVID-19 pandemic: a systematic literature review. BENCHMARKING-AN INTERNATIONAL JOURNAL 2022. [DOI: 10.1108/bij-11-2021-0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to understand the themes and direction of supply chain mitigation and resilience research during the COVID-19 pandemic by conducting a systematic literature review (SLR) of supply chain mitigation literature since pandemic.Design/methodology/approachThis study uses the Web of Science (WoS) Database to analyze the contribution in supply chain mitigation literature by authors, themes in supply chain mitigation and the citing articles. An investigation based on bibliometric approach for the SLR represents the bibliographic data of over 530 publications between the years 2020–2021. Additionally, the article also develops graphical visualizations of the bibliographic data analyzed using the R-program Bibliometrix to ascertain the top sources, authors, keywords and conceptual themes.FindingsMost strategies in the existing literature focused on reactive approaches to supply chain disruption and current mitigation literature has not evolved in parallel to the changing macro environment leaving a wide gap in considering vaccines as a supply chain mitigation strategy. Hence, this study identifies the potential need to focus on building proactive supply chain mitigation strategies preferably by studying the role of vaccines in mitigating supply chains.Practical implicationsThis article helps the reader to understand the scientific research in terms of contributions in supply chain mitigation research since pandemic. Though, the time frame considered limits the connection the findings to previous work on supply chain disruptions and mitigation, it offers an understanding of the various mitigation themes evolved in light of mitigating the supply chain disruptions as one caused by the current pandemic. Further, this research helps us understand how businesses can help reduce the social consequences by preventing the disruptions and helping life normalize during this ongoing COVID-19 pandemic.Originality/valueThis is the first of its kind contribution offering a SLR of supply chain mitigation strategies during the COVID-19 pandemic identifying the focal themes in current literature and establishing the need for future venues of research studying the role of vaccines in supply chain mitigation strategies.
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Yadav AK, Kumar D. A fuzzy decision framework of lean-agile-green (LAG) practices for sustainable vaccine supply chain. INTERNATIONAL JOURNAL OF PRODUCTIVITY AND PERFORMANCE MANAGEMENT 2022. [DOI: 10.1108/ijppm-10-2021-0590] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PurposeThe already-strained vaccine supply chain (VSC) of the expanded program for immunization (EPI) require a more robust and structured distribution network for pandemic/outbreak vaccination due to huge volume demand and time constraint. In this paper, a lean-agile-green (LAG) practices approach is proposed to improve the operational, economic and environmental efficiency of the VSC.Design/methodology/approachA fuzzy decision framework of importance performance analysis (IPA)–analytical hierarchy process (AHP)–technique for order for preference by similarity in ideal solution (TOPSIS) has been presented in this paper to prioritize the LAG practices on the basis of the influence on performance indicators. Sensitivity analysis is carried out to check the robustness of the presented model.FindingsThe derived result indicates that sustainable packaging, coordination among supply chain stakeholders and cold chain technology improvement are among the top practices affecting most of the performance parameters of VSC. The sensitivity analysis reveals that the priority of practices is highly dependent on the weightage of performance indicators.Practical implicationsThis study's finding will help policymakers reframe strategies for sustainable VSC (SVSC) by including new management practices that can handle regular immunization programs as well as emergency mass vaccination.Originality/valueTo the best of the authors' knowledge, this is the first study that proposes the LAG framework for SVSC. The IPA–Fuzzy AHP (FAHP)–Fuzyy TOPSIS (FTOPSIS) is also a novel combination in decision-making.
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11
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Holloway C, Morgado Ramirez DZ, Bhatnagar T, Oldfrey B, Morjaria P, Moulic SG, Ebuenyi ID, Barbareschi G, Meeks F, Massie J, Ramos-Barajas F, McVeigh J, Keane K, Torrens G, Rao PVM, MacLachlan M, Austin V, Kattel R, Metcalf CD, Sujatha S. A review of innovation strategies and processes to improve access to AT: Looking ahead to open innovation ecosystems. Assist Technol 2021; 33:68-86. [PMID: 34951825 DOI: 10.1080/10400435.2021.1970653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
It is essential to understand the strategies and processes which are deployed currently across the Assistive Technology (AT) space toward measuring innovation. The main aim of this paper is to identify functional innovation strategies and processes which are being or can be deployed in the AT space to increase access to AT globally. We conducted a scoping review of innovation strategies and processes in peer-reviewed literature databases and complemented this by identifying case studies demonstrating innovation strategies. The review includes WHO world region, publication year, AT type and a sector analysis against the Systems-Market for Assistive and Related Technologies Framework. We analyzed the case studies and interviews using thematic analysis. We included 91 papers out of 3,127 after review along with 72 case studies. Our results showed that product innovations were more prevalent than provision or supply innovations across papers and case studies. Case studies yielded two themes: open innovation (OI); radical and disruptive innovation. Financial instruments which encourage OI are needed and we recommend pursuing OI for AT innovation. Embedding AT within larger societal missions will be key to success governments and investors need to understand what AT is and their translational socioeconomic value.
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Affiliation(s)
- Catherine Holloway
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK.,Global Disability Innovation Hub, London, UK
| | - Dafne Zuleima Morgado Ramirez
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK.,Global Disability Innovation Hub, London, UK
| | - Tigmanshu Bhatnagar
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK.,Global Disability Innovation Hub, London, UK
| | - Ben Oldfrey
- Global Disability Innovation Hub, London, UK.,Institute of Making, University College London, London, UK
| | - Priya Morjaria
- Global Disability Innovation Hub, London, UK.,International Centre for Eye Health (ICEH), London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ikenna D Ebuenyi
- Assisting Living & Learning (All) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Giulia Barbareschi
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK.,Global Disability Innovation Hub, London, UK
| | - Fiona Meeks
- Institute for Innovation and Entrepreneurship, Loughborough University London, London, UK
| | - Jessica Massie
- International Centre for Eye Health (ICEH), London School of Hygiene and Tropical Medicine, London, UK
| | - Felipe Ramos-Barajas
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK.,Global Disability Innovation Hub, London, UK
| | - Joanne McVeigh
- Assisting Living & Learning (All) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Kyle Keane
- Sinha Lab, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - George Torrens
- School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - P V M Rao
- Department of Design, IIT Delhi, New Delhi, India
| | - Malcolm MacLachlan
- Assisting Living & Learning (All) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Victoria Austin
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK.,Global Disability Innovation Hub, London, UK
| | - Rainer Kattel
- Institute for Innovation and Public Purpose, University College London, London, UK
| | - Cheryl D Metcalf
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Srinivasan Sujatha
- TTK Center for Rehabilitation Research and Device Development (R2d2), Department of Mechanical Engineering, Iit Madras, Chennai, India
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Lugelo A, Hampson K, Czupryna A, Bigambo M, McElhinney LM, Marston DA, Kazwala R, Lankester F. Investigating the Efficacy of a Canine Rabies Vaccine Following Storage Outside of the Cold-Chain in a Passive Cooling Device. Front Vet Sci 2021; 8:728271. [PMID: 34660765 PMCID: PMC8511528 DOI: 10.3389/fvets.2021.728271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Thermostable vaccines greatly improved the reach and impact of large-scale programmes to eliminate infectious diseases such as smallpox, polio, and rinderpest. A study from 2015 demonstrated that the potency of the Nobivac® Rabies vaccine was not impacted following experimental storage at 30°C for 3 months. Whether the vaccine would remain efficacious following storage under more natural, fluctuating temperature conditions remains unknown. We carried out a randomised controlled non-inferiority trial to compare serological responses in dogs following vaccination with doses stored under cold chain conditions with those stored within a locally made Passive Cooling Device ("Zeepot") under fluctuating temperature conditions. Materials and Methods: Nobivac® Rabies vaccine was stored under either cold-chain conditions or within the Zeepot for 2 months. Daily ambient temperatures and temperatures within the Zeepot were recorded every 3 h. Following storage, 412 domestic dogs were randomly assigned to receive either cold-chain or Zeepot stored Nobivac® Rabies vaccine. Baseline and day 28-post vaccination blood samples were collected. Serological analysis using the Fluorescent Antibody Virus Neutralisation assay was carried out with a threshold of 0.5 IU/ml to determine seroconversion. In addition, the impact of dog Body Condition Score, sex, and age on seroconversion was examined. Results: The serological response of dogs vaccinated using Nobivac® Rabies vaccine stored within the Zeepot was not inferior to the response of dogs vaccinated using cold-chain stored vaccine (z = 1.1, df = 313, p-value = 0.25). Indeed, the 28-day post-vaccination group geometric mean titre was 1.8 and 2.0 IU/ml for cold-chain vs. non-cold-chain storage, respectively. Moreover, the percentage of dogs that seroconverted in each arm was almost identical (85%). There was a positive linear trend between Body Condition Score (O.R. 2.2, 95% CI: 1.1-5.1) and seroconversion, suggesting dogs of poor condition may not respond as expected to vaccination. Conclusions: Our study demonstrated the potency of Nobivac® Rabies vaccine is not impacted following storage under elevated fluctuating temperatures within a Zeepot. These results have potentially exciting applications for scaling up mass dog vaccination programmes in low-and-middle income countries, particularly for hard-to-reach populations with limited access to power and cold-chain vaccine storage.
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Affiliation(s)
- Ahmed Lugelo
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Anna Czupryna
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | - Rudovick Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Felix Lankester
- Global Animal Health Tanzania, Arusha, Tanzania
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
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Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
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Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
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Kitamura T, Bouakhasith V, Phounphenghack K, Pathammavong C, Xeuatvongsa A, Kobayashi A, Norizuki M, Okabayashi H, Miyano S, Mori Y, Takeda M, Sugiyama M, Mizokami M, Machida M, Hachiya M. Vaccine temperature management in Lao People's Democratic Republic: A nationwide cross-sectional study. Heliyon 2021; 7:e07342. [PMID: 34307926 PMCID: PMC8258653 DOI: 10.1016/j.heliyon.2021.e07342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the duration and frequency of vaccine exposure to suboptimal temperatures during transit from the central vaccine storage in the capital to health centers in Lao PDR. METHODS Temperature data loggers traveled from the capital to the health centre storages (146) with the vaccines to monitor the vaccine temperature nationwide. One health centre per district was selected using a simple random sampling method for the first round of temperature monitoring. One health centre was selected from every forty-nine high risk districts monitor the trend of vaccine temperature at the health centre storage and during outreach sessions in several districts. Vaccines and temperature data loggers were transported using the normal vaccination transportation. FINDINGS Overall, the vaccines were exposed to temperatures >8 °C for an average of 1648 min, equivalent to 9.0% of the observational period, and to temperatures <0 °C for an average of 184 min, equivalent to 1.35% of the study period. The proportion of exposure to temperatures >8 °C was the highest during the transit from the capital to the province. The proportion of exposure to temperatures <0 °C was the highest during storage at district level. Examined by region, vaccines in the northern provinces had higher risk of exposure to temperatures >8 °C; however, the risk of exposure to temperatures <0 °C was scattered nationwide. Moreover, some health centers showed fluctuations in storage temperature. CONCLUSIONS Challenges associated with cold chain management, and the resulting deterioration of vaccines, might account for outbreaks of vaccine-preventable diseases. The government should examine and invest in suitable technologies and approaches to ensure consistency in cold chain management.
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Affiliation(s)
- Tomomi Kitamura
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | | | | | | | | | - Akiko Kobayashi
- School of International Health, Graduate School of Medicine, University of Tokyo, Tokyo, 113-8654, Japan
| | - Masataro Norizuki
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | - Hironori Okabayashi
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | - Shinsuke Miyano
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | - Yoshio Mori
- National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Makoto Takeda
- National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Masaya Sugiyama
- Genome Medical Sciences Project, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Munehito Machida
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Ishikawa, Kanazawa, 9208640, Japan
| | - Masahiko Hachiya
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
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Masresha B, Dochez C, Bumgarner A, Pienkowski N, Mihigo R. The World Health Organization African regional training course for mid-level immunization managers: lessons and future directions. Pan Afr Med J 2021; 37:194. [PMID: 33505563 PMCID: PMC7813645 DOI: 10.11604/pamj.2020.37.194.26295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022] Open
Abstract
The World Health Organization (WHO) African regional training course for mid-level managers (MLM) of immunization programs launched in 2004, has undergone revisions across the years, to accommodate new developments in the field. In 2016, the WHO African regional office conducted a thorough review of the course materials and delivery methods to document lessons to help improve the course. Some of the gaps included inappropriate selection of trainees, inadequate focus on skills development, heavy reliance on text and presentations, as well as resource limitations to reach a critical mass of learners. The regional office worked with Bull City Learning to redesign the course materials along carefully crafted course objectives and curricula, and to assist facilitators to better deliver the course. In addition, the materials were converted into online learning tools. Within 10 months, a total of 3011 learners were enrolled in the online MLM training platform and earned a total of 9209 certificates. The MLM course will continue to be highly relevant as the immunization area of work expands significantly, with the addition of new vaccines, introduction of new technologies, and expanding opportunities for online learning.
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Affiliation(s)
- Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Carine Dochez
- Network for Education and Support in Immunization, University of Antwerp, Antwerp, Belgium
| | - Alice Bumgarner
- Bull City Learning™, Durham, North Carolina, United States of America
| | - Nathan Pienkowski
- Bull City Learning™, Durham, North Carolina, United States of America
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Controlling Human Rabies: The Development of an Effective, Inexpensive and Locally Made Passive Cooling Device for Storing Thermotolerant Animal Rabies Vaccines. Trop Med Infect Dis 2020; 5:tropicalmed5030130. [PMID: 32796605 PMCID: PMC7558109 DOI: 10.3390/tropicalmed5030130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Thermotolerant vaccines greatly improved the reach and impact of large-scale vaccination programs to eliminate diseases such as smallpox, polio and rinderpest. A recent study demonstrated that the potency of the Nobivac® Canine Rabies vaccine was not impacted following experimental storage at 30 °C for three months. We conducted a study to develop a passive cooling device (PCD) that could store thermotolerant vaccines under fluctuating subambient temperatures. Through a participatory process with local communities in Northern Tanzania, we developed innovative PCD designs for local manufacture. A series of field experiments were then carried out to evaluate the effectiveness of five PCDs for vaccine storage under varying climatic conditions. Following iterative improvement, a final prototype “Zeepot Clay” was developed at the cost of US$11 per unit. During a further field-testing phase over a 12-month period, the internal temperature of the device remained below 26 °C, despite ambient temperatures exceeding 42 °C. Our study thus demonstrated that locally designed PCDs have utility for storing thermotolerant rabies vaccines at subambient temperatures. These results have application for the scaling up of mass dog vaccination programs in low-and-middle income countries, particularly for hard-to-reach populations with limited access to power and cold-chain vaccine storage.
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Briggs KT, Taraban MB, Yu YB. Quality assurance at the point-of-care: Noninvasively detecting vaccine freezing variability using water proton NMR. Vaccine 2020; 38:4853-4860. [DOI: 10.1016/j.vaccine.2020.05.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/08/2020] [Accepted: 05/16/2020] [Indexed: 12/21/2022]
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Comprehensive Temperature Excursion Management Program for the Commercial Distribution of Biopharmaceutical Drug Products. J Pharm Sci 2020; 109:2131-2144. [PMID: 32315663 DOI: 10.1016/j.xphs.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/23/2022]
Abstract
Biopharmaceutical drug products may be exposed to temperatures outside of the intended storage temperature range (typically 2-8°C) during commercial distribution due to uncontrolled variables and unexpected events. Pharmaceutical companies are expected to ensure that product quality and stability are not negatively impacted by temperature excursions defined as being acceptable for the product. It is imperative that all firms involved in the distribution understand key elements of the temperature excursion management program in place to overcome the challenges of global distribution and comply with regulatory requirements. Proactive implementation of a comprehensive temperature excursion management program is expected to help achieve successful commercial distribution. In this article, important aspects related to the key elements of a comprehensive temperature excursion management program are summarized, including standard stability testing, regulatory expectations related to the justification of temperature excursions, thermal cycling studies to assess and support potential temperature excursions (including how/when thermal cycling study data is used to support temperature excursions), good distribution practices to minimize temperature excursions and use of theoretical methods/mathematical simulation models to assess temperature excursions. A comprehensive temperature excursion management program is expected to ensure product quality and help minimize, assess, and justify temperature excursions more efficiently, ensure regulatory compliance and avoid business impact caused by the loss of products or inadequate supply.
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Adamu AA, Gadanya MA, Jalo RI, Uthman OA, Nnaji CA, Bello IW, Wiysonge CS. Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study. Expert Rev Vaccines 2020; 19:395-405. [PMID: 32238070 DOI: 10.1080/14760584.2020.1750379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patent and proprietary medicine vendors (PPMVs) are widespread in communities and can potentially be used to expand access to routine immunization especially in underserved areas. In this study, we aimed to assess their readiness to implement routine immunization in Kano, Nigeria and identify factors associated with it. METHODS We conducted a cross-sectional survey of PPMVs aged 18 years and above in Kano metropolis, Nigeria, using cluster sampling technique. A 10-item Likert scale-based measure was used to estimate readiness score. The relationship between selected factors and readiness score was examined using multilevel linear modeling technique. RESULTS A total of 455 PPMVs with median age of 36 years participated in the study. The median raw score for readiness was 4.7 (IQR: 4.3 - 4-8) (maximum obtainable was 5). The mean readiness score (obtained through factor analysis) was 5.28 (SD: 0.58). Readiness score was associated with factors such as knowledge of immunization and task demand, engagement by other public health programs among others. CONCLUSION This study demonstrated the feasibility of measuring the level of readiness for implementing routine immunization among PPMVs. Given the high level of readiness, policy makers should consider the possibility of expanding access to immunization through PPMVs.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council , Tygerberg, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital , Kano, Nigeria
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital , Kano, Nigeria
| | - Olalekan A Uthman
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa.,Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School , Coventry, UK
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council , Tygerberg, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Imam W Bello
- Department of Public Health and Disease Control, Kano State Ministry of Health , Kano, Nigeria
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council , Tygerberg, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
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Prioritizing the vaccine supply chain issues of developing countries using an integrated ISM-fuzzy ANP framework. JOURNAL OF MODELLING IN MANAGEMENT 2019. [DOI: 10.1108/jm2-08-2018-0111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDelivering vaccines to the children who need them requires a supply chain that is efficient and effective. In most of the developing countries, however, the unknown and unresolved supply chain issues are causing inefficiencies in distributing vaccines. There is, therefore, a great need in such countries to recognize the issues that cause delays in vaccine delivery. With this purpose, the present study aims to identify and analyze the key issues in the supply chain of basic vaccines required to immunize children in developing countries.Design/methodology/approachBased on a field survey of three states of India, in-depth review of relevant literature and experts’ opinions, 25 key issues were recognized as factors of the vaccine supply chain (VSC) and categorized into five main domains. Using integrated interpretive structural modeling and fuzzy analytic network process approaches, the issues have been prioritized to determine their relative importance in the VSC. In addition, a sensitivity analysis has been performed to investigate the priority stability of the issues.FindingsThe results of the analysis show that among the five domains of VSC issues, the economic domain with a weight of 0.4262 is the most important domain, followed by the management (0.2672), operational (0.2222), environmental (0.0532) and social (0.0312).Research limitations/implicationsThis study focuses on the prioritization of VSC issues; therefore, the results of the present study can provide direction to the decision-makers of immunization programs of developing countries in driving their efforts and resources on eliminating the most important obstacles to design successful vaccination programs.Originality/valueTo the authors’ knowledge, this paper is first to provide a direction to the decision-makers in identifying and managing important issues through the use of an analytical approach.
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Guignard A, Praet N, Jusot V, Bakker M, Baril L. Introducing new vaccines in low- and middle-income countries: challenges and approaches. Expert Rev Vaccines 2019; 18:119-131. [PMID: 30689472 DOI: 10.1080/14760584.2019.1574224] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The number of new vaccine introductions (NVIs) in low and middle-income countries (LMICs) has markedly increased since 2010, raising challenges to often overstretched and underfunded health care systems. AREAS COVERED We present an overview of some of these challenges, focusing on programmatic decisions, delivery strategy, information and communication, pharmacovigilance and post-licensure evaluation. We also highlight field-based initiatives that may facilitate NVI. EXPERT COMMENTARY Some new vaccines targeting populations other than infants require alternative delivery strategies. NVIs impact upon existing supply chain management, in particular vaccines with novel characteristics. A lack of understanding about immunization and misconceptions may be detrimental to NVI, as well as insufficient or poorly trained health care workforce. Many barriers exist to achieving good vaccination coverage. Real-world evaluation of vaccine safety, effectiveness and impact in LMICs may be limited by lack of robust demographic and disease epidemiology data, as well as limited health care and surveillance infrastructure. A thorough planning phase is crucial to define the most suitable delivery strategy based on the vaccine's and country's specificities. A communication plan and social mobilization are essential. Implementation research and innovative approaches applied to logistics, delivery, communication and program evaluation can facilitate NVI.
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Affiliation(s)
| | | | - Viviane Jusot
- b Safety Evaluation and Risk Management , GSK , Wavre , Belgium
| | - Marina Bakker
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands.,d PHARMO Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Laurence Baril
- a Research and Development , GSK , Wavre , Belgium.,e Institut Pasteur de Madagascar , Antananarivo , Madagascar
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Affiliation(s)
- Raja Rao
- Bill & Melinda Gates Foundation, Seattle, WA, USA.
| | | | - Bruce Y Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Carey Business School, Baltimore, MD, USA
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Comes T, Bergtora Sandvik K, Van de Walle B. Cold chains, interrupted. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2018. [DOI: 10.1108/jhlscm-03-2017-0006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to analyze how far technology and information enable, facilitate or support the planning and implementation decisions in humanitarian vaccine cold chains for vaccination campaigns. The authors specifically focus on three emerging technologies that have the potential to create more flexible conditions in the field, and identify the need to further explore the link between uncertainty, information and irreversibility.
Design/methodology/approach
The authors present a basic structure for the analysis of cold chain disruptions in terms of three distinct yet connected layers of deficient infrastructure and capacity, information gaps and failures in decision making. The authors then review three humanitarian technologies and their impact on vaccine campaigns along these layers. From there, a research agenda is developed to address research gaps this review brought forward.
Findings
Three critical research gaps in the areas of technology innovation for humanitarian vaccine cold chain management are presented. The authors argue that technology to improve capacity, information and decisions need to be aligned, and that the areas of uncertainty, information and irreversibility require further investigation to achieve this alignment. In this way, the paper contributes to setting the research agenda on vaccine cold chains and connects humanitarian logistics to technology, information management and decision making.
Originality/value
This paper presents the humanitarian vaccine cold chain problem from an original angle by illuminating the implications of technology and information on the decisions made during the planning and implementation phases of a vaccine campaign. The authors develop an agenda to provide researchers and humanitarians with a perspective to improve cold chain planning and implementation at the intersection of technology, information and decisions.
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