1
|
Ridde V, André G, Bouchaud O, Bonnet E. COVID-19 vaccination at a hospital in Paris: Spatial analyses and inverse equity hypothesis. PUBLIC HEALTH IN PRACTICE 2024; 7:100459. [PMID: 38895027 PMCID: PMC11184437 DOI: 10.1016/j.puhip.2023.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 06/21/2024] Open
Abstract
Background Vaccination against SARS-CoV-2 has been deployed in France since January 2021. Without specific action for different population subgroups, the inverse equity hypothesis postulates that people in the most deprived neighbourhoods will be the last to benefit. The article aims to study whether the inverse care law has been verified in the context of vaccination against SARS-CoV-2 from a vaccination centre of a hospital in the Paris region. Methods We performed a spatial analysis using primary data from the vaccination centre of the Avicenne Hospital in Bobigny from January 8th to September 30th, 2021. Primary data variables include the vaccinated person's date, age, and postal address. Secondary data calculates access times between residential neighbourhoods and the vaccination centre and social deprivation index. We performed flow analysis, k-means aggregation, and mapping. Results 32,712 people were vaccinated at the study centre. Vaccination flow to the hospital shows that people living in the most disadvantaged areas were the last to be vaccinated. The number of people immunized according to the level of social deprivation then scales out with slightly more access to the vaccination centre for the most advantaged. The furthest have travelled more than 100 km, and more than 1h45 of transport time to get to this vaccination centre. Conclusion The study confirms the inverse equity hypothesis and shows that vaccination preparedness strategies must consider equity issues. Public health interventions should be implemented according to proportionate universalism and use community health, health mediation, and outreach activities for more equity.
Collapse
Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
| | - Gaëlle André
- Master Carthagéo, University Paris 1 Panthéon-Sorbonne, UMR 215 Prodig, IRD, CNRS, AgroParisTech, 5, course of Humanities, F-93 322, Aubervilliers Cedex, France
| | - Olivier Bouchaud
- Hospital Avicenne-Assistance Publique hospitals de Paris and Université Sorbonne Paris Nord, F-93000, Bobigny, France
| | - Emmanuel Bonnet
- IRD, UMR 215 Prodig, CNRS, Université Paris 1 Panthéon-Sorbonne, AgroParisTech, 5, course of Humanities, F-93 322, Aubervilliers Cedex, France
| |
Collapse
|
2
|
Hassoun N, Basu K, Gostin L. Pandemic preparedness and response: a new mechanism for expanding access to essential countermeasures. HEALTH ECONOMICS, POLICY, AND LAW 2024:1-24. [PMID: 38817149 DOI: 10.1017/s1744133124000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
As the world comes together through the WHO design and consultation process on a new medical counter-measures platform, we propose an enhanced APT-A (Access to Pandemic Tools Accelerator) that builds on the previous architecture but includes two new pillars - one for economic assistance and another to combat structural inequalities for future pandemic preparedness and response. As part of the APT-A, and in light of the Independent Panel on Pandemic Preparation & Response's call for an enhanced end-to-end platform for access to essential health technologies, we propose a new mechanism that we call the Pandemic Open Technology Access Accelerator (POTAX) that can be implemented through the medical countermeasures platform and the pandemic accord currently under negotiation through the World Health Assembly and supported by the High-Level Meeting review on Pandemic Prevention, Preparedness, and Response at the United Nations. This mechanism will provide (1) conditional financing for new vaccines and other essential health technologies requiring companies to vest licenses in POTAX and pool intellectual property and other data necessary to allow equitable access to the resulting technologies. It will also (2) support collective procurement as well as measures to ensure equitable distribution and uptake of these technologies.
Collapse
Affiliation(s)
- Nicole Hassoun
- Helsinki Collegium for Advanced Studies, University of Helsinki, Fabianinkatu 24 00100 Helsinki, Finland
- Binghamton University, 4400 Vestal Parkway East, Box 6000, Binghamton, NY 13902-6000, USA
| | - Kaushik Basu
- Department of Economics, Cornell University, Ithaca, NY 14850, USA
- Brookings Institution, Washington, DC 20036, USA
| | - Lawrence Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC 20057, USA
| |
Collapse
|
3
|
Cheng L, Chan WK, Zhu L, Chao MH, Wang Y. Confronting Inequalities and Bridging the Divide: A Retrospective Study Assessment of Country-Level COVID-19 Vaccine Equality with a Cox Regression Model. Vaccines (Basel) 2024; 12:552. [PMID: 38793804 PMCID: PMC11125969 DOI: 10.3390/vaccines12050552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
COVID-19 vaccination is vital in reducing illness, hospitalization, and mortality in the face of this global pandemic. However, COVID-19 vaccination rates worldwide remain below WHO public health targets, and persistent structural inequities reduce vaccine uptake likelihood among populations of low socioeconomic status. We conducted a cross-sectional study based on publicly available data from the Our World in Data project. We included all 124 countries with available open epidemic data and a population of more than 5 million. We used a Cox Regression Model, with population, population density, median age, human development index, GDP per capita, gender inequality index, healthcare access and quality index, hospital beds per thousand people, completion rate of primary education, infection cases of COVID-19 by the end of 2022, and death rate due to COVID-19 by the end of 2022 as predictors for model hazard rates of completion of 50% population vaccination. According to our study, countries with higher populations, higher population density, higher human development index, lower gender inequality index, and lower hospital beds per 1000 people had a higher hazard rate, which means they were more likely to achieve 50% population vaccination faster. By utilizing the time to achieve vaccination rate goals as our primary endpoint, we evaluated inequity from a dual perspective, considering both the differences in vaccination rates and the duration required to attain them. Consequently, this study employed survival analysis approaches to gain a comprehensive understanding of vaccine drivers and population-level trends nationally and inform all communities from a statistical perspective to prepare for health emergencies. Development-level standing modified the effects of equal access to COVID-19 vaccination on cumulative cases and mortality, for which countries of low or medium human development tended to fare worse in outcomes than high human development countries. As COVID-19 vaccination efforts evolve, healthcare professionals, scholars, and policymakers need to identify the structural impediments to equitable vaccination awareness, access, and uptake so that future vaccination campaigns are not impeded by these barriers to immunization. Recognizing the complex nature of this significant barrier, it is evident that no single statistical analysis method can comprehensively address all intricacies.
Collapse
Affiliation(s)
- Lan Cheng
- Big Data Bio-Intelligence Laboratory, Big Data Institute, The Hong Kong University of Science and Technology, Hong Kong, China;
| | - W. K. Chan
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China;
| | - Lijie Zhu
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Melody H. Chao
- College of Art and Design, Shenzhen University, Shenzhen 518060, China;
| | - Yang Wang
- Big Data Bio-Intelligence Laboratory, Big Data Institute, The Hong Kong University of Science and Technology, Hong Kong, China;
| |
Collapse
|
4
|
Njuguna AG, Wangombe AW, Walekhwa MN, Kamondo DK. Clinical Course and Factors Associated With Hospital Admission and Mortality among Sars-Cov 2 Patients within Nairobi Metropolitan Area. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307403. [PMID: 38798388 PMCID: PMC11118643 DOI: 10.1101/2024.05.15.24307403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
This study aims to investigate the clinical course and factors associated with hospital admission and mortality among SARS-CoV-2 patients within the Nairobi Metropolitan Area. The study utilizes a multicenter retrospective cohort design, collecting clinical characteristics and laboratory parameters of hospitalized patients from March 2020 to May 2022. Data analysis includes percentages, frequencies, chi-square tests, Kaplan-Meier analysis, pairwise comparisons, and multivariate regression models. Ethical considerations are observed throughout the research process. The study findings highlight significant associations between comorbidities, such as hypertension, and increased mortality risk due to COVID-19. Symptoms including fever, cough, dyspnea, chest pain, sore throat, and loss of smell/taste are also identified as predictors of mortality. Abnormal laboratory parameters, such as oxygen saturation, procalcitonin, glucose levels, serum creatinine, and gamma-glutamyl transpeptidase, are associated with mortality. However, demographic factors and certain vital signs do not exhibit significant associations. Recommendations based on this study suggest increased monitoring and management of comorbidities, early identification and management of symptoms, regular monitoring of laboratory parameters, continued research and collaboration, and implementation of preventive measures. Overall, a multidisciplinary approach involving healthcare professionals, researchers, policymakers, and the public is crucial to improve COVID-19 outcomes and reduce mortality rates. Adaptation of strategies based on emerging evidence and resource allocation is essential for effective management of the pandemic.
Collapse
|
5
|
Ba Z, Qin Y, Sang Z, Wu H, Wu X, Cheng H, Ya B, Chen F. Vaccine inequity-induced COVID-19 dilemma: Time to sober up. Leg Med (Tokyo) 2024; 66:102364. [PMID: 38104356 DOI: 10.1016/j.legalmed.2023.102364] [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: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of the study was to discuss the catastrophic consequences of inequitable vaccine distribution and analyze the main challenges to address it, helping to guide efforts to address inequities in vaccine coverage. METHODS All published papers written in English were searched through PubMed, Web of Science, and Google Scholar with the combination of relevant terms of COVID-19 vaccine inequity. RESULTS In this paper, we first outlined the scope of inequitable vaccine distribution and identify its truly catastrophic consequences. Next, from the perspectives of political will, free markets, and profit-driven enterprises based on patent and intellectual property protection, we analyzed in depth the root causes of why this phenomenon is so difficult to combat. In addition, some specific and crucial solutions that should be undertaken in the long term were also put forward in order to provide a useful reference for the authorities, stakeholders, and researchers involved in addressing this worldwide crisis and the next one. CONCLUSIONS Achieving COVID-19 vaccine equity faces funding gaps, vaccine nationalism, and barriers to access to intellectual property and technology. Thus, the scope of global vaccine inequity is immense, and its repercussions will continue to be felt worldwide, especially among the world's most vulnerable residents, both adults and children. Beyond fundamental issues, the growing vaccine hesitancy and unreliable distribution in low-income countries must be addressed.
Collapse
Affiliation(s)
- Zaihua Ba
- Department of Physiology, Jining Medical University, Jining, China
| | - Yining Qin
- Department of Physiology, Jining Medical University, Jining, China
| | - Ziling Sang
- Department of Physiology, Jining Medical University, Jining, China
| | - Hao Wu
- Dongping County People's Hospital, Tai-an 271500, China
| | - Xiaoli Wu
- Dongping County People's Hospital, Tai-an 271500, China
| | - Hongju Cheng
- Department of Physiology, Jining Medical University, Jining, China
| | - Bailiu Ya
- Department of Physiology, Jining Medical University, Jining, China
| | - Fei Chen
- Department of Physiology, Jining Medical University, Jining, China.
| |
Collapse
|
6
|
Ravinetto R, Henriquez R, Srinivas PN, Bradley H, Coetzee R, Ochoa TJ, Semuto Ngabonziza JC, Mazarati JB, Van Damme W, van de Pas R, Vandaele N, Torreele E. Shaping the future of global access to safe, effective, appropriate and quality health products. BMJ Glob Health 2024; 9:e014425. [PMID: 38195155 PMCID: PMC10807033 DOI: 10.1136/bmjgh-2023-014425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Rodrigo Henriquez
- Maestría de Epidemiología y Salud Colectiva, Universidad Andina Simón Bolívar, Quito, Ecuador
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Hazel Bradley
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Renier Coetzee
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jean Claude Semuto Ngabonziza
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
- Department of Clinical Biology, University of Rwanda, Kigali, Rwanda
| | | | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Els Torreele
- , Institute for Innovation and Public Purpose, University College London, London, UK
- Independent Researcher and Advisor, Geneva, Switzerland
| |
Collapse
|
7
|
Martin R, Maleche A, Gay J, Fatima H. Lessons learnt from COVID-19 to reduce mortality and morbidity in the Global South: addressing global vaccine equity for future pandemics. BMJ Glob Health 2024; 9:e013680. [PMID: 38167259 PMCID: PMC10773420 DOI: 10.1136/bmjgh-2023-013680] [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: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
COVID-19, which killed more than 6 million people, will not be the last pandemic. Vaccines are key to preventing and ending pandemics. Therefore, it is critical to move now, before the next pandemic, towards global vaccine equity with shared goals, intermediate steps and long-term advocacy goals. Scientific integrity, ethical development, transparency, accountability and communication are critical. Countries can draw on lessons learnt from their response to the HIV pandemics, which has been at the vanguard of ensuring equitable access to rights-based services, to create shared goals and engage communities to increase access to and delivery of safe, quality vaccines. Access can be increased by: fostering the spread of mRNA intellectual property (IP) rights, with mRNA vaccine manufacturing on more continents; creating price transparency for vaccines; creating easily understandable, accessible and transparent data on vaccines; creating demand for a new international legal framework that allows IP rights to be waived quickly once a global pandemic is identified; and drawing on scientific expertise from around the world. Delivery can be improved by: creating strong public health systems that can deliver vaccines through the lifespan; creating or strengthening national regulatory agencies and independent national scientific advisory committees for vaccines; disseminating information from reliable, transparent national and subnational surveillance systems; improving global understanding that as more scientific data become available, this may result in changes to public health guidance; prioritising access to vaccines based on scientific criteria during an epidemic; and developing strategies to vaccinate those at highest risk with available vaccines.
Collapse
Affiliation(s)
- Rebecca Martin
- Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Jill Gay
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- J Gay Associates, Takoma Park, Maryland, USA
| | - Haram Fatima
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Onwujekwe O, Orjiakor C, Ogbozor P, Agu I, Agwu P, Wright T, Balabanova D, Kohler J. Examining corruption risks in the procurement and distribution of COVID-19 vaccines in select states in Nigeria. J Pharm Policy Pract 2023; 16:141. [PMID: 37957711 PMCID: PMC10641993 DOI: 10.1186/s40545-023-00649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Public health emergencies raise significant concerns about corruption and accountability; however, these concerns can manifest in different ways across diverse locations. For instance, more developed countries with a stronger rule of law may experience more corruption in vaccine procurement, whereas developing countries may experience more corruption at the point of distribution and delivery to end users. This research focuses on corruption concerns in Nigeria, specifically examining the procurement and distribution of COVID-19 vaccines. METHODS This paper utilizes a scoping review and a qualitative research approach. Key informants (n = 40) involved in the procurement and distribution of COVID-19 vaccines across two states in Nigeria were interviewed. Findings from the scoping review were summarized, and collected data were inductively coded and analysed in themes, revealing clear examples of implementation irregularities and corruption in the country's COVID-19 vaccination processes. RESULTS Vaccination programme budgeting processes were unclear, and payment irregularities were frequently observed, resulting in vaccinators soliciting informal payments while in the field. Recruitment and engagement of vaccination personnel was opaque, while target vaccination rates incentivized data falsification during periods of vaccine hesitancy. Accountability mechanisms, such as health worker supervision, vaccination data review, and additional technical support provided by donors were implemented but not effective at preventing corruption among frontline workers. CONCLUSIONS Future accountability measures should be evidence-driven based on findings from this research. Personnel recruitment, contracting, budgeting, and remuneration should focus on transparency and accountability.
Collapse
Affiliation(s)
- Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria
| | - Charles Orjiakor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
- Department of Psychology, University of Toronto, Scarborough, Canada
| | - Pamela Ogbozor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Ifunanya Agu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Prince Agwu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Social Work, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Tom Wright
- Transparency International Global Health Programme, Transparency International, London, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Jillian Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
| |
Collapse
|
9
|
De la Cruz-Sánchez E, Moreno-Llamas A, Mendiola Olivares J, García-Mayor J, Torres-Cantero A, Devine EB. Association between Covid-19 sources of information, beliefs, and vaccination rates: an EU-wide survey. Eur J Public Health 2023; 33:897-904. [PMID: 37459132 PMCID: PMC10567234 DOI: 10.1093/eurpub/ckad115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Misinformation hampers vaccine uptake. The European Union (EU) employed a coordinated effort to curb misinformation during the Covid-19 pandemic. In this context, we investigated relationships between sources of information, vaccine safety/effectiveness, satisfaction with government vaccination strategy, and vaccination intent. METHODS We used cross-sectional survey data (May 2021) from Flash Eurobarometer 494, a population-adjusted dataset comprised of a representative sample of those ≥15 years from 27 EU nations. We employed a latent class analysis to create clusters of information sources as the independent variable and beliefs in vaccine safety/efficacy, satisfaction with government vaccination strategy, and vaccine intent as four outcome variables. We first estimated the association between source clusters and each of the first three outcomes separately. Then, using these three as intermediate variables, we employed structural equation modeling to estimate the relationship between sources and vaccine intent. We adjusted for individual and country-level variables. RESULTS Among 23 012 respondents, four clusters of information sources emerged: (1) national authorities/health professionals (n = 9602; 42%), (2) mostly health professionals (6184; 27%), (3) mixed (n = 1705; 17%) and (4) social media/family/friends (n = 5524; 24%). Using cluster (3) as the referent, we found decreasing odds of beliefs in vaccine safety/effectiveness, satisfaction and vaccine intent across clusters (1), (2) and (4), respectively. Demographics played a role. CONCLUSION In the context of the Covid pandemic, these results provide the first EU-wide estimates of the association between sources of information about vaccine safety/effectiveness, satisfaction and vaccine intent. The coordinated approach promulgated by the EU to minimize misinformation provides a model for managing future pandemics.
Collapse
Affiliation(s)
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, Murcia, Spain
| | - Jaime Mendiola Olivares
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, University of Murcia School of Medicine, Murcia, Spain
| | - Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, Murcia, Spain
| | - Alberto Torres-Cantero
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, University of Murcia School of Medicine, Murcia, Spain
| | - Emily Beth Devine
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, University of Murcia School of Medicine, Murcia, Spain
- The Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Tomori O, Blumberg L. Response to the multi-country monkeypox outbreak: a view from Africa. J Travel Med 2023; 30:taad110. [PMID: 37615490 DOI: 10.1093/jtm/taad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 08/25/2023]
Abstract
Human monkeypox was first reported in Africa in 1970. However, the disease has only entered notoriety since the current public health emergency of international concern in Europe and the Americas in 2022. At present there is significant inequality in access to diagnostics, vaccinations and therapeutics, due to which African nations are being completely left behind.
Collapse
Affiliation(s)
- Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Lucille Blumberg
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa. Right to Care. University of Pretoria, Pretoria, South Africa
| |
Collapse
|
11
|
A'la R, Wijaya AY, Susilowati H, Kuncorojakti S, Diyantoro, Rahmahani J, Rantam FA. Inactivated SARS-CoV-2 vaccine candidate immunization on non-human primate animal model: B-cell and T-cell responses immune evaluation. Heliyon 2023; 9:e18039. [PMID: 37519714 PMCID: PMC10372371 DOI: 10.1016/j.heliyon.2023.e18039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Background SARS-CoV-2 vaccine was proven to be an effective and efficient measure for mitigating pandemic. COVID-19 infection and mortality subsided along with the increaseing COVID-19 vaccination coverage. Vaccine and health resource equity are predominant factors in COVID-19 pandemic management. Vaccine development for Indonesia, aims to ensure a sustainable pandemic control and steady national stability restoration. A decent vaccine must induce immunity against COVID-19 with minimum adverse reaction. Immunogenicity and ability to induce neutralizing antibody evaluation needs to be performed as part of the SARS-CoV-2 inactivated vaccine development from East Java, Indonesia isolate (Vaksin Merah Putih-INAVAC). Objective This research demonstrated INAVAC performance in inducing the production neutralizing antibody along with its effects on CD4+ and CD8+ cells response in Macaca fascicularis (non-human primate). Methods Two dosages of 3 μg and 5 μg were tested, compared to sham (NaCl 0.9%) in 10 Macaca fascicularis (2 injection intramuscular with 14 days interval). All animals were monitored daily for clinical signs. Nasopharyngeal samples were analyzed using qRT-PCR while the serum were tested using ELISA and neutralization assay, whereas PBMCs were flowcytrometrically analyzed to measure CD4+ and CD8+ population. Results It is observed that both vaccine doses could stimulate relatively similar immune response and neutralizing antibody (end GMT post challenge = 905,1), whereas higher CD8+ cells response were reported in the 5 μg group after the 3rd day post-challenge. The dose of vaccine that produce adequate immune cell stimulation with neutralizing antibody induction can be adopted to clinical study, as favorable result of these parameters could predict minimum adverse reaction from inflammation response with balanced immune response. Conclusions Therefore, it is concluded that Vaksin Merah Putih-INAVAC with 3 μg dose showed a favorable potential to be developed and tested as human vaccine.
Collapse
Affiliation(s)
- Rofiqul A'la
- Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Helen Susilowati
- Research Center for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Suryo Kuncorojakti
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Diyantoro
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Jola Rahmahani
- Virology and Immunology Laboratory, Department of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Research Center for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Virology and Immunology Laboratory, Department of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
12
|
Panagopoulos A, Sideri K. From lab to mass production: a policy for enabling the licensing of mRNA vaccines. Front Public Health 2023; 11:1151713. [PMID: 37275488 PMCID: PMC10233741 DOI: 10.3389/fpubh.2023.1151713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
Using the South African vaccine technology transfer hub supported by the WHO as an example, we show that the know-how needed to move mRNA vaccines from prototype to mass-production acts as an invisible barrier to market entry of mRNA vaccines. Overcoming this barrier relies on scarce human capital. In view of this scarcity and in preparation for the next pandemic, we propose broadening the scope of an existing WHO program, the WHO Academy, so that it coordinates knowledge diffusion initiatives by forming a systematized repository of know-how and a register of experts. As we explain, this proposal has an advantage in overcoming barriers to entry over current approaches of know-how acquisition.
Collapse
Affiliation(s)
- Andreas Panagopoulos
- Department of Economics, Knowledge Transfer Office, TECHNIS, University of Crete, Rethymno, Greece
| | - Katerina Sideri
- Department of Political Science and History, TECHNIS, Panteion University, Athens, Greece
| |
Collapse
|
13
|
Starling-Alves I, Hirata G, Oliveira JBA. Covid-19 school closures negatively impacted elementary-school students' reading comprehension and reading fluency skills. INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT 2023; 99:102753. [PMID: 36852098 PMCID: PMC9946888 DOI: 10.1016/j.ijedudev.2023.102753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/16/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
In Brazil, schools remained closed to prevent the spread of COVID-19 for approximately two years. In this study, we investigated how COVID-19 school closures were associated with gaps and losses in Brazilian students' reading skills. We contrasted the reading comprehension and fluency of 2nd- to 4th-graders in 2022 with a 2019 cohort. Furthermore, we investigated how 2022 5th graders' reading comprehension and fluency skills have improved since 2019. Overall, results showed that COVID-19 school closures were associated with gaps but not losses in reading comprehension and fluency. Therefore, these skills should be targets of educational interventions.
Collapse
|
14
|
Wankhede D, Grover S, Hofman P. Determinants of humoral immune response to SARS-CoV-2 vaccines in solid cancer patients: A systematic review and meta-analysis. Vaccine 2023; 41:1791-1798. [PMID: 36792435 PMCID: PMC9922575 DOI: 10.1016/j.vaccine.2023.01.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
IMPORTANCE Solid cancer patients following SARS-CoV-2 vaccination are likely to have a lower seroconversion rate than healthy adults. Seroconversion between those with and without cancer is likely to vary moderately or to be restricted to specific subgroups. Therefore, we sought to conduct a systematic review and meta-analysis to identify risk factors for diminished humoral immune responses in solid cancer patients. METHODS MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were used to search literature through May 1, 2022. Prospective or retrospective studies comparing responders with non-responders against SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) following COVID-19 vaccination were included. Pooled Odds Ratios (pORs) with 95% CIs for binary variables and differences in means (with SDs) for continuous variables were calculated to determine the pooled effect estimates of risk factors for poor antibody response. RESULTS Fifteen studies enrolling 3593 patients were included in the analysis. Seroconversion was seen in 84% of the pooled study population. Male gender, age >65 years, and recent chemotherapy were all factors in a poor immune response. Patients under follow-up, those who received immunotherapy or targeted therapy, were more likely to be seropositive. Cancer subtypes, vaccine types, and timing of antibody testing from the 2nd dose of vaccine did not correlate with seroconversion. CONCLUSION Cytotoxic therapy for solid cancer may portend poor immune response following 2 doses of COVID-19 vaccines suggesting a need for booster doses in these patients. Immunotherapy and targeted therapy are likely to be associated with seropositive status, and thus can be considered as an alternative to cytotoxic agents in cases where both therapies are equally efficacious.
Collapse
Affiliation(s)
- Durgesh Wankhede
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sandeep Grover
- Center for Human Genetics, Universitatsklinikum Giessen und Marburg - Standort Marburg, 35055 Marburg, Germany
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, University Côte d’Azur, 30 avenue de la voie romaine, 06002 Nice, France,Institute for Research on Cancer and Ageing, Nice (IRCAN), INSERM U1081 and UMR CNRS 7284, Team 4, Nice, France,Hospital-Integrated Biobank BB-0033-00025, Pasteur Hospital, Nice, France,University Hospital Federation OncoAge, CHU de Nice, University Côte d’Azur, Nice, France
| |
Collapse
|
15
|
Del Bo CF. Institutional quality and COVID-19 vaccination: does decentralization matter? LETTERS IN SPATIAL AND RESOURCE SCIENCES 2023; 16:6. [PMID: 36876287 PMCID: PMC9965896 DOI: 10.1007/s12076-023-00326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
Vaccination campaigns are one of the factors that can help mitigate the adverse effects of viral pandemics. The aim of this paper is to understand the institutional factors that are associated with a higher success rate, measured by the percentage of vaccinated population against COVID-19 across countries. Along with supply side determinants, institutional factors, related, at the national level, to the organization of the healthcare sector, governance and organization of the State and social capital, and, at the subnational level related to the authority and autonomy of lower tiers of government, are important correlates of successful vaccination campaigns, suggesting potential areas of public policy interventions.
Collapse
Affiliation(s)
- Chiara F. Del Bo
- Department of Economics, Management and Quantitative Methods, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
16
|
Tomori O, Blumberg L. Response to the multi-country monkeypox outbreak: a view from Africa. J Travel Med 2022; 29:6849434. [PMID: 36440640 DOI: 10.1093/jtm/taac138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, 232101, Nigeria
| | - Lucille Blumberg
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, 2192, South Africa. Right to Care. University of Pretoria, Pretoria 0028, South Africa
| |
Collapse
|
17
|
Birhanu Z, Tesfaye G, Tareke KG. COVID-19 self-protective practices and associated factors among secondary school students in Jimma town, Jimma, Oromia, Southwest Ethiopia. Front Public Health 2022; 10:1082563. [PMID: 36620275 PMCID: PMC9816375 DOI: 10.3389/fpubh.2022.1082563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Since there is limited evidence regarding COVID-19 self-protective practices among school students, this study assessed COVID-19 self-protective practices and associated factors among secondary school students. Methods A school-based cross-sectional study was conducted in Jimma town, Oromia regional state, Southwest Ethiopia from 25 May 2021 to 10 June 2021. The total sample size was 634, and students were randomly selected from public and private secondary schools. A self-administered questionnaire was used for data collection. The data were entered into Epidata 3.1 and analyzed using SPSS 21.0 software. Descriptive statistics, such as proportion and mean, were computed to describe the findings. The composite index was computed for each dimension. A linear regression analysis was used to identify the predictors of self-protective practice. A local polynomial smoothing graph was done using Stata 12 software to visualize the relationship between a significant variable and an outcome variable. Results A total of 576 respondents participated in this study, which made a response rate of 90.85%. The mean score for overall knowledge was 31.40 (SD ±8.65). Knowledge about COVID-19 symptoms and preventive practices had a mean score of 23.93 and 45.96, respectively. The mean scores for perceived vulnerability, severity, benefits, barriers, self-efficacy, and school support were 26.37, 33.21, 43.13, 16.15, 33.38, and 25.45, respectively. The mean score for self-protective practice was 28.38 (SD ±11.04). As perceived benefit (AOR = 0.199, p = 0.000, 95% CI: 0.094-0.304), perceived school support (AOR = 0.125, p = 0.009, 95% CI: 0.032-0.218), and self-efficacy (AOR = 0.186, p = 0.000, 95% CI: 0.102-0.270) increased, COVID-19 self-protective practices also increased and vice versa. However, age (AOR = -0.873, p = 0.006, 95% CI = -1.495, -0.251), perceived vulnerability (AOR = -0.107, p = 0.021; 95% CI = -0.199, -0.016), and maternal educational status (no formal education) (AOR = -5.395, p = 0.000, 95% CI = -7.712 to 3.077) had negatively associated with self-protective practices. Conclusion COVID-19 self-protective practice is unsatisfactory. Perceived benefit, perceived school support, and self-efficacy are positively associated with it. However, students' age, perceived vulnerability, and maternal educational status (no formal education) were negatively associated with COVID-19 self-protective measures among secondary school students. The findings underscore that there is a need to conduct risk communications among students. Similarly, awareness creation intervention should target mothers with no formal education.
Collapse
|
18
|
Bhuiyan S. COVID-19 vaccine equity in doldrums: Good governance deficits. PUBLIC ADMINISTRATION AND DEVELOPMENT : A JOURNAL OF THE ROYAL INSTITUTE OF PUBLIC ADMINISTRATION 2022; 42:293-304. [PMID: 36718258 PMCID: PMC9878060 DOI: 10.1002/pad.1999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/17/2022] [Accepted: 11/22/2022] [Indexed: 06/18/2023]
Abstract
This paper explores whether inequities in access to COVID-19 vaccines can be attributed to governance deficits, particularly for developing and emerging countries where poor governance is widespread, but also for developed countries, where governments' performance fell short of expectations. These shared performance deficits beg questions about the impact of governance quality as well as the interplay of ethics in governance when life-or-death decisions must be made. It also explores the impact of COVID-19 on development, especially in the areas of poverty and employment. The findings of the paper show that there is a positive correlation between vaccine equity and good governance, meaning that countries with higher scores in governance rankings have more access to vaccines and have vaccinated most of their populations. Similarly, countries with relatively lower scores in governance rankings have poor access to and distribution of vaccines and have only covered a limited number of their people. The paper further points to disastrous societal impacts of COVID-19 vaccine inequity on poverty and employment, which have hindered global development.
Collapse
Affiliation(s)
- Shahjahan Bhuiyan
- Department of Public Policy and Administration, School of Global Affairs and Public Policy (GAPP)The American University in CairoNew CairoEgypt
| |
Collapse
|
19
|
Borowicz J, Zhang Z, Day G, Pinto da Costa M. Vaccine equity in COVID-19: a meta-narrative review. BMJ Glob Health 2022; 7:bmjgh-2022-009876. [DOI: 10.1136/bmjgh-2022-009876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022] Open
Abstract
The topic of inequitable vaccine distribution has been widely discussed by academics, journalists and policy-makers in the context of the COVID-19 pandemic. However, research into perceptions of vaccine equity has been particularly neglected, resulting in a lack of universal understanding of vaccine equity. To address this, we conducted a meta-narrative review on COVID-19 vaccine equity according to the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standard. The review included articles published between January 2020 and September 2021. It aims to (1) identify research traditions that have considered this topic and investigate how it has been conceptualised; (2) explore any potential differences in understandings of the concept of vaccine equity adopted by distinct research groups; and (3) investigate the angles from which authors based their recommendations on how vaccine equity can be achieved. Five meta-narratives from the literature across various research traditions are identified, contextualised and discussed: frameworks and mechanisms for vaccine allocation, global health law, vaccine nationalism, ethics and morality, and reparative justice. Our findings indicate the need for a comparative review of existing global COVID-19 allocation frameworks, with a focus on explicating understandings of vaccine equity. COVID-19 will not be the last health crisis the world confronts. Heterogeneity in the academic literature is part of the way concepts are debated and legitimised, but in the interests of global public health policy-making, it is desirable to reach a consensus on what constitutes progress on equitable development, production, distribution and research.
Collapse
|
20
|
Aubourg MA, Bisimwa L, Bisimwa JC, Sanvura P, Williams C, Boroto R, Lunyelunye C, Timsifu J, Munyerenkana B, Endres K, Winch PJ, Bengehya J, Maheshe G, Cikomola C, Mwishingo A, George CM. A Qualitative Evaluation of COVID-19 Preventative Response Activities in South Kivu, Democratic Republic of the Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13424. [PMID: 36294005 PMCID: PMC9603344 DOI: 10.3390/ijerph192013424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE In this evaluation of COVID-19 preventative response programs in South Kivu, Democratic Republic of the Congo (DRC), we aimed to explore community understandings of COVID-19, assess operational successes and challenges of COVID response activities, and identify barriers to practicing COVID-19 preventative behaviors. METHODS Thirty-one semi-structured interviews were conducted from April to September 2021 in South Kivu, DRC, with community members (n = 16) and programmatic stakeholders (n = 15) (healthcare providers, government officials, and developmental and NGO staff engaged in COVID-19 response). FINDINGS Most community members were aware of COVID-19 and its global burden, but few were aware of local transmission in their area. Some community members attributed COVID-19 to actions of malevolent neighbors, miasma ("bad air"), or spirits. Awareness of COVID-19 preventative measures was widespread, largely because of radio and TV health promotion programs. Community members and programmatic stakeholders both said community-level non-compliance to COVID-19 preventative measures was high despite high awareness of preventative methods. Community members expressed concern that face masks distributed as part of preventative programs contained the COVID-19 virus. Programmatic stakeholders emphasized the need for broader health system strengthening with improved coordination, provision of resources to health facilities at the provincial level, and prioritization of research. Lessons learned from addressing Ebola were leveraged for COVID-19 health promotion, rapid training of healthcare personnel, and surveillance. CONCLUSIONS Community-informed approaches are needed for effective COVID-19 preventative response programs in South Kivu, DRC. Our study identified successes and challenges in COVID-19 response activities. Future research should assess the effectiveness of integrating preventive programs with COVID-19 vaccination efforts.
Collapse
Affiliation(s)
- Matthew A. Aubourg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lucien Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Jean Claude Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Presence Sanvura
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Raissa Boroto
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Claude Lunyelunye
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Jessy Timsifu
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Brigitte Munyerenkana
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Justin Bengehya
- Bureau de l’Information Sanitaire, Surveillance Epidémiologique et Recherche Scientifique, Division Provinciale de la Santé Sud Kivu, Ministère de la Santé, Bukavu B.P 265, Democratic Republic of the Congo
| | - Ghislain Maheshe
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Cirhuza Cikomola
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Alain Mwishingo
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
21
|
Borghi J, Ismail S, Hollway J, Kim RE, Sturmberg J, Brown G, Mechler R, Volmink H, Spicer N, Chalabi Z, Cassidy R, Johnson J, Foss A, Koduah A, Searle C, Komendantova N, Semwanga A, Moon S. Viewing the global health system as a complex adaptive system - implications for research and practice. F1000Res 2022; 11:1147. [PMID: 37600221 PMCID: PMC10432894 DOI: 10.12688/f1000research.126201.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 08/22/2023] Open
Abstract
The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highlight the numerous policy insights their application could yield. We also discuss the challenges for researchers of applying these methods and for policy makers of digesting and acting upon them. We encourage application of a CAS approach to GHS research and policy making to help bolster resilience to future risks that transcend national boundaries and system scales.
Collapse
Affiliation(s)
- Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Sharif Ismail
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - James Hollway
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Rakhyun E. Kim
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Joachim Sturmberg
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Garrett Brown
- School of Politics and International Studies, University of Leeds, Leeds, UK
| | - Reinhard Mechler
- International Institute for Applied Systems Analysis, Laxenberg, Austria
| | - Heinrich Volmink
- Division of Health Systems and Public Health, Stellenbosch University, Stellenbosch, South Africa
| | - Neil Spicer
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Zaid Chalabi
- Institute for Environmental Design and Engineering, University College London., London, UK
| | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Jeff Johnson
- Faculty of Science, Technology, Engineering & Mathematics, The Open University, Milton Keynes, UK
| | - Anna Foss
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, University of Ghana, Accra, Ghana
| | - Christa Searle
- Edinburgh Business School, Heriot Watt University, Edinburgh, UK
| | | | - Agnes Semwanga
- Health Informatics Research Group, Makerere University, Kampala, Uganda
| | - Suerie Moon
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| |
Collapse
|
22
|
Siedner MJ, Alba C, Fitzmaurice KP, Gilbert RF, Scott JA, Shebl FM, Ciaranello A, Reddy KP, Freedberg KA. Cost-effectiveness of Coronavirus Disease 2019 Vaccination in Low- and Middle-Income Countries. J Infect Dis 2022; 226:1887-1896. [PMID: 35696544 PMCID: PMC9214172 DOI: 10.1093/infdis/jiac243] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 06/10/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the advent of safe and effective coronavirus disease 2019 vaccines, pervasive inequities in global vaccination persist. METHODS We projected health benefits and donor costs of delivering vaccines for up to 60% of the population in 91 low- and middle-income countries (LMICs). We modeled a highly contagious (Re at model start, 1.7), low-virulence (infection fatality ratio [IFR], 0.32%) "Omicron-like" variant and a similarly contagious "severe" variant (IFR, 0.59%) over 360 days, accounting for country-specific age structure and healthcare capacity. Costs included vaccination startup (US$630 million) and per-person procurement and delivery (US$12.46/person vaccinated). RESULTS In the Omicron-like scenario, increasing current vaccination coverage to achieve at least 15% in each of the 91 LMICs would prevent 11 million new infections and 120 000 deaths, at a cost of US$0.95 billion, for an incremental cost-effectiveness ratio (ICER) of US$670/year of life saved (YLS). Increases in vaccination coverage to 60% would additionally prevent up to 68 million infections and 160 000 deaths, with ICERs <US$8000/YLS. ICERs were <US$4000/YLS under the more severe variant scenario and generally robust to assumptions about vaccine effectiveness, uptake, and costs. CONCLUSIONS Funding expanded COVID-19 vaccine delivery in LMICs would save hundreds of thousands of lives, be similarly or more cost-effective than other donor-funded global aid programs, and improve health equity.
Collapse
Affiliation(s)
- Mark J. Siedner
- Corresponding Author: Mark J. Siedner, MD MPH Medical Practice Evaluation Center, Massachusetts General Hospital 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA Fax: 617-724-1637 Telephone: 617-726-4686
| | - Christopher Alba
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Rebecca F. Gilbert
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Justine A. Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Harvard University Center for AIDS Research, Cambridge, MA, USA
| | - Krishna P. Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A. Freedberg
- Alternate Corresponding Author: Kenneth A. Freedberg, MD, MSc Medical Practice Evaluation Center, Massachusetts General Hospital 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA Fax: 617-726-6063
| |
Collapse
|
23
|
Dynamic Analysis of a COVID-19 Vaccination Model with a Positive Feedback Mechanism and Time-Delay. MATHEMATICS 2022. [DOI: 10.3390/math10091583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the novel coronavirus pandemic has spread globally since 2019, most countries in the world are conducting vaccination campaigns. First, based on the traditional SIR infectious disease model, we introduce a positive feedback mechanism associated with the vaccination rate, and consider the time delay from antibody production to antibody disappearance after vaccination. We establish an UVaV model for COVID-19 vaccination with a positive feedback mechanism and time-delay. Next, we verify the existence of the equilibrium of the formulated model and analyze its stability. Then, we analyze the existence of the Hopf bifurcation, and use the multiple time scales method to derive the normal form of the Hopf bifurcation, further determining the direction of the Hopf bifurcation and the stability of the periodic solution of the bifurcation. Finally, we collect the parameter data of some countries and regions to determine the reasonable ranges of multiple parameters to ensure the authenticity of simulation results. Numerical simulations are carried out to verify the correctness of the theoretical results. We also give the critical time for controllable widespread antibody failure to provide a reference for strengthening vaccination time. Taking two groups of parameters as examples, the time of COVID-19 vaccine booster injection should be best controlled before 38.5 weeks and 35.3 weeks, respectively. In addition, study the impact of different expiration times on epidemic prevention and control effectiveness. We further explore the impact of changes in vaccination strategies on trends in epidemic prevention and control effectiveness. It could be concluded that, under the same epidemic vaccination strategy, the existence level of antibody is roughly the same, which is consistent with the reality.
Collapse
|
24
|
Challenges and Drawbacks of the EU Medical System Generated by the COVID-19 Pandemic in the Field of Health Systems' Digitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094950. [PMID: 35564345 PMCID: PMC9100197 DOI: 10.3390/ijerph19094950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/10/2022]
Abstract
The COVID-19 pandemic and the digitalization of medical services present significant challenges for the medical sector of the European Union, with profound implications for health systems and the provision of high-performance public health services. The sustainability and resilience of health systems are based on the introduction of information and communication technology in health processes and services, eliminating the vulnerability that can have significant consequences for health, social cohesion, and economic progress. This research aims to assess the impact of digitalization on several dimensions of health, introducing specific implications of the COVID-19 pandemic. The research methodology consists of three procedures: cluster analysis performed through vector quantization, agglomerative clustering, and an analytical approach consisting of data mapping. The main results highlight the importance of effective national responses and provide recommendations, various priorities, and objectives to strengthen health systems at the European level. Finally, the results reveal the need to reduce the gaps between the EU member states and a new approach to policy, governance, investment, health spending, and the performing provision of digital services.
Collapse
|
25
|
Polašek O, Wazny K, Adeloye D, Song P, Chan KY, Bojude DA, Ali S, Bastien S, Becerra-Posada F, Borrescio-Higa F, Cheema S, Cipta DA, Cvjetković S, Castro LD, Ebenso B, Femi-Ajao O, Ganesan B, Glasnović A, He L, Heraud JM, Igwesi-Chidobe C, Iversen PO, Jadoon B, Karim AJ, Khan J, Biswas RK, Lanza G, Lee SWH, Li Y, Liang LL, Lowe M, Islam MM, Marušić A, Mshelia S, Manyara AM, Htay MNN, Parisi M, Peprah P, Sacks E, Akinyemi KO, Shahraki-Sanavi F, Sharov K, Rotarou ES, Stankov S, Supriyatiningsih W, Chan BTY, Tremblay M, Tsimpida D, Vento S, Glasnović JV, Wang L, Wang X, Ng ZX, Zhang J, Zhang Y, Campbell H, Chopra M, Cousens S, Krstić G, Macdonald C, Mansoori P, Patel S, Sheikh A, Tomlinson M, Tsai AC, Yoshida S, Rudan I. Research priorities to reduce the impact of COVID-19 in low- and middle-income countries. J Glob Health 2022; 12:09003. [PMID: 35475006 PMCID: PMC9010705 DOI: 10.7189/jogh.12.09003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Results Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients’ needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.
Collapse
Affiliation(s)
- Ozren Polašek
- Department of Public Health, University of Split School of Medicine, Split, Croatia
- Croatian Centre for Global Health, University of Split, Croatia
- Algebra University College, Zagreb, Croatia
| | - Kerri Wazny
- Children's Investment Fund Foundation, London, UK
| | - Davies Adeloye
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Peige Song
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, China
| | - Kit Y Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | | | - Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | | | | | | | | | | | | | - Lina D Castro
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Omolade Femi-Ajao
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Balasankar Ganesan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Anton Glasnović
- Croatian Institute for Brain Research, Zagreb University School of Medicine, Zagreb, Croatia
| | - Longtao He
- Southwestern University of Finance and Economics, Chengdu, China
| | | | | | | | - Bismeen Jadoon
- Egyptian Representative, Committee of Fellows of Obstetrics and Gynaecology, Oxford, UK, Royal Berkshire Hospital, NHS, UK
| | | | - Johra Khan
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | | | - Giuseppe Lanza
- Oasi Research Institute-IRCCS, Troina, Italy
- University of Catania, Catania, Italy
| | | | - You Li
- School of Public Health, Nanjing Medical University, China
| | - Li-Lin Liang
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mat Lowe
- Society for the Study of Women's Health, Kanifing, The Gambia
| | | | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | | | | | - Mila NN Htay
- Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Melaka, Malaysia
| | | | - Prince Peprah
- Social Policy Research Centre/Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Emma Sacks
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Konstantin Sharov
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, Russia
| | | | | | | | | | | | | | | | | | - Liang Wang
- Xuzhou Medical University, Yuzhou, China
| | - Xin Wang
- School of Public Health, Nanjing Medical University, China
| | - Zhi X Ng
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
| | | | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Mickey Chopra
- The World Bank, Washington, District of Columbia, USA
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | - Goran Krstić
- International Society of Global Health, Edinburgh, UK
| | - Calum Macdonald
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | | | - Smruti Patel
- Editor, Journal of Global Health Reports, Washington, DC, USA
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Igor Rudan
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| |
Collapse
|