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Towett G, Snead RS, Grigoryan K, Marczika J. Geographical and practical challenges in the implementation of digital health passports for cross-border COVID-19 pandemic management: a narrative review and framework for solutions. Global Health 2023; 19:98. [PMID: 38066568 PMCID: PMC10709942 DOI: 10.1186/s12992-023-00998-7] [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: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rapid global spread of infectious diseases, epitomized by the recent COVID-19 pandemic, has highlighted the critical need for effective cross-border pandemic management strategies. Digital health passports (DHPs), which securely store and facilitate the sharing of critical health information, including vaccination records and test results, have emerged as a promising solution to enable safe travel and access to essential services and economic activities during pandemics. However, the implementation of DHPs faces several significant challenges, both related to geographical disparities and practical considerations, necessitating a comprehensive approach for successful global adoption. In this narrative review article, we identify and elaborate on the critical geographical and practical barriers that hinder global adoption and the effective utilization of DHPs. Geographical barriers are complex, encompassing disparities in vaccine access, regulatory inconsistencies, differences across countries in data security and users' privacy policies, challenges related to interoperability and standardization, and inadequacies in technological infrastructure and limited access to digital technologies. Practical challenges include the possibility of vaccine contraindications and breakthrough infections, uncertainties surrounding natural immunity, and limitations of standard tests in assessing infection risk. To address geographical disparities and enhance the functionality and interoperability of DHPs, we propose a framework that emphasizes international collaboration to achieve equitable access to vaccines and testing resources. Furthermore, we recommend international cooperation to establish unified vaccine regulatory frameworks, adopting globally accepted standards for data privacy and protection, implementing interoperability protocols, and taking steps to bridge the digital divide. Addressing practical challenges requires a meticulous approach to assessing individual risk and augmenting DHP implementation with rigorous health screenings and personal infection prevention measures. Collectively, these initiatives contribute to the development of robust and inclusive cross-border pandemic management strategies, ultimately promoting a safer and more interconnected global community in the face of current and future pandemics.
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Spiker ML, Welling J, Hertenstein D, Mishra S, Mishra K, Hurley KM, Neff RA, Fanzo J, Lee BY. When increasing vegetable production may worsen food availability gaps: A simulation model in India. FOOD POLICY 2023; 116:102416. [PMID: 37234381 PMCID: PMC10206406 DOI: 10.1016/j.foodpol.2023.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/28/2022] [Accepted: 01/11/2023] [Indexed: 05/28/2023]
Abstract
Translating agricultural productivity into food availability depends on food supply chains. Agricultural policy and research efforts promote increased horticultural crop production and yields, but the ability of low-resource food supply chains to handle increased volumes of perishable crops is not well understood. This study developed and used a discrete event simulation model to assess the impact of increased production of potato, onion, tomato, brinjal (eggplant), and cabbage on vegetable supply chains in Odisha, India. Odisha serves as an exemplar of vegetable supply chain challenges in many low-resource settings. Model results demonstrated that in response to increasing vegetable production 1.25-5x baseline amounts, demand fulfillment at the retail level fluctuated by + 3% to -4% from baseline; in other words, any improvements in vegetable availability for consumers were disproportionately low compared to the magnitude of increased production, and in some cases increased production worsened demand fulfillment. Increasing vegetable production led to disproportionately high rates of postharvest loss: for brinjal, for example, doubling agricultural production led to a 3% increase in demand fulfillment and a 19% increase in supply chain losses. The majority of postharvest losses occurred as vegetables accumulated and expired during wholesale-to-wholesale trade. In order to avoid inadvertently exacerbating postharvest losses, efforts to address food security through agriculture need to ensure that low-resource supply chains can handle increased productivity. Supply chain improvements should consider the constraints of different types of perishable vegetables, and they may need to go beyond structural improvements to include networks of communication and trade.
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Affiliation(s)
- Marie L. Spiker
- Nutritional Sciences Program and Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States1
| | - Joel Welling
- Pittsburgh Supercomputing Center, Pittsburgh, PA, United States
| | - Daniel Hertenstein
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States1
| | | | | | - Kristen M. Hurley
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Roni A. Neff
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Center for a Livable Future, Baltimore, MD, United States
| | - Jess Fanzo
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
- Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD, United States
- Johns Hopkins University, School of Advanced International Studies, Washington, DC, United States
| | - Bruce Y. Lee
- PHICOR (Public Health Informatics, Computational, and Operations Research), City University of New York Graduate School of Public Health & Health Policy (CUNY SPH), New York City, NY, United States
- CATCH (Center for Advanced Technology and Communication in Health), City University of New York Graduate School of Public Health & Health Policy (CUNY SPH), New York City, NY, United States
- AIMINGS (Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems) Center, City University of New York Graduate School of Public Health & Health Policy (CUNY SPH), New York City, NY, United States
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Cox SN, Wedlock PT, Pallas SW, Mitgang EA, Yemeke TT, Bartsch SM, Abimbola T, Sigemund SS, Wallace A, Ozawa S, Lee BY. A systems map of the economic considerations for vaccination: Application to hard-to-reach populations. Vaccine 2021; 39:6796-6804. [PMID: 34045101 PMCID: PMC8889938 DOI: 10.1016/j.vaccine.2021.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Understanding the economics of vaccination is essential to developing immunization strategies that can be employed successfully with limited resources, especially when vaccinating populations that are hard-to-reach. METHODS Based on the input from interviews with 24 global experts on immunization economics, we developed a systems map of the mechanisms (i.e., necessary steps or components) involved in vaccination, and associated costs and benefits, focused at the service delivery level. We used this to identify the mechanisms that may be different for hard-to-reach populations. RESULTS The systems map shows different mechanisms that determine whether a person may or may not get vaccinated and the potential health and economic impacts of doing so. The map is divided into two parts: 1) the costs of vaccination, representing each of the mechanisms involved in getting vaccinated (n = 23 vaccination mechanisms), their associated direct vaccination costs (n = 18 vaccination costs), and opportunity costs (n = 5 opportunity costs), 2) the impact of vaccination, representing mechanisms after vaccine delivery (n = 13 impact mechanisms), their associated health effects (n = 10 health effects for beneficiary and others), and economic benefits (n = 13 immediate and secondary economic benefits and costs). Mechanisms that, when interrupted or delayed, can result in populations becoming hard-to-reach include getting vaccines and key stakeholders (e.g., beneficiaries/caregivers, vaccinators) to a vaccination site, as well as vaccine administration at the site. CONCLUSION Decision-makers can use this systems map to understand where steps in the vaccination process may be interrupted or weak and identify where gaps exist in the understanding of the economics of vaccination. With improved understanding of system-wide effects, this map can help decision-makers inform targeted interventions and policies to increase vaccination coverage in hard-to-reach populations.
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Affiliation(s)
- Sarah N Cox
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States
| | - Sarah W Pallas
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Elizabeth A Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States
| | - Taiwo Abimbola
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Sheryl S Sigemund
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States
| | - Aaron Wallace
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States; Department of Maternal and Child Health, UNC Gillings School of Global Health, University of North Carolina, Chapel Hill, NC, United States
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States.
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Ayenigbara IO, Adegboro JS, Ayenigbara GO, Adeleke OR, Olofintuyi OO. The challenges to a successful COVID-19 vaccination programme in Africa. Germs 2021; 11:427-440. [PMID: 34722365 DOI: 10.18683/germs.2021.1280] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 vaccination campaign is an ongoing worldwide effort to vaccinate large numbers of people against COVID-19 in order to ensure protection from the disease, control the rate of infection, reduce severe outcomes, and get back to normal life. Most African countries had a delay in the initiation of their COVID-19 vaccine national rollout compared to other regions in the world, and the goal of the immunization exercise in the continent is to vaccinate over 60% of the African population to attain herd immunity. Over the years, vaccination programmes are usually faced with challenges in Africa because of numerous factors. So far, some of the major challenges threatening the success of the COVID-19 vaccination rollout in most African countries includes the slow onset of the vaccination exercise, limited funds, concerns around vaccine safety and uncertainties, storage requirements and regulatory hurdles for vaccines, limited shelf life of COVID-19 vaccines, inability to access vulnerable communities in a timely fashion, problems around the use of different vaccines, and wars and conflicts. The solutions and other imperative recommendations to these challenges were provided so as to optimize the vaccination programme and to achieve an appreciable success in the COVID-19 vaccination programme on the continent. In conclusion, a holistic and timely planning, fast execution of plans, rigorous community involvement, and a robust multi-sectoral partnership will ensure a successful COVID-19 vaccination campaign in Africa.
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Affiliation(s)
- Israel Oluwasegun Ayenigbara
- M Ed, PhD Student, School and Community Health Education Unit, Department of Health Education, University of Ibadan, post office street number 022, postal code 200284, Ibadan, Nigeria
| | - Joseph Sunday Adegboro
- PhD, Department of Human Kinetics and Health Education, Adekunle Ajasin University Akungba-Akoko, Adefarati street number 001, postal address 342111, Ondo State, Nigeria
| | - George Omoniyi Ayenigbara
- PhD, Department of Human Kinetics and Health Education, Adekunle Ajasin University Akungba-Akoko, Adefarati street number 001, postal address 342111, Ondo State, Nigeria
| | - Olasunkanmi Rowland Adeleke
- M Ed, PhD Student, Department of Human Kinetics and Health Education, Adekunle Ajasin University Akungba-Akoko, Adefarati street number 001, postal address 342111, Ondo State, Nigeria
| | - Oluwaseyi Oye Olofintuyi
- M Ed, Department of Human Kinetics and Health Education, Adekunle Ajasin University Akungba-Akoko, Adefarati street number 001, postal address 342111, Ondo State, Nigeria
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Decouttere C, Vandaele N, De Boeck K, Banzimana S. A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms. Health Syst (Basingstoke) 2021; 12:36-51. [PMID: 36926372 PMCID: PMC10013358 DOI: 10.1080/20476965.2021.1992300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 09/28/2021] [Indexed: 12/21/2022] Open
Abstract
Despite massive progress in vaccine coverage globally, the region of sub-Saharan Africa is lagging behind for Sustainable Development Goal 3 by 2030. Sub-national under-immunisation is part of the problem. In order to reverse the current immunisation system's (IMS) underperformance, a conceptual model is proposed that captures the complexity of IMSs in low- and middle-income countries (LMICs) and offers directions for sustainable redesign. The IMS model was constructed based on literature and stakeholder interaction in Rwanda and Kenya. The model assembles the paradigms of planned and emergency immunisation in one system and emphasises the synchronised flows of vaccinee, vaccinator and vaccine. Six feedback loops capture the main mechanisms governing the system. Sustainability and resilience are assessed based on loop dominance and dependency on exogenous factors. The diagram invites stakeholders to share their mental models and. The framework provides a systems approach for problem structuring and policy design.
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Affiliation(s)
- Catherine Decouttere
- Centre for Access-To-Medicines (ATM) at Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nico Vandaele
- Centre for Access-To-Medicines (ATM) at Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kim De Boeck
- Centre for Access-To-Medicines (ATM) at Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stany Banzimana
- University of Rwanda, EAC Regional Centre of Excellence for Vaccines, Immunisation and Health Supply Chain Management, Kigali, Rwanda
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Controlling Human Rabies: The Development of an Effective, Inexpensive and Locally Made Passive Cooling Device for Storing Thermotolerant Animal Rabies Vaccines. Trop Med Infect Dis 2020; 5:tropicalmed5030130. [PMID: 32796605 PMCID: PMC7558109 DOI: 10.3390/tropicalmed5030130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Thermotolerant vaccines greatly improved the reach and impact of large-scale vaccination programs to eliminate diseases such as smallpox, polio and rinderpest. A recent study demonstrated that the potency of the Nobivac® Canine Rabies vaccine was not impacted following experimental storage at 30 °C for three months. We conducted a study to develop a passive cooling device (PCD) that could store thermotolerant vaccines under fluctuating subambient temperatures. Through a participatory process with local communities in Northern Tanzania, we developed innovative PCD designs for local manufacture. A series of field experiments were then carried out to evaluate the effectiveness of five PCDs for vaccine storage under varying climatic conditions. Following iterative improvement, a final prototype “Zeepot Clay” was developed at the cost of US$11 per unit. During a further field-testing phase over a 12-month period, the internal temperature of the device remained below 26 °C, despite ambient temperatures exceeding 42 °C. Our study thus demonstrated that locally designed PCDs have utility for storing thermotolerant rabies vaccines at subambient temperatures. These results have application for the scaling up of mass dog vaccination programs in low-and-middle income countries, particularly for hard-to-reach populations with limited access to power and cold-chain vaccine storage.
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Ferguson MC, Morgan MJ, O’Shea KJ, Winch L, Siegmund SS, Gonzales MS, Randall S, Hertenstein D, Montague V, Woodberry A, Cassatt T, Lee BY. Using Simulation Modeling to Guide the Design of the Girl Scouts Fierce & Fit Program. Obesity (Silver Spring) 2020; 28:1317-1324. [PMID: 32378341 PMCID: PMC7311310 DOI: 10.1002/oby.22827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/07/2020] [Accepted: 03/28/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The study aim was to help the Girl Scouts of Central Maryland evaluate, quantify, and potentially modify the Girl Scouts Fierce & Fit program. METHODS From 2018 to 2019, our Public Health Informatics, Computational, and Operations Research team developed a computational simulation model representing the 250 adolescent girls participating in the Fierce & Fit program and how their diets and physical activity affected their BMI and subsequent outcomes, including costs. RESULTS Changing the Fierce & Fit program from a 6-week program meeting twice a week, with 5 minutes of physical activity each session, to a 12-week program meeting twice a week with 30 minutes of physical activity saved an additional $84,828 ($80,130-$89,526) in lifetime direct medical costs, $81,365 ($76,528-$86,184) in lifetime productivity losses, and 7.85 (7.38-8.31) quality-adjusted life-years. The cost-benefit of implementing this program was $95,943. Based on these results, the Girl Scouts of Central Maryland then implemented these changes in the program. CONCLUSIONS This is an example of using computational modeling to help evaluate and revise the design of a program aimed at increasing physical activity among girls.
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Affiliation(s)
- Marie C. Ferguson
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Matthew J. Morgan
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Kelly J. O’Shea
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Lucas Winch
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Sheryl S. Siegmund
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Mario Solano Gonzales
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Samuel Randall
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | - Daniel Hertenstein
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
| | | | | | | | - Bruce Y. Lee
- PHICOR (Public Health Informatics, Computational and Operations Research), City University of New York Graduate School of Public Health and Health Policy, New York, New York, (formerly at Johns Hopkins University, Baltimore, MD)
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Wedlock PT, Mitgang EA, Oron AP, Hagedorn BL, Leonard J, Brown ST, Bakal J, Siegmund SS, Lee BY. Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines. Vaccine 2019; 37:2356-2368. [PMID: 30914223 PMCID: PMC6467546 DOI: 10.1016/j.vaccine.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The lack of specific policies on how many children must be present at a vaccinating location before a healthcare worker can open a measles-containing vaccine (MCV) - i.e. the vial-opening threshold - has led to inconsistent practices, which can have wide-ranging systems effects. METHODS Using HERMES-generated simulation models of the routine immunization supply chains of Benin, Mozambique and Niger, we evaluated the impact of different vial-opening thresholds (none, 30% of doses must be used, 60%) and MCV presentations (10-dose, 5-dose) on each supply chain. We linked these outputs to a clinical- and economic-outcomes model which translated the change in vaccine availability to associated infections, medical costs, and DALYs. We calculated the economic impact of each policy from the health system perspective. RESULTS The vial-opening threshold that maximizes vaccine availability while minimizing costs varies between individual countries. In Benin (median session size = 5), implementing a 30% vial-opening threshold and tailoring distribution of 10-dose and 5-dose MCVs to clinics based on session size is the most cost-effective policy, preventing 671 DALYs ($471/DALY averted) compared to baseline (no threshold, 10-dose MCVs). In Niger (median MCV session size = 9), setting a 60% vial-opening threshold and tailoring MCV presentations is the most cost-effective policy, preventing 2897 DALYs ($16.05/ DALY averted). In Mozambique (median session size = 3), setting a 30% vial-opening threshold using 10-dose MCVs is the only beneficial policy compared to baseline, preventing 3081 DALYs ($85.98/DALY averted). Across all three countries, however, a 30% vial-opening threshold using 10-dose MCVs everywhere is the only MCV threshold that consistently benefits each system compared to baseline. CONCLUSION While the ideal vial-opening threshold policy for MCV varies by supply chain, implementing a 30% vial-opening threshold for 10-dose MCVs benefits each system by improving overall vaccine availability and reducing associated medical costs and DALYs compared to no threshold.
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Affiliation(s)
- Patrick T Wedlock
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth A Mitgang
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Assaf P Oron
- Institute for Disease Modeling, Bellevue, WA, United States
| | | | - Jim Leonard
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Shawn T Brown
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; McGill Centre for Integrative Neuroscience, McGill Neurological Institute, McGill University, Montreal, Canada
| | - Jennifer Bakal
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Sheryl S Siegmund
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Bruce Y Lee
- HERMES Logistics Modeling Team, Baltimore, MD & Pittsburgh, PA, United States; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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