ArticleHealth systems (Basingstoke, England)2023
A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms.
Article in Health systems (Basingstoke, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 1 citations in OpenAlex.
- Access to licenced vaccines for high-threat infectious diseases: a scoping review and interpretive analysis of Ebola virus disease.BMC infectious diseases · 2026Article
- Expanding modeling boundaries to design more resilient vaccine supply networks.Health care management science · 2025Article
- Developing an intuitive decision support system for equitable vaccine distribution during pandemics.Scientific reports · 2025Article
- The Governance of Childhood Vaccination Services in Crisis Settings: A Scoping Review.Vaccines · 2023Article
- How Can Authorities Support Distributed Improvisation During Major Crises? A Study of Decision Bottlenecks Arising During Local COVID-19 Vaccine Roll-Out.Journal of cognitive engineering and decision making · 2023Article
- Systems Science and Evidence-Informed Deliberation to Mitigate Dilemmas in Situations of Dual Agency at the Hospital Level Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations".International journal of health policy and management · 2022Article
- Organisational and Structural Drivers of Childhood Immunisation in the European Region: A Systematic Review.Vaccines · 2022Review
- Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights.BMC public health · 2022Article
- Article
- Insights into vaccine hesitancy from systems thinking, Rwanda.Bulletin of the World Health Organization · 2021Article
Corrections and comments
- Erratum issuedCorrection.2026
Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite massive progress in vaccine coverage globally, the region of sub-Saharan Africa is lagging behind for Sustainable Development Goal 3 by 2030. Sub-national under-immunisation is part of the problem. In order to reverse the current immunisation system's (IMS) underperformance, a conceptual model is proposed that captures the complexity of IMSs in low- and middle-income countries (LMICs) and offers directions for sustainable redesign. The IMS model was constructed based on literature and stakeholder interaction in Rwanda and Kenya. The model assembles the paradigms of planned and emergency immunisation in one system and emphasises the synchronised flows of vaccinee, vaccinator and vaccine. Six feedback loops capture the main mechanisms governing the system. Sustainability and resilience are assessed based on loop dominance and dependency on exogenous factors. The diagram invites stakeholders to share their mental models and. The framework provides a systems approach for problem structuring and policy design.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.