COVID-19: Identifying countries with indicators of success in responding to the outbreak

Background: In designing responses to the COVID-19 pandemic, it is critical to understand what has already worked well. We aimed to identify countries with emerging success stories from whom policymakers might draw important lessons.  Methods: We developed a process to first include countries with large enough populations that results were unlikely to be due to chance, that had sufficient cases for response mechanisms to be tested, and that shared the necessary publicly available data. Within these countries, we looked at indicators suggesting success in terms of detecting disease, containing the outbreak, and treating those who were unwell. To support comparability, we measured indicators per capita (per million) and across time. We then used the indicators to identify three countries with emerging success stories to include some diversity in global region, population demographics and form of government. Results: We identified 66 countries that met our inclusion criteria on 18th May 2020. Several of these countries had indicators of success against the set indicators at different times in the outbreak. Vietnam had high levels of testing and successful containment with no deaths reported. South Korea had high levels of testing early in the outbreak, supporting containment. Germany had high levels of sustained testing and slower increases in cases and deaths than seen in other comparable settings. Conclusions: At the time of our assessment, Vietnam and South Korea were able to contain the outbreak of COVID-19 and avoid the exponential growth in cases seen elsewhere. Germany had more cases and deaths, but was nevertheless able to contain and mitigate the outbreak. Despite the many limitations to the data currently available, looking at comparative data can help identify countries from whom we can draw lessons, so that countries can inform and adapt their strategies for success in response to COVID-19.</ns4:p

"Learn from the lessons and don't forget them": Identifying transferable lessons for COVID-19 from meningitis A, yellow fever, and Ebola virus disease vaccination campaigns

Introduction: COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever); and rVSV-ZEBOV (Ebola virus disease). Methods: We conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants&amp;#39 experiences. Interview data were analysed thematically according to seven implementation domains. Results: Participants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities. Conclusion: As supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups, and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns

Staging a conference to frame war as a public health problem

“War & Global Health: Transforming Our Professions, Changing our World,” a conference organized at the University of Washington in the spring of 2010 by the Department of Global Health in the School of Public Health and Physicians for Social Responsibility, aimed to promote a public health approach to war and frame the prevention of war as a legitimate and imperative academic endeavor. The conference planners drew on substantial, yet under-acknowledged, work on the health consequences of war in both research and practice. They considered historical lessons on how a human behavior with negative consequences—generated by political and economic forces—can be framed as a health issue by health professionals. Key elements in the planning and execution of the conference were a strategic partnership between an academic department and an activist organization and the harnessing of considerable student energies. Conference organizers built on a policy statement adopted by the American Public Health Association in 2009 outlining the responsibility of public health professionals to prevent war. The authors document the important elements and the convergence of forces that resulted in a successful conference, examine the lessons learned, and offer a Web-based resource for those interested in staging a similar event

A situational analysis of pharmacovigilance plans in the Global Fund Malaria and U.S. President's Malaria Initiative proposals

Abstract Background Pharmacovigilance programmes can monitor and help ensure the safe use of medicines that are critical to the success of global public health programmes. The widespread deployment of artemisinin-based combination therapy (ACT) by national malaria control programmes as part of the overall Global Malaria Action Plan for malaria control to elimination and eradication makes ACT an excellent candidate for pharmacovigilance activities. In 2008, The Roll Back Malaria partnership issued guidelines for inclusion of pharmacovigilance in Global Fund and other related proposals. In light of this recommendation and the rapid scale-up of ACT worldwide, an analysis of Global Fund Round 8 proposals and the President's Malaria Initiative (PMI) 2009 Malaria Operational Plans was conducted to assess if and how pharmacovigilance has been incorporated into countries' national malaria plans and donor budget requests. Methods The Global Fund - Malaria Round 8 proposals for the 26 countries and the PMI Malaria Operational Plans (MOPs) for fiscal year 2009 for the 15 countries that were approved and received funding from either the Global Fund - Malaria Round 8 or PMI were accessed through the programme websites. The analysis consisted of conducting word counts and key word in context analyses of each proposal and plan. Results Twelve out of 26 (46%) of the Global Fund proposals mentioned that established pharmacovigilance systems were present in their countries. Four of the fifteen PMI MOPs (27%) mentioned that established pharmacovigilance systems were present in their countries. Only seven of the 26 (27%) Global Fund proposals included a request for funding for new or current pharmacovigilance activities. Seven of 15 (47%) MOPs included a request for funding for pharmacovigilance activities. Conclusions There were relatively few requests for funding for pharmacovigilance activities, demonstrating a lack of emphasis placed on pharmacovigilance systems in recipient countries. The findings stress the need for more active direction to strengthen active surveillance and passive adverse event reporting systems to augment the issuance of guidance documents.</p

PMTCT cascade analysis in Côte d\u27Ivoire: Results from a national representative sample

Without treatment, an HIV-positive pregnant woman has a 30–35 percent chance of transmitting the infection to her child. Early detection and appropriate treatment during pregnancy, childbirth, and breastfeeding can reduce those odds to less than 5 percent. Consequently, WHO and countries around the world have instituted prevention of mother-to-child transmission of HIV (PMTCT) programs, consisting of the “PMTCT cascade”: testing for HIV at the first antenatal visit; CD4 test of HIV-positive patients; antiretroviral (ARV) prophylaxis to mother throughout pregnancy and breastfeeding; ARV prophylaxis to child at delivery and throughout breastfeeding; HIV testing of child and initiation of antiretroviral therapy (ART) for children found to be HIV infected. In Côte d’Ivoire, as in much of Africa, PMTCT programs have performed less than optimally due to bottlenecks throughout the cascade that cause delays in initiating care. To help inform the 2012 rollout of the WHO “Option B” treatment regimen in Côte d’Ivoire, an assessment of a sample of existing PMTCT programs in Côte d’Ivoire was carried out. The study’s objectives were to identify time delays in the PMTCT cascade, and suggest recommendations to improve current services to optimize the impact of Option B in Côte d’Ivoire

Strengthening Pharmaceutical Care Education in Ethiopia Through Instructional Collaboration

Objective. To describe the development, implementation, and initial outcomes of a pharmaceutical care training-of-trainers course developed to assist Ethiopian pharmacy faculty members and graduate students in the development of curriculum and provision of pharmaceutical care services of relevance to this low-income country

Interventions for Maintenance of Essential Health Service Delivery during the COVID-19 Response in Uganda, between March 2020 and April 2021

Introduction: The COVID-19 pandemic overwhelmed health systems globally and affected the delivery of health services. We conducted a study in Uganda to describe the interventions adopted to maintain the delivery of other health services. Methods: We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. Results: Governance strategies included the establishment of coordination committees and the development and dissemination of guidelines. Infrastructure and commodity strategies included the review of drug supply plans and allowing emergency orders. Workforce strategies included the provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included the designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and the leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma. Conclusions: Health service maintenance during emergencies requires coordination to harness existing health system investments. The essential services continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic