Leveraging seasonal influenza health worker vaccination programmes for COVID-19 vaccine Introduction: A global qualitative analysis.

BACKGROUND: Health worker vaccination programmes can help to safeguard both health workers (HWs) and their patients and enhance vaccine uptake more broadly in local communities and society. This study's objective was to increase global understanding of how existing HW vaccination programmes were leveraged for emergency COVID-19 vaccine introduction. METHODS: This qualitative study included 13 in-depth group interviews with 38 key informants with expertise in vaccine programme implementation from eleven countries in five WHO regions: Albania, Armenia, Bhutan, Lao PDR, Maldives, Mongolia, Oman, Timor Leste, the United Kingdom, Vietnam, and Zimbabwe in addition to WHO regional focal points from all six regions. These interviews were transcribed, coded, and thematically analyzed. Key informants reviewed the initial results and validated the key findings. RESULTS: Informants characterized key components of both routine and seasonal influenza vaccination programmes that were leveraged for the emergency vaccination of HWs during the COVID-19 pandemic. We identified a set of cross-cutting factors that were used for COVID-19 vaccine roll out: 1) pre-existing occupational health policies, 2) adequate human resources, 3) well-functioning data information systems and vaccine delivery platforms, and 4) established communication channels. Across the eleven countries and six regions interviewed, the ability to adapt existing influenza or other health worker vaccination infrastructure was beneficial for their pandemic response. CONCLUSIONS: Our findings suggest a strong justification for enhanced investment in vaccination of health workers, particularly against seasonal influenza, through country-wide programmes as a foundation for pandemic preparedness and response.

The 2020 immunization programme landscape: Piloting an assessment metric to evaluate the maturity of national immunization programmes across the life course.

BACKGROUND: The World Health Organization (WHO) encourages countries to provide appropriate vaccinations for children, adolescents, and relevant adult populations. Childhood programme have been the focus of global investments, but recent pandemics have increasingly demonstrated the value of life course vaccination. Our objective is to compare national life course immunization programmatic maturity prior to mass COVID-19 vaccine introduction, the largest adult vaccination programme, globally. As coverage estimates (typically used to assess childhood programmes) are not available for adult vaccinations, this analysis pilots a standardized quantitative metric of programmatic maturity. METHODS: Through consultation with vaccination experts, we developed a standardized approach to assess national immunization programme maturity across the life course. In accordance with expert input, five vaccines were selected to represent delivery across the life course: diphtheria tetanus toxoid and pertussis (DTP); measles (MCV) second dose; human papillomavirus (HPV) final dose; pneumococcal conjugate (PCV) final dose; and seasonal influenza annual dose. Experts recommended inclusion of the following indicators for each vaccine: a legal mandate (national policy), experience delivering the vaccine (programme duration), and vaccine use (uptake for relevant populations). We developed a metric accordingly that provides up to 5 points per vaccine ("vaccine specific maturity score") which when summed forms the "life course maturity score", with a maximum score of 25. We analysed the prevalence of national policies, experience, and use by region and World Bank income group. RESULTS: More than 55% of the 194 WHO Member States had childhood vaccine policies for all three of the vaccines considered (DTP, MCV, and PCV) compared to 60% for HPV (proxy for adolescent vaccination programme) and 52% for seasonal influenza (proxy for adult vaccination programme). Childhood vaccination programmes (e.g., MCV and DTP) had the highest vaccine specific maturity scores, while seasonal influenza and HPV vaccination programmes had much lower scores. The national life course maturity scores ranged from 1 to 23, with a global median of 12 (IQR: 8; 16). DISCUSSION: The piloted metric provides an overview of the maturity of life course immunization programmes. The metric is structured to be a flexible, rapid resource that can be used to assess other combinations of vaccines across the life course. The findings from this paper provide a baseline of immunization programme maturity for childhood, adolescent, and adult vaccination programmes immediately prior to the COVID-19 vaccine introduction. This maturity score, or adaptations of this approach, could be used to monitor the trajectory of national immunization programme maturity across the life course in the years ahead.

Assessing the relationship between existing childhood, adolescent and adult immunization programmes and national COVID-19 vaccination capacities in 2021.

BACKGROUND: During the COVID-19 pandemic, nearly all countries introduced COVID-19 vaccination programmes. Yet, countries had a wide range of programmatic experiences. This analysis aims to identify national characteristics associated with COVID-19 vaccination programmatic success. METHODS: We used the following outcome measures: the presence of national COVID-19 vaccination capacities and COVID-19 coverage as of December 2021, June 2022, and December 2022. We developed a standardized metric for assessing national COVID-19 vaccination capacities as a proxy for speed of introduction. We developed this metric through adaptation of the WHO Guide for Conducting an Expanded Programme on Immunization Review and consultations with technical experts specializing in vaccine introduction and emergency deployment; monitoring and data; childhood, adolescent and adult programmes; and COVID-19 vaccination roll-out. Through multivariable linear regressions, we evaluated whether having a mature immunization programme for children, adolescents and adults; recent use of emergency vaccination; World Bank income classification; past early adoption of new vaccines; density of the health workforce; and/or trust in science and government were associated with higher COVID-19 vaccination capacities and coverage. RESULTS: The COVID-19 vaccination capacities scores ranged from 0 to 5 points with a global median score of 2 and an interquartile range of 1;4. After adjusting for World Bank income classifications, the presence of a mature influenza vaccination programme was independently correlated with statistically significant higher scores of national COVID-19 vaccination capacities and higher COVID-19 vaccination coverage in December 2021, June 2022, and December 2022. Trust in government was also associated with higher coverage for all three time stamps. CONCLUSIONS: As countries consider how to prepare for and respond to future pandemics, having an adult seasonal influenza vaccination programme, building trust in government, and ensuring equitable access to vaccines supply emerged as key aspects that can benefit from additional national and global focus.

National vaccination policies for health workers - A cross-sectional global overview.

BACKGROUND: Immunization is essential for safeguarding health workers from vaccine-preventable diseases (VPDs) that they may encounter at work; however, information about the prevalence and scope of national policies that protect health workers through vaccination is limited. Understanding the global landscape of health worker immunization programmes can help direct resources, assist decision-making and foster partnerships as nations consider strategies for increasing vaccination uptake among health workers. METHODS: A one-time supplementary survey was distributed to World Health Organization (WHO) Member States using the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization (JRF). Respondents described their 2020 national vaccination policies for health workers - detailing VPD policies and characterising technical and funding support, monitoring and evaluation activities and provisions for vaccinating health workers in emergencies. RESULTS: A total of 53 % (103/194) Member States responded and described health worker policies: 51 had a national policy for vaccinating health workers; 10 reported plans to introduce a national policy within 5 years; 20 had subnational/institutional policies; 22 had no policy for vaccinating health workers. Most national policies were integrated with occupational health and safety policies (67 %) and included public and private providers (82 %). Hepatitis B, seasonal influenza and measles were most frequently included in policies. Countries both with and without national vaccination policies reported monitoring and reporting vaccine uptake (43 countries), promoting vaccination (53 countries) and assessing vaccine demand, uptake or reasons for undervaccination (25 countries) among health workers. Mechanisms for introducing a vaccine for health workers in an emergency existed in 62 countries. CONCLUSION: National policies for vaccinating health workers were complex and context specific with regional and income-level variations. Opportunities exist for developing and strengthening national health worker immunization programmes. Existing health worker immunization programmes might provide a foothold on which broader health worker vaccination policies can be built and strengthened.

Building global capacity for COVID-19 vaccination through interactive virtual learning.

BACKGROUND: To support the introduction of the COVID-19 vaccine, the World Health Organization and its partners developed an interactive virtual learning initiative through which vaccination stakeholders could receive the latest guidance, ask questions, and share their experiences. This initiative, implemented between 9 February 2021 and 15 June 2021, included virtual engagement between technical experts and participants during a 15-session interactive webinar series as well as web and text-messaging discussions in English and French. METHODS: This article uses a mixed-methods approach to analyze survey data collected following each webinar and a post-series survey conducted after the series had concluded. Participant data were tracked for each session, and feedback surveys were conducted after each session to gauge experience quality and content usability. Chi-square tests were used to compare results across professions (health workers, public health practitioners, and others). RESULTS: The COVID-19 Vaccination: Building Global Capacity webinar series reached participants in 179 countries or 93% of the WHO Member States; 75% of participants were from low- and middle-income countries. More than 60% of participants reported using the resources provided during the sessions, and 47% reported sharing these resources with colleagues. More than 79% of participants stated that this initiative significantly improved their confidence in preparing for and rolling out COVID-19 vaccinations; an additional 20% stated that the initiative "somewhat" improved their confidence. In the post-series survey, 70% of participants reported that they will "definitely use" the knowledge derived from this learning series in their work; an additional 20% will "probably use" and 9% would "possibly use" this knowledge in their work. CONCLUSION: The COVID-19 Vaccination: Building Global Capacity learning initiative used a digital model of dynamic, interactive learning at scale. The initiative enhanced WHO's ability to disseminate knowledge, provide normative guidance, and share best practices to COVID-19 vaccination stakeholders in real time. This approach allowed WHO to hear the information needs of stakeholders and respond by developing guidance, tools, and training to support COVID-19 vaccine introduction. WHO and its partners can learn from this capacity-building experience and apply best practices for digital interactive learning to other health programs moving forward.

Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study.

BACKGROUND: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. OBJECTIVE: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. METHODS: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform's statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. RESULTS: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. CONCLUSIONS: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout.

Does having a seasonal influenza program facilitate pandemic preparedness? An analysis of vaccine deployment during the 2009 pandemic.

BACKGROUND: National seasonal influenza programs have been recommended as a foundation for pandemic preparedness. During the 2009 pandemic, WHO aimed to increase Member States' equitable access to influenza vaccines through pandemic vaccine donation. METHODS: This analysis explores whether the presence of a seasonal influenza program contributed to more rapid national submission of requirements to receive vaccine during the 2009 influenza pandemic. Data from 2009 influenza vaccine donation, deployment, and surveillance initiatives were collected during May-September 2018 from WHO archival material. Data about the presence of seasonal influenza vaccine programs prior to 2009 were gathered from the WHO-UNICEF Joint Reporting Form. Cox proportional hazards models were used to assess the relationship between presence of a seasonal influenza program and time to submission of a national deployment and vaccination plan and to vaccine delivery. FINDING: Of 97 countries eligible to receive WHO-donated vaccine, 83 (86%) submitted national deployment and vaccination plans and 77 (79%) received vaccine. Countries with a seasonal influenza vaccine program were more likely to submit a national deployment and vaccination plan (hazards ratio [HR] 2.1; 95% confidence interval [CI]. Countries with regulatory delays were less likely to receive vaccine than those without these delays (HR 0.4, 95% CI: 0.2-0.6). INTERPRETATION: During the 2009 pandemic, eligible countries with a seasonal influenza vaccine program weremore ready to receive and use donated vaccines than those without a program. Our findings suggest that robust seasonal influenza vaccine programs increase national familiarity with the management of influenza vaccines and therefore enhance pandemic preparedness. FUNDING: N/A.

Stakeholders' perceptions of 10years of the Global Action Plan for Influenza Vaccines (GAP) - Results from a survey.

Ten years after the launch of the Global Action Plan for Influenza Vaccines (GAP), the World Health Organization (WHO) surveyed stakeholders to understand their perceptions of what the programme had achieved. This article provides a summary of the findings; the full report will be available on-line on the GAP website in November 2016 (http://www.who.int/influenza_vaccines_plan/en/). Seventy-seven responses were received from stakeholders including medical doctors, national influenza center officials, country immunization programme teams, surveillance and disease centers, policy-makers, researchers, vaccine manufacturers, and non-governmental organizations from 28 countries, representing all six WHO regions. Respondents cited GAP's biggest successes as capacity building in developing countries; raising international awareness of global needs in the event of a pandemic; and collaborative alignment of influenza stakeholders. The most commonly reported challenges were the limited progress in development of a broadly protective or universal vaccine and the perceived absence of a major increase in seasonal demand. These findings aligned with the perception that less global progress had been made under the third GAP objective, focused on research and development of better vaccines, than on increasing seasonal vaccine use (objective 1) and pandemic vaccine production capacity (objective 2). Respondents explained what they saw as the major challenges to development of better vaccines, including to development of a universal influenza vaccine. The majority of respondents agreed that the goal chosen at the GAP II consultation is still relevant. Results highlighted the importance of promoting research and development of better vaccines, both for facilitating uptake of seasonal vaccines and for ensuring timely vaccine availability in the event of a pandemic. As the GAP concludes its mandate this year, these findings will contribute to discussions on the impact of programme closure and how to address the key issues facing influenza stakeholders thereafter.

Considerations for sustainable influenza vaccine production in developing countries.

Through its Global Action Plan for Influenza Vaccines (GAP), the World Health Organization (WHO) in collaboration with the United States Department of Health and Human Services has produced a checklist to support policy-makers and influenza vaccine manufacturers in identifying key technological, political, financial, and logistical issues affecting the sustainability of influenza vaccine production. This checklist highlights actions in five key areas that are beneficial for establishing successful local vaccine manufacturing. These five areas comprise: (1) the policy environment and health-care systems; (2) surveillance systems and influenza evidence; (3) product development and manufacturing; (4) product approval and regulation; and (5) communication to support influenza vaccination. Incorporating the checklist into national vaccine production programmes has identified the policy gaps and next steps for countries involved in GAP's Technology Transfer Initiative. Lessons learnt from country experiences provide context and insight that complement the checklist's goal of simplifying the complexities of influenza prevention, preparedness, and vaccine manufacturing.

The 2015 global production capacity of seasonal and pandemic influenza vaccine.

A global shortage and inequitable access to influenza vaccines has been cause for concern for developing countries who face dire consequences in the event of a pandemic. The Global Action Plan for Influenza Vaccines (GAP) was launched in 2006 to increase global capacity for influenza vaccine production to address these concerns. It is widely recognized that well-developed infrastructure to produce seasonal influenza vaccines leads to increased capacity to produce pandemic influenza vaccines. This article summarizes the results of a survey administered to 44 manufacturers to assess their production capacity for seasonal influenza and pandemic influenza vaccine production. When the GAP was launched in 2006, global production capacity for seasonal and pandemic vaccines was estimated to be 500million and 1.5billion doses respectively. Since 2006 there has been a significant increase in capacity, with the 2013 survey estimating global capacity at 1.5billion seasonal and 6.2billion pandemic doses. Results of the current survey showed that global seasonal influenza vaccine production capacity has decreased since 2013 from 1.504billion doses to 1.467billion doses. However, notwithstanding the overall global decrease in seasonal vaccine capacity there were notable positive changes in the distribution of production capacity with increases noted in South East Asia (SEAR) and the Western Pacific (WPR) regions, albeit on a small scale. Despite a decrease in seasonal capacity, there has been a global increase of pandemic influenza vaccine production capacity from 6.2 billion doses in 2013 to 6.4 billion doses in 2015. This growth can be attributed to a shift towards more quadrivalent vaccine production and also to increased use of adjuvants. Pandemic influenza vaccine production capacity is at its highest recorded levels however challenges remain in maintaining this capacity and in ensuring access in the event of a pandemic to underserved regions.

A cross-sectional study of pediatric eye care perceptions in Ghana, Honduras, and India.

Of the more than 1.4 million blind children worldwide, 75% live in developing countries. To reduce the prevalence of childhood blindness and associated diseases, attention is given to understanding the perceptions and level of awareness held by caregivers. This understanding can enable tailored health programs to reduce the global prevalence of blindness with increased efficiency. This study, which took place in Ghana, Honduras, and India, found that 95% of caregivers believed in the importance of eye exams for children, yet 66% of caregivers said that none of their children had ever received an eye exam. Participants' major reasons for not bringing their children included the belief that their child had no eye problems along with similar and unique socio-economic barriers. Further information was gained through the use of a five-question test on basic child eye care symptoms, which showed that out of the three country locations, the studied population in India had the least understanding about pediatric eye symptoms. Further analysis revealed significant gaps in understanding of general eye health while detected knowledge barriers provide evidence that fundamental misconceptions appear to be inhibiting caregivers' competence in facilitating their children's eye health.

Caffeinated Alcohol, Sensation Seeking, and Injury Risk.

BACKGROUND: College students who consume caffeinated alcoholic beverages (CaffAlc) are at increased injury risk. This study examines the extent to which a sensation-seeking personality accounts for the relationship between consumption of CaffAlc and negative outcomes. METHODS: A Web-based survey was administered to stratified random samples of 4907 college students from eight North Carolina universities in Fall 2009. Sensation seeking was assessed using the Brief Sensation-Seeking Scale (BSSS) (α=0.81). Data were analyzed using linear and logistic regression. RESULTS: 3390 students (71.2%) reported past 30-day drinking, of whom 786 (23.2%) consumed CaffAlc. CaffAlc past 30-day drinkers had higher BSSS scores (3.8 vs. 3.4; p<0.001), compared to non-CaffAlc drinkers. Consumption of CaffAlc was associated with more frequent binge drinking (p<0.001) and drunken days in a typical week (p<0.001), even after adjusting for the BSSS score. CaffAlc students were more likely to be taken advantage of sexually (adjusted odds ratio [AOR]=1.70, p=0.012), drive under the influence of alcohol (AOR=2.00, p<0.001), and ride with a driver under the influence of alcohol (AOR=1.87, p<0.001). Injury requiring medical treatment was more prevalent among CaffAlc students with higher BSSS-8 scores (interaction p=0.024), even after adjustment for drinking levels and student characteristics. CONCLUSIONS: Sensation seeking does not fully account for the increase in risky drinking among college students who consume CaffAlc, nor does it moderate the relationship between CaffAlc and drinking behaviors. Sensation seeking moderates the risk of alcohol-associated injury requiring medical treatment among college students who consume CaffAlc. Those with strong sensation-seeking dispositions are at the highest risk of alcohol-associated injury requiring medical treatment.