Using the Declaration of Alma Ata’s definition of total health to understand the barriers impeding equitable and effective rotavirus vaccination in LMICs
Bibliographic record
Abstract
Rotavirus infections are the most severe form of acute diarrhea in children around the world (1, 2). The introduction of rotavirus vaccines, such as RotateqTM (manufactured by Merck & Co.) and RotarixTM (manufactured by GlaxoSmithKline Biologicals), has helped address the rotavirus morbidity burden in developed areas (3,4). However, these vaccines have demonstrated to be less efficacious and effective in LMICs (5, 6). The reasons for the discrepancy in health equity between high-income countries and LMICs can be understood when reviewed under the framework of the Declaration of Alma Ata. Under this declaration, total health includes not only physical aspects of health, but also economic, political, and social aspects (7). By analyzing the physical, economic, political, and social aspects of society and healthcare affecting rotavirus vaccination the challenges impeding LMICs from receiving equitable rotavirus healthcare access can be understood. Challenges affecting rotavirus vaccination in LMICs include: reduced efficacy of presently licensed vaccines, limited financial and means to support vaccination programs, political barriers preventing vaccine implementation, issues regarding social acceptance of vaccination programs, and infrastructural limitations (8-12). These challenges must be clearly understood in order to be innovatively addressed so that not only the disparity in health equity regarding rotavirus infections is reduced, but also the global morbidity and mortality burden of rotavirus infections.Background: Diarrheal diseases, because of barriers to necessary healthcare treatments and prevention strategies, disproportionately affect LMICs. The rotavirus is the leading cause of severe diarrhea in children under the age of five; between 352,000 and 592, 000 deaths occur each year because of rotavirus infections (2).The introduction of rotavirus vaccines, such as RotateqTM (manufactured by Merck & Co.) and RotarixTM (manufactured by GlaxoSmithKline Biologicals), has helped address the rotavirus morbidity burden in developed areas (3). However, these vaccines have not proved to be as efficacious in developing areas3. The issues surrounding rotavirus vaccination in LMICs elucidates the disparity in health equity that is present in today’s world.The Declaration of Alma-Ata highlights how equitable access, public participation, health promotion, appropriate technology, and intersectional cooperation are required for primary healthcare (7). By highlighting the interactions between the political, economic, social and health sectors of society the concepts of equitable total health outlined by the Declaration of Alma Ata can lead us to the understanding of how and why rotavirus infections affect those in LMICs more so than in high-income countries.Methodology: A targeted literature review was conducted to critically analyze articles from a number of databases pertaining to the historical and current factors affecting the physical, economic, political and social aspects of healthcare affecting rotavirus vaccination in LMICs.Findings: Challenges affecting rotavirus vaccination in LMICs include: reduced efficacy of presently licensed vaccines, limited financial means to support vaccination programs, political barriers preventing vaccine implementation, issues regarding social acceptance of vaccination programs, and infrastructural limitations (8-12). The reduced efficacy of presently licensed vaccines may be negatively affecting the decision to roll out these vaccines in the most heavily burdened areas. Without political support and involvement these economic challenges cannot be fully addressed. Finally, without the support of the public at large vaccination programs will not succeed.Conclusion: Future research agendas should include innovative approaches to not only further vaccine development, but to also allow for LMICs to become more involved in vaccine development and manufacturing to help reduce costs.Innovative ways to include governments in the development and decision-making process of vaccine programs, the engagement of the public during both the decision and implementation stages of rotavirus vaccine adoption, and innovative ways to avoid relatively simplistic infrastructural challenges are also required. In order for health equity regarding rotavirus infections to be realized total health must be understood and all sectors of societal health have to be innovatively addressed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.006 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.007 | 0.012 |
| Insufficient payload (model declined to judge) | 0.012 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".