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.

The Legacy of the Pandemic Preparedness Regime: An Integrative Review.

Objectives: The global response to COVID-19 inherited a long history of preparedness features pertaining to various threats, including bioterrorism, (re)-emerging infectious diseases, and pandemics. We describe the evolution of pandemic preparedness frameworks, before and after the COVID-19 pandemic. Methods: We conducted an integrative literature review of publicly available documents, including grey and scientific literature, on pandemic preparedness frameworks. We relied on social science literature as a main source and used search keywords: pandemic preparedness, H1N1, COVID-19, "whole-of-society"/"whole-of-community." Results: The H1N1 pandemic (2009-2010) tested pandemic preparedness frameworks. Lessons-learned reports concluded that the global H1N1 response were too strong and unnecessarily alarming. Such critiques, pandemic fatigue, and budgetary cuts post-2008 explain lack of preparedness for COVID-19. Critiques culminated in a shift towards a "whole-of-society" approach to health crises, although its uptake has not been ideal. Conclusion: Traditional preparedness regime limits arose again during the COVID-19 pandemic. The "whole-of-society" approach was not fully deployed in COVID-19 responses. A "whole-of-organizations" approach could be designed, ensuring that countries consider local organizations' potential to partake in containing infectious disease and counter undesirable side-effects of non-pharmaceutical measures.

Post-COVID recovery and renewal through whole-of-society resilience in cities

This paper explores and extends understanding on the role and significance of whole-of-society resilience programmes that support cities when dealing with complex crises, like the COVID-19 pandemic. Highlighting the complexity of whole-of-society resilience as different actors locally shape it, we ask the question: How can collaboration between formal and informal resilience practices help to enhance resilience across the 'whole-of-society'? We answer this question by reviewing the importance of whole-of-society resilience and its complexity in a city's governance of the COVID-19 crisis. We argue that the necessity of renewing approaches to building local resilience capabilities across the whole-of-society requires synchronisation across and between formal and informal approaches – that is, ‘bottom-up’ and governmental initiatives – to meet the diverse needs of communities. Secondly, we detail two recent practice-orientated initiatives that have taken a renewal approach to building resilience through the involvement of whole-of-society in planning recovery from COVID-19 using international standard ISO/TS 22393;and a new initiative called the National Consortium for Societal Resilience [UK+]. Finally, we signpost a set of critical questions for whole-of-society resilience practice.

The World Health Organization's Actions Within the United Nations System to Facilitate a Whole-of-Society Response to COVID-19 at Country Level.

The coronavirus disease (COVID-19) pandemic highlighted that managing health emergencies requires more than an effective health response, but that operationalizing a whole-of-society approach is challenging. The World Health Organization (WHO), as the lead agency for health within the United Nations (UN), led the UN response at the global level through the Crisis Management Team, and at the country level through the UN Country Teams (UNCTs) in accordance with its mandate. Three case studies-Mali, Cox's Bazar in Bangladesh, and Uzbekistan-provide examples of how WHO contributed to the whole-of-society response for COVID-19 at the country level. Interviews with WHO staff, supplemented by internal and external published reports, highlighted that the action of WHO comprised technical expertise to ensure an effective whole-of-society response and to minimize social disruption, including those affecting peacekeeping in Mali, livelihood sectors in Cox's Bazar, and the education sector in Uzbekistan. Leveraging local level volunteers from various sectors led to both a stronger public health response and the continuation of other sectoral work. Risk communication and community engagement (RCCE) emerged as a key theme for UN engagement at country level. These collective efforts of operationalizing whole-of-society response at the country level need to continue for the COVID-19 response, but also in preparedness for other health and non-health emergencies. Building resilience for future emergencies requires developing and exercising multi-sectoral preparedness plans and benefits from collective UN support to countries. Coronavirus disease had many impacts outside of health, and therefore emergency preparedness needs to occur outside of health too.