System factors to explain 2009 pandemic H1N1 state vaccination rates for children and high-risk adults in US emergency response to pandemic

The Impact of Meso-Level Factors on SARS-CoV-2 Vaccine Early Hesitancy in the United States

The extant literature on the U.S. SARS-CoV-2 virus indicates that the vaccination campaign was lagging, insufficient, and uncoordinated. This study uses the spatial model to identify the drivers of vaccine hesitancy (in the middle of the pandemic), one of the critical steps in creating impactful and effective interventions to influence behavioral changes now and in the future. The applied technique accounted for observed and unobserved homogeneity and heterogeneity among counties. The results indicated that political and religious beliefs, quantified by Cook's political bipartisan index and the percentage of the population affiliated with the main Christian groups, were the main drivers of the SARS-CoV-2 vaccine hesitancy. The past vaccination experience and other variables determining the demand and supply of vaccines were also crucial in influencing hesitancy. The results imply that vaccination campaigns require engaging community leaders at all levels rather than depending on politicians alone and eliminating barriers to the supply and demand of vaccines at all levels. Coordination among religious and community leaders would build a practical institutional arrangement to facilitate (rather than frustrate) the vaccination drives.

Supply, then demand? Health expenditure, political leanings, cost obstacles to care, and vaccine hesitancy predict state-level COVID-19 vaccination rates

OBJECTIVES

To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021.

METHODS

Using publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout.

RESULTS

We identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications.

CONCLUSIONS

Both supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time.

POLICY IMPLICATIONS

Investing in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages.

A data-driven robust optimization model by cutting hyperplanes on vaccine access uncertainty in COVID-19 vaccine supply chain

The worldwide COVID-19 pandemic sparked such a wave of concern that made access to vaccines more necessary than before. As the vaccine inaccessibility in developing countries has made pandemic eradication more difficult, this study has presented a mathematical model of a sustainable SC for the COVID-19 vaccine that covers the economic, environmental and social aspects and provides vaccine both domestically and internationally. It has also proposed a robust data-driven model based on a polyhedral uncertainty set to address the unjust worldwide vaccine distribution as an uncertain parameter. It is acceptably robust and is also less conservative than its classical counterparts. For validation, the model has been implemented in a real case in Iran, and the results have shown that it is 21% less conservative than its classical rivals (Box and Polyhedral convex uncertainty sets) in facing the uncertain parameter. As a result, the model proposes the construction of two domestic vaccine production centers, including Pasteur Institute and Razi Institute, and five foreign distributors in Tehran, Isfahan, Ahvaz, Kermanshah, and Bandar Abbas strategically.

Multi-period vaccine allocation model in a pandemic: A case study of COVID-19 in Australia

While the swift development and production of a COVID-19 vaccine has been a remarkable success, it is equally crucial to ensure that the vaccine is allocated and distributed in a timely and efficient manner. Prior research on pandemic supply chain has not fully incorporated the underlying factors and constraints in designing a vaccine allocation model. This study proposes an innovative vaccine allocation model to contain the spread of infectious diseases incorporating key contributing factors to the risk of uninoculated people including susceptibility rate and exposure risk. Analyses of the data collected from the state of Victoria in Australia show that a vaccine allocation model can deliver a superior performance in minimizing the risk of unvaccinated people when a multi-period approach is employed and augmenting operational mechanisms including transshipment between medical centers, capacity sharing, and mobile units being integrated into the vaccine allocation model.

Facing a Health Threat in a Complex Information Environment: A National Representative Survey Examining American Adults' Behavioral Responses to the 2009/2010 A(H1N1) Pandemic

Background. Recent A(H1N1) studies suggest that intrapersonal and interpersonal factors may exert influence on people’s preventive behaviors for avoiding the flu during pandemics. Aims. Nonpharmaceutical interventions (NPIs) and vaccinations play key roles in containing disease transmission during a pandemic. We examined how intrapersonal and interpersonal factors influenced adoption of NPIs and vaccine uptake during the A(H1N1) pandemic of 2009. Method. The data come from a nationally representative sample survey of 1,569 American adults. Hierarchical multivariable logistic regression was conducted to investigate the association between socioeconomic position, concern and knowledge about the threat, social networks for health advice or health care seeking, health consultations with doctors, and NPIs (including individual’s social distancing behaviors and hygiene practices) and vaccine acceptance. Results. People with higher scores on health-related social networks, more knowledge or concern about A(H1N1), and those who have consulted their doctor were more likely than others to adopt NPIs. There was a significant association between being concerned about A(H1N1), having consulted a doctor, and seeking a vaccine. Conclusions. These findings suggest that interpersonal communication factors, such as health-related social networks and consultations with doctors, and intrapersonal factors, such as concern and knowledge, play a critical role in NPIs and vaccine uptake during pandemics and offer avenues for intervention.

Evaluating the Impact of Pharmacies on Pandemic Influenza Vaccine Administration

OBJECTIVES

The objective of this study was to quantify the potential retail pharmacy vaccine administration capacity and its possible impact on pandemic influenza vaccine uptake.

METHODS

We developed a discrete event simulation model by use of ExtendSim software (Imagine That Inc, San Jose, CA) to forecast the potential effect of retail pharmacy vaccine administration on total weekly vaccine administration and the time needed to reach 80% vaccination coverage with a single dose of vaccine per person.

RESULTS

Results showed that weekly national vaccine administration capacity increased to 25 million doses per week when retail pharmacist vaccination capacity was included in the model. In addition, the time to achieve 80% vaccination coverage nationally was reduced by 7 weeks, assuming high public demand for vaccination. The results for individual states varied considerably, but in 48 states the inclusion of pharmacies improved time to 80% coverage.

CONCLUSIONS

Pharmacists can increase the numbers of pandemic influenza vaccine doses administered and reduce the time to achieve 80% single-dose coverage. These results support efforts to ensure pharmacist vaccinators are integrated into pandemic vaccine response planning. (Disaster Med Public Health Preparedness. 2017;11:587-593).

State barriers to appropriating public health emergency response funds during the 2009 H1N1 response

OBJECTIVES

We examined state-specific administrative barriers to allocating 2009 H1N1 influenza public health emergency response (PHER) funds.

METHODS

We conducted a qualitative review of PHER grants management reports to identify and code barriers reported by states in allocating funds. Using linear regression, we examined the relationship between the percentage of funds allocated and each individual barrier and, separately, the cumulative effect of multiple barriers.

RESULTS

States reported 6 barrier types, including regulatory issues (n = 14, or 28%), contracting issues (n = 14, or 28%), purchasing issues (n = 6, or 12%), legislative issues (n = 5, or 10%), staffing issues (n = 5, or 10%), and issues transferring funds between state and local health departments (n = 4, or 8%). In multivariate models, having experienced a purchasing barrier was associated with a significant decrease in PHER allocation (B = -26.4; P = .018). Separately, the cumulative effect of having 3 barriers was associated with a decrease in PHER allocation (B = -16.0; P = .079).

CONCLUSIONS

Purchasing barriers were associated with delayed use of PHER funds. Moreover, the cumulative effect of any 3 barriers hampered the allocation of funds. Understanding barriers to using funds can inform future funding guidance for improved efficiency of response efforts.