The Italian policy of mandating SARS-CoV-2 vaccination for healthcare workers: Analysis of the policy processes and preliminary outcomes

The Interplay of Politics and Conspiracy Theories in Shaping Vaccine Hesitancy in a Diverse Cultural Setting in Italy

Vaccine hesitancy presents a significant challenge to public health, particularly in culturally diverse regions, such as South Tyrol, Italy. This article examines the interplay between political influences, conspiracy theories, and vaccine hesitancy in South Tyrol, an autonomous province characterised by its linguistic diversity and historical scepticism toward central authority. This study aimed to identify the important drivers of vaccine hesitancy and propose targeted strategies to enhance vaccine acceptance. Peer-reviewed and grey literature was examined to explore the sociocultural factors, political dynamics, and conspiracy narratives influencing vaccine hesitancy in South Tyrol. The analysis incorporated publicly available materials, including propaganda from anti-vaccine organisations, and regional public health data to contextualise the findings. Vaccine hesitancy in South Tyrol was influenced by historical tensions with the central government, cultural alignment with Austrian healthcare practices, and politically motivated opposition to vaccination. Conspiracy theories disseminated by local organisations and political entities exploit concerns regarding governmental overreach and personal autonomy. These dynamics are compounded by the selective misrepresentation of scientific discourse, which further polarises public opinion. Addressing vaccine hesitancy in South Tyrol requires culturally sensitive communication, community engagement through trusted local figures, transparency in health policies, and the proactive monitoring of misinformation. These strategies can mitigate mistrust and promote vaccine acceptance in regions with similar sociopolitical complexities.

Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults

Background/Objectives: Frailty screening facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its potential sex bias persist due to item 2, which assigns a frailty point for male sex. This study compared the PRISMA-7 with a modified version, the PRISMA-6 (excluding item 2), to assess their suitability for frailty screening in South Tyrol, Italy. Objectives included evaluating the impact of item 2 on frailty classification and exploring the feasibility of the PRISMA-6 as a more equitable alternative. Methods: A cross-sectional survey of 1695 community-dwelling older adults aged ≥75 years was conducted in South Tyrol. Frailty was assessed using both the PRISMA-7 and PRISMA-6. Sociodemographic, health, and lifestyle data were collected to examine associations with frailty classifications. Logistic regression was applied to identify predictors of frailty for each tool. Agreement between the PRISMA-7 and PRISMA-6 was assessed, and internal consistency was evaluated using Cronbach's alpha. Results: Frailty prevalence was 33.9% with the PRISMA-7 and 27.0% with the PRISMA-6. The PRISMA-7 classified men as frail more frequently than women (34.7% vs. 33.0%), while the PRISMA-6 reversed this trend (men, 21.4%; women, 33.0%). Excluding item 2 improved internal consistency (Cronbach's alpha: PRISMA-7, 0.64; PRISMA-6, 0.75) and aligned frailty classifications with predictors such as age, health status, and physical activity. Logistic regression revealed significant sex differences with the PRISMA-7 but not with the PRISMA-6. Conclusions: The PRISMA-7 introduces sex bias by overestimating frailty in men, whereas the PRISMA-6 provides a more equitable and consistent alternative. The findings highlight the PRISMA-6's potential as a reliable tool for unbiased frailty screening. Future research should validate the PRISMA-6 against established frailty tools to support its integration into primary care settings.

Are COVID-19 vaccination mandates for healthcare workers effective? A systematic review of the impact of mandates on increasing vaccination, alleviating staff shortages and decreasing staff illness

INTRODUCTION

The rapid development of COVID-19 vaccines is a cornerstone in the global effort to combat the pandemic. Healthcare workers (HCWs), being at the forefront of the pandemic response, have been the focus of vaccine mandate policies. This review aims to evaluate the impacts of COVID-19 vaccine mandates among HCWs, a critical step in understanding the broader implications of such policies in healthcare settings.

OBJECTIVE

The review seeks to synthesize available literature to contribute to greater understanding of the outcomes associated with COVID-19 vaccine mandates for HCWs including vaccine uptake, infection rates, and staffing.

METHODS

A systematic search of relevant literature published from March 2020 to September 2023 was conducted. The Newcastle-Ottawa scale was employed for quality assessment of the included articles. A total of 4,779 publications were identified, with 15 studies meeting the inclusion criteria for the review. A narrative synthesis approach was used to analyze these studies.

RESULTS

COVID-19 vaccine mandates for HCWs were broadly successful in increasing vaccine uptake in most settings. Although the penalties imposed on unvaccinated HCWs did not lead to major disruption of health services, less well-resourced areas may have been more impacted. Furthermore, there is insufficient literature on the impact of the vaccine mandate on reducing SARS-CoV-2 infection among HCWs.

CONCLUSION

COVID-19 vaccine mandates for HCWs have significant implications for public health policy and healthcare management. The findings underscore the need for tailored approaches in mandate policies, considering the specific contexts of healthcare settings and the diverse populations of HCWs. While mandates have shown potential in increasing vaccine uptake with minimal impacts to staffing, more work is needed to investigate the impacts of mandates across various contexts. In addition to these impacts, future research should focus on long-term effects and implications on broader public health strategies.

Vaccine Hesitancy and Public Mistrust during Pandemic Decline: Findings from 2021 and 2023 Cross-Sectional Surveys in Northern Italy

This study examines vaccine agreements in South Tyrol, Italy, within distinct socio-cultural and linguistic contexts. Using data from the 2021 and 2023 "COVID-19 Snapshot Monitoring" extended surveys, we assessed changes in attitudes towards COVID-19 and other vaccinations during the second and final years of the pandemic. Multivariate logistic regression analysis was used to examine factors such as trust in institutions, language groups, and the use of complementary and alternative medicine. The representativeness of the study is supported by good participation rates, ensuring a comprehensive view of attitudes towards vaccination in the region. The results show a shift in public agreement with the national vaccination plan to 64% by 2023, from a rate of about 73% agreement in 2021 (p < 0.001). A significant decrease in trust in health authorities and a negative correlation with complementary and alternative medicine consultations were observed. The results highlight the complex nature of vaccine hesitancy in diverse regions such as South Tyrol and underline the need for targeted communication strategies and trust-building initiatives to effectively reduce hesitancy. This study provides critical insights for the formulation of public health strategies in diverse sociocultural settings.

Increasing influenza vaccination coverage in healthcare workers: analysis of an intensified on-site vaccination campaign during the COVID-19 pandemic

PURPOSE

Influenza infections have substantial impact on healthcare institutions. While vaccination is the most effective preventive measure against influenza infection, vaccination coverage in healthcare workers is low. The study investigates the impact of an intensified influenza vaccination campaign in a maximum-care hospital on influenza vaccination coverage in healthcare workers during the COVID-19 pandemic in 2020/21.

METHODS

Building on findings from our previously published review Schumacher et al. (Infection 49(3): 387, 2021), an intensified influenza vaccination campaign comprising a mobile vaccination team providing on-site vaccination and vaccination at a recurring central vaccination site in addition to promotional measures was performed and analysed regarding vaccination coverage. A survey querying vaccination motivation was performed. Campaign strategies and vaccination coverage of influenza seasons between 2017/18 and 2019/20 were analysed.

RESULTS

The influenza vaccination campaign 2020/21 led to a significant 2.4-fold increase yielding an overall vaccination coverage of 40% among healthcare workers. A significant increase in vaccination coverage was observed across all professional fields; especially among nurses, a 2.7-fold increase, reaching a vaccination coverage of 48%, was observed. The COVID-19 pandemic positively influenced vaccination decision in 72% of first time ever or first time in over ten years influenza vaccinees. Vaccination coverage during prior vaccination campaigns focusing on educational measures did not exceed 17%.

CONCLUSION

A mobile vaccination team providing on-site vaccination and vaccinations at a central vaccination site in addition to promotional measures can be implemented to increase influenza vaccination coverage in healthcare workers. Our concept can inform influenza and other vaccination campaigns for healthcare workers.

COVID-19 vaccine uptake among healthcare workers: an achievable quality improvement target

There is a need to optimize SARS-CoV-2 vaccination rates amongst healthcare workers (HCWs) to protect staff and patients from healthcare-associated COVID-19 infection. During the COVID-19 pandemic, many organizations implemented vaccine mandates for HCWs. Whether or not a traditional quality improvement approach can achieve high-rates of COVID-19 vaccination is not known. Our organization undertook iterative changes that focused on the barriers to vaccine uptake. These barriers were identified through huddles, and addressed through extensive peer outreach, with a focus on access and issues related to equity, diversity and inclusion. The outreach interventions were informed by real-time data on COVID-19 vaccine uptake in our organization. The vaccine rate reached 92.3% by 6 December 2021 with minimal differences in vaccine uptake by professional role, clinical department, facility or whether the staff had a patient facing role. Improving vaccine uptake should be a quality improvement target in healthcare organizations and our experience shows that high vaccine rates are achievable through concerted efforts targeting specific barriers to vaccine confidence.