ABSTRACT
(1) Objectives: Inequality in the global distribution of COVID-19 vaccines has brought about great challenges in terms of resolving the pandemic. Although vaccine manufacturers are undoubtedly some of the most influential players, studies on their role in global vaccine distribution have been scarce. This study examined whether the pharmaceutical industry is acting according to the principles of corporate social responsibility (CSR) during the pandemic. (2) Methods: Three categories were used to analyze the CSR of vaccine developers. The first was research and development: effectiveness, funding, and profits were measured. The second was transparency and accountability: the transparency of clinical trials and vaccine contracts was analyzed. The final was vaccine delivery: the status of the provision of vaccines to COVAX and lower-income countries, intellectual property management, manufacturing agreements, and equitable pricing were measured. (3) Results: Vaccine developers have acquired large profits. The vaccine delivery category faces the most challenges. Participation of pharmaceutical companies through COVAX was significantly low, and most vaccine supply agreements were secretive, bilateral deals. It was not clear if companies were maintaining equitable pricing. The evaluation indicated that the companies' CSR practices have differed during the pandemic. (4) Conclusions: Our study contributes to the methodology of assessing the CSR of vaccine developers. This would help understand the current COVID-19 vaccine distribution inequality and propose that pharmaceutical companies re-examine their roles and social responsibilities.
ABSTRACT
BACKGROUND: The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies. METHODS: A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions. DISCUSSION: The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings. TRIAL REGISTRATION: ChiCTR 2100043319 . Registered on 10 February 2021.