Human-Centered Design to Respond to Public Health Crises: Maintaining Canine Rabies Vaccination during the COVID-19 Pandemic in Peru

Ricardo Castillo-Neyra Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania;
Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Ricardo Castillo-Neyra in
Current site
Google Scholar
PubMed
Close
,
Elvis W. Díaz Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Elvis W. Díaz in
Current site
Google Scholar
PubMed
Close
,
Lizzie Ortiz-Cam Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Lizzie Ortiz-Cam in
Current site
Google Scholar
PubMed
Close
,
Guillermo Porras Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Guillermo Porras in
Current site
Google Scholar
PubMed
Close
,
Micaela De La Puente-León Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Micaela De La Puente-León in
Current site
Google Scholar
PubMed
Close
,
Gian Franco Condori Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Gian Franco Condori in
Current site
Google Scholar
PubMed
Close
,
Olimpia Chuquista-Alcarraz National Epidemiology, Prevention, and Disease Control Center, Ministry of Health, Lima, Peru;

Search for other papers by Olimpia Chuquista-Alcarraz in
Current site
Google Scholar
PubMed
Close
,
Sergio E. Recuenco Department of Preventive Medicine and Public Health, Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru;

Search for other papers by Sergio E. Recuenco in
Current site
Google Scholar
PubMed
Close
,
Laura D. Tamayo Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;

Search for other papers by Laura D. Tamayo in
Current site
Google Scholar
PubMed
Close
,
Alison M. Buttenheim Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania;

Search for other papers by Alison M. Buttenheim in
Current site
Google Scholar
PubMed
Close
, and
Valerie A. Paz-Soldan Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru;
Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana

Search for other papers by Valerie A. Paz-Soldan in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

In the early coronavirus disease 2019 pandemic, limited understanding of severe acute respiratory syndrome coronavirus 2 transmission and fears of infection hindered mass dog vaccination efforts in dog rabies-affected areas. Interruption of dog rabies vaccination campaigns could lead to a rapid increase in the risk of human rabies. To address these challenges, we applied human-centered design (HCD) principles to develop a vaccination strategy that prioritizes safety while ensuring dog rabies vaccination continuity in Arequipa, Peru, a rabies-affected area. We describe the process of rapid prototyping and testing undertaken by our research team to adapt the vaccination process in response to a health crisis. A multidisciplinary team met twice a week to prototype a fixed-point vaccination campaign that ensured distancing and reduction of fomite transmission while allowing for the continuation of dog vaccination. Field notes and videos informed successive meetings. The final prototype was used in rabies hotspots. In 4 weeks, six prototypes of safe booths and supporting safety protocols were designed, and two copies of each prototype were field tested. During testing, additional innovations were identified and implemented, including virtual vaccine certificates and online data collection forms. The final prototype was implemented across 251 sites, and 17,876 dogs were vaccinated. Using HCD principles, we swiftly developed a mass vaccination strategy that provided safety and enabled the maintenance of rabies vaccination programs. This work highlights the importance of innovative and adaptive approaches to address public health challenges in times of crisis.

Author Notes

Financial support: This project was supported by NIH-National Institute of Allergy and Infectious Diseases grants K01AI139284 (R. Castillo-Neyra), R01AI168291 (R. Castillo-Neyra), and NIH-Fogarty International Center grant D43TW012741 (R. Castillo-Neyra, E.W. Díaz, L. Ortiz-Cam, G.F. Condori, L.D. Tamayo, V. Paz-Soldan). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosure: The views expressed in this publication do not necessarily reflect the views of the National Center for Epidemiology, Prevention, and Disease Control Center (CDC Peru). Our research team has institutional review board (IRB) approval from University of Pennsylvania, Universidad Peruana Cayetano Heredia, and Tulane for conducting a canine rabies vaccination program in Arequipa (IRB 823736, 65369, and 606720, respectively). The work described in this article was not part of our human subjects work but rather a description of the research team’s internal logistics required to adapt strategies to be able to continue the important vaccination processes during the COVID-19 pandemic when Peru was in lockdown for an extended period.

Current contact information: Ricardo Castillo-Neyra, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: cricardo@upenn.edu. Elvis W. Díaz, Lizzie Ortiz-Cam, Guillermo Porras, Micaela De La Puente-León, Gian Franco Condori, and Laura D. Tamayo, Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: ede1089@gmail.com, lizzie.ortiz@upch.pe, gmporrasc@gmail.com, virginia.de.la.puente@upch.pe, francoguns16@gmail.com, and lauratamayo41@gmail.com. Olimpia Chuquista-Alcarraz, National Epidemiology, Prevention, and Disease Control Center, Ministry of Health, Lima, Peru, E-mail: olimpia.chuquista@upch.pe. Sergio E. Recuenco, Department of Preventive Medicine and Public Health, Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru, E-mail: sergio.recuenco@gmail.com. Alison M. Buttenheim, Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, E-mail: abutt@nursing.upenn.edu. Valerie A. Paz-Soldan, Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, and Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, E-mail: vpazsold@tulane.edu.

Address correspondence to Ricardo Castillo-Neyra, 715 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104. E-mail: cricardo@upenn.edu
  • 1.

    Coleman PG, Dye C, 1996. Immunization coverage required to prevent outbreaks of dog rabies. Vaccine 14: 185186.

  • 2.

    Vigilato MAN, Clavijo A, Knobl T, Silva HMT, Cosivi O, Schneider MC, Leanes LF, Belotto AJ, Espinal MA, 2013. Progress towards eliminating canine rabies: Policies and perspectives from Latin America and the Caribbean. Philos Trans R Soc Lond B Biol Sci 368: 20120143.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    WHO, 2023. Expert Consultation on Rabies: Third Report. Geneva, Switzerland: WHO. Available at: https://www.paho.org/en/documents/who-expert-consultation-rabies-third-report. Accessed August 15, 2024.

    • PubMed
    • Export Citation
  • 4.

    Pan-American Health Organization, 2015. Epidemiological Alert, Rabies (12 June 2015). Washington, DC: Pan-American Health Organization. Available at: https://iris.paho.org/handle/10665.2/50674. Accessed August 15, 2024.

    • PubMed
    • Export Citation
  • 5.

    Ministry of Health, 2017. Resolución Ministerial N.° 024-2017-MINSA. Lima, Peru: Ministry of Health. Available at: https://www.gob.pe/institucion/minsa/normas-legales/190520-024-2017-minsa. Accessed August 15, 2024.

    • PubMed
    • Export Citation
  • 6.

    Castillo-Neyra R, Toledo AM, Arevalo-Nieto C, MacDonald H, De la Puente-León M, Naquira-Velarde C, Paz-Soldan VA, Buttenheim AM, Levy MZ, 2019. Socio-spatial heterogeneity in participation in mass dog rabies vaccination campaigns, Arequipa, Peru. PLoS Negl Trop Dis 13: e0007600.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Kunkel A, Jeon S, Joseph HC, Dilius P, Crowdis K, Meltzer MI, Wallace R, 2021. The urgency of resuming disrupted dog rabies vaccination campaigns: A modeling and cost-effectiveness analysis. Sci Rep 11: 12476.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Nadal D, Abela-Ridder B, Beeching S, Cleaveland S, Cronin K, Steenson R, Hampson K, 2022. The impact of the first year of the COVID-19 pandemic on canine rabies control efforts: A mixed-methods study of observations about the present and lessons for the future. Front Trop Dis 3: 866811.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Raynor B, Díaz EW, Shinnick J, Zegarra E, Monroy Y, Mena C, De la Puente-León M, Levy MZ, Castillo-Neyra R, 2021. The impact of the COVID-19 pandemic on rabies reemergence in Latin America: The case of Arequipa, Peru. PLoS Negl Trop Dis 15: e0009414.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Corrales MG, León D, Falcón N, 2023. Influencia de la pandemia COVID-19 sobre la tenencia de canes y vacunación antirrábica en Lima Metropolitana. Rev Investig Vet Perú 34: e25103.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Ministerio de Salud, 2020. Recomendaciones MINSA Ante La Emergencia Mascotas. Lima, Peru: Ministerio de Salud. Available at: https://es.scribd.com/document/457234892/recomendaciones-MINSA-ante-la-emergencia-mascotas. Accessed August 15, 2024.

    • PubMed
    • Export Citation
  • 12.

    Ho LL, Gurung S, Mirza I, Nicolas HD, Steulet C, Burman AL, Danovaro-Holliday MC, Shoda SV, Kretsinger K, 2022. Impact of the SARS-CoV-2 pandemic on vaccine-preventable disease campaigns. Int J Infect Dis 119: 201209.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Colwell RR, Machlis GE, 2018. Science During Crisis: Best Practices, Research Needs, and Policy Priorities. Cambridge, MA: American Academy of Arts & Sciences. Available at: https://www.amacad.org/publication/science-during-crisis/section/2. Accessed August 15, 2024.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wera E, Mourits MCM, Hogeveen H, 2017. Cost-effectiveness of mass dog rabies vaccination strategies to reduce human health burden in Flores Island, Indonesia. Vaccine 35: 67276736.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Castillo-Neyra R, Brown J, Borrini K, Arevalo C, Levy MZ, Buttenheim A, Hunter GC, Becerra V, Behrman J, Paz-Soldan VA, 2017. Barriers to dog rabies vaccination during an urban rabies outbreak: Qualitative findings from Arequipa, Peru. PLoS Negl Trop Dis 11: e0005460, https://doi.org/10.1371/journal.pntd.0005460.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    CENEPRED, 2021. Escenario de Riesgo Por COVID-19 Para la Ciudad de Arequipa en el Departamento de Arequipa (Biblioteca SIGRID). Lima, Peru: CENEPRED. Available at: https://sigrid.cenepred.gob.pe/sigridv3/documento/10386. Accessed August 15, 2024.

    • PubMed
    • Export Citation
  • 17.

    Kautsar IA, Maika MR, 2021. The use of User-Centered Design Canvas for Rapid Prototyping. J Phys: Conf Ser 1764: 012175.

  • 18.

    Rosenfield PL, 1992. The potential of transdisciplinary research for sustaining and extending linkages between the health and social sciences. Soc Sci Med 35: 13431357.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Göttgens I, Oertelt-Prigione S, 2021. The application of human-centered design approaches in health research and innovation: A narrative review of current practices. JMIR MHealth UHealth 9: e28102.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Gibson AD et al., 2018. One million dog vaccinations recorded on mHealth innovation used to direct teams in numerous rabies control campaigns. PLoS ONE 13: e0200942.

  • 21.

    Luo Y, Heneghan C, Persaud N, 2023. Catalogue of bias: Novelty bias. BMJ Evid-Based Med. 28: 410411. https://ebm.bmj.com/content/early/2023/05/15/bmjebm-2022-112215.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Chen E, Neta G, Roberts MC, 2021. Complementary approaches to problem solving in healthcare and public health: Implementation science and human-centered design. Transl Behav Med 11: 11151121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Johnson T, Das S, Tyler N, 2021. Design for health: Human-centered design looks to the future. Glob Health Sci Pract 9: S190S194.

  • 24.

    McKinnon B et al., 2022. Using human-centred design to tackle COVID-19 vaccine hesitancy for children and youth: A protocol for a mixed-methods study in Montreal, Canada. BMJ Open 12: e061908.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Scanzera AC, Beversluis C, Potharazu AV, Bai P, Leifer A, Cole E, Du DY, Musick H, Chan RVP, 2023. Planning an artificial intelligence diabetic retinopathy screening program: A human-centered design approach. Front Med (Lausanne) 10: 1198228.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Bazzano AN, Martin J, Hicks E, Faughnan M, Murphy L, 2017. Human-centred design in global health: A scoping review of applications and contexts. PLoS ONE 12: e0186744.

  • 27.

    Melles M, Albayrak A, Goossens R, 2021. Innovating health care: Key characteristics of human-centered design. Int J Qual Health Care 33: 3744.

  • 28.

    Schoonderwoerd TAJ, Jorritsma W, Neerincx MA, van den Bosch K, 2021. Human-centered XAI: Developing design patterns for explanations of clinical decision support systems. Int J Hum-Comput Stud 154: 102684.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Black CJ et al., 2023. Applying human-centered design in global mental health to improve reach among underserved populations in the United States and India. Glob Health Sci Pract 11: e2200312.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Shrier LA, Burke PJ, Jonestrask C, Katz-Wise SL, 2020. Applying systems thinking and human-centered design to development of intervention implementation strategies: An example from adolescent health research. J Public Health Res 9: jphr.2020.1746.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Altman M, Huang TTK, Breland JY, 2018. Design thinking in health care. Prev Chronic Dis 15: E117.

  • 32.

    Catalani C, Green E, Owiti P, Keny A, Diero L, Yeung A, Israelski D, Biondich P, 2014. A clinical decision support system for integrating tuberculosis and HIV care in Kenya: A human-centered design approach. PLoS ONE 9: e103205.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Pu L, 2019. Co-Design Approach: A Collective Design Method for Improving Working Efficiency and Satisfaction in User Support Design Processes: An Empirical Study Based on Three Comparison Groups Simulating a Real-World Quick Start Guide Design Process. MSc Thesis, Behavioural, Management and Social Sciences, University of Twente: Enschede, The Netherlands. Available at: https://essay.utwente.nl/79455/. Accessed August 15, 2024.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 3301 3301 2000
Full Text Views 51 51 0
PDF Downloads 52 52 0
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save