Vaccinating a billion people against COVID-19: India’s quest for systems leadership in exceptional times

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kamal Gulati ◽  
Jamiu Busari
Keyword(s):  
Public Health ◽  
Vaccination Programme ◽  
Vaccine Development ◽  
Vaccination Campaign ◽  
Grey Literature ◽  
Scale Up ◽  
System Level ◽  
Indian Government ◽  
Content Type ◽  
Systems Leadership

Purpose In January 2021, India launched the world’s most extensive vaccination campaign against COVID-19. It is estimated that India would need to vaccinate over a billion people to achieve herd immunity. Even though the Indian Government focuses on improving and delivering its vaccination programme, significant challenges still exist. This paper aims to discuss current challenges to scale up India’s vaccination campaign and addresses strategies for achieving this. Design/methodology/approach The paper is based on a review of secondary sources, including journal articles from scholarly and grey literature and information available in the public domain. The search focused explicitly on the COVID-19 scenario, vaccination programme, public health management and systems leadership in the Indian health care system. Findings The analysis revealed that various factors have disrupted India’s vaccination campaign, including shortage of vaccine doses, mandatory prior online registration, lack of infrastructure, safety concerns for older people, untrained workforce and absence of a solid public health framework. Furthermore, India appears to have struggled to reduce tensions and instill trust in its ability to effectively manage the COVID-19 pandemic and vaccination programme due to a lack of cooperation between union government, state governments and other stakeholders, namely, policymakers, hospitals, industry and community. Originality/value The findings indicate that scaling up India’s anti-COVID vaccination programme would require system-level leadership strategies that work within the country’s limited resources. Deeper reforms in vaccine development, storage, delivery, training and regulatory frameworks are also needed to extend the world’s largest anti-COVID-19 vaccination campaign.

scholarly journals Shigella Vaccine Development: Finding the Path of Least Resistance

2016 ◽  
Vol 23 (12) ◽  
pp. 904-907 ◽  
Author(s):  
Wilbur H. Chen ◽  
Karen L. Kotloff
Keyword(s):  
Public Health ◽  
Developing Countries ◽  
Phase I ◽  
Phase I Study ◽  
Vaccine Development ◽  
Shigella Flexneri ◽  
Health Concern ◽  
Childhood Diarrhea ◽  
Public Health Concern ◽  
Content Type

ABSTRACTShigellaspp. represent the second most common etiologic pathogen causing childhood diarrhea in developing countries. There are no licensedShigellavaccines, and progress for such vaccines has been limited. In this issue ofClinical and Vaccine Immunology, Riddle and colleagues (M. S. Riddle, R. W. Kaminski, C. Di Paolo, C. K. Porter, R. L. Gutierrez, et al., Clin Vaccine Immunol 23:908–917, 2016,http://dx.doi.org/10.1128/CVI.00224-16) report results from a phase I study of a parenterally administered monovalent O-polysaccharide “bioconjugate” directed againstShigella flexneri2a. Ultimately, the goal is to develop a broad-spectrumShigellavaccine to address this public health concern. A parenteralShigellavaccine capable of eliciting protection in children of developing countries would be an important tool to reach this goal.

scholarly journals An inter-disciplinary perspective on evaluation of innovation to support care leavers’ transition

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Amy Lynch ◽  
Hayley Alderson ◽  
Gary Kerridge ◽  
Rebecca Johnson ◽  
Ruth McGovern ◽  
...  
Keyword(s):  
Public Health ◽  
Young People ◽  
Social Care ◽  
Grey Literature ◽  
Theoretical Frameworks ◽  
Content Type ◽  
The Past ◽  
Disciplinary Perspective ◽  
Care Leavers ◽  
Evaluation Approaches

Purpose Young people who are looked after by the state face challenges as they make the transition from care to adulthood, with variation in support available. In the past decade, funding has been directed towards organisations to pilot innovations to support transition, with accompanying evaluations often conducted with a single disciplinary focus, in a context of short timescales and small budgets. Recognising the value and weight of the challenge involved in evaluation of innovations that aim to support the transitions of young people leaving care, this paper aims to provide a review of evaluation approaches and suggestions regarding how these might be developed. Design/methodology/approach As part of a wider research programme to improve understanding of the innovation process for young people leaving care, the authors conducted a scoping review of grey literature (publications which are not peer reviewed) focusing on evaluation of innovations in the UK over the past 10 years. The authors critiqued the evaluation approaches in each of the 22 reports they identified with an inter-disciplinary perspective, representing social care, public health and organisation science. Findings The authors identified challenges and opportunities for the development of evaluation approaches in three areas. Firstly, informed by social care, the authors suggest increased priority should be granted to participatory approaches to evaluation, within which involvement of young people leaving care should be central. Secondly, drawing on public health, there is potential for developing a common outcomes’ framework, including methods of data collection, analysis and reporting, which aid comparative analysis. Thirdly, application of theoretical frameworks from organisation science regarding the process of innovation can drive transferable lessons from local innovations to aid its spread. Originality/value By adopting the unique perspective of their multiple positions, the authors’ goal is to contribute to the development of evaluation approaches. Further, the authors hope to help identify innovations that work, enhance their spread, leverage resources and influence policy to support care leavers in their transitions to adulthood.

scholarly journals 80 Archetypes of vaccine hesitant caregivers towards COVID-19 immunization during a global pandemic: A qualitative study

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e58-e59
Author(s):  
Jordan Yeo ◽  
Caitlyn Gudmundsen ◽  
Sajjad Fazel ◽  
Alex Corrigan ◽  
Madison Fullerton ◽  
...  
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Vaccine Development ◽  
Vaccination Campaign ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Pediatric Care ◽  
Vaccine Hesitancy ◽  
Successful Implementation ◽  
Discrete Subgroups

Abstract Primary Subject area Public Health and Preventive Medicine Background As Canada embarks on its rollout of the COVID-19 vaccine, vaccine hesitancy has the potential to hamper success of the vaccination campaign. Multiple surveys show that the number of Canadians willing to take the vaccine is insufficient to achieve herd immunity. Therefore, governments and health agencies are looking for solutions to increase vaccination uptake. Obtaining a better understanding of the perspective of those who are vaccine-hesitant is critical to developing successful implementation strategies for COVID-19 vaccination. Objectives To explore COVID-19 vaccination determinants among hesitant caregivers and describe categories of COVID-19 vaccine hesitancy. Design/Methods We conducted 23 semi-structured telephone interviews with parents recruited from a tertiary pediatric care centre. Seventeen participants had previously attended a specialty clinic to discuss vaccine hesitancy; the remaining were recruited from an infectious diseases follow-up clinic. The interview guide was structured around the Theoretical Domains Framework, assessing 14 behavioural constructs to identify specific determinants that guide behaviour change. Interviews were audio-recorded, transcribed, and analyzed by two independent data coders using a pragmatic inductive approach. Recurring themes were noted among subgroups of participants, who were subsequently divided into categories based on their underlying concerns. Results Five archetypes of vaccine-hesitant caregivers emerged in our data (Table 1). 1). “Bubble Dwellers” perceive themselves to be safe by following public health recommendations, and distinguish themselves from higher-risk groups to whom the vaccine should first be offered. 2). “Worriers and Delayers” identify the pandemic as a threat and are generally supportive of vaccines, but are concerned about side effects and issues surrounding vaccine development and prefer to delay vaccination. 3). “Need-for-Normals” are more concerned about social isolation and the economy than the direct effects of the COVID-19 virus, but express that the idea of a “return to normal” may sway their opinions regarding the vaccine. 4). “Exceptionalists” hold personal misperceptions of vaccine contraindications due to comorbidities or previous experiences with vaccination, and are concerned that the current rollout invokes a “one size fits all” model that does not apply to their circumstances. 5. “Freedom Fighters” view the pandemic as a hoax, are anti-establishment, and believe the information they have been provided is not convincing for them to adopt the vaccine. Conclusion The evolving pandemic provides a unique opportunity to understand determinants of vaccination intention in the vaccine hesitant population. Our qualitative study is unique in that we were able to draw upon pre-identified vaccine hesitant individuals to explore their perspectives around COVID-19 immunization. We propose that rather than viewing these individuals as one homogenous group, policymakers and health professionals address these discrete subgroups with specific communication tools and information. We are hopeful that our results will help tailor implementation strategies that are targeted to different vaccine hesitancy archetypes, as the vaccine is made available to the general public in the coming year.

A review of policy, practices, and players governing and involved in the United States vaccine and immunization enterprise

2017 ◽  
Vol 22 (3) ◽  
pp. 138-151
Author(s):  
Angela K. Shen ◽  
Alice Y. Tsai ◽  
Guthrie S. Birkhead
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Vaccine Development ◽  
The United States ◽  
Federal State ◽  
Content Type ◽  
Wide Range ◽  
The Us ◽  
The Usa ◽  
State And Local

Purpose The purpose of this paper is to outline the organization and governance of the US vaccine and immunization enterprise. It describes the major components of the US system including the various relationships between major federal government entities, stakeholders, and advisory committees that inform government policymaking at various points in the system. Design/methodology/approach The authors describe the complex interdependent network of partners that engage in a wide range of activities such as disease surveillance, research, vaccine development, regulatory licensure, practice recommendations, financing, service delivery, communications, and post-licensure monitoring. Findings The US system of governance is highly participatory and focuses on a transparent and open engagement, with input from a wide range of partners to inform decision-making. This collaborative framework allows many inputs to be heard and helps support the US vaccine and immunization system as it evolves to meet the continued public health needs in the USA through the optimal use of safe and effective vaccines. Originality/value This is an invited article on the US vaccine and immunization enterprise. The development and availability of vaccines in the USA has had profound impact on mortality and morbidity and public health (Centers for Disease Control and Prevention, 2011). The success of this enterprise is a result of a blended public and private sector system with partnerships at the federal, state, and local levels of government to optimize the use of safe and effective vaccines. Governance structures have been established to support the interaction and decision-making among the federal and non-federal actors toward the common goal of controlling and preventing infectious diseases.

scholarly journals Implementing disruptive technological change in UK healthcare: exploring development of a smart phone app for remote patient monitoring as a boundary object using qualitative methods

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Charlotte A. Sharp ◽  
Mike Bresnen ◽  
Lynn Austin ◽  
Jillian McCarthy ◽  
William G. Dixon ◽  
...  
Keyword(s):  
Scale Up ◽  
Smart Phone ◽  
Boundary Object ◽  
System Level ◽  
Structured Interviews ◽  
Content Type ◽  
Healthcare Innovation ◽  
Remote Patient ◽  
Smart Phone Application

PurposeDeveloping technological innovations in healthcare is made complex and difficult due to effects upon the practices of professional, managerial and other stakeholders. Drawing upon the concept of boundary object, this paper explores the challenges of achieving effective collaboration in the development and use of a novel healthcare innovation in the English healthcare system.Design/methodology/approachA case study is presented of the development and implementation of a smart phone application (app) for use by rheumatoid arthritis patients. Over a two-year period (2015–2017), qualitative data from recorded clinical consultations (n = 17), semi-structured interviews (n = 63) and two focus groups (n = 13) were obtained from participants involved in the app's development and use (clinicians, patients, researchers, practitioners, IT specialists and managers).FindingsThe case focuses on the use of the app and its outputs as a system of inter-connected boundary objects. The analysis highlights the challenges overcome in the innovation's development and how knowledge sharing between patients and clinicians was enhanced, altering the nature of the clinical consultation. It also shows how conditions surrounding the innovation both enabled its development and inhibited its wider scale-up.Originality/valueBy recognizing that technological artefacts can simultaneously enable and inhibit collaboration, this paper highlights the need to overcome tensions between the transformative capability of such healthcare innovations and the inhibiting effects simultaneously created on change at a wider system level.

scholarly journals Mechanisms of scaling up: combining a realist perspective and systems analysis to understand successfully scaled interventions

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Harriet Koorts ◽  
Samuel Cassar ◽  
Jo Salmon ◽  
Mark Lawrence ◽  
Paul Salmon ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systems Analysis ◽  
Phase 1 ◽  
Grey Literature ◽  
National Level ◽  
Scale Up ◽  
Scaling Up ◽  
System Level ◽  
Systems Models ◽  
Realist Perspective

Abstract Background Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes. Methods A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions; Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up; Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions (Phase 1); and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up; validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data. Results Seven interventions were analysed, targeting nutrition (n = 1), physical activity (n = 1), or a combination (n = 5). Twenty-six participants completed surveys; 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes; linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included ‘intervention attributes’ and led to outcomes ‘community sustainability/embeddedness’ and ‘stakeholder buy-in/perceived value’. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability); mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability). Conclusion This paper provides the first evidence for mechanisms underpinning outcomes required for successful scale up of state or nationally delivered interventions. Our findings challenge current prerequisites for effective scaling suggesting other conditions may be necessary. Future scale up approaches that plan for complexity and encourage iterative adaptation throughout, may enhance scale up outcomes. Current linear, context-to-outcome depictions of scale up oversimplify what is a clearly a complex interaction between perceptions, worldviews and goals of those involved. Mechanisms identified in this study could potentially be leveraged during future scale up efforts, to positively influence intervention scalability and sustainability.

scholarly journals Expanding U.S. Laboratory Capacity for Neisseria gonorrhoeae Antimicrobial Susceptibility Testing and Whole-Genome Sequencing through the CDC's Antibiotic Resistance Laboratory Network

2020 ◽  
Vol 58 (4) ◽  
Author(s):  
Ellen N. Kersh ◽  
Cau D. Pham ◽  
John R. Papp ◽  
Robert Myers ◽  
Richard Steece ◽  
...  
Keyword(s):  
Public Health ◽  
Antibiotic Resistance ◽  
Neisseria Gonorrhoeae ◽  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Whole Genome ◽  
Content Type ◽  
Laboratory Capacity

ABSTRACT U.S. gonorrhea rates are rising, and antibiotic-resistant Neisseria gonorrhoeae (AR-Ng) is an urgent public health threat. Since implementation of nucleic acid amplification tests for N. gonorrhoeae identification, the capacity for culturing N. gonorrhoeae in the United States has declined, along with the ability to perform culture-based antimicrobial susceptibility testing (AST). Yet AST is critical for detecting and monitoring AR-Ng. In 2016, the CDC established the Antibiotic Resistance Laboratory Network (AR Lab Network) to shore up the national capacity for detecting several resistance threats including N. gonorrhoeae. AR-Ng testing, a subactivity of the CDC’s AR Lab Network, is performed in a tiered network of approximately 35 local laboratories, four regional laboratories (state public health laboratories in Maryland, Tennessee, Texas, and Washington), and the CDC’s national reference laboratory. Local laboratories receive specimens from approximately 60 clinics associated with the Gonococcal Isolate Surveillance Project (GISP), enhanced GISP (eGISP), and the program Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). They isolate and ship up to 20,000 isolates to regional laboratories for culture-based agar dilution AST with seven antibiotics and for whole-genome sequencing of up to 5,000 isolates. The CDC further examines concerning isolates and monitors genetic AR markers. During 2017 and 2018, the network tested 8,214 and 8,628 N. gonorrhoeae isolates, respectively, and the CDC received 531 and 646 concerning isolates and 605 and 3,159 sequences, respectively. In summary, the AR Lab Network supported the laboratory capacity for N. gonorrhoeae AST and associated genetic marker detection, expanding preexisting notification and analysis systems for resistance detection. Continued, robust AST and genomic capacity can help inform national public health monitoring and intervention.

scholarly journals Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature

2021 ◽  
Vol 18 (8) ◽  
pp. 4167
Author(s):  
Amal Chakraborty ◽  
Mark Daniel ◽  
Natasha J. Howard ◽  
Alwin Chong ◽  
Nicola Slavin ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Diseases ◽  
Scoping Review ◽  
Classification System ◽  
Grey Literature ◽  
Indigenous Communities ◽  
Environmental Indicators ◽  
Health Concern ◽  
Environmental Determinants ◽  
Health And Wellbeing

The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the “community infrastructure” domain within the built environment, and the “community capacity” domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.

scholarly journals Artificial intelligence for good health: a scoping review of the ethics literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals Conceptualising natural and quasi experiments in public health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frank de Vocht ◽  
Srinivasa Vittal Katikireddi ◽  
Cheryl McQuire ◽  
Kate Tilling ◽  
Matthew Hickman ◽  
...  
Keyword(s):  
Public Health ◽  
Study Design ◽  
Grey Literature ◽  
Public Health Research ◽  
Natural Experiments ◽  
Target Trial ◽  
Design Elements ◽  
Randomized Controlled ◽  
Study Designs ◽  
The Impact

Abstract Background Natural or quasi experiments are appealing for public health research because they enable the evaluation of events or interventions that are difficult or impossible to manipulate experimentally, such as many policy and health system reforms. However, there remains ambiguity in the literature about their definition and how they differ from randomized controlled experiments and from other observational designs. We conceptualise natural experiments in the context of public health evaluations and align the study design to the Target Trial Framework. Methods A literature search was conducted, and key methodological papers were used to develop this work. Peer-reviewed papers were supplemented by grey literature. Results Natural experiment studies (NES) combine features of experiments and non-experiments. They differ from planned experiments, such as randomized controlled trials, in that exposure allocation is not controlled by researchers. They differ from other observational designs in that they evaluate the impact of events or process that leads to differences in exposure. As a result they are, in theory, less susceptible to bias than other observational study designs. Importantly, causal inference relies heavily on the assumption that exposure allocation can be considered ‘as-if randomized’. The target trial framework provides a systematic basis for evaluating this assumption and the other design elements that underpin the causal claims that can be made from NES. Conclusions NES should be considered a type of study design rather than a set of tools for analyses of non-randomized interventions. Alignment of NES to the Target Trial framework will clarify the strength of evidence underpinning claims about the effectiveness of public health interventions.

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