Medicines and vaccines have transformed the modern world. Thanks to these innovations, diseases that used to kill large populations have been controlled over the past century, enabling more of the world’s population to live long and healthy lives and contribute to the global economy and scientific advancements. Key to the success of these tools is the science of pharmacovigilance—the detection, assessment, understanding, and prevention of any adverse effects related to the use of a specific medicine or vaccine. While all medicines and vaccines undergo rigorous clinical trials, such testing environments cannot account for all factors that products will come in contact with when used by large, heterogeneous populations over long periods. Due to time restraints and limitations on the types of individuals eligible to participate in clinical trials safely (typically not individuals with concurrent diseases, young children, or pregnant women), some side effects related to vaccine or medicine use can only be detected after the products have been widely released.
Countries require robust safety surveillance systems capable of timely detection, reporting, and analysis of adverse events in order to ensure the long-term safety of drugs and vaccines once they are available on the market. Such systems implement advanced pharmacovigilance approaches to ensure healthcare workers diagnose these events, quality data is captured for each event, and teams of experts are available to review the data and take appropriate actions. Ensuring comprehensive and timely surveillance is critical to individual patient safety and an essential factor in ensuring the public trust in medicines and vaccines.
We are thrilled to announce Akros Research has been awarded funding through Mastercard Foundation and Africa CDC’s Saving Lives and Livelihoods initiative! The Mastercard Foundation is a Canadian foundation and one of the largest in the world with more than $40 billion in assets. The Foundation was created in 2006 through the generosity of Mastercard when it became a public company. Since its inception, the Foundation has operated independently of the company. The Foundation’s policies, operations, and program decisions are determined by its Board. Africa CDC is a specialized technical institution of the African Union that strengthens the capacity and capability of Africa’s public health institutions as well as partnerships to detect and respond quickly and effectively to disease threats and outbreaks, based on data-driven interventions and programs.
Saving Lives and Livelihoods is a partnership that enables the purchase of COVID-19 vaccines for at least 65 million people and supports the delivery to millions more across the continent. It will also lay the groundwork for vaccine manufacturing in Africa through a focus on human capital development, and strengthen Africa CDC. The partnership builds on the ongoing efforts of AVAT, COVAX, WHO, and local governments to provide access to vaccines to Africa and support the African Union’s goal of vaccinating 70 percent of Africa’s population by the end of 2022. This joint initiative will focus on four key areas:
Pillar 1—Purchase at least 50M COVID-19 vaccine doses
Pillar 2—Support deployment of COVID-19 vaccine doses
Pillar 3—Strengthen vaccine manufacturing of human vaccines
Pillar 4—Strengthen Africa CDC’s capacity and capabilities
Senegal is hardly alone in experiencing challenges with their COVID-19 vaccine roll out. Like many countries, much of the challenge has been related to hesitancy and demand. Recognizing that having ready access to COVID-19 vaccination-related behavior indicators can inform a better understanding of why coverage is not reaching saturation and to whom additional resources and efforts should be directed, Akros (in collaboration with Fraym and GRID3) worked with Senegal Ministry of Health and Social Action (MSAS) departments and in-country partners to build a custom geospatial dashboard that demonstrates these data.
Hesitancy and lack of demand issues for vaccines can stem from a number of causes. For example, rural communities far from health facilities administering vaccines may require significantly extra effort and expenses to travel to get the intervention, resulting in a demand challenge. The response to this demand-driven low-coverage problem will be different than hesitancy-driven challenges and the data required to respond effectively is likewise different. In this example, understanding: 1) Which communities are farther than a reasonable traveling distance to the health facility, 2) where exactly those communities are, and 3) how many people are expected to be found there, is valuable information that can be used to maximize the chances of a successful response. However, access to these types of granular geospatial demographic and health data that promote this level of evaluation to allow progress against such bottlenecks, has not been widely available or accessible to staff needing to make critical resource prioritization decisions.
The solution—hyperlocal geospatial data for COVID-19 vaccinations
With vaccination hesitancy and demand as the major challenges to achieving higher coverage, the data prioritized for this dashboard were proxy indicators for providing more insight into these challenges. Further, in order to decentralize decision making and empower district and health facility staff to make decisions that drive up coverage, this data was made accessible through the dashboard at 1km x 1km cells that can be aggregated up to health facility and district-level indicators. The dashboard interface allows this hyperlocal data to be, quickly and easily, geospatially explored before downloading for further analysis or input into external planning tools.
This work was built upon a history of collaboration among these partners — which has had success in providing detailed microplanning services utilizing granular spatial data to government malaria and neglected tropical disease (NTD) programs, with demonstrated examples for malaria in Zambia, Nigeria, and Senegal and for NTDs in Rwanda and Kenya. Building on that technical capacity, the dashboard in Figure 1 (showing COVID-19 vulnerable populations against health facility catchment areas) was built to display modeled COVID-19 vulnerability data to enable more informed decisions within vaccination planning workflows.
The geospatial dashboard consolidated a wide variety of data and relevant COVID-19 vulnerability and risk models into the visualization to be filtered by region, district, and health facility to inform all levels of health planning. Largely using demographic and health surveys, the data includes statistically sound high-quality, geo-tagged household survey data, satellite imagery-derived data products, health metrics, and health infrastructure. This hyperlocal data, down to 1km grid cells, allows for the visualization of the spatial distribution of priority groups and classifies individuals within priority groups using WHO-guided indicators of vulnerability. These include elderly population groups and groups that receive a high vulnerability score generated within the COVID-19 vulnerability model. Other COVID-19 indicators within this model included vaccine allocation, exposure, co-morbidities, information access, prevention activities, and vaccination likeliness — all of which were able to be filtered, displayed, and extracted for all levels of the health administration hierarchy to inform microplanning.
Last month, the World Health Organization (WHO) sent joyous shock waves through the global health community and the Global South by officially recommending that the new RTS,S/AS01 (RTS,S) malaria vaccine be adopted into widespread use among children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria incidence. Now the international community, through Gavi, the Vaccine Alliance, has just stepped forward to help finance the rollout of the world’s first malaria vaccine.
It has been true for some time that sub-Saharan Africa bears the largest malaria burden in the world, with children shouldering the largest proportion of deaths. Over 90% of global cases are on the continent, with children under the age of 5 years constituting a staggering two-thirds of all malaria deaths. This is due to a confluence of factors, not least because of the widespread prevalence of P. falciparum (the most deadly species of malaria parasite), and a very efficient mosquito that spreads it (Anopheles gambiae). The economic impact of malaria is estimated to cost Africa $12 billion every year—a figure that also factors in costs of healthcare, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism. The introduction of an effective vaccine offers a beam of hope in the fight to mitigate the massive toll this centuries-old disease inflicts on Africa.
Maximal coverage defines the effectiveness of vaccination campaigns. Over one year after the start of the devastating COVID-19 pandemic, countries around the globe are vaccinating those ages 16 and older, while vaccine-producing companies are conducting vaccine trials for children. Positivity and hope infuse vaccine distribution efforts, but as these initiatives ensue, attention is being drawn to the challenges of vaccine distribution, namely, those left behind.
Mass vaccination campaigns are critical to the introduction of new vaccines, to providing doses to those who may have missed routine doses, and to giving a second opportunity to those who may not have developed immunity. In each instance, with greater coverage comes stronger, more resilient communities. However, zero-dose children, or children who have not received any routine vaccinations, are often missed by these campaigns. With every child left unvaccinated, communities’ vulnerability to vaccine-preventable diseases escalates. Fortunately, in bracing for future vaccination efforts, we can look to previous initiatives to guide our efforts. In particular, the potential of geospatial data and technology to ensure all, including zero-dose children, are included.
From June through to December 2020, Akros, in partnership with Johns Hopkins University, Macha Research Trust, and the Zambia Ministry of Health, utilized spatial intelligence and the Reveal platform to identify and vaccinate zero-dose children following a nationwide Zambian vaccination campaign for measles and rubella.
We are thrilled to announce Akros has been awarded a Grand Challenges Explorations Grant, an initiative of the Bill & Melinda Gates Foundation! Grand Challenges Explorations (GCE) grants support impactful innovations striving to remedy critical global health and development problems. With this grant, Akros will incorporate into Reveal the ability to integrate data from human movement models. Reveal is a web-based mapping platform which uses spatial intelligence to ensure all receive life-saving interventions. With the ability to integrate human movement models with Reveal, decision makers and field teams will be better able to predict where people will be at different times of the day and seasons to ensure no one is missed with lifesaving resources.
The existing Reveal Platform, improves health campaign coverage by utilizing spatial intelligence and context-appropriate technology. Presently, Reveal maps communities at the household level and offers intervention teams a streamlined interface to plan, implement, track and monitor campaign coverage. Relative to traditional approaches in which local health teams aggregate population data by hand and process it in hard copy, Reveal’s user-centered technology offers a more accurate population count and implementation system—designed to include even the most remote of households.
Delivering health campaigns at high coverage rates can be challenging—particularly in places where frequent movement is common. Permanent relocation may swell or shrink a population, influencing critical resource distribution. Seasonal migration may redistribute a population for months at a time. Daily or weekly movements may make certain individuals more likely to be left out of a campaign. In these situations, health workers may arrive at a household to deliver interventions, but instead find the family has shifted, for even just a few months depending on fishing or farming needs. Take for instance, Nchelenge District in Northern Zambia.