Producing a white paper pertaining to an issue such as global vaccine equity can be as complex a process as the issue itself.
Organisations such as non-profits, policy think tanks and businesses often produce white papers to break down complex issues and present solutions to decision makers and stakeholders, while highlighting their stance on said issues.
Often, the wider and deeper the impact of the issue and its solutions, the more comprehensive the white paper should be, so it stands to reason that it must be well-structured, and facts and opinions presented must be supported by research and statistics.
Bridges M&C has been privileged to be given the opportunity to produce a white paper on the global vaccine ecosystem this year. Below is a snapshot of the processes involved in producing the manuscript.
Understanding the objectives
Vaccine inequity is a public health issue which affects about 25 million children globally; it not only concerns the less developed nations, but has a global impact on future measures for pandemic preparedness, as necessitated and demonstrated by the COVID-19 pandemic.
As with any kind of communication, the approach for putting together a white paper is determined by its objectives and the target audience it is intended for.
This paper was prepared with three objectives in mind: educating the wider community about past and ongoing challenges within the vaccine ecosystem, shedding light on debate and discussion between thought leaders on the subject matter, and outlining possible solutions through calls to action.
Interviewing thought leaders and subject matter experts
To gain better understanding of the subject matter, we conducted in-depth interviews with experts and thought leaders in the field such as doctors, directors of supranational organisations, vaccine and infectious disease researchers, as well as public health experts.
The insights from these first-hand interviews could not have been gleaned through reading relevant literature or research alone, and in fact, opened our eyes to the challenges and unmet needs at the macro and micro level.
One of the complex issues the industry is facing is ensuring vaccine candidates are made available in poor countries. Although over 200 vaccines are in the development pipeline in recent years, only two (against meningitis serogroup A and Japanese encephalitis) made it through the pipeline for public use. The availability of and access to vaccines are determined largely by the rate and ease of which the vaccines pass through clinical trials and are approved for public use. Many vaccine candidates fall by the wayside from a lack of resources to continue with clinical trials, which are highly costly, take years to complete, and often involve hundreds to tens of thousands of people.
Another issue is ensuring that effective vaccination programmes are implemented in vaccine-hesitant communities. The COVID-19 pandemic has highlighted some of the deeper issues that plague such communities across the globe. Researchers hope these findings will offer insights for future public health emergencies.
We were then faced with the challenge of closely examining the large amount of information we have gathered and identifying pertinent data and facts so we can present them in a logical and coherent manner. For this, we reviewed past and current reports such as one on The Tuberculosis Campaign, which involved the testing of 37 million people and administration of 16 million BCG vaccines between 1947 to 1951, and a more recent one which discussed lessons learned from the Global Vaccine Action Plan (2011 to 2020). These reports were either directed to us by the thought leaders we interviewed, or found through our own research.
We narrowed our focus to the specifics of infectious disease outbreaks and the vaccination programmes implemented to address them, gathered from multiple sources including global data reported by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).
We also reviewed large data pools such as vaccination rates in the African continent, and vaccine coverage for the rubella vaccine, paying attention to the success rate of each implementation, the gaps which have yet or need to be addressed, and what else could be done to increase coverage.
While the COVID-19 vaccines were made available to populations across the globe in a concerted effort, there were still populations which for economic or other reasons might not have sufficient coverage. To understand how these gaps were identified and addressed, we cited the accomplishments and challenges faced by COVAX, an initiative co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), WHO and vaccine alliance GAVI whose main objectives include guaranteeing fair and equitable access to vaccines in every country.
The complexity of the information we gathered on the distribution of and access to vaccines reflected the complexity of global vaccine equity, and required careful examination, comprehension and presentation.
Connecting facts, experiences and opinions
Having gathered insights from experts and derived supporting data from published reports, the white paper began taking shape.
What is important and often challenging at this stage, is to distinguish facts from opinions. For example, the rising prevalence of obesity across the globe is a fact which can be easily proven by surveys and research, but there are many different opinions as to why this occurs. The challenge, therefore, lies in connecting published statistics with opinions which are based on experience.
Immunisation data is sometimes regionally isolated or only involves pockets of populations in a country. According to the experts we interviewed as well as the literature, some reasons for the low and/or patchy immunisation rate included major, multilevel challenges such as delays in acquiring vaccine supplies due to lack of funds or time taken to negotiate for lower prices, as well as setbacks specific to the population; some villages are so remote that travelling to reach them could compromise the stability and potentially the efficacy of temperature-sensitive vaccines.
Although fragmented or incomplete, such information must be included in the white paper to paint a more complete picture of the issue discussed. Although there are still missing pieces to the puzzle that is global vaccine equity, what information we have and do not have needed to be considered together with the solutions as they are presented.
Structuring a framework aligned to objectives
Equipped with a macro perspective of the vaccine landscape and its multi-layered unmet needs, as well as specific examples we could learn from, we were now able to outline probable solutions. An entire chapter was dedicated to focus on the calls to action.
Not only did we emphasise on reducing the impact of vaccine inequity and how to work towards equity, we also discussed which approaches might be more successful than others based on documented evidence.
Pictorial representations of central points
Finally, even for high-level white papers, it is crucial various stakeholders can easily consume and process the information. To this end, we incorporated infographics, diagrams and charts into the white paper based on the facts we have identified and wanted to highlight, and laid it out in the format agreed upon.
Although a white paper is a labour-intensive undertaking which can take several months to complete and publish, if well thought out and executed it can serve to inform policy makers, industry and other stakeholders in their future decision-making and collaborations for the good of whom it may impact.
Article by Dr Ramona Khanum with assistance from Hyma Haridas and Nanny Eliana
If you'd like to read the white paper, drop us an email at firstname.lastname@example.org and we'd be sure to send you a copy when it is available for viewing!