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Adamu AA, Jalo RI, Muhammad ID, Essoh TA, Ndwandwe D, Wiysonge CS. Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance. Hum Vaccin Immunother 2024; 20:2320505. [PMID: 38414114 PMCID: PMC10903629 DOI: 10.1080/21645515.2024.2320505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D. Muhammad
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Regional Office for Africa, Abidjan, Cote d’Ivoire
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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2
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Tadese ZB, Nigatu AM, Yehuala TZ, Sebastian Y. Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach. Sci Rep 2024; 14:11529. [PMID: 38773175 PMCID: PMC11109113 DOI: 10.1038/s41598-024-62641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 05/20/2024] [Indexed: 05/23/2024] Open
Abstract
The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12-35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers' occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.
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Affiliation(s)
- Zinabu Bekele Tadese
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia.
| | - Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tirualem Zeleke Yehuala
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yakub Sebastian
- Department of Information Technology, Faculty of Science and Technology, Charles Darwin University, Darwin, Australia
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3
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Anteneh LM, Lokonon BE, Kakaï RG. Modelling techniques in cholera epidemiology: A systematic and critical review. Math Biosci 2024; 373:109210. [PMID: 38777029 DOI: 10.1016/j.mbs.2024.109210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Diverse modelling techniques in cholera epidemiology have been developed and used to (1) study its transmission dynamics, (2) predict and manage cholera outbreaks, and (3) assess the impact of various control and mitigation measures. In this study, we carry out a critical and systematic review of various approaches used for modelling the dynamics of cholera. Also, we discuss the strengths and weaknesses of each modelling approach. A systematic search of articles was conducted in Google Scholar, PubMed, Science Direct, and Taylor & Francis. Eligible studies were those concerned with the dynamics of cholera excluding studies focused on models for cholera transmission in animals, socio-economic factors, and genetic & molecular related studies. A total of 476 peer-reviewed articles met the inclusion criteria, with about 40% (32%) of the studies carried out in Asia (Africa). About 52%, 21%, and 9%, of the studies, were based on compartmental (e.g., SIRB), statistical (time series and regression), and spatial (spatiotemporal clustering) models, respectively, while the rest of the analysed studies used other modelling approaches such as network, machine learning and artificial intelligence, Bayesian, and agent-based approaches. Cholera modelling studies that incorporate vector/housefly transmission of the pathogen are scarce and a small portion of researchers (3.99%) considers the estimation of key epidemiological parameters. Vaccination only platform was utilized as a control measure in more than half (58%) of the studies. Research productivity in cholera epidemiological modelling studies have increased in recent years, but authors used diverse range of models. Future models should consider incorporating vector/housefly transmission of the pathogen and on the estimation of key epidemiological parameters for the transmission of cholera dynamics.
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Affiliation(s)
- Leul Mekonnen Anteneh
- Laboratoire de Biomathématiques et d'Estimations Forestières, University of Abomey-Calavi, Cotonou, Benin.
| | - Bruno Enagnon Lokonon
- Laboratoire de Biomathématiques et d'Estimations Forestières, University of Abomey-Calavi, Cotonou, Benin
| | - Romain Glèlè Kakaï
- Laboratoire de Biomathématiques et d'Estimations Forestières, University of Abomey-Calavi, Cotonou, Benin
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4
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Mentzer AJ, Dilthey AT, Pollard M, Gurdasani D, Karakoc E, Carstensen T, Muhwezi A, Cutland C, Diarra A, da Silva Antunes R, Paul S, Smits G, Wareing S, Kim H, Pomilla C, Chong AY, Brandt DYC, Nielsen R, Neaves S, Timpson N, Crinklaw A, Lindestam Arlehamn CS, Rautanen A, Kizito D, Parks T, Auckland K, Elliott KE, Mills T, Ewer K, Edwards N, Fatumo S, Webb E, Peacock S, Jeffery K, van der Klis FRM, Kaleebu P, Vijayanand P, Peters B, Sette A, Cereb N, Sirima S, Madhi SA, Elliott AM, McVean G, Hill AVS, Sandhu MS. High-resolution African HLA resource uncovers HLA-DRB1 expression effects underlying vaccine response. Nat Med 2024; 30:1384-1394. [PMID: 38740997 PMCID: PMC11108778 DOI: 10.1038/s41591-024-02944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/25/2024] [Indexed: 05/16/2024]
Abstract
How human genetic variation contributes to vaccine effectiveness in infants is unclear, and data are limited on these relationships in populations with African ancestries. We undertook genetic analyses of vaccine antibody responses in infants from Uganda (n = 1391), Burkina Faso (n = 353) and South Africa (n = 755), identifying associations between human leukocyte antigen (HLA) and antibody response for five of eight tested antigens spanning pertussis, diphtheria and hepatitis B vaccines. In addition, through HLA typing 1,702 individuals from 11 populations of African ancestry derived predominantly from the 1000 Genomes Project, we constructed an imputation resource, fine-mapping class II HLA-DR and DQ associations explaining up to 10% of antibody response variance in our infant cohorts. We observed differences in the genetic architecture of pertussis antibody response between the cohorts with African ancestries and an independent cohort with European ancestry, but found no in silico evidence of differences in HLA peptide binding affinity or breadth. Using immune cell expression quantitative trait loci datasets derived from African-ancestry samples from the 1000 Genomes Project, we found evidence of differential HLA-DRB1 expression correlating with inferred protection from pertussis following vaccination. This work suggests that HLA-DRB1 expression may play a role in vaccine response and should be considered alongside peptide selection to improve vaccine design.
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Affiliation(s)
- Alexander J Mentzer
- Centre for Human Genetics, University of Oxford, Oxford, UK.
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
| | - Alexander T Dilthey
- Centre for Human Genetics, University of Oxford, Oxford, UK
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital of Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | | | | | | | | | - Allan Muhwezi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Clare Cutland
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amidou Diarra
- Groupe de Recherche Action en Santé (GRAS) 06 BP 10248, Ouagadougou, Burkina Faso
| | | | - Sinu Paul
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Gaby Smits
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan Wareing
- Microbiology Department, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | | | | | - Amanda Y Chong
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Debora Y C Brandt
- Department of Integrative Biology, University of California at Berkeley, California, CA, USA
| | - Rasmus Nielsen
- Department of Integrative Biology, University of California at Berkeley, California, CA, USA
| | - Samuel Neaves
- Avon Longitudinal Study of Parents and Children at University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicolas Timpson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Austin Crinklaw
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | - Anna Rautanen
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Dennison Kizito
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tom Parks
- Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Kate E Elliott
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tara Mills
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Katie Ewer
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Nick Edwards
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Segun Fatumo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- The Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK
| | - Emily Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine London, London, UK
| | - Sarah Peacock
- Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Katie Jeffery
- Microbiology Department, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Bjorn Peters
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Sodiomon Sirima
- Groupe de Recherche Action en Santé (GRAS) 06 BP 10248, Ouagadougou, Burkina Faso
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine London, London, UK
| | - Gil McVean
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Adrian V S Hill
- Centre for Human Genetics, University of Oxford, Oxford, UK
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Manjinder S Sandhu
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK.
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5
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Odero CO, Othero D, Were VO, Ouma C. Trends of non-vaccination, under-vaccination and missed opportunities for vaccination (2003-2014) amongst children 0-23 months in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002906. [PMID: 38319922 PMCID: PMC10846728 DOI: 10.1371/journal.pgph.0002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Abstract
Vaccines are effective and cost-effective. Non-vaccination, under-vaccination, and missed opportunities for vaccination (MOV), have contributed to incomplete vaccination coverage in Kenya. Analyzing their trends is essential for targeting interventions and improvement strategies. This study aimed to assess trends of non-vaccination, under-vaccination, and MOV among children aged 0-23 months in Kenya using data obtained from the Kenya Demographic and Health Surveys (KDHS) conducted in 2003, 2008/09, and 2014. A two-stage, multi-stage, and stratified sampling technique was used. Weighted analysis was conducted to ensure generalizability to the full population. Using the KDHS sample size estimation process, the sample size was estimated for each indicator, with varying standard error estimates, level of coverage and estimated response rates. Final sample size was 2380 (2003), 2237 (2008/09) and 7380 (2014). To determine the level of non-vaccination, under-vaccination and MOV among children aged 0-23 months, a weighted descriptive analysis was used to estimate their prevalence, with 95% confidence intervals (CI) for each year. MOV was defined using an algorithm as a binary variable. Data coding and recoding were done using Stata (version 14; College Station, TX: StataCorp LP). Trends in proportions of non-vaccination, under-vaccination and MOV were compared between 2003, 2008/09, and 2014 using the Cochrane-Armitage trend test. All results with P≤0.05 were considered statistically significant. Trends in proportion of non-vaccination among children aged 0-23 months in Kenya was 13.2%, 6.1% and 3.2% in 2003, 2008/09 and 2014, respectively (P = 0.0001). Trends in proportion of under-vaccination among children aged 0-23 months in Kenya was 54.3%, 50% and 51.3% in 2003, 2008/09 and 2014, respectively (P = 0.0109). The trends in proportion of children who experienced MOV was 22.7% in 2003, 31.9% in 2008/09 and 37.6% in 2014 (P = 0.0001). In the study duration, non-vaccination decreased by 10%, under-vaccination remained relatively stable, and MOV increased by ~15%. There is need for the Government and partners to implement initiatives that improve vaccine access and coverage, particularly in regions with low coverage rates, and to address missed opportunities for vaccination.
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Affiliation(s)
| | - Doreen Othero
- Department of Public Health, Maseno University, Kisumu, Kenya
| | - Vincent Omondi Were
- KEMRI Wellcome-Trust Research Program, Health Economics Research Unit, Kilifi, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya
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6
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Ma F, Xu Q, Wang A, Yang D, Li Q, Guo J, Zhang L, Ou J, Li R, Yin H, Li K, Wang L, Wang Y, Zhao X, Niu X, Zhang S, Li X, Chai S, Zhang E, Rao Z, Zhang G. A universal design of restructured dimer antigens: Development of a superior vaccine against the paramyxovirus in transgenic rice. Proc Natl Acad Sci U S A 2024; 121:e2305745121. [PMID: 38236731 PMCID: PMC10823241 DOI: 10.1073/pnas.2305745121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
The development of vaccines, which induce effective immune responses while ensuring safety and affordability, remains a substantial challenge. In this study, we proposed a vaccine model of a restructured "head-to-tail" dimer to efficiently stimulate B cell response. We also demonstrate the feasibility of using this model to develop a paramyxovirus vaccine through a low-cost rice endosperm expression system. Crystal structure and small-angle X-ray scattering data showed that the restructured hemagglutinin-neuraminidase (HN) formed tetramers with fully exposed quadruple receptor binding domains and neutralizing epitopes. In comparison with the original HN antigen and three traditional commercial whole virus vaccines, the restructured HN facilitated critical epitope exposure and initiated a faster and more potent immune response. Two-dose immunization with 0.5 μg of the restructured antigen (equivalent to one-127th of a rice grain) and one-dose with 5 μg completely protected chickens against a lethal challenge of the virus. These results demonstrate that the restructured HN from transgenic rice seeds is safe, effective, low-dose useful, and inexpensive. We provide a plant platform and a simple restructured model for highly effective vaccine development.
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Affiliation(s)
- Fanshu Ma
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
- School of Advanced Agriculture Sciences, Peking University, Beijing100871, China
- Longhu Laboratory of Advanced Immunology, Zhengzhou450046, China
- College of Life Sciences, Zhengzhou University, Zhengzhou450001, China
- Chinese Academy of Sciences Key Laboratory of Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou215123, China
| | - Qianru Xu
- School of Basic Medical Sciences, Henan University, Kaifeng475004, China
| | - Aiping Wang
- College of Life Sciences, Zhengzhou University, Zhengzhou450001, China
| | - Daichang Yang
- State Key Laboratory of Hybrid Rice, College of Life Sciences, Wuhan University, Wuhan430074, China
| | - Qingmei Li
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Junqing Guo
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Longxian Zhang
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
- Longhu Laboratory of Advanced Immunology, Zhengzhou450046, China
| | - Jiquan Ou
- Wuhan Healthgen Biotechnology Corp., Wuhan430074, China
| | - Rui Li
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Heng Yin
- Wuhan Healthgen Biotechnology Corp., Wuhan430074, China
| | - Kunpeng Li
- Wuhan Healthgen Biotechnology Corp., Wuhan430074, China
| | - Li Wang
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Yanan Wang
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Xiangyue Zhao
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Xiangxiang Niu
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
| | - Shenli Zhang
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
| | - Xueyang Li
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
| | - Shujun Chai
- Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou450002, China
| | - Erqin Zhang
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
- Longhu Laboratory of Advanced Immunology, Zhengzhou450046, China
| | - Zihe Rao
- Laboratory of Structural Biology, School of Life Sciences and School of Medicine, Tsinghua University, Beijing100084, China
| | - Gaiping Zhang
- International Joint Research Center of National Animal Immunology, College of Veterinary Medicine, Henan Agricultural University, Zhengzhou450046, China
- School of Advanced Agriculture Sciences, Peking University, Beijing100871, China
- Longhu Laboratory of Advanced Immunology, Zhengzhou450046, China
- College of Life Sciences, Zhengzhou University, Zhengzhou450001, China
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Daniel A, Oloro J, Hahirwa I, Rizinde T, Mukanyangezi MF. A cross-sectional assessment of the effects of select training modalities on vaccine cold chain management. J Pharm Policy Pract 2023; 17:232-248. [PMID: 38234993 PMCID: PMC10793629 DOI: 10.1080/20523211.2023.2292717] [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] [Indexed: 01/19/2024] Open
Abstract
Background Vaccines offer arguably the most cost-effective public health intervention. Vaccine supply chain management which is a critical building block faces many Human resources challenges mainly due to the special attributes of vaccines. Objective This study attempted to measure the effect of training on vaccine cold chain handler knowledge and practices. Methods A cross-sectional research design, using predominantly quantitative data collection techniques, was used. Facilities that have offered vaccination services for more than a year and report through the HMIS system were eligible for selection. Observation checklists and structured questionnaires were used. SPSS was used to analyse data. Results Vaccine cold chain management among the study group had an average score of 65.33% range (31-85%). The average knowledge score among the study respondents was 62.42% with a range (45-95%). The knowledge of respondents generally increases with an additional increase in the number of training modalities. Conclusions The status of VCCM is at about 65.33% below the target of 80% set by the EVM. The trainings have an effect on both knowledge of handlers and their practice especially when deployed in a multi-pronged design and thus these trainings need to be aligned to achieve synergy. ABBREVIATIONS CCE, Cold Chain Equipment; DHIS2, District Health Information Systems 2; DHO, District Health Officer; DPT, Diphtheria, Pertussis, Tetanus; DVS, District Vaccine Stores; EPI, Expanded Program for Immunisation; EVM, Effective Vaccine Management; FEFO, First Expiry First Out; GAVI, Global Alliance for Vaccines and Immunisation; HMIS, Health Information Management Systems; IRC, International Rescue Committee; KII, Key Informant Interview; LIAT, logistics indicator assessment tool; PATH, Program for Appropriate Technology in Health; PHC, Primary Health Care; QPPU, Quantification and Planning and Procurement Unit; SOPs, Standard Operating Procedures; SPSS, Statistical Package for Social Sciences; UNEPI, Uganda National Expanded Program for Immunisation; UNICEF, United Nations Children's Fund; VPD, Vaccine Preventable Diseases; VVM, Vaccine Vial Monitors; WHO, World Health Organisation.
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Affiliation(s)
- Aguma Daniel
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Ministry of Health UgandaLira Regional Referral Hospital Aguma Daniel (A.D), Mbarara, Uganda
| | - Joseph Oloro
- Department of Pharmacology & Therapeutics (O.J), Mbarara University of Science & Technology, Lira, Uganda
| | - Innocent Hahirwa
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Theogene Rizinde
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Marie Francoise Mukanyangezi
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Tadesse BT, Keddy KH, Rickett NY, Zhusupbekova A, Poudyal N, Lawley T, Osman M, Dougan G, Kim JH, Lee JS, Jeon HJ, Marks F. Vaccination to Reduce Antimicrobial Resistance Burden-Data Gaps and Future Research. Clin Infect Dis 2023; 77:S597-S607. [PMID: 38118013 PMCID: PMC10732565 DOI: 10.1093/cid/ciad562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR) poses an immediate danger to global health. If unaddressed, the current upsurge in AMR threatens to reverse the achievements in reducing the infectious disease-associated mortality and morbidity associated with antimicrobial treatment. Consequently, there is an urgent need for strategies to prevent or slow the progress of AMR. Vaccines potentially contribute both directly and indirectly to combating AMR. Modeling studies have indicated significant gains from vaccination in reducing AMR burdens for specific pathogens, reducing mortality/morbidity, and economic loss. However, quantifying the real impact of vaccines in these reductions is challenging because many of the study designs used to evaluate the contribution of vaccination programs are affected by significant background confounding, and potential selection and information bias. Here, we discuss challenges in assessing vaccine impact to reduce AMR burdens and suggest potential approaches for vaccine impact evaluation nested in vaccine trials.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Trevor Lawley
- Wellcome Sanger Institute and Microbiotica, Cambridge, United Kingdom
| | - Majdi Osman
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Salo H, Sakalauskaitè M, Lévy-Bruhl D, Lindstrand A, Valentiner-Branth P, Wichmann O, Puumalainen T. Prices of paediatric vaccines in European vaccination programmes. Vaccine X 2023; 15:100392. [PMID: 37779660 PMCID: PMC10539658 DOI: 10.1016/j.jvacx.2023.100392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To compare the vaccine prices per vaccinated child under 18 and vaccine funding and procurement systems in the national vaccination programmes (NVPs) in Europe. Methods The on-line survey targeted to NVP managers collected data referred to the information available on 31 December 2016. The prices of vaccines were categorised into three groups. The price per child 1) fully vaccinated comprised all vaccines and doses offered in the NVP; 2) vaccinated with standard vaccines comprised the vaccines included in the NVP in all countries; 3) vaccinated with recent vaccines comprised the pneumococcal conjugate, human papillomavirus and rotavirus vaccines. Results In the 23 out of 32 countries that answered the survey, 17 funded the vaccines by taxes and six by social insurance. 18 countries procured the vaccines through public tenders or negotiations. Five countries purchased the vaccines by healthcare providers and reimbursed from the health insurance system.In the countries with vaccine procurement through public tenders the price per child vaccinated with standard vaccines ranged from €59 to €117 when using pentavalent and from €98 to €220 when using hexavalent vaccines. The mean price per child vaccinated with recent vaccines was €130 for the countries that offered pneumococcal conjugate and human papillomavirus vaccines and €142 for the countries that in addition included rotavirus vaccine.In the countries that purchased the vaccines by healthcare providers and reimbursed from the health insurance system the price per child vaccinated with standard vaccines ranged from €136 to €427. Conclusions The vaccine prices differ notably in Europe. Prices were lower in countries where vaccines in the NVP were tax-funded and nationally or regionally procured. Improved procurement systems could lead to substantial savings or possibilities to introduce more vaccines into the NVP.
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Affiliation(s)
- Heini Salo
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Milda Sakalauskaitè
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Daniel Lévy-Bruhl
- Santé Publique France, Agence Nationale de Santé Publique, Saint-Maurice cedex, France
| | | | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | | | - Taneli Puumalainen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department for Safety, Security and Health, Ministry of Social Affairs and Health, Helsinki, Finland
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Blyth CC, Fathima P, Pavlos R, Jacoby P, Pavy O, Geelhoed E, Richmond PC, Effler PV, Moore HC. Influenza vaccination in Western Australian children: Exploring the health benefits and cost savings of increased vaccine coverage in children. Vaccine X 2023; 15:100399. [PMID: 37908895 PMCID: PMC10613898 DOI: 10.1016/j.jvacx.2023.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction To assess potential benefits and direct healthcare cost savings with expansion of an existing childhood influenza immunisation program, we developed a dynamic transmission model for the state of Western Australia, evaluating increasing coverage in children < 5 years and routinely immunising school-aged children. Methods A deterministic compartmental Susceptible-Exposed-Infectious-Recovered age-stratified transmission model was developed and calibrated using laboratory-notification and hospitalisation data. Base case vaccine coverage estimates were derived from 2019 data and tested under moderate, low and high vaccine effectiveness settings. The impact of increased coverage on the burden of influenza, influenza-associated presentations and net costs were assessed using the transmission model and estimated health utilisation costs. Results Under base case vaccine coverage and moderate vaccine effectiveness settings, 225,460 influenza cases are expected annually across all ages. Direct healthcare costs of influenza were estimated to be A$27,608,286 per annum, dominated by hospital costs. Net cost savings of >$A1.5 million dollars were observed for every 10 % increase in vaccine coverage in children < 5 years. Additional benefits were observed by including primary school age children (5-11 years) in the funded influenza vaccination program - a reduction in cases, presentations, hospitalisations and approximately $A4 million net costs savings were observed for every 10 % increase in coverage. The further addition of older children (12-17 years) resulted in only moderate additional net cost savings figures, compared with a 5-11year-old program alone. Net costs savings were predominantly derived by a reduction in influenza-associated hospitalisation in adults. Conclusions Any increase in influenza vaccine coverage in children < 5 years, above a base case of 50 % coverage resulted in a substantive reduction in influenza cases, presentations, hospitalisations and net costs when applied to the West Australian population. However, the most impactful pediatric program, from both a disease prevention and costs perspective, would be one that increased vaccination coverage among primary-school aged children.
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Affiliation(s)
- Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia
| | - Olivia Pavy
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Elizabeth Geelhoed
- Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Immunology, Perth Children’s Hospital, Perth, WA, Australia
- Department of General Paediatrics, Perth Children’s Hospital, Perth, WA, Australia
| | - Paul V. Effler
- Communicable Disease Control Directorate, Department of Health, Perth, WA, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Ishwarlall TZ, Adeleke VT, Maharaj L, Okpeku M, Adeniyi AA, Adeleke MA. Multi-epitope vaccine candidates based on mycobacterial membrane protein large (MmpL) proteins against Mycobacterium ulcerans. Open Biol 2023; 13:230330. [PMID: 37935359 PMCID: PMC10645115 DOI: 10.1098/rsob.230330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 11/09/2023] Open
Abstract
Buruli ulcer (BU) is a neglected tropical disease. It is caused by the bacterium Mycobacterium ulcerans and is characterized by skin lesions. Several studies were performed testing the Bacillus Calmette-Guérin (BCG) vaccine in human and animal models and M. ulcerans-specific vaccines in animal models. However, there are currently no clinically accepted vaccines to prevent M. ulcerans infection. The aim of this study was to identify T-cell and B-cell epitopes from the mycobacterial membrane protein large (MmpL) proteins of M. ulcerans. These epitopes were analysed for properties including antigenicity, immunogenicity, non-allergenicity, non-toxicity, population coverage and the potential to induce cytokines. The final 8 CD8+, 12 CD4+ T-cell and 5 B-cell epitopes were antigenic, non-allergenic and non-toxic. The estimated global population coverage of the CD8+ and CD4+ epitopes was 97.71%. These epitopes were used to construct five multi-epitope vaccine constructs with different adjuvants and linker combinations. The constructs underwent further structural analyses and refinement. The constructs were then docked with Toll-like receptors. Three of the successfully docked complexes were structurally analysed. Two of the docked complexes successfully underwent molecular dynamics simulations (MDS) and post-MDS analysis. The complexes generated were found to be stable. However, experimental validation of the complexes is required.
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Affiliation(s)
- Tamara Z. Ishwarlall
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Victoria T. Adeleke
- Department of Chemical Engineering, Mangosuthu University of Technology, Umlazi, Durban, South Africa
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Adebayo A. Adeniyi
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Industrial Chemistry, Federal University Oye Ekiti, Ekiti State, Nigeria
| | - Matthew A. Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
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Bahl S, Khanal S, Sangal L, Tabassum S, Ungchusak K, Andrus J. Measles and rubella elimination: protecting children through immunization in South-East Asia Region (SEAR). THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 18:100303. [PMID: 38028171 PMCID: PMC10667283 DOI: 10.1016/j.lansea.2023.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 12/01/2023]
Abstract
The South-East Asia Region (SEAR) adopted the goal of "measles and rubella elimination by 2023". The goal was revised in 2019 to 'measles and rubella elimination by 2023' The strategies adopted to reach the goal included achieving ≥95% coverage with 2 doses of measles- and rubella-containing vaccine (MCV2; RCV2); establishing effective case-based surveillance supported by an accredited laboratory network; and implementing rapid response measures to control measles outbreaks. Of the 11 countries in the Region, to date five countries have eliminated measles and rubella and two more have controlled rubella. An estimated 242 million cases and 4.7 million deaths due to measles were averted between 2014 and 2022. The high-level political commitment, programmatic infrastructure and partnerships developed for the elimination of polio and maternal and neonatal tetanus played a critical role in this achievement. WHO, supported by key partners, provided technical support and strategic guidance for programmatic improvements, generated evidence to guide policy and strategic shifts, strengthened capacity of health workforce and conducted periodic programmatic reviews. However, unexpected occurrence of COVID-19 pandemic impacted vaccine coverage and quality of surveillance, thereby delaying achievement of the goal, and necessitating a revision of the target date of elimination.
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Affiliation(s)
- Sunil Bahl
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Sudhir Khanal
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Lucky Sangal
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Shahina Tabassum
- Member South-East Asia Regional Verification Commission for Measles and Rubella Elimination and Professor, Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kumnuan Ungchusak
- Member South-East Asia Regional Verification Commission for Measles and Rubella Elimination and Advisor, Department of Disease Control, Bangkok, Thailand
| | - Jon Andrus
- Member South-East Asia Regional Verification Commission for Measles and Rubella Elimination and Professor, Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
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13
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Ozawa S, Schuh HB, Nakamura T, Yemeke TT, Lee YFA, MacDonald NE. How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework. Vaccine 2023; 41:6710-6718. [PMID: 37798209 DOI: 10.1016/j.vaccine.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Resilience in vaccination demand is ever more critical as the COVID-19 pandemic has increased our understanding of the importance of vaccines on health and well-being. Yet timid demand for COVID-19 vaccines where available and reduced uptake of routine immunizations globally further raise the urgent need to build vaccination resilience. We demonstrate the complexity of vaccination demand and resilience in a framework where relevant dimensions are intertwined, fluid, and contextual. METHODS We developed the Vaccination Demand Resilience (VDR) framework based on a literature review on vaccination demand and expert consultation. The matrix framework builds on three main axes: 1) vaccination attitudes and beliefs; 2) vaccination seeking behavior; and 3) vaccination status. The matrix generated eight quadrants, which can help explain people's levels of vaccination demand and resilience. We selected four scenarios as examples to demonstrate different interventions that could move people across quadrants and build vaccination resilience. RESULTS Incongruence between individuals' attitudes and beliefs, vaccination behavior, and vaccination status can arise. For example, an individual can be vaccinated due to mandates but reject vaccination benefits and otherwise avoid seeking vaccination. Such incongruence could be altered by interventions to build resilience in vaccination demand. These interventions include information, education and communication to change individuals' vaccination attitudes and beliefs, incentive programs and reminder-recalls to facilitate vaccination seeking, or by strengthening healthcare provider communications to reduce missed opportunities. CONCLUSIONS Vaccination decision-making is complex. Individuals can be vaccinated without necessarily accepting the benefits of vaccination or seeking vaccination, threatening resilience in vaccination demand. The VDR framework can provide a useful lens for program managers and policy makers considering interventions and policies to improve vaccination resilience. This would help build and sustain confidence and demand for vaccinations, and help to continue to prevent disease, disability, and death from vaccine-preventable diseases.
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Affiliation(s)
- Sachiko Ozawa
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tomoka Nakamura
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Nagasaki University, School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Tatenda T Yemeke
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yi-Fang Ashley Lee
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noni E MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Demsash AW, Chereka AA, Walle AD, Kassie SY, Bekele F, Bekana T. Machine learning algorithms' application to predict childhood vaccination among children aged 12-23 months in Ethiopia: Evidence 2016 Ethiopian Demographic and Health Survey dataset. PLoS One 2023; 18:e0288867. [PMID: 37851705 PMCID: PMC10584162 DOI: 10.1371/journal.pone.0288867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/06/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Childhood vaccination is a cost-effective public health intervention to reduce child mortality and morbidity. But, vaccination coverage remains low, and previous similar studies have not focused on machine learning algorithms to predict childhood vaccination. Therefore, knowledge extraction, association rule formulation, and discovering insights from hidden patterns in vaccination data are limited. Therefore, this study aimed to predict childhood vaccination among children aged 12-23 months using the best machine learning algorithm. METHODS A cross-sectional study design with a two-stage sampling technique was used. A total of 1617 samples of living children aged 12-23 months were used from the 2016 Ethiopian Demographic and Health Survey dataset. The data was pre-processed, and 70% and 30% of the observations were used for training, and evaluating the model, respectively. Eight machine learning algorithms were included for consideration of model building and comparison. All the included algorithms were evaluated using confusion matrix elements. The synthetic minority oversampling technique was used for imbalanced data management. Informational gain value was used to select important attributes to predict childhood vaccination. The If/ then logical association was used to generate rules based on relationships among attributes, and Weka version 3.8.6 software was used to perform all the prediction analyses. RESULTS PART was the first best machine learning algorithm to predict childhood vaccination with 95.53% accuracy. J48, multilayer perceptron, and random forest models were the consecutively best machine learning algorithms to predict childhood vaccination with 89.24%, 87.20%, and 82.37% accuracy, respectively. ANC visits, institutional delivery, health facility visits, higher education, and being rich were the top five attributes to predict childhood vaccination. A total of seven rules were generated that could jointly determine the magnitude of childhood vaccination. Of these, if wealth status = 3 (Rich), adequate ANC visits = 1 (yes), and residency = 2 (Urban), then the probability of childhood vaccination would be 86.73%. CONCLUSIONS The PART, J48, multilayer perceptron, and random forest algorithms were important algorithms for predicting childhood vaccination. The findings would provide insight into childhood vaccination and serve as a framework for further studies. Strengthening mothers' ANC visits, institutional delivery, improving maternal education, and creating income opportunities for mothers could be important interventions to enhance childhood vaccination.
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Affiliation(s)
| | - Alex Ayenew Chereka
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Teshome Bekana
- Biomedical Science Department, College of Health Science, Mettu University, Mettu, Ethiopia
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15
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Smalley HK, Castillo-Zunino F, Keskinocak P, Nazzal D, Sakas ZM, Sarr M, Freeman MC. Factors associated with vaccine coverage improvements in Senegal between 2005 and 2019: a quantitative retrospective analysis. BMJ Open 2023; 13:e074388. [PMID: 37793917 PMCID: PMC10551957 DOI: 10.1136/bmjopen-2023-074388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Senegal has demonstrated catalytic improvements in national coverage rates for early childhood vaccination, despite lower development assistance for childhood vaccines in Senegal compared with other low-income and lower-middle income countries. Understanding factors associated with historical changes in childhood vaccine coverage in Senegal, as well as heterogeneities across its 14 regions, can highlight effective practices that might be adapted to improve vaccine coverage elsewhere. DESIGN Childhood vaccination coverage rates, demographic information and health system characteristics were identified from Senegal's Demographic and Health Surveys (DHS) and Senegal national reports for years 2005-2019. Multivariate logistic and linear regression analyses were performed to determine statistical associations of demographic and health system characteristics with respect to childhood vaccination coverage rates. SETTING The 14 administrative regions of Senegal were chosen for analysis. PARTICIPANTS DHS women's survey respondents with living children aged 12-23 months for survey years 2005-2019. OUTCOME MEASURES Immunisation with the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3), widely used as a proxy for estimating immunisation coverage levels and the retention of children in the vaccine programme. RESULTS Factors associated with childhood vaccination coverage include urban residence (β=0.61, p=0.0157), female literacy (β=1.11, p=0.0007), skilled prenatal care (β=1.80, p<0.0001) and self-reported ease of access to care when sick, considering travel distance to a healthcare facility (β=-0.70, p=0.0009) and concerns over travelling alone (β=-1.08, p<0.0001). Higher coverage with less variability over time was reported in urban areas near the capital and the coast (p=0.076), with increased coverage in recent years in more rural and landlocked areas. CONCLUSIONS Childhood vaccination was more likely among children whose mothers had higher literacy, received skilled prenatal care and had perceived ease of access to care when sick. Overall, vaccination coverage is high in Senegal and disparities in coverage between regions have decreased significantly in recent years.
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Affiliation(s)
- Hannah K Smalley
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Francisco Castillo-Zunino
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Pinar Keskinocak
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Center for Health and Humanitarian Systems, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Dima Nazzal
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Zoë M Sakas
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Moussa Sarr
- Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation, Dakar, Senegal
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Saidu Y, Gu J, Ngenge BM, Nchinjoh SC, Adidja A, Nnang NE, Muteh NJ, Zambou VM, Mbanga C, Agbor VN, Ousmane D, Njoh AA, Flegere J, Diack D, Wiwa O, Montomoli E, Clemens SAC, Clemens R. Assessment of immunization data management practices in Cameroon: unveiling potential barriers to immunization data quality. BMC Health Serv Res 2023; 23:1033. [PMID: 37759205 PMCID: PMC10537541 DOI: 10.1186/s12913-023-09965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND One crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon. METHODS A descriptive cross-sectional study was conducted, involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX). RESULTS A total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%). CONCLUSION Our findings unveil important gaps in data collection practices at the facility level that could adversely affect Cameroon's immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc, PO Box 2664, Yaounde, Cameroon.
- Institute for Global Health, University of Siena, Siena, 53100, Italy.
| | - Jessica Gu
- Global Vaccine Team, Clinton Health Access Initiative Inc, Boston, MA, 02127, USA
| | | | | | - Amani Adidja
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | | | - Clarence Mbanga
- Clinton Health Access Initiative Inc, PO Box 2664, Yaounde, Cameroon
| | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Diaby Ousmane
- Department of Projects, Ministry of Public Health, Yaounde, Cameroon
| | - Andreas Ateke Njoh
- Expanded Program on Immunization, Ministry of Public Health, PO Box 2084, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, PO Box 157, Bangui, Central African Republic
| | - Junie Flegere
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Demba Diack
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Owens Wiwa
- Clinton Health Access Initiative Inc, PO Box 2664, Yaounde, Cameroon
| | - Emmanuele Montomoli
- Institute for Global Health, University of Siena, Siena, 53100, Italy
- Department Molecular Medicine, University of Siena, Via Aldo Moro 3, 53100, Siena, Italy
- , VisMederi srl, Via Ferrini 53, 53035, Siena, Italy
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, Siena, 53100, Italy
- Department of Pediatrics, University of Oxford, Oxford, UK
| | - Ralf Clemens
- Institute for Global Health, University of Siena, Siena, 53100, Italy
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17
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Thusini S, Soukup T, Chua KC, Henderson C. How is return on investment from quality improvement programmes conceptualised by mental healthcare leaders and why: a qualitative study. BMC Health Serv Res 2023; 23:1009. [PMID: 37726753 PMCID: PMC10510269 DOI: 10.1186/s12913-023-09911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Return on Investment (ROI), whereby the ratio of costs to benefits is assessed, is encouraged in-order to justify the value of Quality Improvement (QI) programmes. We previously performed a literature review to develop a ROI conceptual framework for QI programmes. We concluded that, QI-ROI is conceptualised as any monetary and non-monetary benefit. In the current study, we explored if this finding is shared by mental healthcare leaders. We also investigated the stability of this conceptualisation against influencing factors and potential for disinvestment. METHODS We performed qualitative interviews with leaders in an NHS mental health organisation. There were 16 participants: nine board members and seven senior leaders. The interviews were held online via Microsoft Teams and lasted an hour on average. We performed deductive-inductive analysis to seek data from our initial ROI framework and any new data. RESULTS We found that in mental healthcare, QI-ROI is also conceptualised as any valued monetary and non-monetary benefits. There was a strong emphasis on benefits to external partners and a de-emphasis of benefit monetisation. This conceptualisation was influenced by the 1) perceived mandates to improve quality and manage scarce resources, 2) expectations from QI, 3) health and social care values, 4) ambiguity over expectations, and 5) uncertainty over outcomes. Uncertainty, ambiguity, and potential for disinvestment posed a threat to the stability of this conceptualisation but did not ultimately change it. Health and social care values supported maintaining the QI-ROI as any benefit, with a focus on patients and staff outcomes. Socio-political desires to improve quality were strong drivers for QI investment. CONCLUSION Mental healthcare leaders primarily conceptualise QI-ROI as any valued benefit. The inclusion of externalised outcomes which are hard to attribute may be challenging. However, mental healthcare services do collaborate with external partners. The de-emphases of benefit monetisation may also be controversial due to the need for financial accountability. Mental healthcare leaders recognise the importance of efficiency savings. However, they raised concerns over the legitimacy and utility of traditional ROI as a tool for assessing QI value. Further research is needed to bring more clarity on these aspects of the QI-ROI concept.
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Asresie MB, Dagnew GW, Bekele YA. Changes in immunization coverage and contributing factors among children aged 12-23 months from 2000 to 2019, Ethiopia: Multivariate decomposition analysis. PLoS One 2023; 18:e0291499. [PMID: 37703252 PMCID: PMC10499235 DOI: 10.1371/journal.pone.0291499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Immunization has been promoted as a global strategy aimed at improving child survival. The World Health Organization strives to make immunization services available to everyone, everywhere to save over 50 million lives by 2030. Monitoring the change and identifying the factors contributing to the change in immunization coverage over time and across the nations is imperative for continuing global success in increasing immunization coverage. In this study, we examined the changes and factors that contributed to the change in full immunization coverage over time in Ethiopia (2000 to 2019). METHODS We analyzed data on children aged 12-23 months, extracted from the 2000 and 2019 Ethiopian Demographic and Health Survey (EDHS) datasets. A total of 3,072 weighted samples (2,076 in 2000 and 966 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine change and identify factors that contributed to the change over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. RESULTS There was a 29.56% (95% CI: 24.84, 34.28) change in full immunization coverage between the two surveys. It increased from 14.62% (95% CI: 12.43, 17.11) in 2000 to 44.18% (95% CI: 37.19, 51.41) in 2019. The decomposition analysis showed that about 75% of explained change was attributed to the differences in the composition of explanatory variables (the endowment effect). Particularly, women aged 35-49 years (-2.11%), those who attended four or more antenatal care visits (17.06%), individual who had postnatal care visits (16.90%), households with two or more under-five children (2.50%), and those with a history of child mortality (17.80%) were significantly attributed to the change. The rest, 25% of the explained change was attributed to the difference in the effects of explanatory variables (coefficient). The change in the coefficient for women who had experienced child death (-20.40%) was statistically significant to the change in full immunization coverage over time. CONCLUSION The finding of this study revealed that there was a statistically significant change in full immunization coverage over time. The majority of the change was attributed to the differences in the composition of explanatory variables such as antenatal care and postnatal care visits, age of the mother, and number of living children in the household. Therefore, strengthening maternal health services utilization may enhance immunization coverage in Ethiopia. Furthermore, the difference in coefficient of mothers with a history of child death had a substantial counteracting effect on the change, emphasizing the importance of raising awareness and delivering vaccine education to them and the larger community.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Alemu Bekele
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Wariri O, Utazi CE, Okomo U, Metcalf CJE, Sogur M, Fofana S, Murray KA, Grundy C, Kampmann B. Mapping the timeliness of routine childhood vaccination in The Gambia: A spatial modelling study. Vaccine 2023; 41:5696-5705. [PMID: 37563051 DOI: 10.1016/j.vaccine.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal epidemiologically relevant local heterogeneities and makeitdifficultto identify pockets of vulnerabilities that could benefit from targeted interventions. Here, we demonstrate the utility of geospatial modelling techniques in generating high-resolution maps of the prevalence of delayed childhood vaccination in The Gambia. To guide local immunisation policy and prioritize key interventions, we also identified the districts with a combination of high estimated prevalence and a significant population of affected infants. METHODS We used the birth dose of the hepatitis-B vaccine (HepB0), third-dose of the pentavalent vaccine (PENTA3), and the first dose of measles-containing vaccine (MCV1) as examples to map delayed vaccination nationally at a resolution of 1 × 1-km2 pixel. We utilized cluster-level childhood vaccination data from The Gambia 2019-20 Demographic and Health Survey. We adopted a fully Bayesian geostatistical model incorporating publicly available geospatial covariates to aid predictive accuracy. The model was implemented using the integrated nested Laplace approximation-stochastic partial differential equation (INLA-SPDE) approach. RESULTS We found significant subnational heterogeneity in delayed HepB0, PENTA3 and MCV1 vaccinations. Specificdistricts in the central and eastern regions of The Gambia consistentlyexhibited the highest prevalence of delayed vaccination, while the coastal districts showed alower prevalence forallthree vaccines. We also found that districts in the eastern, central, as well as in coastal parts of The Gambia had a combination of high estimated prevalence of delayed HepB0, PENTA3 and MCV1 and a significant population of affected infants. CONCLUSIONS Our approach provides decision-makers with a valuable tool to better understand local patterns of untimely childhood vaccination and identify districts where strengthening vaccine delivery systems could have the greatest impact.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Jessica E Metcalf
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Sidat Fofana
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health, Charité Universitatsmedizin, Berlin, Germany
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20
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Kolesar RJ, Spruk R, Tsheten T. Evaluating Country Performance After Transitioning From Gavi Assistance: An Applied Synthetic Control Analysis. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200536. [PMID: 37640489 PMCID: PMC10461703 DOI: 10.9745/ghsp-d-22-00536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Over the past decade, international development assistance for health has slowed. As donors seek to increase domestic cofinancing and ultimately transition countries from donor aid dependence, COVID-19 has severely constrained public budgets. The evaluation of sustainability and longer-term impacts of donor withdrawal is increasingly important. We assess vaccination coverage and post-neonatal mortality to estimate country performance of these outcomes among countries that no longer received assistance from Gavi, the Vaccine Alliance (Gavi) between 2000 and 2018. METHODS Using data from all countries receiving Gavi support between 2000 and 2020, we employed a synthetic control method to generate a pre-transition counterfactual with the same characteristics as the observation of interest to predict a future that empirically never existed. The synthetic unit is constructed from the weighted average of other units with good fit to the unit of interest before transition but did not transition. RESULTS We found substantial heterogeneity after transitioning from Gavi assistance. China, Guyana, and Turkmenistan overperformed their expected coverage rates; Albania, Bhutan, China, Guyana, and Turkmenistan maintained coverage over 90%; and Bosnia and Herzegovina and Ukraine reported precipitous drop-offs that fell well below their synthetic controls. We also observed a vaccination coverage decline in 2020 for several countries after transitioning and most synthetic controls, which we attribute to COVID-19-related service disruptions. CONCLUSIONS We recommend that Gavi adjust its transition model to systematically assess contextual externalities and risk. In addition, countries that no longer receive Gavi assistance can leverage technical assistance and communities of practice to mutually assist each other and other countries advancing toward transition. This could also foster intracountry accountability after transition. We also recommend that Gavi systematize post-transition assessments and evaluations that leverage the expertise and experience of graduated countries to encourage cross-learning.
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Affiliation(s)
- Robert John Kolesar
- Palladium, Washington, DC, USA
- Centre d’Études et de Recherche sur le Développement International, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Rok Spruk
- School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Tsheten Tsheten
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Australia
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21
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Lee D, Lavayen MC, Kim TT, Legins K, Seidel M. Association of vaccine stockout with immunisation coverage in low-income and middle-income countries: a retrospective cohort study. BMJ Open 2023; 13:e072364. [PMID: 37524556 PMCID: PMC10391784 DOI: 10.1136/bmjopen-2023-072364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES This study investigated the association between vaccine stockout and immunisation coverage, and infant/under 5 mortality rates. DESIGN A retrospective cohort study. SETTING Low-income and middle-income countries. PARTICIPANTS A cohort of 131 low-income and middle-income countries from 2004 to 2019. PRIMARY OUTCOME MEASURES Main outcomes included immunisation coverages of (1) diphtheria-tetanus-pertussis containing vaccine (DTP), (2) measles containing vaccine (MCV), (3) BCG and (4) oral polio vaccine (OPV). We also included infant and under 5 mortality rates as secondary outcomes. RESULTS The countries that experienced national-level stockouts of DTP and MCV had 3.7 and 4 percentage points lower coverage rates of DTP3 and MCV1, respectively, compared with the countries without the stockout events (p<0.01). Moreover, the statistically significant differences in the immunisation coverage rates across the countries with and without the stockout events are 2.4 percentage points and 2.6 percentage points for BCG and OPV, respectively (p<0.01). CONCLUSION Our findings show that the incidence of vaccine stockout events is associated with the decreased immunisation coverages for children in low-income and middle-income countries. However, we did not observe a statistically significant association between the increasing frequency of vaccine stockout and infant and under 5 mortality rates.
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Affiliation(s)
- Donghoon Lee
- UNICEF, Copenhagen, Denmark
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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22
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Rubin Thompson LJ, Grubo M, Veller M, Badenhorst RH, Nott J, Debruyne L, Makadzange T, Nicolaou S, Stanberry L, Sall A, James WG. Building global vaccine manufacturing capacity: Spotlight on Africa. Vaccine 2023; 41:4050-4056. [PMID: 37173266 DOI: 10.1016/j.vaccine.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Africa is set to experience a three-fold increase in vaccine demand by 2040, yet the continent possesses few domestic capabilities for vaccine production. This lack of production capacity, heavy reliance on foreign aid, disruptions of hard-won immunization progress due to the effects of the COVID-19 pandemic, and fluctuating vaccine market dynamics threaten to hinder ongoing efforts to increase vaccination rates on the continent. In order meet the vaccine demands of a rapidly growing population, and to be able to provide novel vaccines to its population in the future, the African continent must develop a sustainable vaccine manufacturing infrastructure. The African Union, in partnership with the Africa Centres for Disease Control and Prevention, recently set forth its Program for African Vaccine Manufacturing Framework for Action, which sets the goal of Africa producing 60 % of its vaccine needs by 2040. To meet these goals, African governments and their multinational, philanthropic, and private sector partners must work to secure low-cost financing and provide a favourable regulatory environment for nascent African vaccine manufacturers. Doing so will save lives, safeguard the health of the continent's current and future citizens, and contribute to economic growth through the development of local bioeconomies.
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Affiliation(s)
| | | | - Martin Veller
- University of the Witwatersrand, Faculty of Health Sciences, South Africa
| | | | - Joshua Nott
- Schmidt Futures, New York, NY, United States
| | - Luc Debruyne
- KU Leuven, Faculty of Medicine, Biomedical Sciences Group, Belgium
| | | | | | - Lawrence Stanberry
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | | | - Wilmot Godfrey James
- Columbia University, Institute for Social and Economic Research and Policy, New York, NY, United States
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23
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Jansen D, Brenner M, Illy K, Dembiński Ł, del Torso S, Grossman Z, Valiulis A, De Guchtenaere A, Mazur A, Da Dalt L, Størdal K, Koletzko B, Hadjipanayis A. Leave no one behind: why WHO's regional office for Europe should prioritise children and adolescents in their program of work. A position statement from the European academy of paediatrics. Front Pediatr 2023; 11:1184870. [PMID: 37388289 PMCID: PMC10301733 DOI: 10.3389/fped.2023.1184870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
Children and adolescents are no longer a priority in the most recent European Programme of Work (EPW) 2020-2025 of the World Health Organization (WHO) Regional Office for Europe. In this position statement we provide arguments for why we think this population should be explicitly addressed in this important and influential document. We firstly emphasize the persistent health problems and inequalities in access to care for children and adolescents that are challenging to solve, and thus require a continuous focus. Secondly, we urge the WHO to prioritize children and adolescents in their EPW due to the new and emerging health problems related to global issues. Finally, we explain why permanent prioritization of children and adolescents is essential for the future of children and of society.
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Affiliation(s)
- Danielle Jansen
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Sociology, University of Groningen, Groningen, Netherlands
- Accare, University Centre for Child and Adolescent Psychiatry, Groningen, Netherlands
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Károly Illy
- Dutch PaediatricSociety, Utrecht, Netherlands
- Department of Pediatrics, Hospital Rivierenland, Tiel, Netherlands
- European Academy of Paediatrics (EAP), Brussels, Belgium
| | - Łukasz Dembiński
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Stefano del Torso
- European Academy of Paediatrics (EAP), Brussels, Belgium
- ChidCare WorldWide CCWWItalia OdV, Padova, Italy
| | - Zachi Grossman
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Pediatrics, Maccabi Health Care Services Pediatrics, Tel Aviv, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Arunas Valiulis
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Ann De Guchtenaere
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Paediatrics, Ghent University, Ghent, Belgium
| | - Artur Mazur
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department Pediatrics, Pediatric Endocrinology and Diabetes, Medical College, University of Rzeszow, Rzeszow, Poland
| | - Liviana Da Dalt
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
| | - Ketil Størdal
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Pediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Berthold Koletzko
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Paediatrics, LMU—Ludwig-Maximilians-Universität Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Adamos Hadjipanayis
- European Academy of Paediatrics (EAP), Brussels, Belgium
- Medical School, European University Cyprus, Nicosia, Cyprus
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24
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Sato R. Revisiting the measurement of vaccine hesitancy: Comparison between routine immunization and supplementary immunization activity in Nigeria. Vaccine 2023:S0264-410X(23)00691-6. [PMID: 37316408 DOI: 10.1016/j.vaccine.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ryoko Sato
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Department of Global Health and Population, 90 Smith St, Boston 02120, MA, USA.
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25
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Mumtaz H, Nadeem A, Bilal W, Ansar F, Saleem S, Khan QA, Tango T, Farkouh C, Belay NF, Verma R, Farkouh M, Saqib M. Acceptance, availability, and feasibility of RTS, S/AS01 malaria vaccine: A review. Immun Inflamm Dis 2023; 11:e899. [PMID: 37382251 DOI: 10.1002/iid3.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 05/13/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION In malaria-stricken regions, malaria continues to be one of the primary causes of mortality for children. The number of malaria-related fatalities has drastically decreased because of artemisinin-based pharmacological regimens. METHODS Two independent researchers did a comprehensive literature search using PubMed/MEDLINE and Google Scholar from its inception to September 2022. RESULTS After evaluating RTS, S/AS01 for its safety, effectiveness, and feasibility, the European Medicines Agency (EMA) issued a favorable conclusion. It was suggested that the RTS, S malaria vaccine be used extensively by the World Health Organization on October 6, 2021. The successful pilot program testing the malaria vaccine in Ghana, Kenya, and Malawi served as the basis for this proposal. CONCLUSION Several challenges need to be addressed to ensure the success of vaccination programs. From the acceptability perspective, issues such as inadequate community engagement, concerns about side effects, and issues with the delivery and quality of healthcare services can affect the acceptance of the vaccine. From the feasibility standpoint, factors such as lack of transportation or long distances to healthcare facilities and the perception of completion of the vaccination calendar can affect the feasibility of the vaccine. Lastly, the availability of the vaccine is also a major concern as it may not be readily available to meet the demands.
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Affiliation(s)
| | | | - Wajeeha Bilal
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Tamara Tango
- Faculty of Medicine Universitas, Jakarta, Indonesia
| | | | - Naod F Belay
- Michigan State University, East Lansing, Michigan, USA
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26
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Otaigbe II, Elikwu CJ. Drivers of inappropriate antibiotic use in low- and middle-income countries. JAC Antimicrob Resist 2023; 5:dlad062. [PMID: 37265987 PMCID: PMC10230568 DOI: 10.1093/jacamr/dlad062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global security threat that accounts for about 700 000 deaths annually. Studies have shown that antimicrobial resistance could result in a 2% to 3.5% reduction in global Gross Domestic Product by 2050 and a loss of between 60 and 100 trillion US dollars, worth of economic output resulting in significant and widespread human suffering. Low- and middle-income countries (LMICs) will be worse hit by an unchecked rise of AMR. For example, it is predicted that AMR could kill about 4.1 million people in Africa by 2050 if it is not curbed. Similarly rising rates of AMR will lead to increased treatment costs and an inability to attain universal health coverage, in LMICs with fragile health systems. Sadly, AMR is driven by the inappropriate use of antimicrobials, especially antibiotics. Inappropriate antibiotic use is a pertinent problem in LMICs where regulatory frame works are weak. Inappropriate antibiotic use in LMICs is a multifaceted problem that cuts across clinical and veterinary medicine and agriculture. Therefore, efforts geared at curbing inappropriate antibiotic use in LMICs must identify the factors that drive this problem (i.e. inappropriate antibiotic use) in these countries. A clear knowledge of these factors will guide effective policy and decision making to curb inappropriate antibiotic use and ultimately AMR. The focus of this review is to discuss the factors that drive inappropriate antibiotic use in LMICs.
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Affiliation(s)
| | - Charles John Elikwu
- Department of Medical Microbiology, School of Basic Clinical Sciences, Benjamin Carson (Snr.) College of Health & Medical Sciences, Babcock University, Ilishan Remo, Ogun State, Nigeria
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Baratta F, Enri LR, Brusa P. Community pharmacists as vaccinators in the SARS-CoV-2 immunization campaign: implications beyond the pandemic. Health Policy 2023; 131:104798. [PMID: 36966630 PMCID: PMC10030261 DOI: 10.1016/j.healthpol.2023.104798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
Italy was one of the last European countries to introduce vaccination in pharmacies. The urgent need to extend the vaccination campaign against SARS-CoV-2 led to the approval of Law no. 178/2020. The Law allowed the administration of COVID-19 vaccines in Italian pharmacies by community pharmacists on an experimental basis for the years 2021-2022. Stakeholders took contrasting positions on the idea of enabling pharmacist to vaccinate after proper training. Sometimes, controversy existed even within the same associations representing pharmacists. As observed in other countries, the medical profession in Italy also expressed its opposition to the idea of pharmacists as vaccinators, while the general public and pharmacy customers were generally in favour of the policy. Over two million doses of SARS-CoV-vaccines were administered in Italian pharmacies in less than one year after the introduction of the policy. Criticism and concerns raised during the debate about the introduction of vaccination in pharmacies has subsided. It is yet unclear whether vaccination in pharmacies will be prolonged after the pandemic and whether it will, in fact, be expanded to other vaccines. Potentially, this could contribute towards increasing immunisation rates, not only for COVID-19, but also for other vaccines.
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Affiliation(s)
- Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy.
| | | | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
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28
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Biggs AT, Littlejohn LF. Describing mRNA Vaccine Technology for a Military Audience. Mil Med 2023; 188:547-554. [PMID: 35584186 DOI: 10.1093/milmed/usac129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Vaccine technology has improved substantially since the first smallpox vaccine, developed more than 200 years ago. As technology improves, vaccines can be produced more safely and reliably for many different pathogens. A recent breakthrough saw the first full deployment of mRNA vaccines to fight a pandemic. Despite the technological and logistical feat of developing a viable vaccine in an abbreviated time frame, there have been many questions about this new approach to vaccine development. The current review will provide descriptions about different types of vaccines as well as answers to some common questions about mRNA vaccines. The purpose is to provide military medical professionals with the information needed to better convey the importance and function of these new vaccines to service members. MATERIALS AND METHODS There were no explicit inclusion or exclusion criteria for articles describing mRNA vaccine technology. References included here were intended to illustrate important principles or empirical evidence in demonstrating the safety, efficacy, and function of mRNA vaccines. DISCUSSION The review describes three different types of vaccines: whole-pathogen, subunit, and nucleic acid. Each vaccine type has different implications for the development and production of a vaccine line. For example, whole-pathogen and subunit vaccines often require growing significant amounts of the vaccine sample in laboratory before the material can be incorporated into the vaccine. Nucleic acid vaccines instead provide cells the opportunity to produce key proteins without needing to reproduce the virus and attenuate it in a laboratory setting. This approach has a notable advantage of speed in moving from genome sequencing to vaccine production, but it also creates some potential confusion. The discussion covers three questions with regard to this confusion. First, was the vaccine developed too quickly? Speed here is a byproduct of the new technology and unprecedented government interdepartmental cooperation. No steps were skipped in development or production. Second, does the vaccine modify DNA? No, the mRNA vaccines never enter the cell nucleus and therefore cannot modify DNA. The discussion clarifies how mRNA enters cells and produces the key proteins required to stimulate an immune system response. Third, how long will immunity last? Because mRNA vaccines are new, long-term immunity cannot be projected without significant further study. Still, the discussion does cover issues in determining vaccine efficacy in clinical laboratory trials versus field effectiveness in the real world. CONCLUSIONS AND FUTURE USES These mRNA vaccines are the newest and most sophisticated defensive tool military medicine has against emerging biological threats. Evolving dangers, such as synthetic biology and engineered pathogens, further enhance the importance of having defensive countermeasures that can be rapidly deployed in response. Current evidence suggests high safety and effectiveness for a biological countermeasure, decades in the making, and military medical personnel should feel confident using and recommending this technology to ensure force health protection.
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Affiliation(s)
- Adam T Biggs
- Medical Department, Naval Special Warfare Command, Coronado, CA 92155, USA
| | - Lanny F Littlejohn
- Medical Department, Naval Special Warfare Command, Coronado, CA 92155, USA
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29
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Getchell M, Mantaring EJ, Yee K, Pronyk P. Cost-effectiveness of sub-national geographically targeted vaccination programs: A systematic review. Vaccine 2023; 41:2320-2328. [PMID: 36781333 DOI: 10.1016/j.vaccine.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
Immunization is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns and increasing administrative costs create logistic and financial challenges, especially in resource-limited settings. Sub-national geographic targeting of vaccination programs is a potential strategy for governments to reduce the impact of infectious disease outbreaks while optimizing resource allocation and reducing costs, promoting sustainability of critically important national immunization plans. We conducted a systematic review of peer-reviewed literature to identify studies that investigated the cost-effectiveness of geographically targeted sub-national vaccination programs, either through routine immunization or supplementary immunization activities. A total of 16 studies were included in our review, covering nine diseases of interest: cholera, dengue, enterotoxigenic Escherichia coli (ETEC), hepatitis A, Japanese encephalitis, measles, rotavirus, Shigella and typhoid fever. All studies modelled cost-effectiveness of geographically targeted vaccination. Despite the variation in study design, disease focus and country context, studies generally found that in countries where a heterogenous burden of disease exists, sub-national geographic targeting of vaccination programs in areas of high disease burden was more cost-effective than a non-targeted strategy. Sensitivity analysis revealed that cost-effectiveness was most sensitive to variations in vaccine price, vaccine efficacy, mortality rate, administrative and operational costs, discount rate, and treatment costs. This systematic review identified several key characteristics related to geographic targeting of vaccination, including the vaccination strategy used, variations in modelling parameters and their impact on cost-effectiveness. Additional research and guidance is needed to support the appropriateness and feasibility of geographically targeted vaccination and to determine what country context would make this a viable complement to routine immunization programs.
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Affiliation(s)
- Marya Getchell
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | | | - Kaisin Yee
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Paul Pronyk
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
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Xia Y, Li Q, Jiao W, Lan Y. Dynamic mechanism of eliminating COVID-19 vaccine hesitancy through web search. Front Public Health 2023; 11:1018378. [PMID: 36794073 PMCID: PMC9922755 DOI: 10.3389/fpubh.2023.1018378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
This research focuses on the research problem of eliminating COVID-19 vaccine hesitancy through web search. A dynamic model of eliminating COVID-19 vaccine hesitancy through web search is constructed based on the Logistic model, the elimination degree is quantified, the elimination function is defined to analyze the dynamic elimination effect, and the model parameter estimation method is proposed. The numerical solution, process parameters, initial value parameters and stationary point parameters of the model are simulated, respectively, and the mechanism of elimination is deeply analyzed to determine the key time period. Based on the real data of web search and COVID-19 vaccination, data modeling is carried out from two aspects: full sample and segmented sample, and the rationality of the model is verified. On this basis, the model is used to carry out dynamic prediction and verified to have certain medium-term prediction ability. Through this research, the methods of eliminating vaccine hesitancy are enriched, and a new practical idea is provided for eliminating vaccine hesitancy. It also provides a method to predict the quantity of COVID-19 vaccination, provides theoretical guidance for dynamically adjusting the public health policy of the COVID-19, and can provide reference for the vaccination of other vaccines.
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Affiliation(s)
| | | | | | - Yuexin Lan
- Research Center of Network Public Opinion Governance, China People's Police University, Langfang, China
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Ostermann J, Hair NL, Moses S, Ngadaya E, Godfrey Mfinanga S, Brown DS, Noel Baumgartner J, Vasudevan L. Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania. Vaccine X 2023; 13:100266. [PMID: 36814594 PMCID: PMC9939728 DOI: 10.1016/j.jvacx.2023.100266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/03/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Background Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania. Methods Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children. Findings All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8 %) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95 % confidence interval Tsh 2,523-3,610; 1 USD ∼ Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children. Interpretation Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness. ClinicalTrialsgov Protocol NCT03252288.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Corresponding author at: Arnold School of Public Health, 915 Greene St. #351, Columbia, SC 29208, USA.
| | - Nicole L. Hair
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Moses
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Derek S. Brown
- Brown School of Social Work, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joy Noel Baumgartner
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Sriudomporn S, Sim SY, Mak J, Brenzel L, Patenaude BN. Financing And Funding Gap For 16 Vaccines Across 94 Low- And Middle-Income Countries, 2011-30. Health Aff (Millwood) 2023; 42:94-104. [PMID: 36623227 DOI: 10.1377/hlthaff.2022.00343] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We estimated immunization program costs, financing, and funding gaps for sixteen vaccines among ninety-four low- and middle-income countries during the period 2011-30. Inputs were obtained from the Institute for Health Metrics and Evaluation, the 2020 Decade of Vaccine Economics costing analysis, the World Health Organization, Gavi, and the United Nations Children's Fund. We found a total funding gap of $38.4 billion between 2011 and 2030, with the cost of immunization delivery being the main driver (86 percent) of the funding gap. On average, government financing of vaccination programs steadily rises throughout the period. However, the decline in both Gavi and development assistance for health (DAH) financing anticipated between 2011 and 2030 outpaces the forecasted increases in domestic government immunization spending. Probabilistic sensitivity analysis was applied to both the costing and the scenario analyses to address uncertainty in the financing of vaccines and vaccine delivery. The results highlight a narrowing gap for vaccine acquisition but a growing gap for vaccine delivery, which emphasizes the critical need for resource mobilization and sustainable financial strategies for immunization programs at national and global levels, as well as a need to address the COVID-19 pandemic's potential effects on government financing for vaccines between 2021 and 2030.
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Affiliation(s)
| | - So Yoon Sim
- So Yoon Sim, World Health Organization, Geneva, Switzerland
| | | | - Logan Brenzel
- Logan Brenzel, Bill & Melinda Gates Foundation, Washington, D.C
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Dimitrova A, Carrasco-Escobar G, Richardson R, Benmarhnia T. Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage. PLoS Med 2023; 20:e1004166. [PMID: 36649359 PMCID: PMC9888726 DOI: 10.1371/journal.pmed.1004166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/31/2023] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Globally, access to life-saving vaccines has improved considerably in the past 5 decades. However, progress has started to slow down and even reverse in recent years. Understanding subnational heterogeneities in essential child immunization will be critical for closing the global vaccination gap. METHODS AND FINDINGS We use vaccination information for over 220,000 children across 1,366 administrative regions in 43 low- and middle-income countries (LMICs) from the most recent Demographic and Health Surveys. We estimate essential immunization coverage at the national and subnational levels and quantify socioeconomic inequalities in such coverage using adjusted concentration indices. Within- and between-country variations are summarized via the Theil index. We use local indicator of spatial association (LISA) statistics to identify clusters of administrative regions with high or low values. Finally, we estimate the number of missed vaccinations among children aged 15 to 35 months across all 43 countries and the types of vaccines most often missed. We show that national-level vaccination rates can conceal wide subnational heterogeneities. Large gaps in child immunization are found across West and Central Africa and in South Asia, particularly in regions of Angola, Chad, Nigeria, Guinea, and Afghanistan, where less than 10% of children are fully immunized. Furthermore, children living in these countries consistently lack all 4 basic vaccines included in the WHO's recommended schedule for young children. Across most countries, children from poorer households are less likely to be fully immunized. The main limitations include subnational estimates based on large administrative divisions for some countries and different periods of survey data collection. CONCLUSIONS The identified heterogeneities in essential childhood immunization, especially given that some regions consistently are underserved for all basic vaccines, can be used to inform the design and implementation of localized intervention programs aimed at eliminating child suffering and deaths from existing and novel vaccine-preventable diseases.
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Affiliation(s)
- Anna Dimitrova
- Scripps Institution of Oceanography, University of California, San Diego, California, United States of America
- * E-mail:
| | - Gabriel Carrasco-Escobar
- Scripps Institution of Oceanography, University of California, San Diego, California, United States of America
- Health Innovation Laboratory, Institute of Tropical Medicine “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robin Richardson
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, California, United States of America
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Bahuguna P, Masaki E, Jeet G, Prinja S. Financing Comprehensive Immunization Services in Lao PDR: A Fiscal Space Analysis From a Public Policy Perspective. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:131-140. [PMID: 36136264 PMCID: PMC9492462 DOI: 10.1007/s40258-022-00763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION A comprehensive package of immunization services is an internal component of the Essential Health Service Package (ESP) implemented by Government of Lao People's Democratic Republic (Lao PDR). Thus, the cost of delivering the immunization program and its feasibility given the fiscal space emerges as an important policy question. The present analysis was undertaken to estimate the total cost of implementing the immunization program under ESP, determinants of total cost and the program's fiscal implications from the government's perspective. METHODOLOGY We employed a normative costing approach for costing of immunization services under ESP. Standard treatment guidelines (STGs) from both within and outside Lao PDR were considered to identify the resource use for each vaccine delivery. Subsequently, cost per dose administered and fully immunized beneficiary were computed. We assessed the fiscal space for financing immunization services in Lao PDR by adapting the decomposition method given by Tandon et al. RESULTS: In 2019, the estimated total cost of financing immunization in Lao PDR was US$12 million, which will increase in 2025 by 1.75 times, to US$21 million. The per capita budget for immunization needs to increase from about US$2 to US$7. Introduction of newer vaccines in the immunization schedule accounts for the major share (60%) of the increased cost for financing immunization. In view of current fiscal space, the government immunization expenditure (GIE) allocations will be adequate only in a scenario where no new vaccine is introduced under ESP in future years. CONCLUSION The current fiscal space would fall short of meeting the aspirational goals of ESP-Immunization for the introduction of newer vaccines in Lao PDR. The present analysis of the fiscal space provides important evidence to support a greater role for the Global Alliance for Vaccine Initiative (GAVI) to continue to finance immunization in Lao PDR. A publicly financed immunization model in Lao PDR would require significant strategic amendments with low short-term viability.
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Affiliation(s)
- Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Emiko Masaki
- Health, Nutrition and Population, World Bank, Vientiane, Lao PDR
| | - Gursimer Jeet
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Baptista S, Naidoo S, Suliman S, Nepolo E, Kanoi BN, Gitaka J, Blessing OM, Enany S. COVID-19 vaccinology landscape in Africa. Front Immunol 2022; 13:955168. [PMID: 36544758 PMCID: PMC9760752 DOI: 10.3389/fimmu.2022.955168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
More than two years after the start of COVID-19 pandemic, Africa still lags behind in terms vaccine distribution. This highlights the predicament of Africa in terms of vaccine development, deployment, and sustainability, not only for COVID-19, but for other major infectious diseases that plague the continent. This opinion discusses the challenges Africa faces in its race to vaccinate its people, and offers recommendations on the way forward. Specifically, to get out of the ongoing vaccine shortage trap, Africa needs to diversify investment not only to COVID-19 but also other diseases that burden the population. The continent needs to increase its capacity to acquire vaccines more equitably, improve access to technologies to enable local manufacture of vaccines, increase awareness on vaccines both in rural and urban areas to significantly reduce disease incidence of COVID-19 and as well as other prevalent diseases on the African continent such as HIV and TB. Such efforts will go a long way to reduce the disease burden in Africa.
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Affiliation(s)
- Sara Baptista
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Instituto de Medicina Molecular, João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sanushka Naidoo
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria, South Africa
| | - Sara Suliman
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Zuckerberg San Francisco General Hospital, Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States,Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Emmanuel Nepolo
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Bernard N. Kanoi
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Jesse Gitaka
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Oyedemi Mbaebie Blessing
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Biotechnology, Michael Okpara University of Agriculture, Umudike, Nigeria
| | - Shymaa Enany
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt,*Correspondence: Shymaa Enany,
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Healthcare professionals’ views on access to vaccines in Nigeria: A cross sectional study. Vaccine X 2022; 12:100235. [PMID: 36411828 PMCID: PMC9674536 DOI: 10.1016/j.jvacx.2022.100235] [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: 08/24/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccines are important public health interventions that are critical in preventing the spread of infectious diseases. Sustainable access to these products is therefore critical in articulating contextual policies and strategies. This study aimed at exploring the views of healthcare professionals regarding perceived challenges and strategies that influence access to vaccines in Nigeria. A cross sectional study was undertaken amongst healthcare practitioners that attended a conference targeted at improving access to vaccines. A questionnaire was used for data collection, and analysis was undertaken using Statistical Package for Social Sciences version 25. Questionnaires were administered to a total of 604 participants, response rate was 87.1%, with male participants (54.4%) being slightly better represented than females (45.6%). A tenth of the participants (10.6%) were educated up to doctorate degree level, and a considerable proportion of the participants (43.6%) worked in the government sector. Slightly above three quarters (78.3%) of the participants were of the view that lack of local production capacity was an obstacle preventing access to vaccines, whilst above two thirds of the respondents (70.5%) were of the opinion that the current funding for research and development towards vaccines was sub-optimal. A total of 70.1% of the sample disagreed that the current policy environment was favourable to development of vaccines, whilst more than half of the participants (56%) perceived a lack of support by philanthropists and relevant foundations, for vaccines development in Nigeria. A majority of the participants (73.7%) indicated that sustainable access to vaccines in Nigeria could be achieved by harnessing local research capacity. This study identified critical challenges limiting access to vaccines in Nigeria and can consequently underpin relevant policy and practice reforms that aim to improve access to this public health tool.
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Engelbert M, Jain M, Bagai A, Parsekar SS. Improving routine childhood immunisation outcomes in low-income and middle-income countries: an evidence gap map. BMJ Open 2022; 12:e058258. [PMID: 36356993 PMCID: PMC9660714 DOI: 10.1136/bmjopen-2021-058258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To support evidence-informed decision-making, we created an evidence gap map to characterise the evidence base on the effectiveness of interventions in improving routine childhood immunisation outcomes in low-income and middle-income countries (LMICs). METHODS We developed an intervention-outcome matrix with 38 interventions and 43 outcomes. We searched academic databases and grey literature sources for relevant impact evaluations (IEs) and systematic reviews (SRs). Search results were screened on title/abstract. Those included on title/abstract were retrieved for full review. Studies meeting the eligibility criteria were included and data were extracted for each included study. All screening and data extraction was done by two independent reviewers. We analysed these data to identify trends in the geographic distribution of evidence, the concentration of evidence across intervention and outcome categories, and attention to vulnerable populations in the literature. RESULTS We identified 309 studies, comprising 226 completed IEs, 58 completed SRs, 24 ongoing IEs and 1 ongoing SR. Evidence from IEs is heavily concentrated in a handful of countries in sub-Saharan Africa and South Asia. Among interventions, the most frequently evaluated are those related to education and material incentives for caregivers or health workers. There are gaps in the study of non-material incentives and outreach to vulnerable populations. Among outcomes, those related to vaccine coverage and health are well covered. However, evidence on intermediate outcomes related to health system capacity or barriers faced by caregivers is much more limited. CONCLUSIONS There is valuable evidence available to decision-makers for use in identifying and deploying effective strategies to increase routine immunisation in LMICs. However, additional research is needed to address gaps in the evidence base.
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Affiliation(s)
- Mark Engelbert
- International Initiative for Impact Evaluation, London, UK
| | - Monica Jain
- International Initiative for Impact Evaluation, New Delhi, India
| | | | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sethy G, Nenani Chisema M, Sharma L, Folorunso O, Haile D, Reda Berri Z, Joshi K, Ntenje M, Mitambo C, Laher B, Singhal S, Chirwa S, Damte T, Zulu F, Eleonore Ba A, Seidel M, Phuka J. Key lessons learned from the immunization supply chain of Malawi, an African country using EVM2.0. Vaccine X 2022; 12:100239. [PMID: 36407821 PMCID: PMC9668734 DOI: 10.1016/j.jvacx.2022.100239] [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: 08/22/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives A country’s immunization system's effectiveness depends on its supply chain's efficacy. To assess the challenges of maintaining an efficient vaccine supply chain, Malawi conducted its assessment using The EVM2.0 tool (Effective Vaccine Management). Methods It is a cross-sectional study in which all EVM requirements were assessed between September and October 2021. Data were collected from eighty-two randomly selected sites using the site selection tool of the EVM. Data were entered into the EVM assessment tool 2.0 version 1.12 for analysis. This tool generates performance indicators and criteria scores for assessed sites, compared with a WHO minimum score of 80%. Results Overall criteria scores across all levels of the immunization supply chain showed a statistically significant mean difference of 5.92 (t = 2.58, P = 0.02). Comparative overall mean criteria scores across different levels of the immunization supply chain showed no statistically significant difference for primary (p = 0.76), sub-national (p = 0.69), and lowest distribution stores (p = 0.12). However, a substantial gap was found in the overall mean scores of the health facility’s service point (SP) (t = 4.12, P = 0.001). The overall category scores across all immunization supply chain levels did not show a statistically significant difference. However, among individual category scores, Infrastructure (76 %), Equipment (67 %), Policies and procedures (62 %), Financial (47 %), and Resources (64 %) were found to be below the WHO minimum score. Conclusion Though the 2021 Malawi EVM assessment findings are promising, they still identified the gaps to be improved to ensure the vaccine availability in the right amount, at the right time, and at the right cost.
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Catharina de Beer J, Goto D, Miller-Janson H, Holl R, Bencina G. Vaccine financing in the Middle East and Africa: An overview from 2010 to 2019. Vaccine 2022; 40:5691-5700. [PMID: 36030126 DOI: 10.1016/j.vaccine.2022.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Vaccination is a cost-effective disease prevention measure. Sustainable financing is critical to successful implementation of vaccination programs. Countries in the Middle East and Africa (MEA) have vaccination programs that remain highly vulnerable to budget limitations. OBJECTIVES The objectives of this study were to understand the current vaccine financing landscape in MEA; to assess the availability and variability of data on vaccination budgets, expenditure and schedules including introductions of new vaccines; and to identify and describe key trends. METHOD A targeted literature review was conducted for 69 MEA countries for data between 2010 and 2019. Descriptive analysis of the collected data was conducted. RESULTS Data on vaccination expenditure were available for 96% of the countries. However, data on vaccination budget were limited, and the variability was high. The median vaccination expenditure per capita was between US$0.57 and US$1.02. High-income countries spent the most on vaccination per capita (median US$3.41) compared to low-income countries (median US$0.69). The highest vaccination expenditure per capita was in countries that receive 100% government funding of vaccination programs (US$0.87) compared to those where government pays for > 0% to < 50% of vaccination expenditure (US$0.74). Vaccination expenditure as a proportion of gross domestic product was the highest (0.10%) in low-income countries and the lowest in high-income countries (0.01%). Vaccination expenditure as proportion of healthcare expenditure was the highest (1.76%) in low-income countries and the lowest in high-income countries (0.33%). Statistically significant trends in median expenditure per capita were identified for 27% of the countries. During this period, an average of 4.4 vaccines were introduced. CONCLUSION Data on vaccination expenditure in MEA was available for detailed analysis, and it was useful to understand the characteristics of vaccination funding in the region. It is important to secure adequate financing to sustain current vaccination programs and to introduce new vaccines.
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Linnander E, Ineza L, Mupeta Bobo P, Bechtold K. Improving management of vaccine supply chains: A multi-methods evaluation of vSTEP in Zambia. Vaccine 2022; 40:5579-5584. [PMID: 35987874 DOI: 10.1016/j.vaccine.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Equipping supply chain professionals at all levels of the health care systems with essential leadership and management skills is essential to achieving global immunization targets. Numerous and diverse professional development initiatives have been established to support vaccine supply chain managers in Gavi-eligible countries. However, COVID-19 catalyzed rapid innovation in approaches to support leadership development in times of rapid change, and systematic evaluation of these approaches can inform future workforce development strategies to ensure resilient health systems. Therefore, we sought to evaluate outcomes and short-term impact of the fully virtual Strategic Training Executive Program 2.0 (vSTEP 2.0) program in Zambia on participant engagement, skill development, and application of new skills to improve supply chain performance. METHODS We used a multi-method design to describe the outcomes and short-term impact of vSTEP 2.0 at three levels: (1) delegate response to the training experience (including participation, completion, and satisfaction); (2) delegate change in leadership skill (including achievement of learning objectives and change in competencies); and (3) application of new skills to impact supply chain performance. RESULTS The program achieved high levels of engagement and an 83% graduation rate despite the length and rigor of the program. High satisfaction was evidenced by positive feedback from delegates on the quality and relevance of the program, especially in the context of COVID response (100% would "definitely" recommend). Delegates demonstrated significant growth in all domains of leadership competencies and applied their learnings to address a complex challenge in supply chain performance in their home organization. DISCUSSION These findings demonstrate a strong appetite for leadership development support among vaccine supply chain professionals, especially in times of rapid change such as during the COVID response. These results also demonstrate the feasibility and impact of a fully virtual model for leadership development, with implications well beyond the COVID-19 pandemic.
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Affiliation(s)
- Erika Linnander
- Global Health Leadership Initiative, Yale School of Public Health, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, Connecticut, USA.
| | - Lynka Ineza
- Global Health Leadership Initiative, Yale School of Public Health, Connecticut, USA
| | | | - Kali Bechtold
- Global Health Leadership Initiative, Yale School of Public Health, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, Connecticut, USA
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Bigay J, Le Grand R, Martinon F, Maisonnasse P. Vaccine-associated enhanced disease in humans and animal models: Lessons and challenges for vaccine development. Front Microbiol 2022; 13:932408. [PMID: 36033843 PMCID: PMC9399815 DOI: 10.3389/fmicb.2022.932408] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
The fight against infectious diseases calls for the development of safe and effective vaccines that generate long-lasting protective immunity. In a few situations, vaccine-mediated immune responses may have led to exacerbated pathology upon subsequent infection with the pathogen targeted by the vaccine. Such vaccine-associated enhanced disease (VAED) has been reported, or at least suspected, in animal models, and in a few instances in humans, for vaccine candidates against the respiratory syncytial virus (RSV), measles virus (MV), dengue virus (DENV), HIV-1, simian immunodeficiency virus (SIV), feline immunodeficiency virus (FIV), severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), and the Middle East respiratory syndrome coronavirus (MERS-CoV). Although alleviated by clinical and epidemiological evidence, a number of concerns were also initially raised concerning the short- and long-term safety of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is causing the ongoing COVID-19 pandemic. Although the mechanisms leading to this phenomenon are not yet completely understood, the individual and/or collective role of antibody-dependent enhancement (ADE), complement-dependent enhancement, and cell-dependent enhancement have been highlighted. Here, we review mechanisms that may be associated with the risk of VAED, which are important to take into consideration, both in the assessment of vaccine safety and in finding ways to define models and immunization strategies that can alleviate such concerns.
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Affiliation(s)
| | | | - Frédéric Martinon
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud-INSERM U1184, CEA, Fontenay-Aux-Roses, France
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Kumar M, Dogra R, Mandal UK. Nanomaterial-based delivery of vaccine through nasal route: Opportunities, challenges, advantages, and limitations. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mihigo RM, Okeibunor JC, Karmal F, O'Malley H, Godinho N, Okero L, Poy AN, Onyango O, Fitzgerald N. The Addis Declaration on Immunization: A binding reminder of the political support needed to achieve universal immunization in Africa. Vaccine 2022; 40:5126-5130. [PMID: 35871874 DOI: 10.1016/j.vaccine.2022.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
While African countries have improved access to immunization since the start of the millennium, progress has stagnated in the last few years. One in five African children is not vaccinated with life-saving vaccines, and recent outbreaks of vaccine-preventable diseases (VPDs) including yellow fever, measles, and meningitis, among others point to gaps in immunization coverage as well as disease surveillance. In 2017, African Heads of State endorsed the Addis Declaration on Immunization (ADI) at the 28th African Union Summit and committed to ensuring universal access to immunization across the continent. Since then, countries have taken several steps to translate the ADI commitments into tangible progress. However, the continent continues to face challenges in delivering immunization services, including limited vaccine-related funding, inequitable access to immunization services and weak surveillance systems. In the absence of concerted political will, COVID-19 threatens to reverse progress made so far. This paper reflects on the effects of political will in shaping the immunization agenda on the continent and the continued need for political commitment to deliver on the ADI commitments in a post-COVID world. Data were gathered from the regular national immunization reports, WHO/UNICEF estimates of immunization coverage as well as case studies of country implementation on ADI.
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Krishnamoorthy Y, Rehman T. Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey. Fam Pract 2022; 39:603-609. [PMID: 34564727 DOI: 10.1093/fampra/cmab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization. METHODS Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU). RESULTS In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups. CONCLUSION Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai, Tamil Nadu, India
| | - Tanveer Rehman
- Department of Preventive and Social Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Vidal Fuertes C, Johns NE, Goodman TS, Heidari S, Munro J, Hosseinpoor AR. The Association between Childhood Immunization and Gender Inequality: A Multi-Country Ecological Analysis of Zero-Dose DTP Prevalence and DTP3 Immunization Coverage. Vaccines (Basel) 2022; 10:vaccines10071032. [PMID: 35891196 PMCID: PMC9317382 DOI: 10.3390/vaccines10071032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
This study explores the association between childhood immunization and gender inequality at the national level. Data for the study include annual country-level estimates of immunization among children aged 12–23 months, indicators of gender inequality, and associated factors for up to 165 countries from 2010–2019. The study examined the association between gender inequality, as measured by the gender development index and the gender inequality index, and two key outcomes: prevalence of children who received no doses of the DTP vaccine (zero-dose children) and children who received the third dose of the DTP vaccine (DTP3 coverage). Unadjusted and adjusted fractional logit regression models were used to identify the association between immunization and gender inequality. Gender inequality, as measured by the Gender Development Index, was positively and significantly associated with the proportion of zero-dose children (high inequality AOR = 1.61, 95% CI: 1.13–2.30). Consistently, full DTP3 immunization was negatively and significantly associated with gender inequality (high inequality AOR = 0.63, 95% CI: 0.46–0.86). These associations were robust to the use of an alternative gender inequality measure (the Gender Inequality Index) and were consistent across a range of model specifications controlling for demographic, economic, education, and health-related factors. Gender inequality at the national level is predictive of childhood immunization coverage, highlighting that addressing gender barriers is imperative to achieve universal coverage in immunization and to ensure that no child is left behind in routine vaccination.
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Affiliation(s)
- Cecilia Vidal Fuertes
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (C.V.F.); (N.E.J.)
| | - Nicole E. Johns
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (C.V.F.); (N.E.J.)
| | - Tracey S. Goodman
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (T.S.G.); (S.H.)
| | - Shirin Heidari
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (T.S.G.); (S.H.)
| | - Jean Munro
- Gavi, The Vaccine Alliance, Chemin du Pommier 40, Le Grand-Saconnex, 1218 Geneva, Switzerland;
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (C.V.F.); (N.E.J.)
- Correspondence:
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Return on Investment of 10-Valent Pneumococcal Conjugate Vaccine in Ecuador From 2010 to 2030. Value Health Reg Issues 2022; 31:148-154. [PMID: 35753214 DOI: 10.1016/j.vhri.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Ecuador introduced the pneumococcal conjugate vaccine in 2010. A recent time series analysis has demonstrated the impact of 10-valent pneumococcal conjugate vaccine (PCV10) on hospitalized pneumococcal disease in children. We leveraged these estimates to calculate the return on investment (ROI) of PCV10 in Ecuador from 2010 to 2030 at the national and regional levels. METHODS We used 2 approaches to estimate the economic benefits: (1) cost of illness, which includes treatment, transportation, and productivity loss averted, (2) and the value of statistical life, which reflects society's average willingness to pay to save one life. Costs of the immunization program include vaccine costs (doses, syringes, injection supplies) and immunization delivery costs (personnel, cold chain equipment and maintenance, transportation, distribution services, and other recurrent costs). We estimated the ROI by dividing the net benefits by costs. RESULTS The ROI using the cost-of-illness approach was slightly negative in the introduction year. From 2011 to 2020, we estimated the ROI to be 0.45 (0.15-0.73). For the future decade, the ROI is estimated at 0.37 (-0.03 to 1.03). Using the value-of-statistical-life approach, the ROI was 1.46 (0.82-2.17) in the introduction year. In the first decade, the ROI was 1.01 (0.49-1.60); in the second decade, the ROI fell to 0.83 (0.23-1.78). CONCLUSIONS The results of this study demonstrate the total economic benefits of PCV10 in Ecuador exceed immunization program costs after the introduction year. Estimates from this study will inform country policy makers and will contribute to efforts to mobilize resources for immunization.
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Gender-Related Inequality in Childhood Immunization Coverage: A Cross-Sectional Analysis of DTP3 Coverage and Zero-Dose DTP Prevalence in 52 Countries Using the SWPER Global Index. Vaccines (Basel) 2022; 10:vaccines10070988. [PMID: 35891152 PMCID: PMC9315814 DOI: 10.3390/vaccines10070988] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 12/01/2022] Open
Abstract
Gender-related barriers to immunization are key targets to improve immunization coverage and equity. We used individual-level demographic and health survey data from 52 low- and middle-income countries to examine the relationship between women’s social independence (measured by the Survey-based Women’s emPowERment (SWPER) Global Index) and childhood immunization. The primary outcome was receipt of three doses of the diphtheria-tetanus-pertussis vaccine (DTP3) among children aged 12–35 months; we secondarily examined failure to receive any doses of DTP-containing vaccines. We summarized immunization coverage indicators by social independence tertile and estimated crude and adjusted summary measures of absolute and relative inequality. We conducted all analyses at the country level using individual data; median results across the 52 examined countries are also presented. In crude comparisons, median DTP3 coverage was 12.3 (95% CI 7.9; 16.3) percentage points higher among children of women with the highest social independence compared with children of women with the lowest. Thirty countries (58%) had a difference in coverage between those with the highest and lowest social independence of at least 10 percentage points. In adjusted models, the median coverage was 7.4 (95% CI 5.0; 9.1) percentage points higher among children of women with the highest social independence. Most countries (41, 79%) had statistically significant relative inequality in DTP3 coverage by social independence. The findings suggest that greater social independence for women was associated with better childhood immunization outcomes, adding evidence in support of gender-transformative strategies to reduce childhood immunization inequities.
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Castañeda-Orjuela C, De la Hoz-Restrepo F. Criteria for New Vaccine Introduction in a National Expanded Program on Immunization: A Survey of Expanded Program on Immunization Managers. Value Health Reg Issues 2022; 31:142-147. [PMID: 35717704 DOI: 10.1016/j.vhri.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 04/07/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to critically review the decision-making (DM) processes for new vaccines introduction in Latin America's Expanded Program on Immunization (EPIs) and role of cost-effectiveness analyses (CEAs). METHODS An online survey was conducted between August and December 2019 to Latin America and the Caribbean (LAC) EPI managers, participants of the National Immunization Technical Advisory Group (NITAG). Information about criteria to introduce the most recent vaccine was asked. CEA role in that decision and technical knowledge of informants were investigated. Frequencies of categorical data were calculated. Bar plots and stacked bar plots were used to visualize the data. RESULTS A total of 26 EPI managers and stakeholders participated in the survey from 14 LAC countries. Respondents worked at the Ministry of Health and the Pan American Health Organization. Most recent vaccines included were human papillomavirus (42.3%), injectable polio (26.9%), and varicella (15.4%). High burden of disease and cost-effectiveness/cost-utility were identified as the main a priori criteria used to new vaccine introduction, but not all inputs are available or good quality. Discussion about vaccine introduction was conducted at NITAG meetings, reported as independent by most countries. Nevertheless, NITAG members did not master the essential CEAs concepts. CONCLUSIONS DM of vaccine introduction in LAC is reported by EPI managers as a process of discussion with participation of several actors where economic rationalities had a high role in the decision. It is necessary to strengthen the technical capacity to understand economical inputs to inform DM and advocate to include other rationalities as important in the discussion.
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Affiliation(s)
- Carlos Castañeda-Orjuela
- Epidemiology and Public Health Evaluation Group, Universidad Nacional de Colombia, Bogotá, Colombia; Colombian National Health Observatory, Instituto Nacional de Salud, Bogotá, Colombia.
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Ineza L, Bechtold K, Mwisongo A, Kwedi Nolna S, Linnander EL. Building leadership and management competencies of national immunization teams in 16 Gavi-eligible countries through the EPI leadership and management programme. Vaccine 2022; 40:3581-3587. [DOI: 10.1016/j.vaccine.2022.04.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
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Sato R. Evaluation of catastrophic health expenditure risk due to measles in Nigeria. Hum Vaccin Immunother 2022; 18:2065836. [PMID: 35483039 PMCID: PMC9302492 DOI: 10.1080/21645515.2022.2065836] [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] [Indexed: 11/29/2022] Open
Abstract
Measles can have a substantial negative impact not only on people’s health but also on their finances, especially in developing countries. This study evaluates the household risk of catastrophic health expenditure (CHE) due to measles, according to regions and wealth quintiles. The CHE risk due to measles was computed based on (1) the likelihood of health service utilization to treat measles, (2) out-of-pocket (OOP) expenditure and indirect costs associated with disease treatment, and (3) household consumption expenditures. I derived the CHE risk associated with measles, conditional on contracting the disease, across regions and wealth quintiles in Nigeria, using secondary data sources for health-care utilization, OOP expenditures, and consumption expenditures. There was a large variation in CHE risk according to regions and wealth quintiles. Among the poorest households, those in the northeast and northwest would have the highest risk of CHE, up to 17%, while those in the southwest would have the lowest risk of 5%. For all regions, as the wealth increases, the CHE risk would decrease. There would be zero or very little CHE risk among the richest households in any regions. Given the proven efficacy of measles vaccines, immunizations can prevent households, especially poorer households in northeast and northwest regions, from facing the CHE risk due to measles.
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Affiliation(s)
- Ryoko Sato
- Center for Health Decision Science, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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