Research Proposal

Vaccinations are an important part of healthcare and not everyone has access to them due to failing healthcare systems and a lack of access to resources. The measles is a disease which can be protected against by a vaccination, but people in Africa especially have decreased access to it due to their location, the cost of the vaccine, conflict, or a lack of education about the vaccine. There is a large amount of data about the lack of measles vaccinations in certain areas in Africa, usually obtained by surveys, but there are not immunization records for every part. Also, the two-part system of routine immunization (RI) and supplemental immunization activities (SIA) has worked successfully in some more developed countries to obtain high vaccination rates, but this system has not worked everywhere. A new method or system needs to be created that is more compatible and better suited for regions with different demographics or economic situations so that everyone can receive immunizations. On a broad scale, data needs to be gathered from all of Africa, so that the analysis of vaccination coverage in Africa can be truthful and an in-depth summary of how vaccine distribution needs to change can be created. A large cause of this lack of vaccination, especially in Africa, is the insufficient healthcare system. Because this social entity is not advanced and fully supported, economically, it is difficult for everyone to have primary care visits in order to receive their vaccinations. It is a human right to receive adequate healthcare and finding ways to distribute the measles vaccine to everyone in Africa is one step closer to advancing human development.

The first step towards higher measles vaccination coverage in Africa is to begin collecting more data and combining it with the existing data on where and who needs to be immunized. The method I would use to gather this data is surveys and case-based surveillance. Case-based surveillance is the systemic collection and analysis of data that allows public health departments to gather information about a case and use this to help protect the community (Centers, 2021). This method has been used by multiple studies, but it cannot be used alone because it only accounts for people who have gone to the doctor to receive treatment. It can be combined with surveying to produce the most accurate account of vaccination records. Household surveys have been performed in many studies, and for example in a Nigeria study, these researchers have been successful in determining where the lack of vaccination occurs (Utazi, 2020). In order to improve the survey process to reach everyone, clear boundaries and state lines need to be set in all of Africa. I would obtain all existing data from UNICEF about how they grouped areas in the past for distribution, and then I would communicate and send a few teams to converse with African officials. Communication is key in making sure boundary lines are created so that every person in Africa is accounted for and areas are not missed in figuring out who needs vaccinations. After boundary lines become set, surveys similar to what have been used will be given to officials of each area to distribute to their people. Some medical centers may have vaccination records for some people, but because of SIAs, people have also received vaccination cards, and this is what they would use to report or show to officials.

The second step is analyzing the survey data and creating teams. Analyzing the survey data allows researchers to determine where there are cold spots and a lack of vaccination. The Nigeria study also used a geostatistical equation to evaluate the vaccination data and the Bayesian model to model this equation and to use covariates to predict vaccination rates (Utazi, 2020). These two methods interpret the survey data and are used to determine what factors influence vaccination coverage in different areas in Nigeria. I would employ these methods to the new data found in all of Africa, to determine in areas of people that are lacking immunization, which factors might be contributing to the lower level of vaccination rates. These methods can help predict where most of the teams need to go and what type of conditions might be encountered in each area. Therefore, each team can be fully equipped when heading to its region. Currently, national health authorities and nongovernmental agencies, such as UNICEF, are the main distributers of the measles vaccine in Africa (Verguet, 2012). These different organizations are crucial in the vaccine distribution that has already occurred, so I would join teams with them and add a few more people to aide in the process. First, I think it would be important to call on the blue helmets. The blue helmets are a sector of the United Nations military personnel that protect civilians especially in areas of conflict (United, 2019). I believe having multiple blue helmets on the team would help in terms of distributing measles immunizations to people in conflict. The blue helmets would be strategically placed in the different areas to provide security to people to cross the conflict zone or to go through the zone themselves to administer the vaccines. Second, I would ask the local pharmacists in Africa to join the team. Having them provide measles vaccinations to hospitals or medical practices in Africa could help boost the economy. Each pharmacist would be assigned its own region to manufacture and distribute immunizations. Lastly, teams of current medical authorities and volunteers of organizations would be distributed throughout Africa. However, they would teach people from Africa how to administer an immunization in order to create new jobs and have Africans rely less on outside help to become more self-sufficient. These different teams that will be placed in Africa will consist of about five people at each site. Many sites will be spatially distributed based on the data analysis from the Bayesian method. The teams will be placed in areas of low vaccination coverage and there will be sufficient teams to cover all of these areas.

The last step of the plan is to distribute the vaccines. I want to create mobile units that dock at a medical facility whether it is a hospital or pharmacy and play a role similar to SIAs. However, these trucks would be different because they are mobile and can reach even remote populations. There would be many trucks scattered throughout the different areas, based on need, and the teams would reside in the trucks for the most part. In the beginning, they would have a set plan to reach different areas each day to reach most of the population. Once, the majority in their region is vaccinated, they would take calls to help administer vaccines. The mobile trucks would be a permanent solution to vaccination issues rather than the vaccination activities that occur during random periods of times. Depending on the amount of land in an area or the number of people unvaccinated, there would be more or less trucks stationed there. These trucks would be equipped with medical supplies and technology to preserve the measles vaccines in the correct conditions so that they do not go to waste (Vaccines, 2021). The teams created in step two will have their own truck and for their assignments and routes, they will only acquire the number of vaccines needed for the day so that none expire or become unviable during their trips.

The first round would most likely take about one to two years to determine boundary lines and get on the ground to distribute surveys. Giving out the surveys and then receiving feedback would also take time because there needs to be a window for people to fill out the survey. The second phase of analyzing the data and creating teams would take about eight months to a year. Data can be analyzed using the methods described as it comes in, and once all data is analyzed, teams can be created. This coordination between organizations could take a few months to get all volunteers and then to determine which sites in which everyone would be assigned. The last phase of creating mobile trucks to distribute measles immunizations will take about six months. This step just involves getting the mobile units up and running in Africa and assigning the teams to each truck. The trucks though will hopefully become a permanent alternative to SIAs and a permanent solution to administering measles vaccines to increase vaccination coverage in all of Africa.

Money and the budget for this project would be the biggest factor. This project is necessary, but are people willing to fund it? The first wave of the project, gathering information about the levels of vaccination, will require a bit of money. This part of the project will need funds for paying the researchers and team members to travel to Africa and for their accommodations there. The surveys will be free, they just need to be administered and received, and case-surveillance data is just obtaining records from the hospital so that will be free as well. In total, I would probably send about thirty people to Africa to obtain data, so paying for their expenses would be about $100,000. Their salary, assuming they are working for a year would total each to be $100,000 and that would be a total of $3 million. Part two of the project would be around $500,000 to pay the salary of ten researchers to analyze the data from part one. This is estimating it will take about six months. Lastly, phase three will be the most expensive, requiring funds for the trucks. I estimate about each truck to cost in total about $300,000 for supplies, personnel, gas, and the actual vehicle (Ambulance, 2020). This is based on how much an ambulance might cost, and then this number needs to be multiplied by the number of mobile trucks that would be employed. In total this project would be a multi-billion-dollar project, but to obtain the data alone, would be a little more cost effective. Obtaining data would help the issue in terms of knowing exactly where people that need the vaccines are. It does not solve how these people would actually get the vaccine because SIAs have shown not to be very effective and the trucks seems to be a promising option.

Overall, the main goal is to obtain more data that encompasses every area in Africa through mostly survey data and use this to find areas of low measles vaccination rates. Then mobile units and teams will be assigned to the areas most in need, which lack sufficient access to the measles vaccination. Some of the biggest obstacles will be reaching the most isolated groups and those in conflict, and getting those against vaccination to oblige. Distributing the immunization to people in conflict will hopefully be resolved by getting help from the blue helmets. Reaching the most remote groups though will be harder because there is only so much money and only so many resources to reach these populations. Hopefully by employing the mobile trucks, this will make it easier to reach more remote areas and areas of conflict. Lastly, education would be the best tactic to help people who are against vaccination. Some people decline the vaccination because of cultural or religious beliefs, but some people are uneducated about immunizations as a whole, and education could introduce them to the life saving medicine and make it less scary.

The methods in practice currently to administer measles vaccinations are RIs and SIAs. RIs would be the best course of treatment because that is when someone goes for his or her primary care checkup and receives their vaccination. However, many people in Africa do not have access or the means for primary care visits. SIAs have been somewhat effective in increasing vaccination rates, but they fail to reach and be accessible to everyone. After determining what areas have the lowest vaccination rates, the mobile trucks should help with reaching these areas and would be better equipped to handle the conditions of why these people were not able to access the SIAs. The biggest issue people might have with this idea is the money to create the trucks and the number of team members required to staff each one. However, if native Africans are taught to become workers, this solves the issue of a lack of staff. If all of the different organizations are working together, the process would be more efficient and money and resources can be pooled from all of the organizations that are separately trying to solve this issue. Money is always an issue, but in this case, we are trying to save many lives. People, let alone children, should not have to die from a disease that is treatable by an inexpensive and efficient vaccine.

Implementing surveys and using data science methods to determine where the greatest lack of vaccination is and determining what factors cause this result is crucial to solving this problem. These methods will be implemented in my plan because they have showed to be successful in multiple studies, and now I just need to use them to analyze the entirety of Africa. These methods provide information about the populations that need the most vaccines, and then mobile trucks and team members will eb able to reach these people. In addition to the trucks, the best form of vaccination distribution is through primary care doctors. This sheds light on the underlying problem that could be studied further: Africa’s inadequate healthcare system. People could go on to study the larger question about what Africa is doing wrong or what their healthcare system is lacking, and why people are not successful in meeting their healthcare needs.

Bibliography

Ambulance equipment and supply costs. Operative IQ. (2020, October 1). Retrieved December 14, 2021, from https://operativeiq.com/ambulance-equipment-and-supply-costs/. Centers for Disease Control and Prevention. (2021, September 29). What is case surveillance? Centers for Disease Control and Prevention. Retrieved December 13, 2021, from https://www.cdc.gov/nndss/about/index.html. United Nations. (n.d.). (2019). Military peacekeeping. United Nations. Retrieved December 13, 2021, from https://peacekeeping.un.org/en/military. Utazi, C. E., Wagai, J., Pannell, O., Cutts, F. T., Rhoda, D. A., Ferrari, M. J., Dieng, B., Oteri, J., Danovaro-Holliday, M. C., Adeniran, A., & Tatem, A. J. (2020, February 29). Geospatial variation in measles vaccine coverage through routine and campaign strategies in Nigeria: Analysis of recent household surveys. Vaccine. Retrieved October 4, 2021, from https://www.sciencedirect.com/science/article/pii/S0264410X20303017?via%3Dihub. Vaccines. UNICEF Supply Division. (2021, November 12). Retrieved December 13, 2021, from https://www.unicef.org/supply/vaccines. Verguet S, Jassat W, Hedberg C, Tollman S, Jamison DT, Hofman KJ. Measles control in Sub-Saharan Africa: South Africa as a case study. Vaccine. 2012 Feb 21;30(9):1594-600. doi: 10.1016/j.vaccine.2011.12.123. Epub 2012 Jan 9. PMID: 22230581.