key: cord-0874697-qgtd1hnw authors: Castro, Franz; Miguel Pascale, Juan; Slocum Hewitt, Itzel; Calvo, Arlene title: Mass vaccination campaign during the 2016 influenza outbreak in Panama: challenges and implications for COVID-19 vaccination efforts date: 2021-11-27 journal: Vaccine DOI: 10.1016/j.vaccine.2021.11.048 sha: ca078f137a4d8d27b8106ec723be8581fba2af9a doc_id: 874697 cord_uid: qgtd1hnw nan Vaccination efforts to curb the spread of COVID-19 are unfolding at a global level while health systems are facing the challenges posed by the pandemic. It is relevant to reflect on outcomes and obstacles from previous emergency mass vaccination campaigns, particularly in the scenario of low-and middle-income countries (LMICs). Our aim is to discuss these in relation to Panama's 2016 influenza A H1N1 outbreak, with a focus on two main challenges: (1) taking measures to make the vaccine rollout more equitable, and (2) guaranteeing an adequate demand by influencing the population's behaviors and beliefs. We will elaborate on how this past effort helped shape present COVID-19 immunization campaigns, discussing implications that might be generalizable to similar countries. Panama, a country with a population of four million people exhibited an increase in laboratoryconfirmed cases of influenza A H1N1 beginning on the twentieth week (mid-May) of 2016, exceeding the epidemic threshold ( We lack data on vaccine acceptance during the 2016 influenza outbreak, but it is reasonable to postulate that without appropriate nationwide educational campaigns, low demand driven by lack of confidence in vaccines could have been an important threat to the vaccination efforts. This and gaps yet to be addressed are increasing the availability of materials in indigenous populations' languages, and encouraging the generation of scientific evidence assessing the effect and costeffectiveness of different interventions for increasing vaccine acceptance and uptake. In an era of divisiveness, politization of public health measures, and eroded trust in traditional public health institutions, it is important to regain the public's confidence to build more effective health systems delivering services to healthier and empowered citizens in the long term. Quoting Dr. Barry Bloom: "the critical ingredient in every vaccine is trust". Ministerio de Salud. Boletín epidemiológico semanal de eventos de notificación obligatoria Panamá en cifras: años Burden of Seasonal Influenza A and B in Panama from 2011 to 2017: An Observational Retrospective Database Study. Infectious diseases and therapy Cifras preliminares de pacientes admitidos en los hospitales en la república por dependencia y sexo COVID-19 vaccine decision-making factors in racial and ethnic minority communities in Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at longterm care facilities. American journal of public health Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage: a systematic review Impacto del coronavirus sobre la conducta y la opinión pública 2021 Coronavirus Pandemic (COVID-19) 2021 COVID-19 and the Antipoverty Vaccines Vaccine distribution-equity left behind? Influenza A (H1N1) pdm09 vaccination policies and coverage in Europe Compliance with anti-H1N1 vaccine among healthcare workers and general population Exploring communication, trust in government, and vaccination intention later in the 2009 H1N1 pandemic: results of a national survey Early COVID-19 government communication is associated with reduced interest in the QAnon conspiracy theory Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19 Vaccine communication in the age of COVID-19: Getting ready for an information war All authors attest they meet the ICMJE criteria for authorship. ☐ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☒The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This publication was possible with financial support from Sanofi Pasteur and the Gorgas Memorial Institute for Health Studies