A comparative analysis of COVID-19 vaccination certificates in 12 countries/regions around the world: Rationalising health policies for international travel and domestic social activities during the pandemic

Discursive framework for a multi-disease digital health passport in Africa: a perspective

Africa's dual burden of rising incidence of infectious diseases and increasing prevalence of non-communicable diseases (NCDs), such as cardiovascular diseases and diabetes, demands innovative approaches to disease surveillance, response, and cross-border health management in response to growing economic integration and global connectivity. In this context, we propose a discursive framework for the development and implementation of a multi-disease digital health passport (MDDHP) in Africa. The MDDHP would serve as a secure platform for storing and sharing individual health data, offering a comprehensive solution to track and respond to infectious diseases, facilitate the management of NCDs, and improve healthcare access across borders. Empowering individuals to proactively manage their health and improve overall outcomes is a key aspect of the MDDHP. In the paper, we examine the key elements necessary to effectively implement MDDHP, focusing on minimizing risks, maintaining efficacy, and driving its adoption while also taking into consideration the unique contexts of the continent. The paper is intended to provide an understanding of the key principles involved and contribute to the discussion on the development and successful implementation of MDDHP in Africa.

Geographical and practical challenges in the implementation of digital health passports for cross-border COVID-19 pandemic management: a narrative review and framework for solutions

The rapid global spread of infectious diseases, epitomized by the recent COVID-19 pandemic, has highlighted the critical need for effective cross-border pandemic management strategies. Digital health passports (DHPs), which securely store and facilitate the sharing of critical health information, including vaccination records and test results, have emerged as a promising solution to enable safe travel and access to essential services and economic activities during pandemics. However, the implementation of DHPs faces several significant challenges, both related to geographical disparities and practical considerations, necessitating a comprehensive approach for successful global adoption. In this narrative review article, we identify and elaborate on the critical geographical and practical barriers that hinder global adoption and the effective utilization of DHPs. Geographical barriers are complex, encompassing disparities in vaccine access, regulatory inconsistencies, differences across countries in data security and users' privacy policies, challenges related to interoperability and standardization, and inadequacies in technological infrastructure and limited access to digital technologies. Practical challenges include the possibility of vaccine contraindications and breakthrough infections, uncertainties surrounding natural immunity, and limitations of standard tests in assessing infection risk. To address geographical disparities and enhance the functionality and interoperability of DHPs, we propose a framework that emphasizes international collaboration to achieve equitable access to vaccines and testing resources. Furthermore, we recommend international cooperation to establish unified vaccine regulatory frameworks, adopting globally accepted standards for data privacy and protection, implementing interoperability protocols, and taking steps to bridge the digital divide. Addressing practical challenges requires a meticulous approach to assessing individual risk and augmenting DHP implementation with rigorous health screenings and personal infection prevention measures. Collectively, these initiatives contribute to the development of robust and inclusive cross-border pandemic management strategies, ultimately promoting a safer and more interconnected global community in the face of current and future pandemics.

Viral Respiratory Epidemic Modeling of Societal Segregation Based on Vaccination Status

BACKGROUND

Societal segregation of unvaccinated people from public spaces has been a novel and controversial coronavirus disease 2019 (COVID-19)-era public health practice in many countries. Models exploring potential consequences of vaccination-status-based segregation have not considered how segregation influences the contact frequencies in the segregated groups. We systematically investigate implementing effects of segregation on population-specific contact frequencies and show this critically determines the predicted epidemiological outcomes, focusing on the attack rates in the vaccinated and unvaccinated populations and the share of infections among vaccinated people that were due to contacts with infectious unvaccinated people.

METHODS

We describe a susceptible-infectious-recovered (SIR) two-population model for vaccinated and unvaccinated groups of individuals that transmit an infectious disease by person-to-person contact. The degree of segregation of the two groups, ranging from zero to complete segregation, is implemented using the like-to-like mixing approach developed for sexually transmitted diseases, adapted for presumed severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) transmission. We allow the contact frequencies for individuals in the two groups to be different and depend, with variable strength, on the degree of segregation.

RESULTS

Segregation can either increase or decrease the attack rate among the vaccinated, depending on the type of segregation (isolating or compounding), and the contagiousness of the disease. For diseases with low contagiousness, segregation can cause an attack rate in the vaccinated, which does not occur without segregation.

INTERPRETATION

There is no predicted blanket epidemiological advantage to segregation, either for the vaccinated or the unvaccinated. Negative epidemiological consequences can occur for both groups.

Individual preferences, government policy, and COVID-19: A game-theoretic epidemiological analysis

Purpose

The ongoing COVID-19 pandemic imposes serious short-term and long-term health costs on populations. Restrictive government policy measures decrease the risks of infection, but produce similarly serious social, mental health, and economic problems. Citizens have varying preferences about the desirability of restrictive policies, and governments are thus forced to navigate this tension in making pandemic policy. This paper analyses the situation facing government using a game-theoretic epidemiological model.

Methodology

We classify individuals into health-centered individuals and freedom-centered individuals to capture the heterogeneous preferences of citizens. We first use the extended Susceptible-Exposed-Asymptomatic-Infectious-Recovered (SEAIR) model (adding individual preferences) and the signaling game model (adding government) to analyze the strategic situation against the backdrop of a realistic model of COVID-19 infection.

Findings

We find the following: 1. There exists two pooling equilibria. When health-centered and freedom-centered individuals send anti-epidemic signals, the government will adopt strict restrictive policies under budget surplus or balance. When health-centered and freedom-centered individuals send freedom signals, the government chooses not to implement restrictive policies. 2. When governments choose not to impose restrictions, the extinction of an epidemic depends on whether it has a high infection transmission rate; when the government chooses to implement non-pharmacological interventions (NPIs), whether an epidemic will disappear depends on how strict the government's restrictions are.

Originality/value

Based on the existing literature, we add individual preferences and put the government into the game as a player. Our research extends the current form of combining epidemiology and game theory. By using both we get a more realistic understanding of the spread of the virus and combine that with a richer understanding of the strategic social dynamics enabled by game theoretic analysis. Our findings have important implications for public management and government decision-making in the context of COVID-19 and for potential future public health emergencies.

The barriers, facilitators and association of vaccine certificates on COVID-19 vaccine uptake: a scoping review

BACKGROUND

Globally, COVID-19 vaccines have proven to be instrumental for promoting population health by reducing illness from SARS-CoV-2. Vaccine certificates emerged as a potentially promising solution for encouraging vaccination and facilitating the safe reopening of society, however, they were controversial due to criticisms of infringing upon individual rights. While there is extensive literature describing the ethical, legal, and public health implications of vaccine certificates, there is currently a gap in knowledge about the association of vaccine certificates on vaccine uptake during the COVID-19 pandemic and barriers and facilitators to their use.

OBJECTIVES

The objectives of this scoping review are to (i) describe the existing literature on the association of vaccine certificates on the rates of COVID-19 vaccine uptake across several countries and (ii) describe the intrinsic and extrinsic barriers or facilitators that moderate this relationship.

METHODS

We conducted a scoping review based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. We searched three bibliographic databases (APA PsychInfo, Embase Classic + Embase, OVID-Medline) and preprint severs during the first week of July 2023. Three reviewers independently screened the studies based on pre-specified eligibility criteria and performed quality assessments of the primary literature and data extraction.

RESULTS

Sixteen studies met the inclusion criteria. 14 or these were surveys and 2 were modelling studies. The majority documented that vaccine certificates were significantly associated with increased rates of COVID-19 vaccine uptake (n = 12), motivated by factors such as travel/employer requirements, influence from the government/peers, and trust in the safety, efficacy, and science behind COVID-19 vaccines. Three studies had non-significant or mixed findings. Only one study found a significant decrease in COVID-19 vaccine uptake, motivated by pervasive distrust in the QR code-based system of digital vaccine certificates in Russia. Quality of survey studies was generally high.

CONCLUSION

Our findings provide insights into the existing literature on vaccine certificates association with vaccine uptake in several different jurisdictions and barriers and facilitators to their uptake. This information can be used to guide future examinations of the implementation of vaccine certificates and more effective implementations.

The Impact of SARS-CoV-2 Immune Status and Societal Restrictions in Controlling COVID-19 across the World

To control the COVID-19 pandemic, many countries implemented vaccination and imposed societal restrictions both at the national level and for international travel. As a check of corona status, COVID passes have been issued. A COVID pass could be obtained when either fully vaccinated against COVID-19, or after recovering from a documented COVID-19 episode, or after a recent (24-48 h) negative SARS-CoV-2 antigen test. A global analysis of SARS-CoV-2 immune status determined by past infection and/or vaccination, vaccination rates, as well as societal restrictions in controlling the COVID-19 pandemic is presented. The data show that across the world, vaccination was more effective in reducing SARS-CoV-2 infections with the delta variant than the omicron variant. Strict societal restrictions could control spread of the virus, but relief of the restrictions was associated with an increase in omicron infections. No significant difference in SARS-CoV-2 infections were found when comparing countries or territories which did or did not implement a COVID pass.

Public Preferences for Introducing a COVID-19 Certificate: A Discrete Choice Experiment in the Netherlands

OBJECTIVE

Here we investigate public preferences for coronavirus disease 2019 (COVID-19) certificates in the Netherlands, and whether these preferences differ between subgroups in the population.

METHODS

A survey including a discrete choice experiment was administered to 1500 members of the adult population of the Netherlands. Each participant was asked to choose between hypothetical COVID-19 certificates that differed in seven attributes: the starting date, and whether the certificate allowed gathering with multiple people, shopping without appointment, visiting bars and restaurants, visiting cinemas and theatres, attending events, and practising indoor sports. Latent class models (LCMs) were used to determine the attribute relative importance and predicted acceptance rate of hypothetical certificates.

RESULTS

Three classes of preference patterns were identified in the LCM. One class a priori opposed a certificate (only two attributes influencing preferences), another class was relatively neutral and included all attributes in their decision making, and the final class was positive towards a certificate. Respondents aged > 65 years and those who plan to get vaccinated were more likely to belong to the latter two classes. Being allowed to shop without appointment and to visit bars and restaurants was most important to all respondents, increasing predicted acceptance rate by 12 percentage points.

CONCLUSIONS

Preferences for introduction of a COVID-19 certificate are mixed. A certificate that allows for shopping without appointment and visiting bars and restaurants is likely to increase acceptance. The support of younger citizens and those who plan to get vaccinated seems most sensitive to the specific freedoms granted by a COVID-19 certificate.

Estimation and sensitivity analysis of a COVID-19 model considering the use of face mask and vaccination

To model the COVID-19 infection and develop effective control measures, this paper proposes an SEIR-type epidemic model considering the impact of face-mask wearing and vaccination. Firstly, the effective reproduction number and the threshold conditions are obtained. Secondly, based on the data of South Korea from January 20, 2022 to March 21, 2022, the model parameters are estimated. Finally, a sensitivity analysis and the numerical study are conducted. The results show that the face-mask wearing is associated with [Formula: see text] and [Formula: see text] reductions in the numbers of cumulative cases and newly confirmed cases, respectively, after a period of 60 days, when the face mask wearing rate increases by [Formula: see text]. Furthermore, the vaccination rate is associated with [Formula: see text] and [Formula: see text] reductions in the numbers of cumulative cases and the newly confirmed cases, respectively, after the same period of 60 days when the vaccination rate is increased by [Formula: see text]. A combined measure involving face-mask wearing and vaccination may be more effective and reasonable in preventing and controlling this infection. It is also suggested that disease control departments should strongly recommended the wearing of face masks s as well as vaccination to prevent the unvaccinated people from becoming infected.

Nationalism, conspiracy theories and vaccine mandates: Exploring the statism determinants for attitudes to COVID-19 control in China

Introduction

China's loosening its COVID-19 controls highlighted its insufficiency in vaccination protection. Mandatory vaccination might be necessary if the gap cannot be filled over a short time. However, few studies have explored how Chinese people view the COVID-19 vaccine mandates, let alone placing such views in the country's highly politicized context.

Material and methods

The current study utilizes data from a national survey adopting quota sampling to analyze the Chinese public's medical and non-medical considerations when judging compulsory COVID-19 vaccination (n = 1,523). The survey was conducted between 1 and 8 April 2021. All adults aged 18 years and older were eligible to take part. The survey included sociodemographic details, perceived susceptibility to infection, perceived vaccine benefit, attitudes to vaccination policies, nationalism, beliefs in various conspiracy theories and science literacy. Multiple regression analyses were done to examine factors associated with the attitude to COVID-19 vaccine mandates.

Results

The study reveals that personal risk and benefit perceptions did not dominate the Chinese public's attitude toward vaccination mandates. Instead, nationalism was relatively strongly associated with their willingness to accept mandatory vaccination. Contrary to studies in the West, various conspiracy beliefs and conspiratorial thinking were robustly related to the support for mandatory vacciniation. Science literacy didn't link to the attitude to vaccination mandates. It only had a weak moderating effect on the influence of conspiratorial thinking on attitudes to the vaccination policies.

Conclusions

The results indicated that Chinese people's attitude to the COVID-19 vaccination policy is highly politicized and influenced by conspiracy theories. Given the potentially massive impacts of the COVID-19 infection, we need to educate the Chinese public with more medically valuable and relevant information to help them make sound decisions regarding vaccination. Meanwhile, we can adopt nationalistic tones to improve the persuasion effect, but misinformation during the process must be overcome.

Health Passport: A blockchain-based PHR-integrated self-sovereign identity system

During the COVID-19 pandemic, it was necessary to validate a person’s health status along with their identity to permit travel. This was facilitated via paper-based certificates and centralized digital apps. Even after COVID-19, it is anticipated that such health status verifications will be required for travel and other purposes. As a result, there needs to be an additional credential, a “Health Passport,” that establishes whether a person satisfies the health requirements for various purposes. Digital credentials so prepared should be trustable, unforgeable, and verifiable. The Health Passport should be designed to protect the end-users’ privacy and give people control over the data they use to confirm their credentials. This article explores the requirements for a generalized Health Passport system and uses agent-oriented modeling (AOM) to design a blockchain-based self-sovereign identity (SSI) system integrated with the Personal Health Record (PHR) to address this requirement. The article demonstrates the feasibility of the solution by implementing a proof of concept on Hyperledger Indy and Aries, integrated with the PHR – MediTrans. Credential issuance and verification time were calculated, and it was observed that the time overhead was minimal. This solution allows users to verify their credentials with the verifier without revealing any significant personal information. Our solution can be integrated into any PHR solution as the SSI solution is added as a plugin to the PHR accessible via a mobile/web app.

Differences in BNT126b2 and ChAdOx1 Homologous Vaccination Antibody Response among Teachers in Poznan, Poland

Children are among the best vectors to spread respiratory viruses, including emerging variants of SARS-CoV-2 due to the asymptomatic or relatively mild course of infection and simultaneously high titres of pathogens in the respiratory tract. Therefore, individuals who have constant contact with children, e.g., teachers should be vaccinated against COVID-19 as essential workers within the first phases of a vaccination campaign. In Poland, primary and secondary school teachers were vaccinated with ChAdOx1 from February 2021 with a three month interval between the two doses, while lecturers at medical universities, who are simultaneously healthcare workers, received the BNT126b2 vaccine from December 2020 with three weeks between the first and second doses. The aim of this study was to compare the antibody responses at two weeks and three months after vaccination and to estimate the vaccine effectiveness against COVID-19 among infection-naïve teachers vaccinated with mRNA and a vector vaccine. We found that the anti-SARS-CoV-2 spike protein antibodies were significantly higher among the lecturers but antibody waning was slower among the schoolteachers. However, those vaccinated with ChAdOx1 complained significantly more often of vaccine side effects. In addition, during the three months after the second vaccine dose no study participants were infected with SARS-CoV-2. The BNT126b2 vaccine gave higher antibody titres in comparison with ChAdOx1 but protection against COVID-19 in both cases was similar. Moreover, we did not find any anti-SARS-CoV-2 nucleoprotein antibodies at two weeks as well as at three months after vaccination among the study participants, which shows a very high vaccine effectiveness in the occupational group with a high SARS-CoV-2-infection risk.

Accelerated Digitalization of the Epidemiological Measures: Overcoming the Technological and Process Complexities of Establishing the EU Digital COVID Certificate in Slovenia

OBJECTIVE

In order to facilitate free movement of EU citizens during the COVID-19 pandemic, in early 2021 the European Commission proposed the establishment of an EU Digital COVID Certificate. By 1 July 2021, all EU Member States have successfully implemented the EU Digital COVID Certificate. The technological and procedural complexities encountered while establishing the EU Digital COVID Certificate in Slovenia are reviewed in this article.

METHODS

This research employs a case study methodology. Controlled focus group sessions comprising eighteen eminent experts (not including medical and other expert groups involved in the epidemiological measures) in charge of the EU Digital COVID Certificate and other national eHealth services in Slovenia were used as the primary data collection technique. Focus group discussions were preceded by an all-encompassing review of the literature and the examination of numerous materials covering the EU Digital COVID Certificate-related content.

RESULTS

The study findings reveal that the technological and process complexities are associated with the fragmented data sources and complicated and abundant business rules used for the generation and verification of the EU Digital COVID Certificate. However, despite the technological, process and other impediments that arose during the establishment of the EU Digital COVID Certificate in Slovenia, it can be argued that the approach used and stakeholder commitment, especially in critical pandemic conditions, offered the much-desired harmonisation and application of this digital service at the EU level.

CONCLUSIONS

The study highlights the importance of a sound and coherent model for the impending establishment of cross-border eHealth services and suggests that the ad hoc implementation of such challenging and delicate digital solutions in the future will only be feasible with the prior construction of robust and interoperable digital health infrastructures across the EU Member States.

More Time, Carrot-and-Stick, or Piling Coffins? Estimating the Role of Factors Overcoming COVID-19 Vaccine Hesitancy in Poland and Lithuania in the Years 2021–2022

In this study, motivation for late (from 2021-W22, i.e., 24 July 2021) uptake of the first dose of the COVID-19 vaccine among adults in Poland and Lithuania is indirectly measured in order to avoid social-desirability bias or rationalisation in retrospect of prior decisions. Weekly vaccine uptake is modeled as if vaccine hesitant people were late adopters of a new product, with a fitted non-linear trend representing steadily decreasing interest. Before the analysed period, the vaccine uptake among Polish and Lithuanian adults was almost identical. Vaccination simply explainable by the trend was responsible for the vaccination of an additional 19.96% and 19.06% adults, respectively. The fear incurred by spikes in consecutive waves of infection motivated 3.20% and 3.89% more people, respectively, while the COVID-19 passport, introduced only in Lithuania, convinced an additional 13.98% of the overall population. The effect of the COVID passport was the biggest in the 18–24 age group, and the least visible among people aged 80 or more. In the latter group, other factors also had a limited impact, with merely 1.32% tempted by the one-time €100 payment offered to everybody aged 75 or more.