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Introduction Stakeholders in the health sector have advocated for the optimization of digital payment channels in low-and-middle-income countries in order to improve program outcomes. We conducted a landscape analysis of the local context, challenges, and opportunities for digitized health worker payments in Nigeria. Methods This study was an exploratory qualitative case study with mixed-methods approach to data collection including; i) desk review, ii) interview of key informants and iii) engagement of stakeholders. In the desk review, the databases searched were MEDLINE (PubMed), Google Scholar and Google. For the qualitative interviews, 17 stakeholders were interviewed between May and July 2022. Audio recordings of interviews were transcribed and analyzed using thematic approach with the Nvivo software. At the stakeholders’ ( n  = 15) engagement, findings from the desk review and interviews were discussed and additional data collected. Results Digital payment systems for health personnel described in the reviewed documents included the direct disbursement mechanisms, direct bank transfers and mobile money. Among these-payment methods, direct bank transfer was the most prominent digital payment method. Also, there is a high level of acceptability of digitized means of payment of health workers among stakeholders in the Nigerian health sector. From the regulatory point of view, the Nigerian government has initiated a number of digital payment policies including the cashless policy. Other incentives for digitization of payments were: availability of credible financial institutions, improved financial accountability and transparency, previous experience of under-payment or non-payment of end beneficiaries, to avoid delays in payment and ensure timely retirement of funds. Challenges of digital payments included: delayed resolution of problems associated with digital payment such as failed transactions, cyber security, double payments, and unfriendly bank policies. Conclusion Digital payment system is being utilized, accepted and would be beneficial for payments for the Nigerian healthcare system. Harnessing its benefits of improved health workers’ performance and program outcomes by enacting appropriate policies is recommended.

Objective To assess the efficacy of modest non-financial incentives on immunisation rates in children aged 1-3 and to compare it with the effect of only improving the reliability of the supply of services.Design Clustered randomised controlled study. Setting Rural Rajasthan, India.Participants 1640 children aged 1-3 at end point.Interventions 134 villages were randomised to one of three groups: a once monthly reliable immunisation camp (intervention A; 379 children from 30 villages); a once monthly reliable immunisation camp with small incentives (raw lentils and metal plates for completed immunisation; intervention B; 382 children from 30 villages), or control (no intervention, 860 children in 74 villages). Surveys were undertaken in randomly selected households at baseline and about 18 months after the interventions started (end point).Main outcome measures Proportion of children aged 1-3 at the end point who were partially or fully immunised.Results Among children aged 1-3 in the end point survey, rates of full immunisation were 39% (148/382, 95% confidence interval 30% to 47%) for intervention B villages (reliable immunisation with incentives), 18% (68/379, 11% to 23%) for intervention A villages (reliable immunisation without incentives), and 6% (50/860, 3% to 9%) for control villages. The relative risk of complete immunisation for intervention B versus control was 6.7 (4.5 to 8.8) and for intervention B versus intervention A was 2.2 (1.5 to 2.8). Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8). The average cost per immunisation was $28 (1102 rupees, about £16 or €19) in intervention A and $56 (2202 rupees) in intervention B.Conclusions Improving reliability of services improves immunisation rates, but the effect remains modest. Small incentives have large positive impacts on the uptake of immunisation services in resource poor areas and are more cost effective than purely improving supply.Trial registration IRSCTN87759937.

Background Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. Findings WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. Conclusions Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.

An effective rollout of vaccinations against COVID-19 offers the most promising prospect of bringing the pandemic to an end. We present the Our World in Data COVID-19 vaccination dataset, a global public dataset that tracks the scale and rate of the vaccine rollout across the world. This dataset is updated regularly and includes data on the total number of vaccinations administered, first and second doses administered, daily vaccination rates and population-adjusted coverage for all countries for which data are available (169 countries as of 7 April 2021). It will be maintained as the global vaccination campaign continues to progress. This resource aids policymakers and researchers in understanding the rate of current and potential vaccine rollout; the interactions with non-vaccination policy responses; the potential impact of vaccinations on pandemic outcomes such as transmission, morbidity and mortality; and global inequalities in vaccine access. The Our World in Data COVID-19 vaccination tracker charts the scale and rate of global vaccinations against COVID-19, making the data available to scientists, policymakers and the general public

•Three surveys since 2013 show persistently low MCV coverage in much of northern Nigeria.•The 2017–18 measles SIA reached higher and more homogeneous coverage than seen previously.•Geospatial differences exist in the SIA’s reach of previously unvaccinated children.•Nearly all the country is far from the goal of 95% coverage with ≥ 2 doses of MCV.•Routine services need strengthening nationwide, especially in the north. Measles vaccination campaigns are conducted regularly in many low- and middle-income countries to boost measles control efforts and accelerate progress towards elimination. National and sometimes first-level administrative division campaign coverage may be estimated through post-campaign coverage surveys (PCCS). However, these large-area estimates mask significant geographic inequities in coverage at more granular levels. Here, we undertake a geospatial analysis of the Nigeria 2017–18 PCCS data to produce coverage estimates at 1 × 1 km resolution and the district level using binomial spatial regression models built on a suite of geospatial covariates and implemented in a Bayesian framework via the INLA-SPDE approach. We investigate the individual and combined performance of the campaign and routine immunization (RI) by mapping various indicators of coverage for children aged 9–59 months. Additionally, we compare estimated coverage before the campaign at 1 × 1 km and the district level with predicted coverage maps produced using other surveys conducted in 2013 and 2016–17. Coverage during the campaign was generally higher and more homogeneous than RI coverage but geospatial differences in the campaign’s reach of previously unvaccinated children are shown. Persistent areas of low coverage highlight the need for improved RI performance. The results can help to guide the conduct of future campaigns, improve vaccination monitoring and measles elimination efforts. Moreover, the approaches used here can be readily extended to other countries.

Abstract We provide here an updated analysis of primary COVID-19 vaccination and vaccine booster doses efficacy, emerging from the ongoing Italian nationwide COVID-19 vaccination campaign. Primary COVID-19 vaccination efficacy was 76–92% within 6 months, decreasing to 34–80% after 6 months. Administration of vaccine booster doses decreased SARS-CoV-2 infections by 65%, COVID-19-related hospitalizations and deaths by 69% and 97% compared with vaccine efficacy after 6 months, but also decreased SARS-CoV-2 infections by 39% compared with vaccine efficacy within 6 months. These results suggest that COVID-19 vaccine booster doses are important for restoring vaccine efficacy and further limiting virus circulation.

A key focus of the health-related sustainable development goal (SDG) 3 is universal health coverage (UHC), including access to safe, effective, quality, and affordable essential medicines and vaccines. However, the challenges to achieving UHC are substantial, especially with increased demands on the health sector and with most budgets being static or shrinking.1Immunization programmes have been successful in reaching children worldwide. For example, 86% of the world's infants had received three doses of diphtheria-tetanus-pertussis (DTP3) vaccine in 2018.2 The experiences from such programmes can contribute to UHC, and as these programmes strive to adapt to new global strategic frameworks, such as Gavi, the Vaccine Alliance's strategy Gavi 5.0 and the World Health Organization's (WHO) Immunization Agenda 2030, these efforts can inform the progressive realization of UHC. Immunization programmes that can sustain regular levels of contact between health providers and beneficiaries at the community level have enabled new vaccines to be added to routine immunization schedules and other interventions to be delivered to children and their families. In addition, experiences from both polio campaigns and the child health days strategy show that incorporating additional interventions into campaigns can increase coverage of these interventions as well as of vaccinations.3'4

Background To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to which efficiencies are achieved. To fill this evidence gap, we estimated the cost of integrated immunization campaigns in Nigeria and Sierra Leone, and the potential savings from integration. Methods We conducted a retrospective ingredients-based costing study from a payer perspective of a campaign held in 2019 in Sierra Leone with measles-rubella vaccine and oral polio vaccine, during which nutrition supplements were also offered in part of the country, and yellow fever campaigns held in three states in Nigeria in 2019 and 2020, where in one state (Anambra) meningococcal A vaccines were co-delivered. We collected data from 108 health facilities, all relevant administrative levels, and implementing partners. We estimated the full financial and economic cost of each campaign, the average unit cost of delivery, as well as the cost by activity and resource type. We also estimated the cost savings from integration in Anambra state by modelling out the cost of the alternative of two standalone campaigns. Results The average financial delivery cost was $0.34 per dose in Sierra Leone, and the economic cost was $0.73 per dose. In Nigeria, the financial cost per dose was $0.29–$0.35 across the three states, and the economic cost per dose was $0.62–$0.85. Facilities and wards delivering more doses achieved a lower financial and economic unit cost of delivery, demonstrating evidence of economies of scale. We estimated that Anambra may have saved at least $1,204,133 in financial resources by integrating yellow fever and meningitis A vaccine delivery, amounting to $0.17 per dose delivered. When including opportunity costs, the economic cost saving was estimated at $0.34 per dose delivered. Conclusions The study offers evidence on what it costs to deliver integrated campaigns, and shows that integrated delivery is likely to result in significant cost savings. Where high delivery volumes can be achieved, integrated campaigns can benefit from economies of scale. The findings can be used to inform planning and budgeting for immunization campaigns in low- and middle-income countries.

To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost-effectiveness and recommendations for use, particularly in high-risk settings. We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines. Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although pre-exposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability. Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities.

Worldwide, leaders are implementing nonpharmaceutical interventions to slow transmission of the novel coronavirus while pursuing vaccines that confer immunity to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. In this article we describe lessons learned from past pandemics and vaccine campaigns about the path to successful vaccine delivery. The historical record suggests that to have a widely immunized population, leaders must invest in evidence-based vaccine delivery strategies that generate demand, allocate and distribute vaccines, and verify coverage. To generate demand, there must be an understanding of the roots of vaccine hesitancy, involvement of trusted sources of authority in advocacy for vaccination, and commitment to longitudinal engagement with communities. To allocate vaccines, qualified organizations and expert coalitions must be allowed to determine evidence-based vaccination approaches and generate the political will to ensure the cooperation of local and national governments. To distribute vaccines, the people and organizations with expertise in manufacturing, supply chains, and last-mile distribution must be positioned to direct efforts. To verify vaccine coverage, vaccination tracking systems that are portable, interoperable, and secure must be identified. Lessons of past pandemics suggest that nations should invest in evidence-informed strategies to ensure that coronavirus disease 2019 (COVID-19) vaccines protect individuals, suppress transmission, and minimize disruption to health services and livelihoods.