Global inequity creates local insufficiency: A qualitative study of COVID-19 vaccine implementation challenges in low-and-middle-income countries

Victoria Haldane; Archchun Ariyarajah; Isha Berry; Miranda Loutet; Fabio Salamanca-Buentello; Ross E. G. Upshur

doi:10.1371/journal.pone.0281358

Peer Review History

Original SubmissionMay 26, 2022
22 Nov 2022 Decision Letter - Saurav Basu, Editor PONE-D-22-15264Global inequity creates local insufficiency: A qualitative study of COVID-19 vaccine implementation challenges in low-and-middle-income countries.PLOS ONE Dear Dr. Upshur, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: 1. Go through reviewer 1 comments and address each of them 2. Explain data availability for this manuscript3. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: You are requested to make the changes as per reviewer comments especially with regards to data availability. Also any publications (published or under review) associated with the same dataset need to be clarified with reasons [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The study as a whole was well-designed and developed. I have only a few minor edits to recommend. 1) The data should be made fully available or explicitly justify not making the data available. 2) There are a few minor typos, e.g., page 4 that says, "Figure 1 about here" that should be corrected. The grammar is solid overall, but would benefit from a final review. 3) The authors should explain why they have broken their data out into multiple publications, including only the Round 1 data here. It would help to have all of the rounds in context here or justify why the other rounds are not included. 4) Please identify the countries represented in the study for context (even a range of how many countries are represented would be helpful). 5) Please list the response rate to invitations to participate in the study. Reviewer #2: This manuscript is well written. I only have concerns for some 'over-looked' absurdities. For instance, some sections of the tables that bear the results of the study still retain the flavour of the survey instrument, e.g. 'select all that apply'. You should read through the entire paper and eliminate typographical issues from it. Overall, this is a very good paper on the subject matter. It has established that global inequity is a driver of COVID-19 vaccine programme implementation insufficiency in LMICs. I am sure that the paper, when published, will be a good addition to the efforts that are being directed at recovery from the pandemic. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0281358.r001
Revision 1
12 Jan 2023 Author Response Journal Requirements: Comment 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response 1. We have updated our manuscript to adhere to PLOS ONE’s style requirements Comment 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. Response 2: We have provided a de-identified version of the data set. It is available here: Haldane, V; Ariyarajah, Archchun; Berry, Isha; Loutet, Miranda; SALAMANCA-BUENTELLO, FABIO; Upshur, Ross EG (2023): Round 1 Delphi responses (de-identified) - COVID-19 vaccine consensus study (LMICs). figshare. Dataset. https://doi.org/10.6084/m9.figshare.21825135.v1 Comment 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response 3. We have reviewed the reference list and all is in order. Comment 4. Also, any publications (published or under review) associated with the same dataset need to be clarified with reasons. Response 4. The complete results of the Delphi have previously been published as: Ariyarajah A, Berry I, Haldane V, Loutet M, Salamanca-Buentello F, Upshur RE. Identifying priority challenges and solutions for COVID-19 vaccine delivery in low-and middle-income countries: A modified Delphi study. PLOS Global Public Health. 2022 Sep 8;2(9):e0000844. Available at: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000844#references The manuscript currently under review is a companion to this Delphi. Whereas the full Delphi process leads to consensus, in the initial phase of the study many participant perspectives were collected that offer a breadth of important considerations for vaccine implementation in low- and middle-income settings. This study uses qualitative methods to explore these perspectives and in doing so differs significantly from the Delphi and sheds different light on COVID-19 vaccine program implementation. Reviewer #1: Comment 5. The data should be made fully available or explicitly justify not making the data available. Response 5. TBD. Comment 6. There are a few minor typos, e.g., page 4 that says, "Figure 1 about here" that should be corrected. The grammar is solid overall but would benefit from a final review. Response 6. Thank you, we have copy edited the document. We have removed the placeholder text for figure 1. Comment 7. The authors should explain why they have broken their data out into multiple publications, including only the Round 1 data here. It would help to have all of the rounds in context here or justify why the other rounds are not included. Response 7. We have chosen to focus on our Round 1 data in this manuscript as it offers a breadth of perspectives on COVID-19 vaccine program implementation. The goal of the Delphi is to generate consensus, which while important, by nature distills and ranks many challenges and solutions into only a few. It is important that the diverse perspectives offered in the free text responses of the first phase have a place to be explored and discussed, which is not within the scope or aims of Delphi, but which is well suited to qualitative analysis as presented here. All rounds of data are not included here as only the first round involves gathering qualitative data – subsequent rounds use quantitative methods to determine agreement and ranking, thus making these data inappropriate for content analysis. Comment 8. Please identify the countries represented in the study for context (even a range of how many countries are represented would be helpful). Response 8. We have reported on the region of expertise of the panel that answered the survey questions in Table 1. We asked in this way as many participants in our target population have expertise across several countries, as well as challenges in the distinction between an expert’s country of origin, country of residence, or country where they work. Phrasing it as country of expertise and allowing for multiple selections allows our participants to self-identify. Comment 9. Please list the response rate to invitations to participate in the study. Response 9. Thank you for bringing this to our attention. We have now added the response rate in the results section, line 174. The section now reads “A total of 426 participants were invited to be involved in the Delphi study. Of these, 96 (22%) completed Round I of the survey and provided responses that were included in the content analysis.” Reviewer #2: Comment 10. This manuscript is well written. I only have concerns for some 'over-looked' absurdities. For instance, some sections of the tables that bear the results of the study still retain the flavour of the survey instrument, e.g. 'select all that apply'. You should read through the entire paper and eliminate typographical issues from it. Overall, this is a very good paper on the subject matter. It has established that global inequity is a driver of COVID-19 vaccine programme implementation insufficiency in LMICs. I am sure that the paper, when published, will be a good addition to the efforts that are being directed at recovery from the pandemic. Response 10. Thank you for your support of the manuscript. We have clarified in table 1 that the ‘select all that apply’ is an indication that participants could select as many regions as they felt were their region of expertise. The title of the category now says, “Region of expertise (participants could select multiple regions).” We hope this clarifies and adequately addresses the reviewer’s concern. Attachments Attachment Submitted filename: Response to reviewers_Plos GPH _Delphi content analysis.docx https://doi.org/10.1371/journal.pone.0281358.r002
23 Jan 2023 Decision Letter - Saurav Basu, Editor Global inequity creates local insufficiency: A qualitative study of COVID-19 vaccine implementation challenges in low-and-middle-income countries. PONE-D-22-15264R1 Dear Dr. Ross Upshur We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Saurav Basu, M.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0281358.r003
Formally Accepted
3 Feb 2023 Acceptance Letter - Saurav Basu, Editor PONE-D-22-15264R1 Global inequity creates local insufficiency: A qualitative study of COVID-19 vaccine implementation challenges in low-and-middle-income countries. Dear Dr. Upshur: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Saurav Basu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0281358.r004

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