'Learn from the lessons and don't forget them': identifying transferable lessons for COVID-19 from meningitis A, yellow fever and Ebola virus disease vaccination campaigns

Social and Behavioural Change Communication Challenges, Opportunities and Lessons from Past Public Health Emergencies and Disease Outbreaks: A Scoping Review

Background: Documentation of social behavioural change communication (SBCC) regarding challenges, opportunities and lessons drawn from past public health emergencies is worthwhile to inform priorities for future response efforts. Aim: The aim of this review is to scope the evidence on social behavioural change communication regarding challenges, opportunities and lessons drawn from Ebola, coronavirus disease 2019 (COVID-19), monkeypox and cholera outbreaks from studies published before March 2024, and suggest priorities for future response efforts. Methods: A Boolean strategy was used to search electronic databases for relevant published articles, complemented by relevant studies identified from reference lists. Results: The challenges, opportunities, lessons learnt and priorities for SBCC were consistent across study contexts, showing marked variations over time. The significance of technology, infodemic management, and behavioural data generation emerged more frequently and became increasingly important over time. Identified challenges were uptake hesitancy, limited capacity to undertake infodemic management, inadequate funding and human resources for SBCC, competing priorities, parallel or conflicting interventions due to inadequate coordination, difficulties evaluating SBCC programmes and missed opportunities for integration into routine programmes. Existing supportive structures for SBCC, strong political will and participation, as well as rapid information exchange enabled by technological advancement, represented opportunities for enhancing the effectiveness of SBCC programmes. Key lessons were that a multisectoral approach and coordination, partnership and active collaboration amongst stakeholders; building/strengthening trust, target population segmentation and localization of interventions, are important for enhancing the effectiveness of SBCC programmes. Political will, involvement and participation represent the core of social behavioural change (communication) interventions during a public health emergency. Conclusion: SBCC programming for future response to public health emergencies and disease outbreaks should consider the diverse assortment of benefits, threats/challenges and opportunities brought about by technology, infodemics and behavioural data generation to be more effective.

Urgent support mechanism: saving millions of COVID-19 vaccines from expiry in Africa

Delivering COVID-19 vaccines with 4-6 weeks shelf life remains one of Africa's most pressing challenges. The Africa Centres for Disease Control and Prevention (Africa CDC) leadership recognised that COVID-19 vaccines donated to many African countries were at risk of expiry considering the short shelf life on delivery in the Member States and slow vaccine uptake rates. Thus, a streamlined rapid response system, the urgent support mechanism, was developed to assist countries accelerate COVID-19 vaccine uptake. We describe the achievements and lessons learnt during implementation of the urgent support mechanism in eight African countries. An Africa CDC team was rapidly deployed to meet with the Ministry of Health of each country alerted for COVID-19 vaccine expiry and identified national implementing partners to quickly develop operational work plans and strategies to scale up the urgent use of the vaccines. The time between the initiation of alerts to the start of the implementation was typically within 2 weeks. A total of approximately 2.5 million doses of vaccines, costing $900 000, were prevented from expiration. The urgent support has also contributed to the increased COVID-19 vaccination coverage in the Member States from 16.1% at the initiation to 25.3% at the end of the urgent support. Some of the effective strategies used by the urgent support mechanism included coordination between Africa CDC and country vaccine task forces, establishment of vaccination centres, building the capacity of routine and surge health workforce, procurement and distribution of vaccine ancillaries, staff training, advocacy and sensitisation events, and use of trusted religious scriptures and community influencers to support public health messages. The urgent support mechanism demonstrated a highly optimised process and serves as a successful example for acceleration and integration of vaccination into different healthcare delivery points.

Drivers of success in global health outcomes: A content analysis of Exemplar studies

Applying a positive outlier lens is one effective approach for generating evidence to inform global health policy, program, and funding decisions. Exemplars in Global Health (EGH) is a program that studies positive outlier countries that have made extraordinary progress in health outcomes (despite limited resources) and disseminates their successes through multiple types of outputs. To date, EGH has studied, or is studying, 14 global health topics in 28 countries. This paper aims to identify findings, summarized as themes and sub-themes, that appear among all completed EGH studies. We developed a conceptual framework and used a content analysis approach to identify the top thematic areas that appear as drivers for programmatic success across EGH studies that were completed between June 2020-May 2023. The EGH studies (N = 31) spanned six topics including under-five child mortality (n = 6), childhood stunting (n = 5), community health workers (CHW) (n = 4), vaccine delivery (n = 3), COVID-19 response (n = 6), and newborn and maternal mortality reduction (n = 7) across 19 countries in sub-Saharan Africa, Latin America, South and Central Asia, and the Caribbean regions. Top drivers of success were defined as those critical or catalytic in achieving the intended outcome. Eight key drivers were identified: (1) efficient data collection and use for decision-making, (2) strong political commitment and health leadership, (3) effective stakeholder coordination, (4) a local, connected, and capacitated workforce, (5) intentional women's empowerment and engagement, (6) effective adoption and implementation of national policies, (7) effective and sustainable financing, and (8) equitable, efficient outreach and targeting. These cross-cutting drivers span a broad range of development outcomes, sectors, and populations, and indicate a need to effectively integrate people, systems, and sectors to improve global health outcomes. Findings from this study aim to support peer learning among countries and support evidence-based decision-making for funders, policymakers, and other key stakeholders.

Vaccination coverage and adverse events following a reactive vaccination campaign against hepatitis E in Bentiu displaced persons camp, South Sudan

INTRODUCTION

Hepatitis E (HEV) genotypes 1 and 2 are the common cause of jaundice and acute viral hepatitis that can cause large-scale outbreaks. HEV infection is associated with adverse fetal outcomes and case fatality risks up to 31% among pregnant women. An efficacious three-dose recombinant vaccine (Hecolin) has been licensed in China since 2011 but until 2022, had not been used for outbreak response despite a 2015 WHO recommendation. The first ever mass vaccination campaign against hepatitis E in response to an outbreak was implemented in 2022 in Bentiu internally displaced persons camp in South Sudan targeting 27,000 residents 16-40 years old, including pregnant women.

METHODS

We conducted a vaccination coverage survey using simple random sampling from a sampling frame of all camp shelters following the third round of vaccination. For survey participants vaccinated in the third round in October, we asked about the onset of symptoms experienced within 72 hours of vaccination. During each of the three vaccination rounds, passive surveillance of adverse events following immunisation (AEFI) was put in place at vaccination sites and health facilities in Bentiu IDP camp.

RESULTS

We surveyed 1,599 individuals and found that self-reported coverage with one or more dose was 86% (95% CI 84-88%), 73% (95% CI 70-75%) with two or more doses and 58% (95% CI 55-61%) with three doses. Vaccination coverage did not differ significantly by sex or age group. We found no significant difference in coverage of at least one dose between pregnant and non-pregnant women, although coverage of at least two and three doses was 8 and 14 percentage points lower in pregnant women. The most common reasons for non-vaccination were temporary absence or unavailability, reported by 60% of unvaccinated people. Passive AEFI surveillance captured few mild AEFI, and through the survey we found that 91 (7.6%) of the 1,195 individuals reporting to have been vaccinated in October 2022 reported new symptoms starting within 72 hours after vaccination, most commonly fever, headache or fatigue.

CONCLUSIONS

We found a high coverage of at least one dose of the Hecolin vaccine following three rounds of vaccination, and no severe AEFI. The vaccine was well accepted and well tolerated in the Bentiu IDP camp community and should be considered for use in future outbreak response.

The Influence of Introducing Free Vaccination against Streptococcus pneumoniae on the Uptake of Recommended Vaccination in Poland

Since 2017, pneumococcal vaccination has evolved from a recommended chargeable vaccination to a mandatory, and therefore free, vaccination for all children. While a 10-valent vaccine is commonly used, parents have the option to use a 13-valent vaccine for a fee. This study aimed to investigate whether and how the introduction of free pneumococcal vaccination affected the uptake of recommended vaccination and to assess the association of chargeable pneumococcal vaccination with recommended vaccination. Data from 1595 vaccination record cards kept by six primary care clinics in urban and rural areas of Poland were collected and analyzed for children born between 2015 and 2018. Belonging to the clinic and the year of birth were the only inclusion criteria. Following the introduction of free universal pneumococcal vaccination, more children were vaccinated with the recommended vaccination (61.2% vs. 66.6%, p = 0.026). The most significant change was in vaccination against rotavirus (48.5% vs. 54.4%, p = 0.018) and against meningococcal B bacteria (4.8% vs. 17.0%, p < 0.001). Children who received chargeable pneumococcal vaccination were also significantly more likely to be vaccinated with recommended vaccines (54.6% vs. 75.9%, p < 0.001). In particular, this was the case for multivalent vaccinations-against rotavirus, chickenpox, and meningococcal C bacteria. Reducing the impact of the economic factor, for example, by introducing free vaccinations, should have a positive impact on the uptake of other recommended vaccinations.

The Role of Vaccination Centers in a National Mass Immunization Campaign-Policymaker Insights from the German COVID-19 Pandemic Vaccine Roll-Out

During the COVID-19 vaccination campaign, Germany, like other high-income countries, introduced mass vaccination centers for administering vaccinations. This qualitative study aimed to examine the role that these novel, temporary government healthcare structures played in a mass immunization roll-out and how they can be optimally deployed. In addition, learnings for general emergency preparedness were explored. A total of 27 high-level policymakers responsible for planning and implementing the COVID vaccination campaign at the national and state level in Germany were interviewed in May and June 2022. The semi-structured interviews were analyzed using thematic analysis. Interviewees indicated that mass vaccination structures played an essential role with respect to controllability, throughput, accessibility and openness in line with the key success criteria vaccination coverage, speed and accessibility. In contrast to the regular vaccination structures (private medical practices and occupational health services), public administration has direct authority over mass vaccination centers, allowing for reliable vaccine access prioritization and documentation. The deployment of vaccination centers should be guided by vaccine availability and demand, and vaccine requirements related to logistics, as well as local capacities, i.e., public-health-service strength and the physician density, to ensure effective, timely and equitable access. Improvements to the capacity use, scalability and flexibility of governmental vaccination structures are warranted for future pandemics.

Community engagement to support COVID-19 vaccine uptake: a living systematic review protocol

INTRODUCTION

Widespread vaccination against COVID-19 is one of the most effective ways to control, and ideally, end the global COVID-19 pandemic. Vaccine hesitancy and vaccine rates vary widely across countries and populations and are influenced by complex sociocultural, political, economic and psychological factors. Community engagement is an integral strategy within immunisation campaigns and has been shown to improve vaccine acceptance. As evidence on community engagement to support COVID-19 vaccine uptake is emerging and constantly changing, research that lessens the knowledge-to-practice gap by providing regular and up-to-date evidence on current best-practice is essential.

METHODS AND ANALYSIS

A living systematic review will be conducted which includes an initial systematic review and bimonthly review updates. Searching and screening for the review and subsequent updates will be done in four streams: a systematic search of six databases, grey literature review, preprint review and citizen sourcing. The screening will be done by a minimum of two reviewers at title/abstract and full-text in Covidence, a systematic review management software. Data will be extracted across predefined fields in an excel spreadsheet that includes information about article characteristics, context and population, community engagement approaches, and outcomes. Synthesis will occur using the convergent integrated approach. We will explore the potential to quantitatively synthesise primary outcomes depending on heterogeneity of the studies.

ETHICS AND DISSEMINATION

The initial review and subsequent bimonthly searches and their results will be disseminated transparently via open-access methods. Quarterly briefs will be shared on the reviews' social media platforms and across other interested networks and repositories. A dedicated web link will be created on the Community Health-Community of Practice site for sharing findings and obtaining feedback. A mailing list will be developed and interested parties can subscribe for updates.

PROSPERO REGISTRATION NUMBER

CRD42022301996.

The RTS,S malaria vaccine: Journey from conception to recommendation

The RTS,S malaria vaccine was recently recommended for use among children at risk in malaria endemic regions. Although significant efforts have been made to minimise malaria cases, the results of these innovations have not been totally satisfactory due to specific limitations. However, this revolutionary vaccine has a great tendency to put an end to malaria. Being the first vaccine against malaria, this commentary examines its journey from the idealisation and conception to the recommendation by the World Health Organization. The commentary also examines some of the challenges that might affect the execution of the vaccination programme in sub-Saharan Africa and other malaria endemic regions and suggest recommendations to overcome the possible them.

Role conflict, job crafting, stress and resilience among nurses during COVID‐19

Crises have the potential to heighten stress levels among frontline employees. In general, to cope with crisis‐related stress, employees often improvise or job craft to meet the demands of the crisis. In addition to this, they need resources and directions to support their innovation by lowering role conflict. During the COVID‐19 pandemic, nurses too were compelled to improvise as they struggled with multiple challenges related to the uncertainty associated with the virus and the assignment of atypical job functions. These concerns affected nurses' wellbeing and impacted their jobs. This two‐phase sequential study began with interviews (n = 14), followed by a survey (n = 152) exploring nurses' perspectives regarding this noncausality crisis and the impact of organizational variables on their stress levels. While improvisation and job crafting were found to be important for adaptive resilience, the process involved in achieving resilience ended up increasing stress for nurses. Additionally, nurses faced role conflict, which contributed to greater levels of stress. To support nurses and enhance resilience, organizations should provide resources, role direction and training for effective job crafting and orientation.

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

Despite having safe and efficacious vaccines against COVID-19, vaccine hesitancy is widespread. Although a trusted source of information, vaccine hesitancy has been reported among healthcare professionals, yet few studies have explored this phenomenon in sub-Saharan Africa. We conducted a cross-sectional survey of healthcare professionals in Sierra Leone from January to March 2022. Measures included sociodemographic/health-related information and COVID-19-related concerns. From the responses, we constructed a hesitancy (VAX) score, with higher scores implying negative attitudes or unwillingness to vaccinate. Multivariate linear regression was used to access factors associated with vaccine hesitancy. Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students). The mean VAX score was 43.27 ± 8.77, with 60.1% of respondents classified as vaccine hesitant (>50th percentile) and 13.8% as highly hesitant (>75th percentile). Worries about unforeseen future effects (76.3%), a preference for natural immunity (59.5%), and profiteering/mistrust of health authorities (53.1%) were the most common concerns. Being a medical student (β = 0.105, p = 0.011) and previously refusing a recommended vaccine (β = 0.177, p < 0.001) were predictors of COVID-19 vaccine hesitancy. Our findings call for addressing vaccine hesitancy among healthcare professionals as an essential component of strategies aimed at increasing COVID-19 vaccine uptake in this setting.

Progress with COVID-19 vaccination in the WHO African Region in 2021

INTRODUCTION

as of end 2021, ten different vaccines have received Emergency use listing by the World Health Organisation. The vaccination response to the COVID pandemic started in February 2021 in the WHO African Region. WHO proposed a national coverage target of fully vaccinated population of 40% by the end of December 2021. This manuscript attempts to review the progress in the roll-out of COVID-19 vaccination in the African Region.

METHODS

we analysed the aggregate COVID-19 vaccine uptake and utilization data from the immunisation monitoring databases set up by countries and shared with the WHO Regional Office for Africa.

RESULTS

as of 31 December 2021, a total of 340,663,156 doses of COVID-19 vaccine were received in 46 countries in the African Region. The weekly average doses administered was 4,069,934 throughout the year. In the same period, a total of 114,498,980 persons received at least one dose, and 71,862,108 people were fully vaccinated, amounting to 6.6% of the total population in the Region. Only 5 countries attained the target of 40% full vaccination coverage. Disaggregated information was not available from all countries on the number of persons vaccinated by gender, and according to the priority population groupings. A total of 102,046 cases of adverse events following immunisation (AEFIs) were reported among which 6,260 (6.1%) were labelled as severe AEFIs.

CONCLUSION

COVID-19 vaccination coverage remains very low in the African Region, with all but 5 countries missing the 40% coverage target as of December 2021. Countries, donors and partners should mobilise political will and resources towards the attainment of the coverage targets. Countries will need to implement vaccination efforts using tailored approaches to reach unreached populations. The reporting gaps indicate the need to invest on efforts to improve the capture, analysis and use of more granular program data.

Prioritization of operational research questions on COVID-19 vaccination in the African Region

Introduction

a year after the start of COVID-19 vaccination, coverage remains very low in the African Region. Different challenges and operational barriers have been documented, but countries will need to supplement the available information with operational research in order to adequately respond to practical questions regarding how best to scale up COVID-19 vaccination. We conducted a survey among immunisation program staff working in the African Region, in order to identify the high priority operational research questions relevant to COVID-19 vaccination.

Methods

proposed operational research questions categorized into six topic areas were sent to resource persons, asking them to rate according to the relevance, urgency, feasibility, and potential impact of the research questions on the progress of COVID vaccination.

Results

a total of 25 research questions have been given an average weighted rating of 75% or more by the respondents. Nine of these top priority research questions were in the area of demand generation, risk communication and community engagement while 8 questions covered the area of service delivery.

Conclusion

countries should plan for and coordinate stakeholders to ensure that relevant operational research is done to respond to the top priority research questions, with a view to influence policies and implementation of strategies.

The first year of COVID-19 vaccine roll-out in Africa: challenges and lessons learned

Introduction

in the first year following the introduction of COVID-19 vaccines, only 6.8% of the total population in the 47 countries in the WHO African Region have received full vaccination. In an emergency context, the intra-action review helps countries to assess their progress and document what has worked and not worked.

Methods

we reviewed and identified the key lessons and challenges documented in the reports from intra-action review of COVID vaccine roll out in 22 African countries.

Results

all countries documented high level political commitment, but a serious shortage of COVID-19 vaccines and funding. Seven countries identified gaps in microplanning because of lack of funding or due to the unpredictability in the type and volume of vaccine supplies. The shortage of operational funding also affected training of health workers and hampered the expansion of service delivery. The countries implemented multi-channel communications and social mobilisation activities, alongside social media engagement and social listening. However, country capacity was limited in terms of timely responding to infodemics. Hesitancy among health workers and the general population was a challenge in most of the countries.

Conclusion

countries have gained valuable experiences exploring various COVID-19 vaccination delivery models, including implementing the integration of COVID-19 vaccination within routine health care programs. There is a need to regularly monitor or do studies measuring public perceptions towards COVID-19 vaccination in order to drive the demand generation efforts, as well as use evidence in addressing hesitancy.