1,721,001 research outputs found
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Countries on the Edge: Evaluating the Sustainability of Gavi’s Immunization Support in Former Gavi-supported Countries: Evidence from the COVID-19 Pandemic
No full textGavi, the Vaccine Alliance, has been critical in improving immunization coverage and equity in low- and middle-income countries (LMICs) since its inception in 2000. Based on Gavi’s unique transition model, 19 countries have transitioned from Gavi’s support and become “Gavi graduates,” expecting to sustain their immunization performance as a self-financing country. However, the COVID-19 pandemic tested the resilience of these countries' immunization systems and raised concerns about their sustainability after graduation. This study evaluated whether Gavi’s past investments contributed to building resilient immunization systems in former Gavi-supported countries (FGCs) and what systemic challenges they faced.
This study applied a mixed-methods approach by integrating Difference-in-Differences (DiD) analysis and key informant interviews (KIIs). The quantitative analysis compared immunization performance trends in 19 FGCs and 26 never-Gavi-supported LMICs (NGCs) during the pandemic, focusing on DTP3, DTP1, and MCV1 coverage using WHO-UNICEF Estimates of National Immunization Coverage (WUENIC) data. The qualitative component consists of 20 semi-structured interviews with policymakers, global health experts, and immunization program managers to explore systemic factors affecting immunization sustainability in FGCs.
The DiD analysis revealed that FGCs experienced 3.74 (95% CI -4.92, -2.56) percentage points greater decline in DTP3, 3.85 (95% CI -4.78, -2.93) percentage point in DTP1, and 5.7 (95% CI -6.72, -4.69) percentage points in MCV1, compared to NGCs by 2023. The decline of DTP1 coverage in FGCs is equivalent to 371,000 to 430,000 additional zero-dose children. Qualitative findings revealed systemic gaps in vaccine procurement capacity, budget constraints, and governance systems. Stakeholders noted that graduation criteria may not fully capture a country’s readiness to sustain immunization performance, and the lack of tailored transition support limits the sustainability of immunization programs in FGCs.
The study proposed prioritized recommendations: refining graduation criteria to assess country readiness in the short-term, establishing a post-transition technical assistance mechanism in the mid-term, and institutionalizing the MICs Approach for tailored support in the long term. As Gavi enters its 6.0 strategy cycle (2026–2030), there is a window opportunity to implement these recommendations and strengthen the sustainability of immunization systems in FGCs and transitioning countries.Public Healt
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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Using Quality Improvement Collaboratives to Improve Health Service Delivery in the Context of Public Health Emergencies: Lessons From the Zika Epidemic
No full textRecent Public Health Emergencies (PHEs) have highlighted gaps in health systems to effectively prepare for, prevent and respond to these emergencies. Quality improvement collaboratives (QICs) promote rapid improvement and learning through collaboration and have been widely used to improve clinical processes and health outcomes at a large-scale. QICs are a potential approach to improve health service delivery during PHEs.
As part of the response to the 2016 Zika epidemic, a QIC approach was used to promote the adoption adaptation of evidence-based practices to improve the quality of Zika-related health services. This multi-phase study aimed to develop a better understanding of the role of QICs in responding to PHEs. Changes in outcome measures following the adoption of the QIC and participants’ perspectives regarding QIC implementation were assessed for 38 health facilities from Guatemala and 17 from the Dominican Republic.
Phase 1. Results for all outcome measures for both countries were statistically significantly higher (p<0.001) during the implementation phase of the QIC compared with the demonstration phase.
Phase 2. Participants perceived the QIC approach to be feasible, appropriate and easy-to-use, and reported high levels of satisfaction and high visibility of outcomes. The speed of adoption was low and a high number of modifications and/or adaptations to the implementation strategy were required. Barriers and challenges identified included insufficient infrastructure and capacity, low levels of commitment and resistance to change from clinical providers. Features that participants valued most included teamwork, shared learning and collaboration, use of data to guide decision-making, flexibility for local-context adaptation, and the ability to see rapid results.
Phase 3. Results for outcome measures from the health facilities with higher levels of agreement with the QIC implementation categories were statistically significantly higher (p<0.001) compared with those from the facilities with lower levels of agreement.
The QIC approach demonstrated potential to improve health service delivery in the context of the response to a PHE. The results from this study highlighted the importance of understanding how interventions are implemented and participants’ experience and perspectives on the factors that may limit or facilitate its optimal implementation.Public Healt
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Planning Ahead for Access to Medicines: Strategy to Integrate Access as a Core Driver of a Vaccines Company
No full textPharmaceutical companies are investing a considerable amount of effort and resources into access to medicines–related initiatives. However, the manner in which access to medicines is framed and understood may differ between companies, as may its outcomes. This project is based on the idea that access to medicines programs need to evolve towards a more integrated approach that implies incorporating access provisions in the early stages of product development.
By analyzing how Takeda Pharma conceptualizes and operationalizes access, this study aims to develop an adequate access strategy for its vaccines unit. To that end, a series of interviews with employees and external experts on vaccines and access have been conducted. Documentation analysis has also been performed: review of internal data on processes together with the access-related information generated by the company, as well as the outcome of the biannual Access to Medicines Index report.
The outcome of this initial research phase opens the door to the definition of a strategy for Takeda Vaccines that aims at integrating access concepts into the different stages of product development with the objective of strengthening its approach to access to medicines. This strategy needs to be adapted to the specificity of the company; therefore, it is important to understand not only its standard operating procedures and internal organization, but also how its culture and vision integrate and align with access concepts.
This research proposes incremental changes in existing procedures and systems that will lead to structural changes in the way in which the company manages access to vaccines. This implementation will potentially induce a cultural change in the organization that will culminate in the embodiment of access as a core part of the business model of Takeda Vaccines.Public Healt
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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The Anatomy of Indirect Swarming and Its Potential Threat to Democracies
No full textNetworked harassment disproportionately targets women and historically marginalized communities (Krook, 2017; Vitak et al., 2017; Blackwell et al., 2017; Data and Society, 2018; EVAW, 2020a; EVAW, 2020b; Glitch, 2023). Gamergate was dangerous back in 2014, but in an election year with at least 70 countries headed to the polls involving two to three billion citizens (O’Caroll and Milmo, 2023), the continued lack of language and legal conceptualization around networked harassment has serious consequences for platforms’ accountability and our democracies.
This work advances the discussion by looking at an as-yet-to-be understood form of networked harassment, what I term “indirect swarming”. This is characterized by the sudden rise in the volume of posts and engagement over a short time-period, catalyzed by an amplifier, a highly-networked account, who covertly signals to their followers to harass a target. The research objectives were: What is indirect swarming and what are the methods to discern its empirical patterns? How do we distinguish between direct and indirect swarming?
Using a critical feminist lens to foreground the lived experiences of the targets, I analyzed case studies of networked harassment to further expand upon Alice Marwick’s 2021 model, employing a mixed-method approach using datasets from X and Facebook, collected from the target’s standpoint (Haraway, 1988; Harding, 2004). Through descriptive statistics, quantitative and qualitative analysis, I compared these cases to illustrate the similarities and differences and establish the thresholds that had led us to propose the new categories of direct and indirect swarming. The event of foci in both case studies are the targets’ resignation announcements posted on X.
Focusing on the novel risks and harms linked to indirect swarming, this paper offers a solution by sketching out what I call a “protective correlate” as a method that could help platforms mitigate the risks of indirect swarming. This method focuses on signals–similar to signals utilized in recommender systems–rather than content. For social media platforms, the protective correlate gives agency to the user to report indirect swarming while protecting platforms’ editorial rights vis-à-vis the First Amendment. This work thus has important ramifications for democracy and public discourse
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Seasonal Work, Interrupted Care: Maternal and Child Health Gaps of Brick Kiln Migrants in Bihar, India
No full textIn India nearly 40% of the population is considered a migrant, yet migration is poorly understood and not prioritized in government policy. Seasonal migrants represent a particularly vulnerable category of people who come from the poorest sectors of society, often from scheduled castes and scheduled tribes. As seasonal migrants move between their home and work locations, continuity of care is interrupted and the portability of benefits denied. Working under what are often exploitative or slave-like conditions, they are systematically excluded from social services, as existing policies have largely failed to provide protection to this population, especially with regard to state-provided services such as healthcare.
This project explores the challenges seasonal migrant workers face in identifying, accessing, and receiving maternal and child health services through the lens of seasonal brick kiln workers. As many as 50 million women and children could be residing as seasonal migrants at brick kilns in India.
A literature review and expert interviews were conducted to provide an overview of the migration landscape in India. This research informed a qualitative study, which was carried out at brick kilns in Bihar through in-depth interviews and focus group discussions with brick kiln workers, brick kiln managers, and healthcare workers. Thematic analysis was used to synthesize findings, which were placed within the Three Delays Framework.
System level barriers to maternal and child healthcare arising from the exploitative nature of the employment system, the power the manager has over his employees, the social segregation brick kiln workers experience from the local population, stigma and discrimination, and the delivery mechanisms of government community health schemes were identified.
There is a need for systematic investments in knowledge and data around seasonal migrants. Surveying methods need to be improved to better count the number of seasonal migrants and understand their health status. The development of pilot projects involving community health workers to ensure maternal and child health programs are accessible is important. Finally advocacy with state and national government, as well as convening of key stakeholders, in order to bring about changes in labour laws is needed.seasonal migrants, migrant health, brick kiln workers, maternal and child health, Indi
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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The Role of Pharmaceutical Companies in Global Health: Lessons From Bedaquiline
No full textMany diseases that cause significant morbidity and mortality around the world do not attract adequate investment from private sector pharmaceutical companies to research and develop new medicines. During an eight-month fellowship with the Johnson & Johnson Global Public Health team, I explored the role of pharmaceutical companies in tackling global health problems. I use a case study on bedaquiline (brand name SIRTURO®), the first new drug with a novel mechanism of action used to treat tuberculosis in 50 years, to explore barriers and facilitators to engaging pharmaceutical companies in tackling complex global health problems. Further, I discuss implications and lessons from the development of bedaquiline, and the motivations of the pharmaceutical company behind it, that the public health community can learn about the role of pharmaceutical companies in global health.Tuberculosis; Pharmaceutica
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