Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

My recommendation: Major Revision

The manuscript addresses an important and timely topic—interoperable vaccination records—and presents a broad, cross‑national perspective enriched by examples from the Nordic countries, the UK, and the US. The paper is well‑organized and readable, and the roadmap it proposes is conceptually sound.

However, the manuscript in its current form has several limitations:

The novelty of the work is insufficiently articulated; much of the content synthesizes existing knowledge without clearly stating what new insights the manuscript contributes.

The evidence base lacks methodological description, making the manuscript read more like an opinion piece than a rigorous scientific analysis.

Several claims regarding feasibility and benefits of interoperability are not supported by empirical data.

The roadmap, while thoughtful, is too high‑level and needs operational detail to be actionable.

With revisions that clarify novelty, formalize the methodological approach, strengthen evidence, and operationalize the roadmap, the manuscript has the potential to make a meaningful contribution to the field.

 

Summary for the Authors

Dear Authors,

Thank you for submitting your manuscript on interoperable vaccination records. Your work addresses an increasingly important global challenge in health informatics. Below is a summary of the key points that, if addressed, will significantly strengthen the manuscript.

 

1. Clarify the Novel Contributions

Your manuscript synthesizes existing practices in vaccination records across the Nordic countries, the UK, and the US, and proposes a conceptual roadmap. However, the paper does not clearly articulate what is new compared with existing literature on interoperability, immunization information systems, or computable vaccination artifacts.

Consider highlighting:

• What unique insights your cross‑national comparison reveals
• How your roadmap advances or diverges from existing frameworks
• Any original technical, policy, or operational recommendations

2. Enhance Methodological Transparency

As a perspective paper, your narrative approach is understandable, but the manuscript would benefit from a brief description of:

• How you selected countries, examples, and references
• What criteria guided the synthesis of challenges and solutions
• How stakeholder roles were defined (e.g., individuals, providers, authorities)

This addition will improve the perceived scientific integrity of the work.

3. Strengthen Empirical Support for Claims

Certain statements—such as the improvements in safety, reduction in redundant vaccination, and enhanced data quality from interoperable records—are well reasoned but not empirically demonstrated.

Where possible:

• Include data from countries with existing national registries
• Cite evidence on the impact of interoperability on patient outcomes or system efficiency
• Add examples showing measurable improvements from existing digital immunization systems

4. Provide Evidence for Sociopolitical Assertions

Your discussion of cultural, political, and social barriers is important, but some assertions (e.g., media misinformation, politicization of vaccines) are not accompanied by specific sources.

To improve overall rigor:

• Support statements with public health studies or surveys
• Distinguish between observations grounded in evidence and author interpretations
• Consider adding regional differences where relevant

5. Operationalize the Proposed Roadmap

Figure 4 captures the high‑level dimensions (social/cultural, political, technical, policy) needed for interoperability. Yet, the roadmap remains conceptual.

Strengthen it by adding:

• Specific implementation steps
• Stakeholder roles and accountabilities
• Milestones or maturity levels
• Examples of successful approaches
• Guidance on harmonizing national versus regional policies

This would greatly improve the manuscript’s utility for policymakers and implementers.

 

Closing Remarks:

Your manuscript offers a valuable multidisciplinary perspective on an important global health challenge. With revisions addressing novelty, evidence, methodological clarity, and practical applicability, it can become a strong contribution to the literature on vaccination informatics and interoperability.

I look forward to seeing a revised version.

Author Response

Please see the attached file for a point-by-point response to all reviewers' comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The study briefly described  vaccination records and their practices in the Nordic countries, the UK, and the USA. The comments are as follows:

1. The authors selected Nordic countries, US and USA as study sites. The reasons of selection need to be elaborated, e.g., similitary and difference of vaccination records and practices policies among the sites. It is better to use tables to compare them. 
2. For Figure 1, has it drawn by the authors or from literature? If latter, the authors need to provide the origin of the figure, as well as figures 3 and 4.
3. Line 81-83, can the figure explain the situation in UK and Nordic countries, besides the USA?
4. Figure 2 can be presented as a supplementary file. 
5. It is better to present more comparison between the three regions (Nordic countries, UK and USA) in the manuscript, as more details in the USA system have been presented in this study. 
6. The reference style needs to follow the requirement of the journal. 

Author Response

Please see the attached file for the point-by-point responses to the reviewer's comments.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

Thanks for addressing my comments.

The manuscript is ready now for publication.

Regards,

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have revised the manuscript according to the reviewer's comments. Thus, the manuscript can be accepted after proofreading.