Photo = Maeil Business Newspaper
IVI Director General Jerome Kim shares his thoughts on resurgence of COVID-19 outbreaks in S. Korea with Maeil Business Newspaper, one of Korea’s major business dailies.
The Korean-language article can be found here:
https://m.mk.co.kr/news/it/view/2020/08/849886/
An English translation of the article is below.
[Maekyung Meets] Jerome Kim, Director General of the International Vaccine Institute
2020-08-18 | Park Bong kwon, Lee Jong ha | Maeil Business Newspaper
“Despite having enjoyed relatively more freedom than other countries, the recent resurgence of outbreaks has shown South Korea that it cannot afford to let its guard down.”
Photo = Maeil Business Newspaper
Jerome Kim, who has led the International Vaccine Institute (IVI) since 2015, said, “Until a vaccine is developed, outbreaks, big and small, will continue to occur. Even if a vaccine is found, it will take some time until it can be delivered. Until then, we should not let our guard down.” Further, “The Korean public seems to be shocked because church-originated COVID-19 cluster infections continue to occur, and one church in particular is quite big in size, but in fact, outbreaks were predicted to occur anywhere – from churches to call centers to bars, etc.
“I don’t think Korea’s successful response to the first wave was solely a result of the government’s efforts,” Kim said. “The cooperation of the Korean public was key to success, and it will be required again this time.” Regarding the timeline for a COVID-19 vaccine, which is expected to be a game changer, he expects to see a vaccine with proven efficacy as early as November or December this year. Accordingly, tens of millions of doses could be produced and delivered to some parts of the public from early next year. Jerome Kim, Director General of IVI, which is the first international organization based in South Korea (Seoul National University), is a Korean-American expert on vaccine development and a world authority on AIDS research.
― Since last week, there has been a surge in COVID-19 cases
▷ The government should take a serious look at the resurgence of COVID-19. Korea was able to enjoy a more carefree summer than other countries. However, the recent resurgence of outbreaks has shown that we need to continue our efforts to contain the spread and that we need to remain vigilant until a vaccine is found. Until then, small-scale outbreaks will keep occurring. There can be no carelessness in dealing with infectious diseases.
It is only possible for life to regain some level of normalcy if both the government and the public stay vigilant. We have to assume that COVID-19 will continue to remain in the human body. This is different from SARS, which was transmitted when symptoms were present. But COVID-19 is capable of asymptomatic infection. Thus, it is difficult to identify spreaders as Korea has learned during the ‘Itaewon outbreak.’
― Many people are confused by the sudden resurgence of COVID-19
▷ There might have been problems with social distancing, proper mask-wearing, or people sitting close together at church to eat, but there is a slight difference to the big outbreak Korea experienced in March. At the time the virus was able to spread without any countermeasures in place as nobody knew what to do. This time, everyone is aware of the virus and that the resurgence of outbreaks should be prevented, and that the government has to identify, track, and monitor the virus to contain the spread.
Other countries that had a similar approach also faired well in dealing with the virus. Until a vaccine comes out, the government has no other options. The government’s role is to control the spread and to communicate with the public to encourage participation in control efforts and seek their understanding. The public should not let their guard down. Cooperation is everyone’s business if we want to gain back the level of freedom and economic activity that we enjoyed before the pandemic.
―There are expectations that a vaccine might arrive as early as next month
▷ I think September is a little too soon. It will not be until November or December this year that we can expect a vaccine that has been proven effective. Currently, many pharmaceutical companies worldwide, including Moderna and Pfizer, are working on a vaccine. By the end of this year, we may have several vaccines available, and in fact, the more different vaccines we have, the better it will be. Since COVID-19 affects the whole world, we need more vaccines than any single pharmaceutical company could possibly produce.
― When to expect COVID-19 vaccinations
▷ The journey of a vaccine consists of three stages: testing, production, and distribution. Generally, it takes five to ten years for a vaccine to be developed and administered to the general public. As COVID-19 has become a pressing issue around the world, the timeline for a COVID-19 vaccine will be considerably shorter. We expect a vaccine to arrive in 12 to 18 months as activities are conducted at high speed with many necessary steps overlapping while being executed.
If there are no major side effects from phase I trials start, phase II trials start almost in parallel even before the conclusion of the previous phase. Similarly, phase III trials start as soon as phase II trials show successful antibody formation, even if the analysis of the antibodies is not completed at that stage.
While not in accordance with the usual vaccine development process, it is one way to significantly reduce development time.
The plan is to start production before a vaccine candidate has been proven effective. Vaccine production will begin in Q4, and tens of millions of doses are expected to be available early next year. CEPI, in which the Korean government is also participating, is moving to secure two billion doses by the end of next year. Starting next year, older people, who are more vulnerable to COVID-19, will likely be first in line to receive vaccines.
―The U.S. and other rich nations are scrambling to pre-purchase vaccines
▷ Therefore, it is important for Korea to join the efforts of CEPI. The Johnson & Johnson vaccine was signed by CEPI months ago, and CEPI has also entered contracts with the Oxford Vaccine Group, Inovio, Moderna, etc.
These contracts contain a clause guaranteeing ‘global access’ at ‘affordable cost.’ Accordingly, CEPI will provide vaccines to the COVAX facility which GAVI, the WHO, and CEPI are part of, and which will help COVAX to secure two billion doses in total.
In order to lower prices, South Korea also needs to think about joint vaccine purchases with other countries. In fact, there are cases in which four European countries joined forces to purchase vaccines together. In the case of the U.S., which has a population of over 300 million, it is clear that they will buy a large amount, which gives them better bargaining power.
― I don’t think we need to worry about securing the vaccine if we produce it ourselves. What is
‘vaccine sovereignty’ about and what is the status of vaccine development in Korea?
▷ Although it is not sure yet, Korean companies will likely be able to develop vaccines in the first quarter of next year. Genexine is working on a DNA based vaccine candidate similar to that of Inovio, and SK Bioscience is working on several vaccine candidates simultaneously.
SK Bioscience also signed with U.S. manufacturers NovaVax and AstraZeneca to contract manufacture vaccines for them.
The Indian government is also believed to have entered into similar contracts to receive part of the production output. If the AstraZeneca or NovaVax vaccine works, and I think Korea will also receive a part of the output.
― What if the virus mutates and makes the vaccine useless.
▷ It depends on how much the virus mutates. So far, more than 40,000 COVID-19 viruses have been analyzed. Of course, there are mutations. But if we were to liken the mutation rate of COVID-19 to the size of a pen point, the mutation rate of the influenza virus would be the size of a finger. The human immunodeficiency virus (HIV) then, which mutates every year, would be about the size of an orange. In comparison, COVID-19 mutations are relatively small. In Europe and North America, only six of the 30,000 RNA “letters” mutated.
The vaccine that is being developed now is expected to protect us from COVID-19 strains in circulation for the next few years.
― It is said that flu epidemics in the winter amid the pandemic could potentially be disastrous.
▷ Make sure you get a flu vaccine to avoid confusion with COVID-19. It is difficult to respond to both the flu and COVID-19 at the same time. On a more positive note, people started to take masks, personal hygiene, and proper social distancing more seriously, so there have been fewer flu cases recently.
― Do you have any personal relationship to LG Chairman Koo Kwang-mo, who recently donated 1 billion won to the International Vaccine Institute?
▷ No, not at all. It was a personal donation of him and not from LG. I had heard before that he was interested in donating. It would be nice to meet in person to express our gratitude. The donation will be used to support the search for a COVID-19 vaccine.
― There is a lot of interest in “Korea’s response to COVID-19.” What is behind Korea’s success story?
▷ With the help of its advanced biotechnology companies, the Korean government was able to mass-produce diagnostic kits quickly and to prevent further infections effectively through rapid isolation of confirmed cases.
Due to its experience with MERS, the government also knew how to communicate effectively. The prime minister was sent to head the Central Disaster and Safety Countermeasure Headquarter and Jeong Eun-kyung, Director ofthe Centers for Disease Control and Prevention to the team, making responsibilities clear. The government made full use of its powers.
Date:Tuesday, 29 November 2022
Objectives:
A total of 39 participants from Bangladesh, Malawi, Nepal, and Uganda participated in the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 7 was to:
Session 15: Presentation of Formative Evidence Brief for Policy
The final Webinar/Session focused on the Presentation of Formative EBP. Participants from Bangladesh, Malawi, Nepal, and Uganda presented their EBP, with a peer review, and feedback and comments from the EVIPNet/K2P team. The session finished with reflections on the next steps, including the potential for scale-up.
Wrap-up and closing
Date:Thursday, 10 November2022
Objectives:
A total of 39 participants from Bangladesh, Malawi, Nepal, and Uganda participated in the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 6 was to:
Feedback from country teams on preparatory work/progress to date:
Uganda, Malawi, Nepal briefly shared progress and EVIPNet/K2P team commented on the progress.
Webinar Session 13: Organizing a policy dialogue presented by EVIPNet-K2P Center, focusing on how policy dialogues influence the use of evidence in health policy and decision-making including:
Considerations for conducting policy dialogues, i.e., does the dialogue address a high priority issue? Does it provide opportunities to discuss/address the issue, and considerations for implementation? Is there fair representation among those involved in/affected by future decisions related to the issue? Are follow-up activities undertaken to support action?
Preparation for policy dialogues, i.e., informed by pre-circulated evidence on the policy issue.
Stakeholder selection, i.e., degree of involvement in/knowledge about the issue and relevant solutions; ability to constructively engage in discussions; ability to take forward recommended actions within respective constituencies; and the importance of the dialogue facilitator’s role.
Dialogue summary, i.e., tools to outline the results of the discussions during the policy dialogue; and post-dialogue summaries.
Session 14: Data visualization and role of media in policy-making
Group or individual work with support from EVIPNet/K2P
The webinar ended with Group work based upon Session 14.
Wrap-up and closing
The final Webinar (#8) will be a Simulation Meeting: Presentation of Formative EBP, with the objective:
To present the draft formative EBPs among countries teams (peer review)
To propose outreach strategies for EBPs
To reflect on next steps (including potential for scale up)
Preparatory work (prior to Webinar 8): To complete the formative EBP
Presentation slides are available here
Date:Thursday, 27 October 2022
Objectives:
A total of 42 participants from Bangladesh, Malawi, Nepal, and Uganda participated in the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 5 was to:
Feedback from country teams on progress to date (10 minutes per team)
Uganda, Malawi, Nepal briefly shared progress and EVIPNet/K2P team commented on the progress.
Webinar 6 provided a ‘Refresher: from problem statement to policy options‘ on the content of Evidence-to-Policy Briefs (EBP) including the problem statement, options and elements, and implementation considerations; framing the problem, clarifying its underlying causes, the appropriate types of evidence to use in framing problems, and framing, developing, and expanding on the options/ elements to address the problem. The refresher session finished with ‘Case examples’.
The webinar then focused on
Session 11: Identifying Key Implementation Considerations Framing presented by EVIPNet-K2P Center. Session 11 included: approaches to policy implementation (i.e. ‘top-down’ and ‘Bottom-up’); identifying and addressing barriers to implementing policies; health system, and social and political constraints; and tips on developing the implementation considerations.
Session 12: Overview of EBP outline (and semi-structured interviews/litmus) including: the policy brief outline, e.g., identification of how the problem related to risk factors/disease, to a program or service, and/or to the current health system; viable policy or programmatic options to address the problem; and potential barriers that could influence implementation policy options. The session also covered: stake- holder selection framework for litmus testing, and semi-structured interviews with stakeholders.
The next steps for countries include:
To agree on preliminary timeline for the updated policy brief outlines
To coordinate with assigned team lead for each country team
Group or individual work with support from EVIPNet/K2P
The webinar ended with Group work – using the EBP template – based upon Sessions 11 and 12.
Presentation slides are available here
Date:Thursday, 15 September 2022
Objectives:
A total of 51 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 4 was to:
The introduction to the webinar provided: an Overview of methodologies to measure antibiotic use, and the use of surveillance data; the link between AMR and use of antimicrobials; and the integrated national action needed on optimal use of antimicrobials, including through data, surveillance, and monitoring.
The webinar then focused on Session 10: Framing Viable Policy Options to Address a Problem: A Step-by-Step Guide presented by EVIPNet-K2P Center. Session 10 included: Content of EBPs (i.e. problem statement, options or elements, and implementation considerations); Developing options/elements to address the problem (i.e. policy options, and health system/governance/financial arrangements/delivery arrangements); Steps for developing options/elements to address the issue (literature review, thematic analysis, tailoring to the country issue/context, and selecting 3-4 options); and practical examples of AMR and underlying causes to policy options.
A Q&A session followed, with questions on the behavioural and economic dimensions of policy response and options; the specificity and feasibility of options; and appropriate types of research evidence for developing options.
The webinar ended with Group work – with support from EVIPNet/K2P and using the EBP template to:
Identify 3-4 policy options/elements to address the problem and its underlying causes
Date:Thursday, 8 September 2022
Objectives:
A total of 57 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
Webinar 4 began with the ‘Feedback on preparatory work’ outlined in Webinar 3, which was to:
Dr Fadi El-Jardali from the American University of Beirut updated participants on the progress of the four countries including: on the topics selected (Uganda on irrational antibiotic use; Nepal on AMR National Action Plan (NAP) implementation [adjudged to be more about the solution than the problem]; Malawi on the utilization of AMR evidence generated at facility/national level and translation into policy [also more about the solution than the problem]; and Bangladesh, which had not yet been reviewed. The review also included country search strategies. The feedback included questions from participants.
The webinar then focused on the next (of the 15) training sessions:
Session 9. Preparing the EBPs: clarifying and framing the problem including:
Knowledge Translation (KT). Which facilitates the process of translating research into policy and action; and KT products which allow evidence generated from systematic reviews – the basic units of KT – to be packaged in a user-friendly format, written in clear language, and with key messages to increase the likelihood of adoption by policy-makers, and resonance among different target audiences. The use of systematic reviews enable policy-makers to scan large bodies of research evidence to address key features of any policy issue of interest.
– Problem statement: A policy problem that summarizes the best available evidence to clarify the size and nature of the problem and its underlying causes.
– Options or elements: Three or more viable policy and programmatic options described.
– Implementation considerations: Potential barriers to implementing the options/elements and strategies for addressing those.
The EBP does not provide recommendations for action.
The remainder of Webinar 4 featured the Group work exercise facilitated by Racha Fadlallah from K2P Lebanon (and support from EVIPNet). The group work comprised four groups – one for each country (including representatives from WHO country offices, and observers from EVIP/RADAAR) – with the aim:
A template was provided by EVIP facilitators (based on the presentation from Session 9) with sections for completion by country groups.
Presentation slides are available here
Date:Thursday, 25 August 2022
Objectives:
A total of 59 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
Webinar 3 began with the ‘Feedback on preparatory work’ outlined in Webinar 2, which was to:
Fadi El-Jardali from the American University in Beirut updated participants on the progress of the four countries and provided further guidance for countries on completing these two crucial stages. Malawi was used as an example applicable to other countries, in terms of structuring thinking in relation to identifying the issue, the political context, what has already been done in terms of AMR, what is missing and why, and stakeholder mapping. Country participants summarised their experiences. The feedback ended with a discussion on the priority areas of focus for the Evidence Brief for Policy (EBP), with updates from countries.
Following feedback reporting, the webinar focused on the next two (of 15) training sessions:
Session 7. Designing search strategies to identify and access research evidence on priority topics including: the importance of effective searches (6,500 medical articles published daily); the use of ‘Boolean Operators (e.g., And, Or, Not); identification of search terms; building a search strategy, including formulating the question/issue, choosing appropriate databases, dividing the question/issue into 2 or 3 concepts, generating search terms for each concept, and combining concepts – and search terms within concepts – using Boolean operators; and validating/documenting the search.
An example of a ‘search’ template was presented, and which participants would complete in the group work at the end of the webinar. The template included: the Problem/Issue being addressed, the Options, the Concepts, the Search terms for each concept, and Combining concepts using Boolean operators
The importance of collecting the best available evidence for EBPs was stressed: local evidence and global research evidence from systematic reviews. Guidance was provided on where to search for such information, including local and national databases, websites of relevant organisations, search engines, ‘grey’ literature, and systematic reviews.
Session 8: Understanding the role of systematic reviews in influencing policy decisions including: the Concept of a systematic review; key databases to search – and how to search – for reviews (e.g., Health Systems Evidence, Cochrane, PubMed); a live demonstration of a search on Health Systems Evidence and PubMed databases; and assessing the quality of reviews (e.g., using AMSTAR).
The remainder of Webinar 3 featured the Group work exercise facilitated by Racha Fadlallah and
Lama Bou Karroum from K2P Lebanon (with support from EVIPNet). The group work was comprised of four groups
– one for each country (including representatives from WHO country offices, with observers from EVIP/RADAAR) – with the aim: To develop a search strategy and search key databases for systematic reviews.
A template was provided by EVIP facilitators (based on the presentation from Session 7) with sections for completion by country groups as follows: the Topic/Issue being addressed, the Concepts, the Search terms for each concept, Combining concepts using Boolean operators, and the Databases searched.
Date:Thursday, 18 August 2022
Objectives:
A total of 65 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and WHO.
After a brief introduction, Webinar 2 began with ‘Feedback on preparatory work’ outlined in Webinar 1:
The EBP Team is responsible for developing the EBP and conducting key informant interviews (KIIs), hence an appropriate mixture of expertise is key to a successful team, including members with experience in: methods of writing an EBP; administration; evidence search, appraisal and synthesis; technical expertise on the topic being addressed in the EBP; and communication. Each country must also appoint an EBP steering committee to support the EBP development process, comprising: 4-6 multisectoral, multidisciplinary and high-level stakeholders from government/policy-makers/researchers knowledgeable in the topic and able to contribute to the development of the EBP for AMR.
Each of the four countries reported briefly on the steps taken to form the Core Team, Steering Committee, and in identifying AMR stakeholders (some countries had also informed RADAAR/EVIP prior to the Webinar via email).
Following reporting, the Webinar focused on the next two (of 15) training sessions:
Session 5. Understanding the political and health system and outlining key areas to keep in mind when mapping the policy and political context including: the importance of context-specific and actionable evidence, in particular the political/policy context (e.g., characteristics of government structures, civil service – and interests of – policy-making stakeholders, societal values and external factors, such as social and economic); and health system context (e.g., evidence on health system inputs, processes, and outputs and the analysis of how they combine to produce outcomes, such as – the WHO defined – service delivery, health workforce, information, medical technologies, finance, and leadership/governance).
Session 6:Stakeholder mapping including: on stakeholder interests, i.e., concerns over how a policy may impact them; their positions, i.e., degree of agreement or disagreement with the policy; and their power, i.e., capacity to influence policy. The steps in stakeholder mapping include: defining the goal and implications of the proposed policy change; listing interest groups involved in the issue; categorizing stakeholders according to their influence and power over, and level of interest in the issue; determining a strategy to engage relevant stakeholders; conducting KIIs; and presenting stakeholder analysis.
Stakeholders identified include: decision-/policy-makers (e.g., ministries, government agencies, parliamentarians, municipalities); influencers (e.g., NGOs/CSOs, religious leaders, media, private sector); and the public (e.g., those affected by AMR).
A case example from Ghana was presented to highlight the steps in stakeholder mapping.
Webinar 2 concluded with a Group work exercise (with support from EVIPNet/K2P)
Group work was comprised of four groups – one for each country (including representatives from WHO country offices) – with the aim of:
A template was provided by facilitators with nine questions to capture the above details including: the issue; progress made in addressing the issue; previous related policies/laws/regulations; whether the issue is on the government agenda; windows of opportunity; requirements to reach the policy objective; how laws/regulations are implemented to this purpose; stakeholders involved; and the power interplay among/between stakeholders. The questions provided background information to enable completion of full ‘Stakeholder Mapping’ template (including stakeholder, description, name, power, interest).
Date:Thursday, 11 August 2022
Objectives:
A total of 88 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and WHO.
After an introduction to evidence-informed policy-making (EIP) and EVIPNet, Webinar 1 included the first four (of 15) training sessions:
Session 1. Brief overview of the policy-making process including: promoting the use of research evidence in policy-making to improve health systems; increasing country capacity in/institutionalising knowledge translation (KT); approaches to increase research utilization; developing evidence briefs to inform health policy deliberations, and assess the impacts of policy options; and the evidence-action cycle, including priority-setting, evidence, convening deliberative dialogue, and policy implementation.
Presentation slides are available here
Session 2: Understanding role of evidence in policy-making process and efforts to support use of evidence in policy-making including: policy process overview; major public policy theories/frameworks; stages in public policy making, i.e., definition, agenda setting, and policy instruments/implementation/ evaluation; importance of robust research/data/evidence, as well as KT tools/strategies; and enhancing awareness/capacity of, and engaging policy-makers/stakeholders early, and sustaining engagement.
Session 3: Knowledge generation and knowledge translation as a spectrum: evidence on establishing and/or strengthening national health research system using a systems approach and the need of cross evidence ecosystem collaboration including: the National health research system (NHRS); WHO guides/ tools; key workstreams of the evidence ecosystem, i.e., partnering for complementary support in decision-making; HO workstreams, i.e., data analytics, guidelines, health technology assessment (HTA), evidence-informed policy-making supports, modelling, and behavioral research; and the evidence ecosystem framework and policy/action cycle.
Session 4: Learning from success stories of EVIPNet Member Countries: development of evidence briefs for policy on AMR including: Slovenia case study on ‘Translating AMR data and evidence into effective policies (EBP development); driving factors, challenges, and lessons learned; importance of a multi-level/sectoral approach; the need to integrate local evidence; the crucial role of Ministries of Health to put options on the political agenda (and sufficient capacity within the MoH and NIPH).
