Sustainable R&D portfolio assessment.

Research and development portfolio management is traditionally technologically and financially dominated, with little or no attention to the sustainable focus, which represents the triple bottom line: not only financial (and technical) issues but also human and environmental values. This is mainly due to the lack of quantified and reliable data on the human aspects of product/service development: usability, ecology, ethics, product experience, perceived quality etc. Even if these data are available, then consistent decision support tools are not ready available. Based on the findings from an industry review, we developed a DEA model that permits to support strategic R&D portfolio management. We underscore the usability of this approach with real life examples from two different industries: consumables and materials manufacturing (polymers).R&D portfolio management; Data envelopment analysis; Sustainable R&D;

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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CONTRA Project report #1: Requirements identification and system mapping

The research project “COVID-19 Network Technology-based Responsive Action” (CONTRA), funded by the Research Council of Norway, commenced in June 2020. The CONTRA project develops a decision support system (DSS) based on mathematical modeling and stochastic optimization, and machine learning tools for designing a robust COVID-19 vaccine distribution network. The project follows two main objectives within two phases. In response to the on-going COVID-19 outbreak, rapid analyses will provide actionable advice to public health authorities in Norway regarding vaccine distribution and delivery to responders. This phase involved a systematic study of vaccine distribution system actors in Norway and their decision-making needs. Based on such insights, the project will develop a DSS based on mathematical models to support designing the vaccine distribution network. The DSS should contribute to the effectiveness, efficiency, equity, and sustainability of the COVID-19 vaccine distribution. The proposed solution will also support vaccine distribution in future pandemics. The report describes the results of the first work package (WP) in the CONTRA project. The WP1 aims to identify the key actors in the vaccine distribution network in Norway, map their relation to each other, and distinguish critical decisions in the system. Moreover, the report presents an overview of related research on vaccine distribution networks, related decision support systems, and the progress in the literature about the COVID-19 pandemic. Through preliminary interviews, document review, and a workshop with multiple representatives from Norwegian public health authorities, the current vaccine distribution system is analyzed, and its actors have been mapped. This system map is the basis for further discussion both within the project team and with stakeholders. It should be noted that this map will change throughout the project due to the additional insights from other validation opportunities and the fact that the COVID-19 context is dynamic and is changing permanently. However, the system map has served as a basis for the problem definition in the CONTRA project. Based on our findings from the stakeholder workshop and system mapping, we have decided to focus on defining and studying the central vaccine allocation problem (CVAP), which is faced by Public Health Institute (FHI). As such, the CONTRA will investigate the problem of determining the amount of each vaccine to be shipped to every municipality. CVAP is challenged by the scarce amount of vaccines, the current immunization level, population, and priority groups in each municipality. In our project, CVAP will be formulated as a multi-objective resource allocation problem. Specifically, we will define and formulate objectives related to the following performance dimensions: efficacy (e.g., total coverage, coverage per priority group, etc.), efficiency and sustainability (e.g., logistics costs, waste), and fairness (e.g., distribution of efficacy among municipalities). The next step in the project will be to validate the problem definition and develop the mathematical model (second work package). Moreover, two individual reports for the actors map and system map will be published in the upcoming months by project partners.submittedVersionacceptedVersionpublishedVersionpublishedVersio

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

the interplay of two wicked problems

Funding Information: This work was funded by VLIR-UOS, grant numbers TZ2019SIN263 and TZ2020JOI032A101. Publisher Copyright: ©Concern is justified observing the link between the AIDS and COVID-19 pandemics. COVID-19 outcomes are significantly worse in many people living with HIV (PLHIV), even when vaccinated, because of their impaired immune system. Moreover, CD4 T-cells are affected by both HIV and SARS-CoV-2.1-3 SARS-CoV-2 variants can evolve in immunosuppressed patients due to prolonged viral replication in the context of an inadequate immune response.4 Accelerated intrahost evolution of SARS-CoV-2 was reported in a South African HIV patient with antiretroviral therapy (ART) failure.5 6 With 25 million HIV patients in sub-Saharan Africa (SSA) of whom an estimated 8 million are not virologically suppressed, this potentially creates a reservoir for future variants. Such variants, arising in PLHIV anywhere in the world, can spread to other continents, as has been reported for variants of concern (VoCs) (Beta, Omicron) and variants of interest (B.1.6.20, B.1.640.2) that arose in Africa.7-9 Conversely, the COVID-19 pandemic impacts HIV treatment programmes, due to supply chain issues, overburdening of healthcare systems, limiting access to testing, treatment and prevention programmes and further increasing inequalities.10 Modelled COVID-19 disruptions of HIV programmes in SSA included decreased functionality of HIV prevention programmes, HIV testing and treatment, healthcare services such as viral load testing, adherence counselling, drug regimen switches and ART interruptions, which may lead to selection of drug-resistant HIV.11 A 6-month interruption affecting 50% of the population would lead to a median number of excess deaths of 296 000, during 1 year. Scientists advocate for the AIDS and COVID-19 pandemics in Africa to be addressed simultaneously, by increasing African access to COVID-19 vaccines, prioritising research on the interaction between HIV care and COVID-19, maintaining high-quality HIV services and integrating health services for both viruses.7 Both the COVID-19 and the AIDS pandemic, more specifically the issue of HIV drug resistance (HIVDR), have previously been described as wicked problems which are best studied as complex adaptive systems (CASs).12-15Wicked problems consist of diverse interconnected factors and require complexity-informed and locally adapted solutions rather than one solution that fits all. We recently designed a qualitative model of all known factors influencing HIVDR in SSA and analysed its complexity.13 Our detailed systems map featured three main feedback loops driving HIVDR, representing (1) the alternation between adherence and non-adherence, (2) the impact of an overburdened healthcare system and (3) the importance of sustaining global efforts of tackling HIVDR even when new antiretroviral drugs with high genetic barriers become available. These HIV-related feedback loops are interconnected with COVID-19 pandemic impact (in yellow, figure 1). The loop starts from PLHIV with an unsuppressed viral load, which weakens the immune system and may in turn slow down immune clearance of SARS-CoV-2, allowing prolonged replication and mutation of the virus in the context of an inadequate immune response. Prolonged viral clearance facilitates the selection of immune escape SARS-CoV-2 variants. Variants may emerge that have a selective advantage and therefore may spread through populations due to increased transmissibility (with possibly increased virulence), thereby creating an additional burden on the healthcare system, putting the overall healthcare system and the HIV care at risk. These stressors on the healthcare system lead to a higher risk of unsuppressed viral load in PLHIV, increasing the risk of HIVDR. Figure 1 shows the need to address both wicked problems simultaneously and to do so in a complexity-informed manner as they are inevitably linked and influence each other. Evidently, the exact interconnections between both pandemics need to be locally assessed. For instance, a study in South Africa showed that while lockdown severely impacted HIV testing and ART initiation, ART provision was largely maintained, indicating that the strength of the connection between the virological suppression-related loop and the pandemic, indicated in figure 1, are context-dependent.16publishersversionpublishe

A dynamic model for the end-to-end vaccine supply chain

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Sustainable immunization system design in sub-Saharan Africa

Since their inception in the 1970s, immunization programs have succeeded in drastically reducing under-five mortality, improving health equity, and contributing to 14 of the 17 sustainable development goals. In sub-Saharan Africa, however, vaccination coverage rates have been stagnating in recent years, and environmental and economic challenges threaten the sustainability of current immunization systems. In addition, vaccine hesitancy and disruptive events such as the covid-19 pandemic challenge the resilience of immunization systems. Based on a broad, transdisciplinary literature review we investigate on the one hand the links between immunization and the SDGs and on the other hand the existing models capable of capturing the complexities of immunization systems. Subsequently, we propose a conceptual systems-inspired model that frames the core elements of both planned and emergency immunization, as a tool for problem structuring and stakeholder engagement. As a next step, based on the Rwandese immunization system, we develop a quantitative, community-level system dynamics model to support sustainable immunization system design. Finally, we formulate summarized conclusions with respect to the design and modeling of immunization systems together with some recommendations for future research directions.status: publishe

Sustainable R&D portfolio assessment

Research and development portfolio management is traditionally technologically and financially dominated, with little or no attention to the sustainable focus, which represents the triple bottom line: not only financial (and technical) issues but also human and environmental values. This is mainly due to the lack of quantified and reliable data on the human aspects of product/service development: usability, ecology, ethics, product experience, perceived quality etc. Even if these data are available, then consistent decision support tools are not ready available. Based on the findings from an industry review, we developed a DEA model that permits to support strategic R&D portfolio management. We underscore the usability of this approach with real life examples from two different industries: consumables and materials manufacturing (polymers).nrpages: 35status: publishe

A broader view on health care system design and modelling

Many rigorous models have been developed to support health care system design. However, embedding these models in a broader stakeholder based framework, will substantially enhance the societal and human impact of the health care service delivery. Moreover, the acceptance of the (re)designed health care system will be much more evident for all stakeholders involved. These broader base of stakeholders will deliver a balanced set of Key Performance Indicators, against which the new design options or scenarios will be evaluated. These scenarios will be the outcome of an iterative design and modelling process moderated by a group of key stakeholders. Subsequently, a multi-criteria ranking method will reveal a shortlist of championing scenarios. Finally, a group decision process will decide on the final design choice. We build upon an exemplary model of a Nuclear Magnetic Resonance scanning department.nrpages: 35status: publishe

Sustainable R&D portfolio management

Research and development portfolio management is traditionally technologically and financially dominated, with little or no attention to the sustainable focus, which represents the triple bottom line: not only financial (and technical) issues but also human and environmental values. This is mainly due to the lack of quantified and reliable data on the human aspects of product/service development: usability, ecology, ethics, product experience, perceived quality and the like. Even if these data are available, consistent decision support tools are not ready available. Based on the findings from an industry review, a DEA model has been developed that permits to support strategic R&D portfolio management. The usability of this approach is underscored with real life examples from two different industries: consumables and materials manufacturing (polymers). © 2012 Elsevier B.V.status: publishe