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The “Let ́s Control Flu” (LCF) is a high-level online digital tool to support Public Health Policy (PHP) decision-making, with the aim of increasing Influenza Vaccination Coverage Rates (VCR) to at least 75% in EU countries, a goal defined by the WHO and reiterated by the ECDC.

The LCF project allows to easily compare countries' influenza-related PHP through a gamification tool. Different policies are organized according to a five pillars of vaccination policy, and each of the five pillars has different components or policies. These policies affect parameter values - vaccine coverage rates - with in a compartmental model, allowing decision-makers to assess the impact of such policies on outcomes using modelled scenarios that provide a real-time view of how different combinations of health policies focused on VCR may affect influenza control outcomes and outputs.

In summary, the project employs a gamification process, aligned with what has been produced in other assessment studies designed to support public health decision-making. The LCF tool empowers both patient advocacy and PHP decision-making enabling users to create epidemiological scenarios with technological opacity, meaning that the user does not have to master epidemiological modelling techniques or search for statistical datasets, thus being an empowerment tool for health democracy.

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Influenza is not a common cold. It is a serious disease that can lead to severe complications. It spreads easily from person to person, primarily through saliva droplets, contact with people who cough or sneeze, and indirectly via respiratory secretions on hands, handkerchiefs, and similar items. The contagious period can begin 1 to 2 days before symptoms and lasts up to 7 days after, though this period may be longer in children.

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Influenza vaccination is the best tool for preventing the disease. Vaccines have been one of the greatest advances in human health, helping to control – and in some cases eradicate - several diseases. Currently, there are over 20 vaccine-preventable diseases, including smallpox, diphtheria, measles, mumps, rabies, tetanus, pertussis, yellow fever, meningococcal disease, diseases caused by human papillomaviruses, polio, among others.

Vaccines work in two ways: they reduce the likelihood of contracting the disease and, if infection occurs, they provide greater protection against severe forms of the disease compared to being unvaccinated. However, vaccination does not guarantee 100% protection, as its effectiveness depends on different factors (e.g., age and health conditions).

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The LCF project is coordinated by the NOVA Center for Global Health, with the cooperation of several partners, including professionals in image, IT, management, modelling, and programming. The project also benefits from external validation through international scientific advising from a leading public health school, as well as National Advisory Boards with Key Opinion Leaders in influenza from Sweden, Czechia and Germany.

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The LCF tool is designed to help flu-related stakeholders better understand how different PHP decisions may affect the influenza epidemics in selected countries. Although the project identifies several stakeholder groups, anyone can use the LCF tool.

The tool is structured in layers of knowledge about influenza, ensuring it remains user friendly for everyone from individuals interested in flu but who are not experts (such as citizens or individuals affected by influenza), to specialists who may benefit from the bibliography and supporting materials provided by the model.

The main target users are PHP decision-makers, such as health authorities and politicians related to health, NGOs and influenza patient associations. The general population is also a secondary target audience.

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The tool allows the user to choose any number of public health policies from the 13 included in the project, with the degree of “implemented” or “not implemented” in the country, applied to a set of populations also defined by the user.

The landing page of the tool allows the user to choose the country of application and the output years, from 2022 until 2031. The public health policies of the reference country that are currently implemented at a national level are pre-selected in the LCF tool.

In this page it is possible to consult the national and population baseline vaccination coverage rates, in percentage and absolute values. It is also possible to verify the baseline values for the different outputs and populations.

By selecting other policies other than the pre-selected set, the tool will provide a modelled scenario with updated values for each indicator, having as basis the baseline value for comparison. Gains in health are identified in green highlight and in red if the values are losses in relation to the baseline.

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The LCF tool is based on thirteen policies derived from the Kassianos model, organized into five pillars: Health authority accountability; Facilitated access to vaccination; Healthcare professional accountability and engagement; Awareness of the burden and severity of the disease; Belief in influenza vaccination benefits.

The thirteen policies in the LCF model are as follows:

Pillar #1 - Health authority accountability & strengths of the influenza immunisation programme

Policy 1. Vaccination coverage rates targets set at national and regional levels for recommended populations.

Policy 2. Funding of flu vaccinations for all recommended groups.

Policy 3. Nationwide regular monitoring of patient vaccination coverage rates at vaccination site/healthcare provider level by health authority.

Policy 4. Healthcare provider vaccination coverage rates as part of performance criteria in hospitals.

Policy 5. Sustainable procurement system to ensure appropriate vaccine supply.

Pillar #2 - Facilitated access to vaccination

Policy 6. Access to multiple vaccination settings.

Policy 7. Call-to-action communications to target groups by multiple stakeholders.

Policy 8. Healthcare provider pop-up notification/SMS to population to vaccinate eligible patients.

Pillar #3 - Healthcare professional accountability and engagement

Policy 9. Regular healthcare provider education and training.

Policy 10. Fair and specific healthcare provider compensation per vaccination.

Policy 11. Mandatory healthcare provider vaccination.

Pillar #4 - Awareness of the burden and severity of the disease

Policy 12. Coordinated multi-stakeholder awareness/communication campaigns.

Pillar #5 - Belief in vaccination benefits

Policy 13. Positive media coverage of vaccines.

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Seasonal influenza viruses evolve continuously and cause severe illness each year, particularly among the elderly, children, pregnant women and people with underlying chronic conditions. Although the European Union Health Council recommended increased vaccination of risk groups and healthcare workers by the Member States in 2009, the vaccine coverage rates in these populations remain belowthe recommended target of 75%.

To address this challenge, the LCF project focuses on the following populations:

• Children

• Elderly

• Pregnant Women

• Healthcare Workers

• High-risk population

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The tool allows users to select the country of application and the output years, within a period of 10 years. The public health policies currently implemented at the national level in the reference country are pre-selected in the LCF tool.

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The multidisciplinary teams involved in the LCF project ensure that the gamification tool is built with several layers of reliability and security, including: 1) the use of indexed scientific bibliographic references; 2) control, analysis and validation of all the steps that are taken by all LCF partners in the tool construction process, by a university, in this case the NOVA Center for Global Health, of the NOVA University from Lisbon, followed by discussion and validation by the National Advisory Board in the context of its application to the country’s specific cultural health ecosystem; 3) discussion, validation and external evaluation by International Scientific Advisor.

Another important feature of the project is that, as new scientific references or status reports with more current, detailed, or credible data become available, existing references can be updated to improve the model’s accuracy. Naturally, given the dynamic nature of public health policies, there is a degree of unpredictability stemming from the evolution of the cultural health ecosystem itself. For example, the sudden and intense behavioral changes among European citizens during the war between Ukraine and Russia.

Scientific articles, reports and other bibliographic elements are cited on the LCF website according to their title to allow easy queries in search engines, without overloading the LCF tool display, specially on smaller screen devices.

See the bibliographical references used in the LCF Project.

The LCF project research receives funding from the pharmaceutical industry through Sanofi. The research is completely independent from the funding sponsoring.

The website in all countries where the LCF tool is applied will be available in the local language and in English.

The LCF tool is available across multiple platforms, including computer, tablet and mobile devices, through browser and apps (iOS and Android).

A contact form is available if you need more information about the LCF project. You are also invited to contribute with suggestions, ideas, data, and anything useful for improving influenza vaccination campaigns. Even a small contribution can prove to be very important as there is still much to be known, but that is already verified in thesis, research not yet published and other works/experiences.

Sometimes even personal experiences can be a relevant element to help contextualize existing data. Therefore, regardless of academic background, everyone is encouraged to contribute, as progress in science depends on gathering knowledge from all sources.