Role of digital interventions in advancing immunization programs

Great topic for discussion in current times where India is battling with strengthening supply of vaccines on Covid 19. The 18- 44 population are struggling to find any slots as vaccine are not there in the facilities. The government were mentioning on eVIN (Electronic Vaccine Intelligence Network).However, this has not shown any results! There is need Covid-19 vaccine tracking system digitally. The eVIN network in whatever stage might need to strengthen and add artificial intelligence featured to identify the vaccine beneficiary who is to be vaccinated.The digital way to track the stocks of the vaccine from the stage of procurement to storage in various cold storages and its movement to various health facilities and tracking up to whether immunisation has been person those registered for vaccine. The digital app Aarogya Setu is encountering lot of issues and I have myself not able to find slots for immunisation when it was opened on 28th April. There is need to develop, expand and make use of robust digital methods to immunise and these digital methods can be modelled with any immunisation programme.

In the National Family Health Survey NFHS 1 (1992-93) the coverage of all basic vaccines was about 65%, which drastically increased to 89% in NFHS 2 (1998-99). NFHS 3 (2005-06) saw an immunization coverage rate of 81%, a reduction over the coverage in NFHS 2 and the NFHS 4 (2015-16) saw a further reduction to 69%. Despite having a robust and well-functioning health system some states faced a reduction in immunization coverage due to vaccine hesitancy. Several factors have been said to influence vaccine hesitancy including socio-cultural context, religious beliefs, misinformation spread through social media, historical influences and mistrust, beliefs and attitudes about vaccines, and specific characteristics of the vaccines.

The advent of new technology has revolutionized the ways in which information on problems of health is collected and disseminated. One way forward is to adopt rapidly developing digital health tools that offer solutions to improve service delivery.

Digitization can help boost providers’ capability to make immunization health value chains more efficient and resilient. While efficiency improvements arising from streamlined resource flows result in additional funds for possible investments to improve service delivery, resilience needs redundancy for enhanced capacity and diversity to respond effectively to risks such a stock-outs for both supplier and user.

Digital tools are highly productive in several vaccine-related areas:

• Immunization registries, dose tracking, and decision support systems
• Vaccine-preventable diseases surveillance
• Surveillance of adverse events following immunization
• Vaccine confidence monitoring
• Delivery of information on vaccines to the public

For improved decision support systems, leading to effective and efficient service delivery, GIS is a powerful tool to identify gaps and inequities in access to immunization services and to support better decision-making around targeting immunization resources. It helps integrate, visualize and analyze data on immunization resources, population distribution, and the connecting geographic environment (e.g., transport network, geographic barriers), as well as model accessibility to health services.

In a resource constraint setting, better integration of immunization information system and CRVS (Civil Registration and Vital Statistics) data architecture has the potential to provide transformative improvements in both systems. Among these are streamlining and extending registration coverage, integrating data from multiple systems, and securely storing data at scale – all in a cost-effective way.

For example, health workers, by virtue of their extended reach, can notify civil registrars of births/deaths. In turn, health programs benefit from fully functioning CRVS data because it makes real-time data available to expand immunization coverage.

Digital architecture is essential to attain interoperability between health programs, CRVS, and related systems such as unique health identifiers.

Interoperability requires developing protocols to share information and data. This covers master patient indexes, electronic health records and registries, health management information systems, health IDs, and population censuses, to name a few.

To achieve interoperability, it is imperative to work with communities to address issues of confidentiality, privacy, and data security within a sound legal and governance framework. Joint capacities and human resources need to be developed to implement the innovations.

For instance, training materials can be adapted to diverse settings alongside institutional mechanisms for capacity development, with a particular focus on immunization and CRVS interoperability. Social workers, case managers, school employees, and community health workers must be trained on notifications of births/deaths to ensure these are officially registered according to international standards.

Finally, a logistics management information system (LMIS) provides data on vaccine supply and demand, which can be used to reach more children with greater efficiency.

As vaccines become more expensive and demand greater storage capacity at every level of the cold chain, countries could keep lower stock levels, reduce wastage, accurately forecast vaccine requirements, and prevent equipment failure. This requires a consistently high standard of supply chain management, which can only be achieved if all the links comply with current standards for storage and distribution.

Digitization can improve LMIS via standardized data collection, quick data transmission throughout the system, error reduction, and automated reports that elucidate the best course of action. Strong vaccine supply chains ensure that children have access to the right vaccines, at the right time, in the right place.

//apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf?ua=1  

Immunization programs require an appropriate maintenance of vaccine coverage. There are several challenges that come in the way of an immunization program such as dose tracking , timely detection of Epidemiological signals - with the help of digital tools we can overcome these challenges.

Nowadays in the ongoing pandemic where the vaccination program at a mass level is the need of the hour, it becomes furthermore essential to highlight the pressing need and added advantages digital tools play in easing out the process so that a large number of population can be vaccinated in a shorter span or within the planned timing.

Manual tracking of data on vaccination is time consuming and offers limited accessibility whereas on the other hand digital tools helps in providing valuable information can be used to evaluate the effectiveness of the vaccination program, assess the vaccine safety and aids in timely administration of the vaccine.

1) Professionals from IT industry,  IIT and IIM can be pooled in to help in developing software which can provide practical solutions in administering the vaccination programs.

2) This digital tool/app can provide a database to the Healthcare professionals about the minute to minute status of the vaccination all over their nation or a particular region, furthermore it can also chart out areas which contain high risk population (with reference to the infectious disease).

3) The people can track their status of doses of vaccine and also can be given timely reminders regarding their next dose.

4) It can also disseminate the database of people suffering from adverse effects of vaccine,if any.

5) People can also connect to healthcare experts through this data base on a one to one basis to ask their doubts and questions regarding the vaccine and to determine if they are eligible to get vaccinated.

Reference 

//www.researchgate.net/publication/297692759_Can_Digital_Tools_Be_Used_for_Improving_Immunization_Programs/link/58283bf408ae254c5085df67/download

Considering the global COVID-19 pandemic, adaptive digital public health information systems will definitely be a keystone in amplifying and guiding the rollout and in upholding a robust surveillance system of the SARS-CoV-2 vaccine. There is an urgent need for comprehensive Immunization Information Systems (IISs) which are centralized repositories of personally identifiable vaccination information for individual members of a population. These information systems can track down the immunization uptake at both individual and population levels and can also recognize populations by geographic, demographic, or behavioral characteristics who are at risk for under-immunization. This can be a ground-breaking accomplishment towards ensuring the effectiveness of increasingly complex immunization programs.

In an interesting read “The digital immunization system of the future: imagining a patient-centric, interoperable immunization information system”, the authors have well-presented their vision for the next generation of digital immunization information systems which would contribute to facilitating reports of adverse events following immunization, issuing digital immunization receipts, identifying areas of need and generating a plan for delivery of interventions targeting these areas. Also, through immunization reminders and targeted immunization promotion campaigns, the system can enhance immunization rates.  A strong IIS of the future should facilitate simultaneous access by the public, healthcare providers, and public health, which can only be achieved through a set of interoperable systems which will in a way maximize the collection and utilization of these data. This will also ensure the availability of information to all the above-mentioned stakeholders, in a real-time and digitalized form which will further contribute to provide accessible and accurate datasets for health officials to assess the reach, coverage, vaccine effectiveness and thereby addressing vaccine hesitancy as well.

This is indeed a timely concern, specifically relevant to countries like ours, having limited resources and varied objectives.

Originally conceived as contact tracing tool and now leveraged with integration of vaccine network, Aarogya Setu, attempts to scale and facilitate vaccination program. However, there are few set backs like difference in actual stock of vaccine at site versus reflected on portal, display of different quantity of stock while searching with different pattern e.g. state>district>village and searching by pin code. With passage of time, these glitches would get resolved, but important aspect is its helping individuals in getting info on nearby vaccination sites and comfort of scheduling appointment from home only. In addition to this, the dashboard provides information on vaccine category, session site wise vaccinations done, vaccination by age groups  and AEFI reported. 

The portal provides appointment option only while session is planned by field staff and updated on portal. It may be quite useful if registration can be booked irrespective of vaccine stock, and system can auto assign the dates based on stock availability with flexibility to modify by user. A reminder message before due date for second dose would also be very useful.

While the health systems and government of India are opening up vaccination programmes for all the age groups the key interface connecting supply and demand side of the vaccine intaitve is the COWIN software allowing individuals to find nearby vaccination centre, check the avilability of vaccination slot, book an appointment for suitable centre and time. 

Similar interfaces are presents across countries and are adopted to suit the national and regional standards. 

The COWIN web interface used in India can only be accessed via Smartphones or Computers, whereas majority of Indian Mobie Phone subscribers use standard phones which limits access to COWIN portal to a big chunk of population mostly rural and urban poor. The only access to these populations is to visit in-person to nearby vaccination centre, line-in for on-spot registration and get appointment scheduled and revisit on the scheduled date for vaccination. This increase the travel, waiting time, adds to long queue at vaccination centre and more importantly increases risk of exposure to COVID virus as most vaccination centres are located within hospital or primary healthcare centre which are also testing centres.

Though digital health techniques like AI/ML predictive modelling can be deployed in backend to improve the distribution, increase availability of the vaccines at the vaccination centers, reduce wastage, however the bottle neck will remain in form of spot registration which will slow down the vaccination program.

Key focus has to be directed towards making the registration process through online kiosks, via phone calls, whatsapp. Another area of focus has to be on reducing the number of foot fall at vaccination centres, which can be done thorough primarily discouraging on-spot registration, minimising walk-ins, providing contact details of vaccination centre co-ordinator with vaccination slip to enquire about stock-outs. 

Digital technology can very much aid in solving this bottle necks, e-commerce startups like lenskart have developed process to book orders via whatsapp with live assistance, IRTC (The Ticket booking arm of Indian Railways) implements Kiosk based point of sale counter for ticket bookings, Most mobile service providers and coustmer care centres allow booking of service appointment via Interactive Voice Recording services. None of the technology is new or untested. 

The need of the hour is to rationalise the process, develop human centric approach of providing services.

Digital interventions Could play an important role to promote immunization programs by digitalising the whole immunization process and it is also important to carefully map all workflows and stakeholders of the immunization platform.

Many countries rely on digital interventions to rollout recent COVID vaccination process.

The application of technology is done mainly to track and search vaccine or vaccine providers, to check the eligibility of the candidate by using online questionnaire, scheduling the vaccination. Secondly, digital health interventions could be a potential tool to retrieve user data for data analytics.  The data privacy and confidentiality is a major concern to be addressed.

Read more ….

//www.healthcareitnews.com/blog/how-optimize-health-it-systems-immunization-drives

A digital framework is essential to operate between many platforms in order to share information and data related to vaccination programs. This includes Real-time monitoring (RTM) of all the online health records and registries, population statistics, LMIS, HMIS and so on. Implementation of innovations targeting capacity development, vaccine supply and demand, outreach with greater efficiency is required. For instance, community health workers such as ASHAs, SHGs, ANMs, programme managers, and other social workers must be trained to adopt to diversified institutional mechanisms for improving capacity, interoperability related to immunisation programmes and qualifying to meet international standards. 

Digitised interventions have a potential to address logistics based issues such as supply chain management, cold chain storage capacity, stock levels, reduction of vaccine wastage, vaccine requirements region wise, and preventing equipment failure. 

In the best manner, digitisation of immunisation programmes can advance quick and standardised data collection, data transmission throughout the system, fault reduction, and online reports generation. Recent examples of such web based applications are COWIN, AROGYA SETU, and UMANG etc. This ensures people's access to the right vaccines, at the right time, in the right place.