Travel Vaccines Enter the Digital Age: Creating a Virtual Immunization Record

Parent and family characteristics associated with reported pediatric influenza vaccination in a sample of Canadian digital vaccination platform users. An exploratory, cross-sectional study in the 2018-2019 influenza season

Seasonal vaccination remains one of the best interventions to prevent morbidity and mortality from influenza in children. Understanding the characteristics of parents who vaccinate their children can inform communication strategies to encourage immunization. Using a cross-sectional study, we described parental characteristics of people who reported vaccinating their children against influenza during 2018/2019 in a cohort of Canadian digital immunization record users. Data was collected from a free, Pan-Canadian digital vaccination tool, CANImmunize. Eligible accounts contained at least one parental and one "child/dependent" record. Each parental characteristic (gender, age, family size, etc) was tested for association with pediatric influenza vaccination, and a multivariate logistic regression model was fit. A total of 6,801 CANImmunize accounts met inclusion criteria. After collapsing the dataset, the final sample contained 11,381 unique dyads. Influenza vaccination was reported for 32.3% of the children and 42.0% of the parents. In the multivariate logistic regression analysis, parents receiving the seasonal influenza vaccine were most strongly associated with reporting pediatric influenza vaccination (OR 17.05, 95% CI 15.08, 19.28). Having a larger family size and fewer transactions during the study period was associated with not reporting pediatric influenza vaccination. While there are several limitations to this large-scale study, these results can help inform future research in the area. Digital technologies may provide a unique and valuable source of vaccine coverage data and to explore associations between individual characteristics and immunization behavior. Policy makers considering digital messaging may want to tailor their efforts based on parental characteristics to further improve pediatric seasonal influenza vaccine uptake.

Proof-of-vaccination credentials for COVID-19 and considerations for future use of digital proof-of-immunization technologies: Results of an expert consultation

Objective

As part of COVID-19 pandemic control efforts, digital proof-of-vaccination credentials were launched in Canada in 2021-2022 following widespread vaccine availability. Given the controversy over proof-of-vaccination credentials-often colloquially called vaccine or immunization "passports"-it is imperative to document successes, shortcomings, and recommendations for any future uses.

Methods

This expert consultation applied inductive qualitative content analysis to online video interviews with key informants whose expertise ranged from ethics to public health to computer science to identify what we can learn from this experience with proof-of-vaccination credentials, and what decision-makers must keep in mind for possible future use of such technologies.

Results

There remains a lack of consensus regarding appropriate language and scope for digital proof-of-vaccination technologies, the respective roles of the technology sector versus government in design and implementation, and parameters for future use. However, experts agree on many recommendations, including the importance of clear communication, evidence-based rationale for the use of proof-of-vaccination credentials, multidisciplinary consultation including academic experts and the public, and the importance of pan-Canadian standards for accessibility and interoperability. Identified risks of use that emerged, and should be minimized in the future, include risks of coercion and backlash; threats to access, equity and privacy; and impacts such as costs of the technology and workload burden of enforcement and fraud detection.

Conclusions

There is much to learn from this first major use of digital proof-of-vaccination credentials. A full scientific review of the impacts on health and equity should be combined with expert recommendations to create pan-Canadian guidelines for the future use of digital proof-of-vaccination solutions.

The Use of Digital Technologies to Support Vaccination Programmes in Europe: State of the Art and Best Practices from Experts' Interviews

Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake.

Using Innovation to Develop Digital Tools for Public Health During the COVID-19 Pandemic

Introduction: Technology has played a key role in enabling public health to respond to the COVID-19 pandemic at a pace and scale never seen before. The Digital Health and Care Innovation Centre (DHI) assisted with development of two new digital services to enable testing and contact tracing at scale using innovative methods. Methods: The DHI employed a design innovation approach by bringing all relevant stakeholders together to co-design new technology services to identify the ‘preferred future’. Workshops were used to identify the preferred solutions. The innovative methods for development of digital health tools included adopting an iterative approach, addressing the situational requirements posed by COVID-19, and democratising technology for purposes of pandemic control. Results: A National Notification Service (NNS) for automation of delivery and feedback (if results messages were viewed) was developed and adopted by five of the 14 health boards in Scotland, processing over 7 million results since inception. The Simple Tracing Tools (STT) is an open-platform web-based app that is designed for data entry by contact tracing teams. STT was adopted by all local health protection teams and informed development of the national case management system. Discussion: The Cynefin framework can be used to understand the design innovation process when facing the challenges of designing digital tools during a pandemic. There are significant opportunities for public health to engage with digital health to transform the pandemic response and derive benefit for tackling future population health challenges.

The digital immunization system of the future: imagining a patient-centric, interoperable immunization information system

To ensure the effectiveness of increasingly complex immunization programs in upper-middle and high-income settings, comprehensive information systems are needed to track immunization uptake at individual and population levels. The maturity of cloud systems and mobile technologies has created new possibilities for immunization information systems. In this paper, we describe a vision for the next generation of digital immunization information systems for upper-middle and high-income settings based on our experience in Canada. These systems center on the premise that the public is engaged and informed about the immunization process beyond their interaction with primary care, and that they will be a contributor and auditor of immunization data. The digital immunization system of the future will facilitate reporting of adverse events following immunization, issue digital immunization receipts, permit identification of areas of need and allow for delivery of interventions targeting these areas. Through features like immunization reminders and targeted immunization promotion campaigns, the system will reduce many of the known barriers that influence immunization rates. In light of the global COVID-19 pandemic, adaptive digital public health information systems will be required to guide the rollout and post-market surveillance of the SARS-CoV-2 vaccine.

Evaluation of digital vaccine card in nursing practice in vaccination room

OBJECTIVE

develop and evaluate a vaccine application for mobile devices, with update integrated with the National Immunization Program Information System, for care in vaccination rooms.

METHOD

methodological research based on the Pressman System Development Life Cycle theory developed in three stages: integrative literature review, computational development, and application evaluation. The product was evaluated as to satisfaction, using a validated questionnaire, and as to usability by the System Usability Scale.

RESULTS

the application functionalities were based on the survey of technological Innovations on immunization, published in the scientific literature. It displays user vaccines directly from the National Immunization Program Information System, notifies about upcoming vaccines, and enables the inclusion of vaccine cards of dependents. The evaluation resulted in users' mean score of 90.5 ± 11.1 and health professionals' mean score of 84.2 ± 19.4.

CONCLUSION

the application is a technological tool with potential to improve the work process in vaccination rooms and to reach the goals of vaccine coverage. It synchronizes data with the National Immunization Program Information System, thus enabling the maintenance of people's vaccination history.

To err is human: Clinical incident calls to a national travel health advice line

The National Travel Health Network and Centre (NaTHNaC) offers a telephone advice line for travel health practitioners in the UK. In this study we review clinical incidents concerning vaccines or malaria prophylaxis reported between 2016 and 2018. Two-hundred-and-fifty-one clinical incident calls were recorded, and commonly concerned scheduling or dosing errors. Vaccine scheduling errors accounted for 103 calls (41%), predominantly due to hepatitis A or hepatitis B vaccination either alone or in combination (65/103, 63%). Administration of yellow fever vaccine within 28 days of measles, mumps and rubella accounted for a further 15 (15%) calls. Twenty-six (10%) calls reported administration of a vaccine that was not recommended either for the destination or contraindicated in the traveller. Yellow fever was the commonest single vaccine discussed in 28.4% of vaccine clinical incidents reported. By highlighting common mistakes, we hope to raise awareness of common issues and improve practice in travel health.

Countering vaccine hesitancy through immunization information systems, a narrative review

Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.

Modernizing Immunization Practice Through the Use of Cloud Based Platforms

Collection of timely and accurate immunization information is essential for effective immunization programs. Current immunization information systems have important limitations that impact the ability to collect this data. Based on our experience releasing a national immunization app we describe a cloud-based platform that would allow individuals to store their records digitally and exchange these records with public health information systems thus improving the quality of immunization information held by individuals and public health officials.