How Can Authorities Support Distributed Improvisation During Major Crises? A Study of Decision Bottlenecks Arising During Local COVID-19 Vaccine Roll-Out

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Toward a decision support system for COVID-19 vaccine allocation inside countries

The distribution of COVID-19 vaccines has proved to be a challenging task for public health authorities in many countries. Among several decisions involved in the task, allocating limited available vaccines to administration points is indeed critical. However, the operation management literature lacks evidence-based mathematical models that could support effective, efficient, sustainable and equitable vaccine allocation decision. This paper develops the fundamentals of a decision support system for COVID-19 vaccine allocation inside countries. The proposed DSS intends to support public health authorities in real-time by illustrating possible vaccine alternatives. The system could also inform and support other actors in the COVID19 distribution for planning and collaboration. Two illustrative cases for the COVID-19 vaccine allocation have been investigated to highlight potential benefits of our methodology

Embracing context: Lessons from designing a dialogue-based intervention to address vaccine hesitancy.

Dialogue with people who are vaccine hesitant has been recommended as a method to increase vaccination uptake. The process of cultivating dialogue is shaped by the context in which it occurs, yet the development of interventions addressing vaccine hesitancy with dialogue often overlooks the role of context and favors relatively fixed solutions. This reflexive paper shares three key lessons related to context for dialogue-based interventions. These lessons emerged during a participatory research project to develop a pilot intervention to create open dialogue among healthcare workers in Belgium about COVID-19 vaccination concerns. Through a mixed methods study consisting of in-depth interviews, focus group discussions, and surveys, we engaged healthcare workers in the design, testing, and evaluation of a digital platform featuring text-based and video-based (face-to-face) interactions. The lessons are: (1) what dialogue means, entails, and requires can vary for a population and context, (2) inherent tension exists between helping participants voice (and overcome) their concerns and exposing them to others' ideas that may exacerbate those concerns, and (3) interactional exchanges (e.g., with peers or experts) that matter to participants may shape the dialogue in terms of its content and form. We suggest that having a discovery-orientation-meaning to work not only inductively and iteratively but also reflexively-is a necessary part of the development of dialogue-based interventions. Our case also sheds light on the influences between: dialogue topic/content, socio-political landscape, population, intervention aim, dialogue form, ethics, researcher position, and types of interactional exchanges

Vaccination in individuals/patients and populations at risk

Vaccination does not only provide direct protection against infectious diseases but also contributes to the protection of an entire population when a large proportion of the population is vaccinated and herd immunity is reached. This way vulnerable individuals, namely those who cannot be vaccinated and those who do not respond to vaccination, can also be protected. My PhD project includes different projects which are related to the direct and indirect protection of patients and individuals at risk. In a first project, we have performed a phase III clinical trial on the safety and immunogenicity of a ninevalent vaccine against Human Papillomavirus (HPV) (Gardasil-9®) in 171 solid-organ transplant (SOT) patients and 100 HIV patients. As chronic HPV-infection is more prevailing among these patients, they have an increased risk of developing genital warts and (pre)cancerous lesions of the uterus, vagina, anus or penis. Whereas in healthy persons, HPV vaccination has proven to be very efficacious in preventing HPV infections, little is known for these patients. We found that all HIV patients seroconverted for all HPV types included in the vaccine (HPV 6/11/16/18/31/33/45/52/58), but seroconversion ranged from 46% for HPV45 to 72% for HPV58 among SOT patients. Seroconversion rates were particularly low in lung transplant patients for HPV18 (38%), HPV31 (43%) and HPV45 (32%). The vaccine was found to be safe and well tolerated in both patient groups. In a second project we assessed whether the current vaccination programs provide adequate protection to at-risk patients. Therefore, in different groups of at-risk patients we evaluated their vaccination status and degree of protection to some vaccine-preventable diseases. We found that many at-risk patients were inadequately vaccinated. In particular, only 44% of adult subjects were vaccinated against influenza, 32% against pneumococcal disease, 29% against diphtheria-tetanus and 10% against pertussis. Moreover, except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis. We found that seroprotective titers were reached in 83% of adult at-risk patients for tetanus (≥0,1IU/ml), 29% for diphtheria (≥0,1IU/ml), and seropositive titers in 22% for pertussis (≥5IU/ml). In pediatric patients, the seroprevalence of antibodies was 83.3% for measles (≥150mIU/ml), 82.9% for mumps (≥230 labU/ml) and 80.6% of children was protected against rubella (≥10IU/ml). Most pediatric patients were protected against tetanus (≥0.1IU/ml; 93.2%), but only 61.3% were protected against diphtheria (≥0.1IU/ml) and 53.2% had antibodies (≥5 IU/ml) against pertussis. Based on these results, we advocate for a closer follow-up of vaccination status. In a third project we aimed to increase influenza vaccination coverage in healthcare workers and as such to avoid transmission of influenza to vulnerable patients. A practical manual was developed for the organization of seasonal influenza vaccination campaigns (http://www.laatjevaccineren.be/hou-griep-uit-je-team). The use of the manual was evaluated in 11 nursing homes and was associated with a 10 to 30% increased vaccination uptake.status: publishe

Increased vaccine uptake and less perceived barriers towards vaccination in long-term care facilities that used multi-intervention manual for influenza campaigns

Seasonal influenza is an annually recurring threat to residents of long-term care facilities (LTCFs) since high age and chronic disease diminish immune response following vaccination. Although immunization of healthcare workers (HCWs) has proven to be an added value, coverage rates remain low. A ready-to-use instruction manual was designed to facilitate the implementation of interventions known to increase vaccination coverage in healthcare institutions. It includes easy-access vaccination, role model involvement, personalized promotional material, education and extensive communication. We evaluated this manual during the 2017-vaccination campaign in 11 LTCFs in Belgium. Vaccination coverage before and after the campaign was recorded by the LTCFs and the usefulness of the manual was assessed by interviewing the organizers of the local campaigns. Attitudes toward vaccination and reasons for vaccination were evaluated with a quantitative survey in HCWs before and after the campaign. The mean vaccination coverage reported by the LTCFs was 54% (range: 35-72%) in 2016 and 68% (range: 45-81%) in 2017. After the campaign, HCWs were less likely to expect side effects after influenza vaccination (OR (95%CI): 0.4 (0.2-0.9)) or to oppose vaccination (OR (95%CI): 0.3 (0.1-0.9)). The majority (>60%) indicated to be well informed about the risks of influenza and the efficacy of the vaccine. The main reason for vaccination in those who previously refused it was resident protection. The manual was found useful by the organizers of the campaigns. We conclude that the use of an intervention manual may support vaccination uptake and decrease perceived barriers toward influenza vaccination in countries without mandatory vaccination in HCWs.status: submitte

Increased vaccine uptake and less perceived barriers toward vaccination in long-term care facilities that use multi-intervention manual for influenza campaigns

Seasonal influenza is an annually recurring threat to residents of long-term care facilities (LTCFs) since high age and chronic disease diminish immune response following vaccination. Although immunization of healthcare workers (HCWs) has proven to be an added value, coverage rates remain low. A ready-to-use instruction manual was designed to facilitate the implementation of interventions known to increase vaccination coverage in healthcare institutions. It includes easy-access vaccination, role model involvement, personalized promotional material, education and extensive communication. We evaluated this manual during the 2017-vaccination campaign in 11 LTCFs in Belgium. Vaccination coverage before and after the campaign was recorded by the LTCFs and the usefulness of the manual was assessed by interviewing the organizers of the local campaigns. Attitudes toward vaccination and reasons for vaccination were evaluated with a quantitative survey in HCWs before and after the campaign. The mean vaccination coverage reported by the LTCFs was 54% (range: 35–72%) in 2016 and 68% (range: 45–81%) in 2017. After the campaign, HCWs were less likely to expect side effects after influenza vaccination (OR (95%CI): 0.4 (0.2–0.9)) or to oppose vaccination (OR (95%CI): 0.3 (0.1–0.9)). The majority (>60%) indicated to be well informed about the risks of influenza and the efficacy of the vaccine. The main reason for vaccination in those who previously refused it was resident protection. The manual was found useful by the organizers of the campaigns. We conclude that the use of an intervention manual may support vaccination uptake and decrease perceived barriers toward influenza vaccination in countries without mandatory vaccination in HCWs

Project report #3: Vaccine supply chain decision support system

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