Advance Market Commitments (AMC) model application for Colombian purchase strategy of COVID-19 vaccines1

This research estimated the optimal size and composition of the portfolio, and its benefit–cost ratio, of COVID-19 vaccines that Colombia should negotiate as a price-taking country. The Advance Market Commitments (AMC) mathematical model was applied using the parameters from the Colombian context and from a literature review. The findings indicate that the optimal portfolio of Colombia should include 13 vaccines, mainly from two platforms: i) RNA and ii) inactivated virus. The benefit–cost ratio was always greater than one in the baseline scenario and after performing many sensitivity analyses on parameters such as the percentage of the population at risk, the price per treatment, and the herd immunity threshold, among others. In a context of high uncertainty, the best decision – with high benefit – is to anticipate the negotiation processes with the providers of COVID-19 vaccines, which will generate positive economic and health impacts

One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients

The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5–24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) number of symptoms of 5.7 ± 4.6, and 61.3% met the criteria for post-COVID syndrome at 1 year. During the follow-up, 46 patients were discharged, and 16 were transferred to other consultations. Other conditions, such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%), and lung cancer (1%) were identified. A high use of health care resources is observed in the first year. In conclusion, one-third of critically ill COVID-19 patients need to continue follow-up beyond 1 year, due to abnormalities on DLCO, chest CT, or persistent symptoms.

Advance Market Commitments (AMC) model application for Colombian purchase strategy of COVID-19 vaccines.

This research estimated the optimal size and composition of the portfolio, and its benefit-cost ratio, of COVID-19 vaccines that Colombia should negotiate as a price-taking country. The Advance Market Commitments (AMC) mathematical model was applied using the parameters from the Colombian context and from a literature review. The findings indicate that the optimal portfolio of Colombia should include 13 vaccines, mainly from two platforms: i) RNA and ii) inactivated virus. The benefit-cost ratio was always greater than one in the baseline scenario and after performing many sensitivity analyses on parameters such as the percentage of the population at risk, the price per treatment, and the herd immunity threshold, among others. In a context of high uncertainty, the best decision - with high benefit - is to anticipate the negotiation processes with the providers of COVID-19 vaccines, which will generate positive economic and health impacts.

Trust in Institutions, Not in Political Leaders, Determines Covid-19 Public Health Compliance in Societies across the Globe (preprint)

A core assumption often heard in public health discourse is that increasing trust in national political leaders is essential for securing public health compliance during crises like the Covid-19 pandemic (2019-ongoing). However, studies of national government trust typically are too coarse-grained to differentiate between trust in institutions versus more interpersonal trust in political leaders. Here, we present multiscale trust measurements for twelve countries and territories across the West, Oceania and East Asia. These trust results were used to identify which specific domains of government and social trust were most crucial for securing public health compliance (frequency of mask wearing and social distancing) and understanding the reasons for following the health measures (belief in effectiveness of public health measures). Through the use of linear regression and structural equation modeling, our cross-cultural survey-based analysis (N=3369 subjects) revealed that higher trust in national and local public health institutions were a universally consistent predictor of public health compliance, while trust in national political leaders was not predictive of compliance across cultures and geographical regions. Institutional trust was mediated by multiple types of transparency, including providing rationale, securing public feedback, and honestly expressing uncertainty. These results highlight the importance of distinguishing between components of government trust, to better understand which entities the public gives the most attention to during crises.