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Charles CM, Noles M, Munezero A, Gallardo N, Bahamondes L, Bento SF, de Pádua KS, Nhauche M, Metelus S, Cecatti JG, Souza RT, Pacagnella RC. Risk factors related to the SARS-CoV-2 vaccine additional doses hesitancy among pregnant and non-pregnant people of reproductive age and partners: A Brazilian cross-sectional study. Int J Gynaecol Obstet 2024; 166:1144-1160. [PMID: 38532554 DOI: 10.1002/ijgo.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The aim of this study was to assess the predictors of acceptance and hesitancy of additional doses of any SARS-CoV-2 (COVID-19) vaccine among pregnant or recently pregnant and non-pregnant people of reproductive age and partners in Brazil. METHODS We conducted an online cross-sectional study from June 2022 to April 2023 and invited women and partners between 18 and 49 years old to participate. We employed a snowball strategy to reach all potential eligible participants. Our primary outcome was the acceptance rate of the COVID-19 booster vaccine. We estimated the frequency and percentage for the three groups and compared categorical variables using the Chi-square test. Moreover, bivariate, backward stepwise regression, and subgroup analyses were performed to evaluate risk factors and predictors of COVID-19 vaccine booster hesitancy. We reported the effect size as OR with a 95% CI. RESULTS We included 1487 participants, and among them, 334 (22.5%) were pregnant or recently pregnant people, 905 (60.8%) were non-pregnant people, and 247 (16.6%) were male partners. Pregnant and recently pregnant people showed greater hesitancy for the COVID-19 vaccine booster than non-pregnant people (28% vs 15%, P < 0.001) and male partners (28% vs 16%, P < 0.001). Non-pregnant women accepted the COVID-19 vaccine more often than pregnant or recently pregnant people (OR 1.75; 95% CI: 1.13-2.70). The associated factors to the reduced COVID-19 vaccine booster acceptance were family income between US$ 566-945.00 (54%), evangelic religion (65%), concern about vaccine safety (80%) and perceived common vaccine importance (93%). CONCLUSION Pregnant people were more hesitant than non-pregnant people to accept the COVID-19 booster vaccine. Family income, religious beliefs, vaccine safety concerns, and perceived common vaccine importance were significant barriers to accepting COVID-19 booster vaccines. The impact of these factors was more evident among pregnant or recently pregnant people, emphasizing the harmful effect of misinformation among this vulnerable population.
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Affiliation(s)
- Charles M Charles
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
- Provincial Health Administration, DPS Manica, Chimoio, Mozambique
| | - Marcelo Noles
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
| | - Aline Munezero
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
| | - Negli Gallardo
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brazil
| | - Silvana F Bento
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brazil
- Women's Hospital "Prof. Dr. José A Pinotti" - Center for Integral Attention to Women (CAISM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Karla S de Pádua
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brazil
- Women's Hospital "Prof. Dr. José A Pinotti" - Center for Integral Attention to Women (CAISM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Marta Nhauche
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
| | - Sherly Metelus
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
| | - José G Cecatti
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas - (UNICAMP), Campinas, SP, Brazil
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McKeithen MC, Gilkey MB, Kong WY, Oh NL, Heisler-MacKinnon J, Carlson R, James G, Grabert BK. Policy Approaches for Increasing Adolescent HPV Vaccination Coverage: A Systematic Review. Pediatrics 2024; 153:e2023064692. [PMID: 38623635 PMCID: PMC11035154 DOI: 10.1542/peds.2023-064692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/17/2024] Open
Abstract
CONTEXT US jurisdictions have enacted a wide range of policies to address low human papillomavirus (HPV) vaccination coverage among adolescents, but it is unclear which policies are effective. OBJECTIVE To systematically review the impact of governmental policies on adolescent HPV vaccination coverage. DATA SOURCES PubMed, Embase, and Scopus databases. STUDY SELECTION Eligible studies, published from 2009 to 2022, evaluated the impact of governmental policies on HPV vaccination coverage among adolescents ages 9 to 18. DATA EXTRACTION Two investigators independently extracted data on study sample, study design and quality, policy characteristics, and HPV vaccination outcomes. We summarized findings by policy type: school-entry requirements (SERs), federally-funded policies related to the Vaccines for Children program and Medicaid, educational requirements, and others. RESULTS Our search yielded 36 eligible studies. A majority of studies evaluating HPV vaccine SERs found positive associations between SERs and HPV vaccination coverage (8 of 14), particularly for SERs in Rhode Island and Washington, DC. All studies evaluating SERs for other adolescent vaccines observed positive spillover effects for HPV vaccination (7 of 7). Federally-funded policies related to Vaccines for Children and Medicaid were consistently associated with higher HPV vaccination coverage (7 of 9). Relatively few studies found associations between educational requirements and HPV vaccination coverage (2 of 8). LIMITATIONS Studies used limited vaccination data sources and non- or quasi-experimental designs. Some studies had no or poorly matched comparison groups. CONCLUSIONS Our findings suggest promise for SERs and federally-funded policies, but not educational requirements, for increasing HPV vaccination coverage among adolescents.
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Affiliation(s)
| | - Melissa B. Gilkey
- Gillings School of Global Public Health
- Lineberger Comprehensive Cancer Center
| | | | - N. Loren Oh
- Gillings School of Global Public Health
- School of Medicine
| | | | - Rebecca Carlson
- Health Sciences Library
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Greeshma James
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Brigid K. Grabert
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Alhajji M, Alzeer AH, Al-Jafar R, Alshehri R, Alyahya S, Alsuhaibani S, Alkhudair S, Aldhahiri R, Alhomaid A, Alali D, Alothman A, Alkhulaifi E, Alnashar M, Alalmaee A, Aljenaidel I, Alsaawi F. A national nudge study of differently framed messages to increase COVID-19 vaccine uptake in Saudi Arabia: A randomized controlled trial. Saudi Pharm J 2023; 31:101748. [PMID: 37662677 PMCID: PMC10472300 DOI: 10.1016/j.jsps.2023.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background During the COVID-19 pandemic, Saudi Arabia witnessed hesitancy from a proportion of the population toward taking the vaccine; thus, it was necessary to nudge them to uptake it. This study was conducted to assess the impact of using different types of messages to nudge the public to increase the proportion of vaccinated individuals. Methods This study is a multi-arm randomized controlled trial aiming to assess the efficacy of using differently framed messages that appear as pop-notifications in Sehatty application. Of those who preregistered to receive a COVID-19 vaccine but didn't take it according to the Saudi national vaccine registry (n = 1,291,686), 12,000 individuals were randomly recruited and randomly assigned to one of five intervention groups (commitment, loss aversion, salience, social norms, and ego) or a control group. To ensure the exposure occurred in the intervention groups, we included only those who received the notification, which was confirmed by checking the information technology system. We used the Chi-square test to compare each intervention group against the control group separately. Also, we used the same test to investigate whether sex and age influenced the percentage of booked appointments in the intervention groups. Results Social norms, ego, salience and loss aversion groups had higher percentages of booked appointments when compared to the control group (21.0%, p = 0.001; 19.1%, p = 0.011; 19.0%, p = 0.013; 18.4%, p = 0.034, respectively). Moreover, when combining the intervention groups, the percentage was higher than the control group (p < 0.001). The percentages of booked appointments made by Young adults (18-35 years old) were higher than that of adults over 35 years old in the social norms (22.6%, p = 0.016) and ego groups (21.0%, p = 0.010). At the same time, sex didn't affect the percentages of booked appointments in any group. Conclusion Using different framings of messages to nudge the public to take vaccines can help increase the percentage of immunized individuals in a community. Nudges can boost the public health of a population during an unusual spread of vaccine-preventable diseases. Findings might also inspire governmental responses to other public health situations.
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Affiliation(s)
| | - Abdullah H. Alzeer
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Rami Al-Jafar
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
- School of Public Health, Imperial College London, London, UK
| | - Reem Alshehri
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alyahya
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
| | - Sara Alsuhaibani
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sarah Alkhudair
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Raghad Aldhahiri
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Ahmed Alhomaid
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Dalal Alali
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Fahad Alsaawi
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
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Araujo-Chaveron L, Sicsic J, Moffroid H, Díaz Luévano C, Blondel S, Langot F, Mueller JE. Impact of a COVID-19 certificate requirement on vaccine uptake pattern and intention for future vaccination. A cross-sectional study among French adults. Vaccine 2023; 41:5412-5423. [PMID: 37481404 DOI: 10.1016/j.vaccine.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/02/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND In August 2021, France enacted a COVID-19 certificate requirement (vaccination/recovery/test) to access specific services, with mandates for professional groups. We evaluated the impact of this incentive-coercive policy in terms of vaccine uptake equality, future vaccine intention and confidence in authorities' crisis management. METHODS In late August 2021, a representative sample of adults (18-75 years) completed an internet-based questionnaire. We classified vaccinated participants by stated reasons for vaccination and estimated adjusted prevalence ratios (aPR) using multivariable Poisson regression. Counterfactual vaccine status assumed non-vaccination of those vaccinated for the certificate. We analysed the association of free-text testimonial themes with level of confidence in authorities. RESULTS Among 972 participants, 85.7% were vaccinated or intended vaccination: 3.6% only for certificate/mandate, 17.7% mainly for certificate/mandate plus other reasons, and 64.4% mainly for other reasons. In the counterfactual situation, vaccine uptake would have been significantly more likely among older vs. younger participants (aPR = 1.35) and among those with moderate-high vs. low levels of confidence in authorities for COVID-19 crisis management (aPR = 2.04). In the observed situation, confidence was the only significant determinant of vaccine status (moderate-high vs. low, aPR = 1.39). Among those without genuine motivation for vaccination, professionally active persons were more likely to have ceded to the certificate requirement (aPR = 3.76). Those vaccinated only for the certificate were more likely to express future COVID-19 vaccine intention than unvaccinated persons (aPR = 6.41). Themes significantly associated with lower confidence were criticism of morality (aPR = 1.76) and poor communication by the authorities (aPR = 1.66). CONCLUSION The incentive-coercive policy has reduced the negative association of vaccine status with younger age and low confidence in authorities, but may have reinforced isolation of professionally inactive persons. The requirement did not negatively impact future COVID-19 vaccine intention. Future vaccine-incentive policies should pay special attention to populations with low levels of confidence in authorities.
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Affiliation(s)
- Lucia Araujo-Chaveron
- EHESP French School of Public Health, Rennes, France; Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France
| | | | - Hadrien Moffroid
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France; University of Melbourne, Australia
| | | | - Serge Blondel
- Université Paris Cité, LIRAES, F-75006 Paris, France; GRANEM - Groupe de Recherche Angevin en Economie et Management, Paris, France
| | - François Langot
- Le Mans Université (Gains-TEPP, IRA), Le Mans, France; IUF - Institut Universitaire de France, Paris, France; PSE - Paris School of Economics, Paris, France; CEPREMAP - Centre pour la recherche économique et ses applications, Paris, France; IZA - Forschungsinstitut zur Zukunft der Arbeit - Institute of Labor Economics, Bonn, Germany
| | - Judith E Mueller
- EHESP French School of Public Health, Rennes, France; Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France; Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, F-35000 Rennes, France.
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"Any idea how fast 'It's just a mask!' can turn into 'It's just a vaccine!'": From mask mandates to vaccine mandates during the COVID-19 pandemic. Vaccine 2022; 40:7488-7499. [PMID: 34823912 PMCID: PMC8552554 DOI: 10.1016/j.vaccine.2021.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 01/28/2023]
Abstract
Protests starting in the summer of 2020, notedly in the US and UK, have brought together two constituencies: pre-existing anti-vaccine groups and newly formed oppositional COVID-19 groups. The oppositional COVID-19 groups vary in composition and nature, but the central focus is a disagreement about the seriousness and threat of COVID-19 and with the public health measures to control COVID-19. What unites many disparate interests is an aversion to mandates. The compulsion to undertake particular public health activities such as mask-wearing and vaccination is a complex topic of public attitudes and beliefs alongside public health goals and messaging. We aim to analyse social media discussions about facemask wearing and the adoption of potential vaccines for COVID-19. Using media monitoring software MeltwaterTM, we analyse English-language tweets for one year from 1st June 2020 until 1st June 2021. We pay particular attention to connections in conversations between key topics of concern regarding masks and vaccines across social media networks. We track where ideas and activist behaviours towards both health interventions have originated, have similarities, and how they have changed over time. Our aim is to provide an overview of the key trends and themes of discussion concerning attitudes to and adoption of health measures in the control of COVID-19 and how publics react when confronted with mandatory policies. We draw on an already extensive literature about mandatory vaccination policies to inform our assessment, from psychology and behavioural science to ethics, political theory, sociology, and public policy.
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Attwell K, Rizzi M, Paul KT. Consolidating a research agenda for vaccine mandates. Vaccine 2022; 40:7353-7359. [PMID: 36396514 PMCID: PMC9662755 DOI: 10.1016/j.vaccine.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A workshop on mandatory vaccination was pitched to the World Public Health Congress in 2019 and the resultant special issue was pitched to Vaccine in 2020. During this project, the COVID-19 pandemic pushed vaccine policy to the forefront of global public health policy, and the imposition of vaccine mandates prompted a new wave of scholarship in the field. This introductory article employs the heuristic of Lasswell's (1956) policy cycle to synthesise the findings of the articles in the special issue. It considers the temporal lifetime of mandates and highlights findings regarding: the emergence of mandates as a policy option, public support and policy instrument design, what matters in the implementation of mandates, and what we can learn from evaluating them. The second half of the paper categorizes the included papers in terms of what aspects of mandates they study and the methods they employ to do so, in order to formulate a guide for future researchers of vaccine mandates. Scholars study either speculative or existing mandates - research can address several stages of the policy cycle or just one of them, ranging from attitudinal research to implementation studies and impact studies. Historical and contextual studies that take deep dives into a particular mandate are a much needed resource for studying emerging mandates, too, and scoping and framework- building work will undoubtedly be valuable in understanding and appreciating the wealth of knowledge production in this growing field. This special issue can serve as a roadmap for a consolidation of this interdisciplinary research agenda, and provide a helpful resource for decisionmakers at this historical juncture.
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Affiliation(s)
- Katie Attwell
- School of Social Science, The University of Western Australia, Perth, Australia.
| | - Marco Rizzi
- UWA Law School, The University of Western Australia, Perth, Australia
| | - Katharina T Paul
- Department of Political Science, Faculty of Social Sciences, The University of Vienna, Vienna, Austria
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Iannello P, Colautti L, Magenes S, Antonietti A, Cancer A. Black-and-white thinking and conspiracy beliefs prevent parents from vaccinating their children against COVID-19. APPLIED COGNITIVE PSYCHOLOGY 2022; 36:ACP3999. [PMID: 36250193 PMCID: PMC9537936 DOI: 10.1002/acp.3999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
Abstract
Understanding predictors of parents' willingness to vaccinate their children appears fundamental to promote vaccine acceptability, especially in a pandemic scenario. The present study aimed to investigate the role of conspiracy beliefs and absolutist thinking in parental attitude toward COVID-19 vaccine, and the predictive role of parents' individual differences on decisions against children's vaccination. An online survey was administered to 415 parents of children aged 5-11, at the very beginning of the vaccination targeting this population in Italy. Results showed that absolutism predicted the tendency to believe in conspiracies, associated with a negative attitude toward the COVID-19 vaccine administration to children. Moreover, mothers were less willing to vaccinate children and parents of children aged 5-7 were more hesitant, or even against vaccination, than parents of older children. Finally, the worry about consequences of COVID-19 infection on children's health facilitated vaccine adherence. These findings contribute to deepening mechanisms regarding the vaccine acceptability.
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Affiliation(s)
| | | | - Sara Magenes
- Catholic University of the Sacred HeartMilanItaly
- Fraternità e Amicizia Società Cooperativa Sociale ONLUSMilanItaly
| | | | - Alice Cancer
- Catholic University of the Sacred HeartMilanItaly
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Caliskan Y, Hippen BE, Axelrod DA, Schnitzler M, Maher K, Alhamad T, Lam NN, Anwar S, Kute V, Lentine KL. International Practices on COVID-19 Vaccine Mandates for Transplant Candidates. KIDNEY360 2022; 3:1754-1762. [PMID: 36514724 PMCID: PMC9717656 DOI: 10.34067/kid.0004062022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for solid organ transplant centers worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against mandate policies. Methods We administered an electronic survey to staff at transplant centers outside the United States (October 14, 2021-January 28, 2022) assessing the reasons cited by transplant centers for or against implementing a COVID-19 vaccine mandate. Each responding center was represented once in the analysis. Results Respondents (N=90) represented 27 countries on five continents. Half (51%) of responding transplant center representatives reported implementing a COVID-19 vaccine mandate, 38% did not, and 12% were unsure. Staff at centers implementing a vaccine mandate cited efficacy of pretransplant vaccination versus post-transplant vaccination, importance for public health, and minimizing exposure of other patients as rationale for the mandate. Of centers with a mandate, the majority (81%) of the centers mandate vaccination regardless of prior SARS-CoV-2 infection status and regardless of prevaccination spike-protein antibody titer or other markers of prior infection. Only 27% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to living donor candidates. Centers not implementing a vaccine mandate cited concerns for undue pressure on transplant candidates, insufficient evidence to support vaccine mandates, equity, and legal considerations. Conclusions The approach to pretransplant COVID-19 vaccination mandate policies at international transplant centers is heterogeneous. International transplant centers with a vaccine mandate were more willing to extend vaccine requirements to candidates' support persons, cohabitants, and living donors. Broader stakeholder engagement to overcome vaccine hesitancy across the world is needed to increase the acceptance of pretransplant COVID-19 vaccination to protect the health of transplant patients.
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Affiliation(s)
- Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Benjamin E. Hippen
- Global Medical Office, Fresenius Medical Care, Charlotte, North Carolina
| | | | - Mark Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Kennan Maher
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Tarek Alhamad
- Washington University School of Medicine at St. Louis, St. Louis, Missouri
| | - Ngan N. Lam
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Canada
| | - Siddiq Anwar
- Sheikh Shakhbout Medical Hospital, Abu Dhabi, United Arab Emirates
| | - Vivek Kute
- Dr. H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
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Reñosa MDC, Landicho J, Wachinger J, Dalglish SL, Bärnighausen K, Bärnighausen T, McMahon SA. Nudging toward vaccination: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006237. [PMID: 34593513 PMCID: PMC8487203 DOI: 10.1136/bmjgh-2021-006237] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Vaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. ‘Nudging’, defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH. Methods We conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework. Findings Identified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings. Conclusion Nudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research. PROSPERO registration number CRD42020185817.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Sarah L Dalglish
- Institute for Global Health, University College London, London, UK
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
Seasonal influenza kills many hundreds of thousands of people every year. We argue that the current pandemic has lessons we should learn concerning how we should respond to it. Our response to the COVID-19 not only provides us with tools for confronting influenza; it also changes our sense of what is possible. The recognition of how dramatic policy responses to COVID-19 were and how widespread their general acceptance has been allowed us to imagine new and more sweeping responses to influenza. In fact, we not only can grasp how we can reduce its toll; this new knowledge entails new responsibilities to do so. We outline a range of potential interventions to alter social norms and to change structures to reduce influenza transmission, and consider ethical objections to our proposals.
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Affiliation(s)
- Neil Levy
- Uehiro Centre for Practical Ethics, University of Oxford
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11
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Savulescu J, Giubilini A, Danchin M. Global Ethical Considerations Regarding Mandatory Vaccination in Children. J Pediatr 2021; 231:10-16. [PMID: 33484698 PMCID: PMC7817402 DOI: 10.1016/j.jpeds.2021.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
Whether children should be vaccinated against coronavirus disease-2019 (COVID-19) (or other infectious diseases such as influenza) and whether some degree of coercion should be exercised by the state to ensure high uptake depends, among other things, on the safety and efficacy of the vaccine. For COVID-19, these factors are currently unknown for children, with unanswered questions also on children's role in the transmission of the virus, the extent to which the vaccine will decrease transmission, and the expected benefit (if any) to the child. Ultimately, deciding whether to recommend that children receive a novel vaccine for a disease that is not a major threat to them, or to mandate the vaccine, requires precise information on the risks, including disease severity and vaccine safety and effectiveness, a comparative evaluation of the alternatives, and the levels of coercion associated with each. However, the decision also requires balancing self-interest with duty to others, and liberty with usefulness. Separate to ensuring vaccine supply and access, we outline 3 requirements for mandatory vaccination from an ethical perspective: (1) whether the disease is a grave threat to the health of children and to public health, (2) positive comparative expected usefulness of mandatory vaccination, and (3) proportionate coercion. We also suggest that the case for mandatory vaccine in children may be strong in the case of influenza vaccination during the COVID-19 pandemic.
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Affiliation(s)
- Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK and Murdoch Children's Research Institute, Victoria, Australia.
| | - Alberto Giubilini
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Margie Danchin
- Department of General Medicine, The Royal Children's Hospital and Vaccine Uptake Group, Murdoch Children's Research Institute and Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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