# Decision-making for pediatric vaccination scheduling under multiple constraints: a case study from China✰

## TL;DR

This study introduces a scheduling method to improve pediatric vaccination services in China, balancing routine and outbreak-related demands.

## Contribution

A quantitative decision-support approach for pediatric vaccination scheduling under operational constraints.

## Key findings

- The approach reduces day-to-day fluctuations in vaccination volume and improves predictability.
- Routine immunization services remain stable even during influenza outbreaks.
- Structured scheduling enhances operational efficiency and resource use in vaccination centers.

## Abstract

Providing timely and equitable pediatric vaccination services is a fundamental responsibility of public health systems. As vaccination schedules become more complex-with an increasing number of vaccines, age-specific eligibility rules, and strict dose interval requirements-vaccination centers are under growing pressure to manage routine services while still being able to respond to epidemic-related demand.

This study presents a quantitative decision-support approach designed to assist pediatric vaccination scheduling under real-world operational constraints, including age eligibility, inter-dose intervals, and daily service capacity. Using data from a public health vaccination center in Shenzhen, China, the approach is applied to develop balanced vaccination schedules for both routine childhood immunization and periods of increased demand during influenza outbreaks.

Compared with conventional walk-in or unscheduled vaccination practices, the proposed approach noticeably reduces day-to-day fluctuations in vaccination volume and makes service delivery more predictable. Daily vaccination workloads stabilize over time, which helps vaccination centers plan staffing more efficiently and use resources more effectively. Even when additional demand related to influenza outbreaks is taken into account, routine immunization services remain stable, suggesting that adequate capacity can be maintained for emergency situations.

By making vaccination schedules more balanced and predictable, this approach offers practical decision support for public health vaccination centers. The findings suggest that more structured scheduling can improve operational efficiency, strengthen preparedness for epidemic outbreaks, and help ensure equitable access to pediatric immunization services.