ACME
Améliorer l’Acceptabilité et l’accessibilité des Contre- Mesures préventives dont les vaccins lors d’émergences Épidémiques / Improving acceptability and accessibility of countermeasures including vaccines against emerging epidemic diseasesThe COVID-19 emergence has led to a pandemic with over 6.9 million estimated deaths worldwide [1]. The epidemic management in Europe including France has allowed reducing the expected burden of disease. This was achieved in particular by a combination of initial reduction of transmission via containment policies of variable stringency and, one year later, strongly incentivised high uptake of Covid-19 vaccines among the adult population, using vaccines with high and well-persisting effectiveness against severe forms of the disease. This period was marked by scientific, societal and political debate about the effectiveness, safety, feasibility, legitimacy, parsimony and fairness of a variety of preventive countermeasures (PCMs) and related policies. This illustrated the challenges to control emerging infectious diseases while maintaining trust among and between stakeholders and limiting social inequalities. While it can be argued that rapid biomedical innovation combined with strong incentives will successfully control future emerging infectious disease events, others question the high societal costs of this approach, in particular at the expenses of societal trust and equity.
A considerable body of social sciences and public health evidence has described the need to foster individuals’ confidence in decisions and actions, and to address social inequalities during epidemic response, and that preference-based recommendation, organisation at the local level including healthcare workers (HCWs) can help achieving these requirements. However, less is known about how this evidence can be operationalised and translated into public health practice during epidemic situations and, to achieve this, methodological frames are needed.
The ACME project aims to contribute to the development and implementation of effective, acceptable and accessible PCMs, including vaccination, specifically for use during epidemics of (re-)emerging infectious diseases in France. The vision is to identify and prepare, during epidemic preparedness activities, confidence-building and inclusive strategies and programmes. The ACME project responds to the PEPR frame by constructing a multidisciplinary research consortium of academic institutions in France who will use social sciences and public health methods to prepare for future emerging infectious disease epidemics. Our project corresponds to the Axis 2 (Knowledge, expertise, communication), as it aims at a better understanding of key factors that impact the acceptance and the physical and psychological accessibility of various PCMs in epidemic situations, and will recommend approaches for the translation of this evidence into public health action. Although programme development and implementation are member state competencies, PCM recommendations can be expected to be increasingly guided by European supranational entities, a dimension that will be taken into account in the ACME project through involvement of European stakeholders in specific steps.
The general objectives of the ACME project are to:
1. Assess determinants, facilitators and barriers of uptake/adherence, confidence and social equity regarding PCMs in epidemic situations in France, and identify approaches to monitor these factors for epidemic preparedness that should be implemented in non-epidemic periods (WP1).
2. Develop potential scenarios of epidemic diseases and relevant PCMs, and evaluate preferences around corresponding strategies and programmes among the general population, HCWs and other relevant subgroups (WP2).
3. Prepare interventional research on confidence-building and inclusive PCM programmes in epidemic situations, by identifying experiences reported in France and elsewhere (case studies) and evaluate their transferability to an epidemic context in France (WP3).
4. Develop recommendations and roadmaps towards strategies and programmes that assure acceptability and accessibility of PCMs during epidemic situations in France and Europe, elaborate pre-protocols (blueprints) for rapid implementation of interventional research in future emergencies, and prepare their transfer and implementation into research and public health action for epidemic preparedness (WP4).
Bruno Ventelou (bruno.ventelou@univ-amu.fr)