Hard-to-reach Populations: A systems mapping approach to bridging the gaps for vaccination

Presenter: Sachiko Ozawa

Twitter: '@GHEP_UNC

Co-authors: Elizabeth Mitgang, Tatenda Yemeke, Sarah Bartsch, Patrick Wedlock, Aaron Wallace, Sarah W Pallas, Taiwo Abimbola, Bruce Y. Lee

Poster file: [download]
Expanding vaccination coverage into populations that are hard-to-reach for vaccination has increased in priority for immunization initiatives; however, economic evidence to inform decision making on how to best expand vaccination coverage among these populations remains unclear. Vaccination involves a complex system of people, equipment, processes, and locations, which can make it challenging for policy makers, health officials, logisticians, and managers of national immunization programs to determine the costs or economic impacts of vaccination. We developed a systems map of the steps involved in an individual getting vaccinated, the associated vaccination program costs at service delivery level, and the health and economic impacts of vaccination in order to help decision makers see the whole picture of the processes involved, including the mechanisms that create hard-to-reach populations for vaccination. Systems maps are diagrams of the relevant components of a system and the connections among and between them. A systems map utilizes shapes, words, colors, and relational arrows to visually depict the components and processes of a system. To validate the content of our map and solicit expert feedback, we interviewed and incorporated the feedback of twenty-four immunization economics experts from academic institutions, government agencies, major technical organizations, and key philanthropies. Using this systems map, decision makers can consider where mechanisms or processes may be interrupted or weak, leading to hard-to-reach populations for vaccination, as well as possible health and economic effects throughout the entire system, when designing interventions to improve vaccination coverage and allocating finite resources.