Priority allocation of pandemic influenza vaccines in Australia - Recommendations of 3 community juries

Public values to guide childhood vaccination mandates: A report on four Australian community juries

OBJECTIVE

Governments use vaccination mandates, of different degrees of coerciveness, to encourage or require childhood vaccination. We elicited the views of well-informed community members on the public acceptability of using childhood vaccination mandates in Australia.

METHODS

Four community juries were conducted in Canberra, Launceston, Cairns and Melbourne, Australia between 2021 and 2022. We recruited 51 participants from diverse backgrounds, genders and ages through random digit dialling and social media. Two juries were held in metropolitan areas, and two in regional/rural settings. Outcome measures included jury verdicts and reasons in response to structured questions.

RESULTS

All juries were concerned about collective protection and individual rights but prioritised the former over the latter. A majority in all juries supported mandates but juries disagreed with respect to the appropriate mandate types. All juries endorsed using the least restrictive or coercive means to encourage vaccination (providing incentives or education, e.g.) before imposing penalties such as financial losses and school exclusions. The overriding view was that it is fairer to place a direct burden on parents rather than children and that mandates should be designed to avoid inequitable impacts on less advantaged groups in society. Many jurors found conscientious objection acceptable as a controlled option for resolute refusers, provided that overall vaccination coverage remains high.

CONCLUSION

This paper gives policymakers access to the reasons that Australians have for supporting or opposing different mandates under conditions of high knowledge, understanding and deliberation regarding policy options. Sustaining high rates of vaccination requires high levels of co-operation between governments, public health actors and the public. Our findings highlight the importance of considering public values in the design and implementation of vaccination mandates.

PATIENT AND PUBLIC INVOLVEMENT

We sought input from individuals who did and did not vaccinate during the study design. The views and perspectives of nonvaccinating parents were presented in the evidence to juries. We deliberately excluded nonvaccinating individuals from participating, as the divisive and often hostile nature of the topic, and their minority status, made it difficult to ensure they would feel safe as members of the jury without overrepresenting their perspective in the sample. Two related projects engaged directly with these parents.

Having a real say: findings from first nations community panels on pandemic influenza vaccine distribution

BACKGROUND

Recent deliberations by Australian public health researchers and practitioners produced an ethical framework of how decisions should be made to distribute pandemic influenza vaccine. The outcome of the deliberations was that the population should be considered in two categories, Level 1 and Level 2, with Level 1 groups being offered access to the pandemic influenza vaccine before other groups. However, the public health researchers and practitioners recognised the importance of making space for public opinion and sought to understand citizens values and preferences, especially First Nations peoples.

METHODS

We conducted First Nations Community Panels in two Australian locations in 2019 to assess First Nations people's informed views through a deliberative process on pandemic influenza vaccination distribution strategies. Panels were asked to make decisions on priority levels, coverage and vaccine doses.

RESULTS

Two panels were conducted with eighteen First Nations participants from a range of ages who were purposively recruited through local community networks. Panels heard presentations from public health experts, cross-examined expert presenters and deliberated on the issues. Both panels agreed that First Nations peoples be assigned Level 1 priority, be offered pandemic influenza vaccination before other groups, and be offered two doses of vaccine. Reasons for this decision included First Nations people's lives, culture and families are important; are at-risk of severe health outcomes; and experience barriers and challenges to accessing safe, quality and culturally appropriate healthcare. We found that communication strategies, utilising and upskilling the First Nations health workforce, and targeted vaccination strategies are important elements in pandemic preparedness and response with First Nations peoples.

CONCLUSIONS

First Nations Community Panels supported prioritising First Nations peoples for pandemic influenza vaccination distribution and offering greater protection by using a two-dose full course to fewer people if there are initial supply limitations, instead of one dose to more people, during the initial phase of the vaccine roll out. The methodology and findings can help inform efforts in planning for future pandemic vaccination strategies for First Nations peoples in Australia.

Predictors and prevalence of COVID-19 vaccination in patients with focal epilepsy following resection surgery

BACKGROUND AND PURPOSE

In light of the ongoing COVID-19 pandemic, vaccination has emerged as the primary and most effective solution. The aim of this study was to examine compliance rates of vaccination and explore the factors that predict vaccine uptake among patients with epilepsy (PWE) who have undergone resection surgery.

METHOD

To examine the variations in vaccination coverage, safety concerns, and factors influencing vaccination hesitancy among PWE who have undergone resection surgery, this study recruited patients with at least one-year follow-up. We utilized questionnaires to gather clinical characteristics and obtain information regarding COVID-19 vaccines.

RESULTS

Among the 303 patients included in the study, a majority of 229 (75.58%) achieved a seizure-free outcome (Engel Ia). Of these patients, 178 (58.75%) received at least one dose of COVID-19 vaccine, and the vaccination rate has remained relatively consistent over the past six months. Nearly 94.95% of those who received the vaccine completed the full vaccination regimen, with the majority (n = 174, 97.75%) opting for an inactivated vaccine. Only three patients reported side effects unrelated to epilepsy, and one patient experienced a worsening of typical aura seizures within one month after vaccination. Notably, significant positive associations were observed between COVID-19 vaccine acceptance and adulthood (age 18 years or older) (OR = 1.820, 95% CI = 1.018-3.252, p = 0.043) as well as achieving a seizure-free outcome (OR = 2.823, 95% CI = 1.619-4.921, p < 0.001). Regarding the unvaccinated patients, approximately one-fifth expressed willingness to receive a future COVID-19 vaccine, while the remainder were hesitant (41.60%) or unsure (39.20%) about vaccination. These reservations mainly stemmed from concerns about the potential worsening of seizures and vaccine safety.

CONCLUSIONS

Inactivated vaccines can be considered safe for individuals with epilepsy who have undergone resection surgery. The likelihood of being vaccinated was found to be comparatively higher among the cohort with seizure-free status or adults. To promote COVID-19 vaccination among children, it is crucial to implement comprehensive education and public awareness campaigns that emphasize the safety of vaccines. These efforts will help encourage widespread acceptance of vaccination and ensure the well-being of individuals with epilepsy.

Understanding the impact of disease and vaccine mechanisms on the importance of optimal vaccine allocation

Vaccination is an important epidemic intervention strategy. However, it is generally unclear how the outcomes of different vaccine strategies change depending on population characteristics, vaccine mechanisms and allocation objective. In this paper we develop a conceptual mathematical model to simulate strategies for pre-epidemic vaccination. We extend the SEIR model to incorporate a range of vaccine mechanisms and disease characteristics. We then compare the outcomes of optimal and suboptimal vaccination strategies for three public health objectives (total infections, total symptomatic infections and total deaths) using numerical optimisation. Our comparison shows that the difference in outcomes between vaccinating optimally and suboptimally depends on vaccine mechanisms, disease characteristics, and objective considered. Our modelling finds vaccines that impact transmission produce better outcomes as transmission is reduced for all strategies. For vaccines that impact the likelihood of symptomatic disease or dying due to infection, the improvement in outcome as we decrease these variables is dependent on the strategy implemented. Through a principled model-based process, this work highlights the importance of designing effective vaccine allocation strategies. We conclude that efficient allocation of resources can be just as crucial to the success of a vaccination strategy as the vaccine effectiveness and/or amount of vaccines available.

Comparison of health-oriented cross-regional allocation strategies for the COVID-19 vaccine: a mathematical modelling study

BACKGROUND

Controlling the epidemic spread and establishing the immune barrier in a short time through accurate vaccine demand prediction and optimised vaccine allocation strategy are still urgent problems to be solved under the condition of frequent virus mutations.

METHODS

A cross-regional Susceptible-Exposed-Infected-Removed dynamic model was used for scenario simulation to systematically elaborate and compare the effects of different cross-regional vaccine allocation strategies on the future development of the epidemic in regions with different population sizes, prevention and control capabilities, and initial risk levels. Furthermore, the trajectory of the cross-regional vaccine allocation strategy, calculated using a particle swarm optimisation algorithm, was compared with the trajectories of other strategies.

RESULTS

By visualising the final effect of the particle swarm optimisation vaccine allocation strategy, this study revealed the important role of prevention and control (including the level of social distancing control, the speed of tracking and isolating exposed and infected individuals, and the initial frequency of mask-wearing) in determining the allocation of vaccine resources. Most importantly, it supported the idea of prioritising control in regions with a large population and low initial risk level, which broke the general view that high initial risk needs to be given priority and proposed that outbreak risk should be firstly considered instead.

CONCLUSIONS

This is the first study to use a particle swarm optimisation algorithm to study the cross-regional allocation of COVID-19 vaccines. These data provide a theoretical basis for countries and regions to develop more targeted and sustainable vaccination strategies.KEY MESSAGEThe innovative combination of particle swarm optimisation and cross-regional SEIR model to simulate the pandemic trajectory and predict the vaccine demand helped to speed up and stabilise the construction of the immune barrier, especially faced with new virus mutations.We proposed that priority should be given to regions where it is possible to prevent more infections rather than regions where it is at high initial risk, thus regional outbreak risk should be considered when making vaccine allocation decisions.An optimal health-oriented strategy for vaccine allocation in the COVID-19 pandemic is determined considering both pharmaceutical and non-pharmaceutical policy interventions, including speed of isolation, degree of social distancing control, and frequency of mask-wearing.

Designing a sustainable reverse supply chain network for COVID-19 vaccine waste under uncertainty

The vast nationwide COVID-19 vaccination programs are implemented in many countries worldwide. Mass vaccination is causing a rapid increase in infectious and non-infectious vaccine wastes, potentially posing a severe threat if there is no well-organized management plan. This paper develops a mixed-integer mathematical programming model to design a COVID-19 vaccine waste reverse supply chain (CVWRSC) for the first time. The presented problem is based on minimizing the system's total cost and carbon emission. The uncertainty in the tendency rate of vaccination is considered, and a robust optimization approach is used to deal with it, where an interactive fuzzy approach converts the model into a single objective problem. Additionally, a Lagrangian relaxation (LR) algorithm is utilized to deal with the computational difficulty of the large-scale CVWRSC network. The model's practicality is investigated by solving a real-life case study. The results show the gain of the developed integrated network, where the presented framework performs better than the disintegrated vaccine and waste supply chain models. According to the results, vaccination operations and transportation of non-infectious wastes are responsible for a large portion of total cost and emission, respectively. Autoclaving technology plays a vital role in treating infectious wastes. Moreover, the sensitivity analyses demonstrate that the vaccination tendency rate significantly impacts both objective functions. The case study results prove the model's robustness under different realization scenarios, where the average objective function of the robust model is less than the deterministic model ones' in all scenarios. Finally, some insights are given based on the obtained results.

Engage, understand, listen and act: evaluation of Community Panels to privilege First Nations voices in pandemic planning and response in Australia

Introduction

First Nations Peoples of Australia have not been included in the development nor prioritised in pre-2009 pandemic plans despite being a priority population in Australian health policy. Marginalised groups experience amplified barriers and systemic disadvantage in emergencies, however, their voices have not been heard in past pandemic responses. Through effective engagement with disadvantaged and oppressed groups, health authorities can gain a deeper understanding of how to design and implement pandemic control strategies. There have been limited studies with First Nations Peoples that has focused on pandemic planning and response strategies. Deliberative inclusive approaches such as citizens juries have been a way to uncover public perceptions.

Methods

Qualitative thematic research methods were used to conduct the study. We convened five First Nations Community Panels in three locations in Australia between 2019 and 2020. We used an Indigenist research approach, community-based Participatory Action Research framework and ‘yarning’ to understand whether Community Panels were an acceptable and appropriate way of engaging First Nations Peoples. Forty First Nations participants were purposively recruited through local and cultural networks. Panels heard evidence supporting various pandemic response strategies, and cross-questioned public health experts.

Results

All 40 participants from the 5 panels verbally indicated strong support of the Community Panels approach as an effective way of engaging First Nations Peoples in making decisions about pandemic planning and response strategies. The main theme of ‘respect’ centred on the overarching principle that First Nations Peoples are important in the context of continuation of culture and ongoing political resistance.

Conclusion

First Nations Community Panels are a way of enabling active participation of First Nations peoples, increasing knowledge and understanding, and a way for government and policymakers to respectfully listen to First Nations opinions and values.

An alternative vaccine prioritization approach in response to COVID-19 pandemic

Purpose

The purpose of this study is to evaluate the impact of food access and other vulnerability measures on the COVID-19 progression to inform the public health decision-makers while setting priority rules for vaccine schedules.

Design/methodology/approach

In this paper, the authors used the Supplemental Nutrition Assistance Program (SNAP) data combined with the Centers for Disease Control and Prevention (CDC)’s social vulnerability score variables and diabetes and obesity prevalence in a set of models to assess the associations with the COVID-19 prevalence and case-fatality rates in the United States (US) counties. Using the case prevalence estimates provided by these models, the authors developed a COVID-19 vulnerability score. The COVID-19 vulnerability score prioritization is then compared with the pro-rata approach commonly used for vaccine distribution.

Findings

The study found that the population proportion residing in a food desert is positively correlated with the COVID-19 prevalence. Similarly, the population proportion registered to SNAP is positively correlated with the COVID-19 prevalence. The findings demonstrate that commonly used pro-rata vaccine allocation can overlook vulnerable communities, which can eventually create disease hot-spots.

Practical implications

The proposed methodology provides a rapid and effective vaccine prioritization scoring. However, this scoring can also be considered for other humanitarian programs such as food aid and rapid test distribution in response to the current and future pandemics.

Originality/value

Humanitarian logistics domain predominantly relies on equity measures, where each jurisdiction receives resources proportional to their population. This study provides a tool to rapidly identify and prioritize vulnerable communities while determining vaccination schedules.

From Climate Change to Pandemics: Decision Science Can Help Scientists Have Impact

Scientific knowledge and advances are a cornerstone of modern society. They improve our understanding of the world we live in and help us navigate global challenges including emerging infectious diseases, climate change and the biodiversity crisis. However, there is a perpetual challenge in translating scientific insight into policy. Many articles explain how to better bridge the gap through improved communication and engagement, but we believe that communication and engagement are only one part of the puzzle. There is a fundamental tension between science and policy because scientific endeavors are rightfully grounded in discovery, but policymakers formulate problems in terms of objectives, actions and outcomes. Decision science provides a solution by framing scientific questions in a way that is beneficial to policy development, facilitating scientists’ contribution to public discussion and policy. At its core, decision science is a field that aims to pinpoint evidence-based management strategies by focussing on those objectives, actions, and outcomes defined through the policy process. The importance of scientific discovery here is in linking actions to outcomes, helping decision-makers determine which actions best meet their objectives. In this paper we explain how problems can be formulated through the structured decision-making process. We give our vision for what decision science may grow to be, describing current gaps in methodology and application. By better understanding and engaging with the decision-making processes, scientists can have greater impact and make stronger contributions to important societal problems.

Using Public Deliberation to Set Priorities: The Case of COVID-19 Vaccine Access in New York City

CONTEXT

The COVID-19 pandemic has resulted in a record number of deaths in the United States and tremendous economic and personal strain. During 2020, in anticipation of a vaccine to slow the spread of disease, local and state governments in the United States developed plans for vaccine prioritization, given a limited initial supply. Recognizing the challenges inherent in prioritization, the New York City (NYC) health department sought guidance from members of the public about the fairest approach to early-stage vaccine distribution.

OBJECTIVE

To solicit recommendations from NYC residents on priorities regarding vaccine access for essential worker occupations, considering risk factors and preferred approaches to fairness.

IMPLEMENTATION

Five public deliberations were conducted with NYC residents (N = 91). Participants heard presentations on the COVID-19 vaccine, the local distribution of illness and death, and approaches to fairness in the context of deliberating on priorities for 6 essential worker occupations and 4 risk factors. Discussions were transcribed, and transcriptions were coded and analyzed using preidentified and emergent themes. Pre- and post-surveys, focused on factors relevant to prioritization, were administered during each public deliberation.

RESULTS

Recommendations for prioritization emphasized risk of severe morbidity and mortality, and work and neighborhood conditions with fewer protections (eg, in-person work, exposure to many people). Participants prioritized elementary schoolteachers, grocery store workers, and bus drivers, underlying health conditions, and neighborhood of residence. Participants focused on equity, recognizing that those at highest risk were largely low-income populations of color and individuals living in low-resourced neighborhoods.

CONCLUSIONS

Participants' focus on equity, and acknowledgment of racial and ethnic disparities, revealed a nuanced understanding of the broader determinants of health. Recommendations reinforced the NYC health department's approach to vaccine distribution.

PUBLIC HEALTH IMPLICATIONS

Results from these public deliberations confirmed community support for approaches prioritizing health equity, recognizing both societal and personal factors affecting vulnerability to poor health.

Spatial priority for COVID-19 vaccine rollout against limited supply

The COVID-19 vaccines are limited in supply which requires vaccination by priority. This study proposes a spatial priority-based vaccine rollout strategy for Bangladesh. Demographic, economic and vulnerability, and spatial connectivity - these four types of factors are considered for identifying the spatial priority. The spatial priority is calculated and mapped using a GIS-based analytic hierarchy process. Our findings suggest that both demographic and economic factors are keys to the spatial priority of vaccine rollout. Secondly, spatial connectivity is an essential component for defining spatial priority due to the transmissibility of COVID-19. A total of 12 out of 64 districts were found high-priority followed by 22 medium-priorities for vaccine rollout. The proposed strategy by no means suggests ending mass vaccination by descending age groups but an alternative against limited vaccine supply. The spatial priority of the vaccine rollout strategy proposed in this study might help to curb down COVID-19 transmission and to keep the economy moving. The inclusion of granular data and contextual factors can significantly improve the spatial priority identification which can have wider applications for other infectious and transmittable diseases and beyond.

Who's Getting Shots First? Dealing With the Ethical Responsibility for Prioritizing Population Groups in Vaccination

BACKGROUND

The current pandemic has raised several ethical dilemmas, related to conducting real-time trials for new treatments or vaccines or with decisions such as accessibility to vaccines.

STUDY QUESTION

Should there be a prioritization of access to the vaccine based on ethical and objective criteria or should the access be done at random?

STUDY DESIGN

To determine the ethics and reality of rationing the accessibility to anti-COVID vaccine according to the official strategies.

DATA SOURCES

The study is based on the consultation of (1) scientific articles from international databases (Google Scholar, PubMed, ProQuest, and Clarivate), (2) public health documents, and (3) official information of various governments.

RESULTS

The analyzed documents revealed that a few similarities can be observed in European countries when it comes to the first categories of people who have received the vaccine: people living in care facilities and medical staff; it can also be seen that the vaccination plan was adopted by each country for the needs and characteristics of its population, the prioritization being done in 2-14 stages; some of them divided, in their turn, into subsequent substages. Most of the states subject to the analysis assigned the medical staff in the first stage, followed by those in the sectors ensuring the maintenance of essential services, afterward by the elderly or people with comorbidities, only later to expand to other social categories.

CONCLUSIONS

Prioritization of vaccine administration is not only necessary, unavoidable, but also problematic both ethically and logistically, which should involve leaders in the field of public health, but also medical staff, regardless of their specialization. Prioritization of vaccination can not only have an impact on individual health (physical and emotional) but also on society from public health, economic, and sociocultural point of view.

A mathematical programming approach for equitable COVID-19 vaccine distribution in developing countries

Developing countries scramble to contain and mitigate the spread of coronavirus disease 2019 (COVID-19), and world leaders demand equitable distribution of vaccines to trigger economic recovery. Although numerous strategies, including education, quarantine, and immunization, have been used to control COVID-19, the best method to curb this disease is vaccination. Due to the high demand for COVID 19 vaccine, developing countries must carefully identify and prioritize vulnerable populations and rationalize the vaccine allocation process. This study presents a mixed-integer linear programming model for equitable COVID-19 vaccine distribution in developing countries. Vaccines are grouped into cold, very cold, and ultra-cold categories where specific refrigeration is required for their storage and distribution. The possibility of storage for future periods, facing a shortage, budgetary considerations, manufacturer selection, order allocation, time-dependent capacities, and grouping of the heterogeneous population are among the practical assumptions in the proposed approach. Real-world data is used to demonstrate the efficiency and effectiveness of the mathematical programming approach proposed in this study.