Defining "success" in managing pandemic across disciplines: insights from an expert consultation

Abstract

vaccination, each focusing on clinical, economic, and policy-related decisions. The project explored leading international practices in adult vaccination, the changes required to transition to a lifelong model, and how healthcare and community structures can integrate this vaccine ecosystem. The study proposed specific recommendations to be adopted by all stakeholders, ensuring the lifelong vaccination commitment through society. Results: The Think Tank resulted in 21 recommendations organised in three pillars. Key findings highlighted the importance of investing in prevention and healthy ageing by revising the National Vaccination Programme and promote lifelong vaccination. To support the transition, it is necessary to create a vaccination ecosystem, change communication on vaccination and strengthen healthcare and community synergies. Lastly, to foster the proposed approach it was defended that all information systems should be improved: transparent, stronger and sustained by real-world evidence. Lessons: The proposal was presented to the parliament receiving unanimous support from all parties, highlighting the role of political engagement in shaping the national vaccination strategy. Lifelong approach on vaccination is already supported by scientific evidence but must be supported by all health-related sectors, including occupational health, social security and similar systems. Key messages: • Society needs a lifelong vaccination strategy to reduce the burden of disease across all stages of life. Although much remains to be done, it is possible to accomplish this goal. • Political and social engagement is crucial for shaping national lifelong vaccination strategies. To achieve this, it is crucial to build a vaccination ecosystem and not only a provider one. is a voluntary scheme aimed at protecting informal sector populations from out-of-pocket costs. Ethiopia targets 80% coverage by 2025. However, challenges including low enrollment, adverse selection, and moral hazard challenge its sustainability. This study examines factors affecting CBHI sustainability and strategies for improvement in rural Ethiopia. Methods: This study is part of a research to improve NCD detection and care in rural Sidama. It uses data from a cross-sectional survey of adults aged 45þ conducted in May 2024. The study examines adverse selection and moral hazard in CBHI by analyzing member characteristics-age, health status, service use, healthcare spending, and family size. It also assesses willingness to raise premiums and accept co-payments to improve scheme sustainability. Results: The study included 2,875 adults, 55.2% of whom were female , 48.6% aged 45-54, and 89.6% had no formal education. About 75% had family sizes >4, 73.6% had 1-3 children under 18, 15.5% had recent healthcare expenses, and 7.3% reported a family member NCD diagnosis. CBHI enrollment was 34.4%, with 82.3% renewing their membership and 88.1% supporting continuation of the scheme. Enrollment was significantly higher among those with elementary education (AOR: 2.1), recent health facility visitors (AOR: 12.9), family members with NCDs (AOR: 2.8), and families with more children. Although 83% viewed the annual premium as high, 56.7% preferred raising it over discontinuing the scheme, and 83.1% supported co-payments to sustain CBHI. Conclusions: CBHI enrollment in the study area was low, with disproportionately higher participation among high-risk groups-those with NCDs, large families, and frequent healthcare users-suggesting adverse selection and moral hazard. To enhance sustainability , raising premiums and introducing co-payments could be viable. Expanding membership and attracting lower-risk individuals is also essential. Key messages: • Community-based health insurance in rural Ethiopia faces sustainability challenges due to adverse selection and moral hazard, with enrollment disproportionately higher among high-risk groups. • Despite perceiving premiums as high, most participants support raising contributions and introducing co-payments, suggesting strong community willingness to sustain the scheme. Abstract citation ID: ckaf161.1852 Defining "success" in managing pandemic across disciplines: insights from an expert consultation Background: Learning from COVID-19 pandemic can improve future preparedness. A key question is how to define "success" in pandemic management. We aimed to establish a workable set of definitions for success over different distinct pandemic stages, as well as cumulatively from pandemic emergence to epidemic control. Methods: We first developed through an iterative process of a struc-tured brainstorm session and a pilot survey (20 project members from 7 EU countries) a set of success indicators for the entire pandemic and for six distinct COVID-19 pandemic stages: pre-pandemic , rising pandemic outside Europe, rising pandemic in other countries/regions inside Europe, within-country first wave, pre-vaccination waves, post-vaccination. These indicators were then validated by COVID-19 experts from different fields, including sociologists, psychologists, medical doctors, political scientists, economists , ethicists or philosophers, and policymakers, via an online survey. Experts ranked the indicators by importance and answered two open-ended and five background questions. Results: The developed indicator lists differed according to the pandemic stages. A total number of 45 experts completed the survey (29% response rate). All 50 indicators were ranked by at least 70% of the respondents as important. Notably, experts from all disciplines agreed that mortality was the most important indicator over the entire pandemic and during pre-vaccination waves, while vaccination coverage was considered the most important indicator post-vaccination. There was broad agreement on top 5 indicators, though their ranking preferences differed slightly between disciplines. Conclusions: The indicator list can serve to inform the design of further studies on their relative importance (eg discrete choice experiments), to guide the development of pandemic intelligence monitoring tools (eg mental wellbeing monitors), and to validate similar opinions of non-European experts, and the general public. Key messages: • This study adopted an iterative method to develop and validate a comprehensive list of determinants of success in managing pathogen X based on the SARS-CoV-2 pandemic. • These indicators, including mortality and vaccination coverage, can guide pandemic intelligence in Europe, and will inform the design of further studies.