Exploring the critical risk factors in COVID-19 vaccination clinics aimed uncertainty: Insight from Pakistan

One of the key lessons emerging from the COVID-19 pandemic is the necessity of assessing and strengthening the operational capacity of COVID-19 vaccination clinics (CVCs) to ensure effective response and service delivery during current and future pandemics. Countries with more robust and resilient CVC infrastructure were better equipped to manage mass vaccination efforts compared to those with constrained capacities. This study focuses on Pakistan, a lower-middle-income country, where mass vaccination campaigns across five regions encountered substantial operational challenges due to limited CVC capacity. Therefore, the main objective of this study is to develop a decision support framework and identify CVCs critical capacity factor criteria for regional risk ranking. Secondly, to analyse the negative impact of one most critical factor's weight change on other factors in each capacity domain and the ranking of five different regions under the uncertainty of the COVID-19 pandemic.

CVC's capacity domains and associated risk factors are identified from the literature, and a decision support framework is constructed based on the consensus of expert opinion through the Delphi technique. Further, secondary data is extracted from Pakistan's national COVID-19 vaccination database. Overall, CVC's capacity risk evaluation process is comprised of the entropy weight method, grey rational analysis (GRA), and the new weight change method. The Shannon entropy weight method was used to determine the criteria weight. The GRA was based on the grey system theory. It was adopted for regional risk ranking and the sequential process. The new weight change method was selected for the sensitivity analysis.

The study identified nine critical factor criteria for evaluating CVCs capacity: Operational status, Monitoring of CVCs, Standee/charts providing basic COVID-19 information, Availability of smart devices for data entry and reporting, Minimum number (0-50) of vaccinations per shift, Staff trained in cold chain management, Vaccine administration checklist, Staff trained to identify Adverse Events Following Immunization (AEFI), and Display of Healthcare Waste Management (HCWM) guidelines. The regional risk ranking revealed that Sindh and Khyber Pakhtunkhwa (KPK) were categorized as high-risk regions, while Baluchistan was assessed as moderate risk. In contrast, Punjab and other composite regional areas exhibited low risk, indicating relatively stronger preparedness and operational performance.

This research provides a comprehensive CVC capacity risk assessment. Findings from this research may provide key information that can be helpful in countries where health systems are facing severe CVC capacity constraints.