The whole-of-society approach of mass COVID-19 vaccination in China: a qualitative study.

BACKGROUND: Many countries have an inefficient vaccination system, which hinders global exit from the COVID-19 pandemic. It is vital to summarize COVID-19 vaccination practices in countries with high vaccination coverage and provide implications for other countries. This study aimed to investigate China's COVID-19 vaccination system and to summarize its implementation experience from a health system perspective. METHODS: We conducted key informant interviews in five representative cities of China in late 2021. Guided by the health systems framework proposed by WHO, we developed our interview guidelines which included seven building blocks-leadership and governance, health workforce, vaccination service delivery, vaccination mobilization and communication, financing, access to vaccines, and information systems. Semi-structured interviews and COVID-19 vaccination policy documents were collected and coded using a thematic analysis approach. RESULTS: A total of 61 participants (nine vaccination programme directors of the local Center for Disease Control and Prevention, four government staff and 48 vaccination service workers) were interviewed. We found that China adopted a whole-of-society approach with adequate government engagement and linked health and non-health sectors to promote COVID-19 vaccination. Key measures included the collaboration of multiple systems and departments from a governance perspective, allocating sufficient health workers and resources, large-scale vaccination mobilization and communication, expansion of vaccine financing channels, localized production and digital information systems. With the vaccination system strengthening, the two-doses vaccination coverage reached 89.5% for the total population but relatively lower coverage for older adults as of July 2022. CONCLUSIONS: Our study highlights the importance of a government-led whole-of-society approach to promote mass vaccination. The low vaccination coverage among older adults should be paid the greatest attention to. The experiences and lessons from China may serve as a reference for other countries.

A Bi-Level Vaccination Points Location Problem That Aims at Social Distancing and Equity for the Inhabitants

Designing efficient vaccination programs that consider the needs of the population is very relevant to prevent reoccurrence of the COVID-19 pandemic. The government needs to provide vaccination points to give out vaccine doses to the population. In this paper, the authors analyze the location of vaccination points whilst addressing the inhabitants' preferences. Two objectives that prevent crowding of inhabitants are considered. The government aims for the minimum distance between located vaccination points is maximized, and for the number of inhabitants that attend the different vaccination points to be equitable. One of the key aspects of this problem is the assumption that inhabitants freely choose the located vaccination point to go. That decision affects the objectives of the government, since crowding at vaccination points may appear due to the inhabitants' decisions. This problem is modeled as a bi-objective, bi-level program, in which the upper level is associated to the government and the lower level to the inhabitants. To approximate the Pareto front of this problem, a cross-entropy metaheuristic is proposed. The algorithm incorporates criteria to handle two objective functions in a simultaneous manner, and optimally solve the lower-level problem for each government decision. The proposed algorithm is tested over an adapted set of benchmark instances and pertinent analysis of the results is included. An important managerial insight is that locating far vaccination points does not lead us to a more equitable allocation of inhabitants. © 2023 by the authors.