An analysis of the COVID-19 vaccination campaigns in France, Israel, Italy and Spain and their impact on health and economic outcomes

Looking beyond vaccines: Cultural tightness-looseness moderates the relationship between immunization coverage and disease prevention vigilance

Advancements in vaccination technologies mitigate disease transmission risks but may inadvertently suppress the behavioral immune system, an evolved disease avoidance mechanism. Applying behavioral immune system theory and utilizing robust big data analytics, we examined associations between rising vaccination coverage and government policies, public mobility, and online information seeking regarding disease precautions. We tested whether cultural tightness-looseness moderates the relationship between mass immunization and disease prevention vigilance. Comprehensive time series analyses were conducted using American data (Study 1) and international data (Study 2), employing transfer function modeling, cross-correlation function analysis, and meta-regression analysis. Across both the US and global analyses, as vaccination rates rose over time, government COVID-19 restrictions significantly relaxed, community mobility increased, and online searches for prevention information declined. The relationship between higher vaccination rates and lower disease prevention vigilance was stronger in culturally looser contexts. Results provide initial evidence that mass immunization may be associated with attenuated sensitivity and enhanced flexibility of disease avoidance psychology and actions. However, cultural tightness-looseness significantly moderates this relationship, with tighter cultures displaying sustained vigilance amidst immunization upticks. These findings offer valuable perspectives to inform nuanced policymaking and public health strategies that balance prudent precautions against undue alarm when expanding vaccine coverage worldwide.

Effectiveness of Treatment Approaches in COVID-19 Pneumonia: A Comparative Evaluation between a Specialized Center and Conventional Hospitals

BACKGROUND

The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal (HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain.

METHODS

The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments.

RESULTS

The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781-2.079; p = 0.332).

CONCLUSIONS

During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs.

The Israeli health system's rapid responses during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic posed numerous challenges to health systems around the world. In addressing many of those challenges, Israel responded quite rapidly. While quick action is not an end in it itself, it can be important in responding to disease outbreaks. Some of Israel's rapid responses to the pandemic contributed significantly to population health and provided important learning opportunities for other countries.

MAIN BODY

Some of the most prominent Israeli rapid responses were related to vaccination. Israel led the world in the pace of its initial vaccine rollout, and it was also the first country to approve and administer booster vaccines to broad segments of the population. In addition, Israeli scholars published a series of timely reports analyzing vaccination impact, which informed policy in Israel and other countries. Israel was a rapid responder in additional areas of public health. These include the partial closure of its borders, the adoption of physical distancing measures, the use of digital surveillance technology for contact tracing, the use of wastewater surveillance to monitor viral spread, and the use of vaccine certificates ("green passes") to facilitate a return to routine in the face of the ongoing pandemic. Many factors contributed to Israel's capacity to repeatedly respond rapidly to a broad array of COVID-19 challenges. These include a national health insurance system that promotes public-private coordination, a system of universal electronic health records, a high level of emergency preparedness, a culture of focusing on goal attainment, a culture of innovation, and the presence of a strong scientific community which is highly connected internationally. In addition, some of the rapid responses (e.g., the rapid initial vaccination rollout) facilitated rapid responses in related areas (e.g., the analysis of vaccination impact, the administration of boosters, and the adoption of green passes). While rapid response can contribute to population health and economic resilience, it can also entail costs, risks, and limitations. These include making decisions and acting before all the relevant information is available; deciding without sufficient consideration of the full range of possible effects, costs, and benefits; not providing enough opportunities for the involvement of relevant groups in the decision-making process; and depleting non-renewable resources.

CONCLUSIONS

Based on our findings, we encourage leaders in the Israeli government to ensure that its emergency response system will continue to have the capacity to respond rapidly to large-scale challenges, whether of a military or civilian nature. At the same time, the emergency response systems should develop mechanisms to include more stakeholders in the fast-paced decision-making process and should improve communication with the public. In addition, they should put into place mechanisms for timely reconsideration, adjustment, and-when warranted-reversal of decisions which, while reasonable when reached, turn out to have been ill-advised in the light of subsequent developments and evidence. These mechanisms could potentially involve any or all branches of government, as well as the public, the press, and professional organizations. Our findings also have implications for health system leaders in other countries. The Israeli experience can help them identify key capacities to develop during non-emergency periods, thus positioning themselves to respond more rapidly in an emergency. Finally, health system leaders in other countries could monitor Israel's rapid responses to future global health emergencies and adopt selected actions in their own countries.

Fertility Declines Near the End of the COVID-19 Pandemic: Evidence of the 2022 Birth Declines in Germany and Sweden

Following the onset of the COVID-19 pandemic, many countries faced short-term fertility declines in 2020-2021, a development which did not materialize in the majority of German-speaking and Nordic countries. However, more recent birth statistics show a steep fertility decline in 2022. We aim to provide empirical evidence on the unexpected birth decline in 2022 in Germany and Sweden. We rely on monthly birth statistics and present seasonally adjusted monthly Total Fertility Rates (TFR) for Germany and Sweden. We relate the nine-month lagged fertility rates to contextual developments regarding COVID-19. The seasonally adjusted monthly TFR of Germany dropped from 1.5-1.6 in 2021 to 1.4 in early 2022 and again in autumn 2022, a decline of about 10% in several months. In Sweden, the corresponding TFR dropped from about 1.7 in 2021 to 1.5-1.6 in 2022, a decline of almost 10%. There is no association of the fertility trends with changes in unemployment, infection rates, or COVID-19 deaths, but a strong association with the onset of vaccination programmes and the weakening of pandemic-related restrictions. The fertility decline in 2022 in Germany and Sweden is remarkable. Common explanations of fertility change during the pandemic do not apply. The association between the onset of mass vaccinations and subsequent fertility decline indicates that women adjusted their behaviour to get vaccinated before becoming pregnant. Fertility decreased as societies were opening up with more normalized life conditions. We provide novel information on fertility declines and the COVID-19-fertility nexus during and in the immediate aftermath of the pandemic.

From intentions to practices: what drove people to get the COVID-19 vaccine? Findings from the French longitudinal socioepidemiological cohort survey

OBJECTIVE

In many countries, before COVID-19 vaccines became available, reluctance to get vaccinated was particularly prevalent among women, the most disadvantaged social groups and ethnoracial minorities, known to be at higher risk for the virus. Using a longitudinal perspective, we analyse the social determinants that are associated with the transition from attitudes towards vaccination to actual vaccination practices.

DESIGN

Representative population-based prospective cohort.

SETTINGS

From November 2020 to July 2021.

PARTICIPANTS

Adults included in the Epidemiology and Living Conditions (EpiCoV) cohort (n=86 701).

MAIN OUTCOME MEASURES

Attitudes towards vaccination in November 2020 before COVID-19 vaccines were available in France (in January 2021) and vaccination practices in July 2021.

RESULTS

Among those who were initially reluctant in November 2020, the youngest, the poorest 10% (OR=0.68, 0.59-0.77), non-European immigrants (OR=0.72, 0.59-0.88) and descendants of non-European immigrants (OR=0.72, 0.61-0.86) were less likely to be vaccinated in July 2021, irrespective of trust in government and scientists. The same social factors were associated with non-vaccination among those who initially were undecided or who favoured vaccination.

CONCLUSION

Despite the fact that COVID-19 vaccines were relatively available and free of charge in France in July 2021, social inequalities in vaccination against the virus remained the same than those observed in vaccination reluctance in November 2020, before vaccines were available. While adjusting for trust, migration background, younger age and lower income were associated with lower vaccination uptake irrespective of initial intention. By neglecting to genuinely target specific groups that were initially reluctant to be vaccinated, vaccination policies contributed to strengthening pre-existing social inequalities around COVID-19 burden.

Extracellular vesicle features are associated with COVID-19 severity

COVID-19 is heterogeneous; therefore, it is crucial to identify early biomarkers for adverse outcomes. Extracellular vesicles (EV) are involved in the pathophysiology of COVID-19 and have both negative and positive effects. The objective of this study was to identify the potential role of EV in the prognostic stratification of COVID-19 patients. A total of 146 patients with severe or critical COVID-19 were enrolled. Demographic and comorbidity characteristics were collected, together with routine haematology, blood chemistry and lymphocyte subpopulation data. Flow cytometric characterization of the dimensional and antigenic properties of COVID-19 patients' plasma EVs was conducted. Elastic net logistic regression with cross-validation was employed to identify the best model for classifying critically ill patients. Features of smaller EVs (i.e. the fraction of EVs smaller than 200 nm expressing either cluster of differentiation [CD] 31, CD 140b or CD 42b), albuminemia and the percentage of monocytes expressing human leukocyte antigen DR (HLA-DR) were associated with a better outcome. Conversely, the proportion of larger EVs expressing N-cadherin, CD 34, CD 56, CD31 or CD 45, interleukin 6, red cell width distribution (RDW), N-terminal pro-brain natriuretic peptide (NT-proBNP), age, procalcitonin, Charlson Comorbidity Index and pro-adrenomedullin were associated with disease severity. Therefore, the simultaneous assessment of EV dimensions and their antigenic properties complements laboratory workup and helps in patient stratification.

Optimal vaccination strategies for a heterogeneous population using multiple objectives: The case of L1- and L2-formulations

The choice of the objective functional in optimization problems coming from biomedical and epidemiological applications plays a key role in optimal control outcomes. In this study, we investigate the role of the objective functional on the structure of the optimal control solution for an epidemic model for sexually transmitted infections that includes a core group with higher sexual activity levels than the rest of the population. An optimal control problem is formulated to find a targeted vaccination program able to control the spread of the infection with minimum vaccine deployment. Both L1- and L2-objectives are considered as an attempt to explore the trade-offs between control dynamics and the functional form characterizing optimality. The results show that the optimal vaccination policies for both the L1- and the L2-formulation share one important qualitative property, that is, immunization of the core group should be prioritized by policymakers to achieve a fast reduction of the epidemic. However, quantitative aspects of this result can be significantly affected depending on the choice of the control weights between formulations. Overall, the results suggest that with appropriate weight constants, the optimal control outcomes are reasonably robust with respect to the L1- or L2-formulation. This is particularly true when the monetary cost of the control policy is substantially lower than the cost associated with the disease burden. Under these conditions, even if the L1-formulation is more realistic from a modeling perspective, the L2-formulation can be used as an approximation and yield qualitatively comparable outcomes.

Stakeholders' Understanding of European Medicine Agency's COVID-19 Vaccine Information Materials in EU and Regional Contexts

The COVID-19 pandemic posed challenges to communicating accurate information about vaccines because of the spread of misinformation. The European Medicines Agency (EMA) tried to reassure the public by communicating early on about the development and approval of COVID-19 vaccines. The EMA surveyed patients/consumers, healthcare professional organizations, and individual stakeholders, both at the EU level and in an Italian regional context. The objectives of the study were to see if the EMA's core information materials were informative and well-understood and which communication channels were preferred by the public. The main findings showed that individual patients/consumers generally prefer to obtain information about COVID-19 vaccines from the internet or mass media, while organizations and individual healthcare professionals prefer to obtain information from national and international health authorities. Both at EU and local levels, participants had a good understanding of the key messages from regulators and found the materials useful and relevant. However, some improvements were recommended to the visual, text, and dissemination formats, including publishing more information on safety and using a more public-friendly language. Also, it was recommended to maintain the EMA's approach of using media, stakeholder engagement, and web-based formats to communicate about COVID-19 vaccines. In conclusion, user-testing of proactive communication materials aimed to prebunk misinformation during a public health crisis helps to ensure that users understand the development and safety of novel vaccine technologies. This information can then be used as a basis for further evidence-based communication activities by regulators and public health bodies in an emergency context.

The COVID-19 green certificate's effect on vaccine uptake in French and Italian regions

The COVID-19 green certificates were introduced in many countries in 2021 to encourage vaccine uptake against the COVID-19 virus in order to reduce the spread of severe infection among the population, ensure the safety of cross-border movements, and facilitate the resumption of social life and economic activities. This study uses a single-group interrupted time series approach to examine the effect of the green certificate announcement on the first doses of the COVID-19 vaccine in 20 Italian and 18 French regions during the summer of 2021. The estimation results show that the green certificate announcement mitigated regional disparities in vaccine uptake. It persuaded undecided people to have their first doses of the COVID-19 vaccine, especially in regions lagging in the mass vaccination campaign. It was less effective in those regions where there was already a high level of vaccine protection. The announcement also proved to be an effective political strategy with which to increase the first-dose rates immediately, but not in the long term.

Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada

BACKGROUND

The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature.

METHODS

Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes.

RESULTS

Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities.

CONCLUSIONS

Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

COVID-19 Vaccination in the WHO African Region: Progress Made in 2022 and Factors Associated

This study summarizes progress made in rolling out COVID-19 vaccinations in the African region in 2022, and analyzes factors associated with vaccination coverage. Data on vaccine uptake reported to the World Health Organization (WHO) Regional Office for Africa by Member States between January 2021 and December 2022, as well as publicly available health and socio-economic data, were used. A negative binomial regression was performed to analyze factors associated with vaccination coverage in 2022. As of the end of 2022, 308.1 million people had completed the primary vaccination series, representing 26.4% of the region's population, compared to 6.3% at the end of 2021. The percentage of health workers with complete primary series was 40.9%. Having carried out at least one high volume mass vaccination campaign in 2022 was associated with high vaccination coverage (β = 0.91, p < 0.0001), while higher WHO funding spent per person vaccinated in 2022 was correlated with lower vaccination coverage (β = -0.26, p < 0.03). All countries should expand efforts to integrate COVID-19 vaccinations into routine immunization and primary health care, and increase investment in vaccine demand generation during the transition period that follows the acute phase of the pandemic.

Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner's perceptions

BACKGROUND

A national SARS-CoV-2 vaccination programme was implemented in England from 8th December 2020, adopting a series of local level service delivery models to maximise rollout. The evidence base informing service design programme at inception was limited. We examined the real-world implementation of the programme through an assessment of sub-national providers' and commissioners' perspectives on the service delivery models used, to strengthen evidence on the acceptability, effectiveness and efficiency of the service delivery approaches used for SARS-CoV-2 vaccination in England or elsewhere.

METHODS

Qualitative, cross-sectional analysis based on semi-structured interviews conducted with 87 stakeholders working in SARS-CoV-2 vaccination delivery across four regions in England. Localities were selected according to geography and population socio-economic status. Participants were purposively sampled from health service providers, commissioners and other relevant bodies. Interviews were conducted between February and October 2021, and transcripts were thematically analysed using inductive and deductive approaches.

RESULTS

Various service delivery models were implemented over the course of the programme, beginning with hospital hubs and mass vaccination sites, before expanding to incorporate primary care-led services, mobile and other outreach services. Each had advantages and drawbacks but primary care-led models, and to some extent pharmacies, were perceived to offer a better combination of efficiency and community reach for equitable delivery. Common factors for success included availability of a motivated workforce, predictability in vaccine supply chains and strong community engagement. However, interviewees noted a lack of coordination between service providers in the vaccination programme, linked to differing financial incentives and fragmentated information systems, among other factors.

CONCLUSION

A range of delivery models are needed to enable vaccine rollout at pace and scale, and to mitigate effects on routine care provision. However, primary care-led services offer a tried-and-trusted framework for vaccine delivery at scale and pace and should be central to planning for future pandemic responses. Mass vaccination sites can offer delivery at scale but may exacerbate inequalities in vaccination coverage and are unlikely to offer value for money. Policymakers in England should prioritise measures to improve collaboration between service providers, including better alignment of IT systems.

Health system, surveillance and the COVID-19 pandemic response in France

France was the first European country to confirm cases of COVID-19, being one of the most affected by the pandemic in the first wave. This case study analyzed the measures adopted by the country in the fight against COVID-19 in 2020 and 2021, correlating it to the characteristics of its health and surveillance system. As a welfare state, it relied on compensatory policies and protection of the economy, as well as increased investments in health. There were weaknesses in the preparation and delay in the implementation of the coping plan. The response was coordinated by the national executive power, adopting strict lockdowns in the first two waves, mitigating restrictive measures in the other waves, after the increase in vaccination coverage and in the face of population resistance. The country faced problems with testing, case and contact surveillance and patient care, especially in the first wave. It was necessary to modify the health insurance rules to expand coverage, access and better articulation of surveillance actions. It indicates lessons learned about the limits of its social security system, but also the potential of a government with a strong response capacity in the financing of public policies and regulation of other sectors to face the crisis.

EU Member States’ Institutional Twitter Campaigns on COVID-19 Vaccination: Analyses of Germany, Spain, France and Italy

The development of an effective vaccine against the SARS-CoV-2 coronavirus became the hope for halting the spread of the disease. In recent years, social networks have become important tools for political and strategic communication in the dialogue with citizens. Therefore, the messages emitted through them were important to address vaccine hesitancy and achieve collective immunity. This paper analyses the use of Twitter by politicians and institutions in EU Member States during the first fifty days after the Commission’s marketing authorisation of the first COVID-19 vaccine (21 December 2020 to 8 February 2021). To do so, a triple approach content analysis was carried out (quantitative, qualitative and discursive on feelings) applied to 1913 tweets published by the official profiles of the prime ministers, health ministers, governments and health ministries of Germany, Spain, France and Italy, the four most populous EU countries. The results point out that politicians and institutions gave preference to other issues on their political agenda over vaccine-related issues. Moreover, previous research hypotheses, such as those related to the underutilization of the Twitter tool as a two-way communication channel with citizens, are validated.

Evolution of the incidence of COVID-19 during the first five waves in residents and professionals of nursing homes in Normandy, France

BACKGROUND

Older adults living in nursing homes (NH) paid a heavy price to the COVID-19 pandemic, despite early and often drastic prevention measures.

AIMS

To study the characteristics and the impact of the pandemic on NH residents and professionals over 2 years.

METHODS

Cross-sectional study of COVID-19 clusters among residents and/or professionals in NH, from March 2020 to February 2022, in Normandy, France. We used data from the French mandatory reporting system, and cross-correlation analysis.

RESULTS

The weekly proportion of NH with clusters was strongly correlated with population incidence (r > 0.70). Attack rates among residents and professionals were significantly lower in period 2 (vaccination rate in residents ≥ 50%) compared with periods 1 (waves 1 and 2) and 3 (Omicron variant ≥ 50%). Among residents, mortality and case fatality rates decreased drastically during periods 2 and 3.

CONCLUSION

Our study provides figures on the evolution of the pandemic in NH.

Using Social Marketing to Promote COVID-19 Vaccination Uptake: A Case Study from the "AUBe Vaccinated" Campaign

The availability of and access to COVID-19 vaccines has been challenging in many low- and middle-income countries (LMICs), coupled with mistrust in public health organizations instigated by misinformation and disinformation diffused by traditional and social media. In the Spring of 2021, the American University of Beirut (AUB) in Lebanon spearheaded a nationwide vaccination drive with the ambitious goal of vaccinating its entire community by the beginning of the academic year 2021-2022, as the campus was due to be opened only to vaccinated individuals. This case study outlines the development, implementation, and evaluation of a social marketing campaign to encourage COVID-19 vaccinations among members of the AUB community, comprising students, faculty, staff, and dependents. Following French and Evans' 2020 guidelines, we implemented an evidence-based and co-designed strategy to maximize the availability and facilitate vaccine access. The campaign used a mix of methods to convince the segments of the population to receive their shots before accessing campus, resulting in a 98% uptake among the community segments within three months (July-September 2021). In this case study, we reflect on the experience and share suggestions for future research and applications that other higher education institutions could use to address similar problems.

Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment

BACKGROUND

The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial.

OBJECTIVE

This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam's waning vaccine immunity period.

METHODS

A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined.

RESULTS

Among the participants, 761 (87.4%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US $8.02, and most participants indicated an unwillingness to pay (n=225, 25.8%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95% CI 0.86-1.00) were negative factors associated with the level of willingness to pay.

CONCLUSIONS

A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities.

The far-right and anti-vaccine attitudes: lessons from Spain's mass COVID-19 vaccine roll-out

BACKGROUND

Far-right politicians in several countries have been vocal opponents of COVID-19 vaccination. But can this threaten vaccine roll-out?

METHODS

We take advantage of repeated cross-sectional surveys with samples of around 3800 individuals across Spain conducted monthly from December 2020 to January 2022 (n = 51 294) to examine any association between far-right politics and vaccine hesitancy through the whole vaccine roll-out.

RESULTS

Consistent with prior data, we found that far-right supporters were almost twice as likely to be vaccine-hesitant than the overall population in December 2020, before vaccines became available. However, with a successful vaccine roll out, this difference shrank, reaching non-significance by September 2021. From October 2021, however, vaccine hesitancy rebounded among this group at a time when the leadership of the far-right promoted a 'freedom of choice' discourse common among anti-vax supporters. By the latest month analysed (January 2022), far-right voters had returned to being twice as likely to be vaccine-hesitant and 7 percentage points less likely to be vaccinated than the general population.

CONCLUSIONS

Our results are consistent with evidence that far-right politicians can encourage vaccine hesitancy. Nonetheless, we show that public attitudes towards vaccination are not immutable. Whereas a rapid and effective vaccine rollout can help to overcome the resistance of far-right voters to get vaccinated, they also seem to be susceptible to their party leader's discourse on vaccines.

Perspective: Lessons from COVID-19 of countries in the European region in light of findings from the health system response monitor

Introduction

Decision-makers initially had limited data to inform their policy responses to the COVID-19 pandemic. The research community developed several online databases to track cases, deaths, and hospitalizations; however, a major deficiency was the lack of detailed information on how health systems were responding to the pandemic and how they would need to be transformed going forward.

Approach

In an effort to fill this information gap, in March 2020, the European Observatory on Health Systems and Policies, the WHO European Regional Office and the European Commission created the COVID-19 Health System Response Monitor (HSRM) to collect and organise up-to-date information on how health systems, mainly in the WHO European Region, were responding to the COVID-19 pandemic.

Findings

The HSRM analysis and broader Observatory work on COVID-19 shone light on a range of health system challenges and weaknesses and catalogued policy options countries put in place during the pandemic to address these. Countries prioritised policies on investing in public health, supporting the workforce, maintaining financial stability, and strengthening governance in their response to COVID-19.

Outlook

COVID-19 is likely to continue to impact health systems for the foreseeable future; the ability to cope with this pressure, and other shocks, depends on having good information on what other countries have done so that health systems develop adequate policy options. In support of this, the country information on the COVID-19 HSRM will remain available as a repository to inform decision makers on options for actions and possible measures against COVID-19 and other public health emergencies. Building on its previous work on health systems resilience, the European Observatory on Health Systems and Policies will sustain its focus on analysing key issues related to the recovery from the pandemic and making health systems more resilient. This includes policy knowledge transfer between countries and systematic resilience testing, aiming at contributing to an improved understanding of health system response, recovery, and preparedness.

Contribution to the literature in non-technical language

The COVID-19 Health System Response Monitor (HSRM) was the first database in the WHO European Region to collect and organise up-to-date information on how health systems were responding to the COVID-19 pandemic. The HSRM provides a repository of policies which can be used to inform decision makers in health and other policy domains on options for action and possible measures against COVID-19 and other public health emergencies. This initiative proved particularly valuable, especially during the early phases of the pandemic, when there was limited information for countries to draw on as they formulated their own policy response to the pandemic. Our perspectives paper highlights some key challenges within health systems that the HSRM was able to identify during the pandemic and considers policy options countries put in place in response. Our research contributes to literature on emergency responses and recovery, health systems performance assessment, particularly health system resilience, and showcases the Observatory experience on how to design such a data collection tool, as well as how to leverage its findings to support cross-country learning.

Socioeconomic Inequalities in COVID-19 Vaccination and Infection in Adults, Catalonia, Spain

Evidence on the impact of the COVID-19 vaccine rollout on socioeconomic COVID-19-related inequalities is scarce. We analyzed associations between socioeconomic deprivation index (SDI) and COVID-19 vaccination, infection, and hospitalization before and after vaccine rollout in Catalonia, Spain. We conducted a population-based cohort study during September 2020-June 2021 that comprised 2,297,146 adults >40 years of age. We estimated odds ratio of nonvaccination and hazard ratios (HRs) of infection and hospitalization by SDI quintile relative to the least deprived quintile, Q1. Six months after rollout, vaccination coverage differed by SDI quintile in working-age (40-64 years) persons: 81% for Q1, 71% for Q5. Before rollout, we found a pattern of increased HR of infection and hospitalization with deprivation among working-age and retirement-age (>65 years) persons. After rollout, infection inequalities decreased in both age groups, whereas hospitalization inequalities decreased among retirement-age persons. Our findings suggest that mass vaccination reduced socioeconomic COVID-19-related inequalities.

COVID-19 Vaccine Booster Dose Acceptance: Systematic Review and Meta-Analysis

The World Health Organization (WHO) recommended coronavirus disease 2019 (COVID-19) booster dose vaccination after completing the primary vaccination series for individuals ≥18 years and most-at-risk populations. This study aimed to estimate the pooled proportion of COVID-19 vaccine booster dose uptake and intention to get the booster dose among general populations and healthcare workers (HCWs). We searched PsycINFO, Scopus, EBSCO, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, Web of Science, Google Scholar, and ScienceDirect according to PRISMA guidelines. From a total of 1079 screened records, 50 studies were extracted. Meta-analysis was conducted using 48 high-quality studies according to the Newcastle-Ottawa Scale quality assessment tool. Using the 48 included studies, the pooled proportion of COVID-19 vaccine booster dose acceptance among 198,831 subjects was 81% (95% confidence interval (CI): 75-85%, I2 = 100%). The actual uptake of the booster dose in eight studies involving 12,995 subjects was 31% (95% CI: 19-46%, I2 = 100%), while the intention to have the booster dose of the vaccine was 79% (95% CI: 72-85%, I2 = 100%). The acceptance of the booster dose of COVID-19 vaccines among HCWs was 66% (95% CI: 58-74%), I2 = 99%). Meta-regression revealed that previous COVID-19 infection was associated with a lower intention to have the booster dose. Conversely, previous COVID-19 infection was associated with a significantly higher level of booster dose actual uptake. The pooled booster dose acceptance in the WHO region of the Americas, which did not include any actual vaccination, was 77% (95% CI: 66-85%, I2 = 100%). The pooled acceptance of the booster dose in the Western Pacific was 89% (95% CI: 84-92%, I2 = 100), followed by the European region: 86% (95% CI: 81-90%, I2 = 99%), the Eastern Mediterranean region: 59% (95% CI: 46-71%, I2 = 99%), and the Southeast Asian region: 52% (95% CI: 43-61%, I2 = 95). Having chronic disease and trust in the vaccine effectiveness were the significant predictors of booster dose COVID-19 vaccine acceptance. The global acceptance rate of COVID-19 booster vaccine is high, but the rates vary by region. To achieve herd immunity for the disease, a high level of vaccination acceptance is required. Intensive vaccination campaigns and programs are still needed around the world to raise public awareness regarding the importance of accepting COVID-19 vaccines needed for proper control of the pandemic.

COVID-19 Vaccination, Morbidity, and Mortality During a 12-Month Period in Israel: Can We Maintain a "Herd Immunity" State?

Despite widespread vaccination, the COVID-19 pandemic continues to cause global disruption. Authors describe the pace of COVID-19 vaccination in Israel and examine differences in morbidity and mortality rates over time between vaccinated and unvaccinated populations. Retrospective data were obtained between December 2020 and December 2021 on daily vaccine uptake by age group (20-39, 40-59, 60+ years): rate of hospitalized severely ill cases, vaccination status and age group, and death rate per 100,000 by date and vaccination status. Uptake of first and second doses was slower in 20-59-year olds, whereas in 60+-year olds, it occurred without delay. Once most adults were vaccinated, a gap appeared with much higher severe cases and deaths in unvaccinated versus vaccinated populations; this gap attenuated by late May with very low rates in both vaccinated and unvaccinated populations until mid-July, when rates began to rise again. A herd-immunity-like period occurred in Spring 2021, with unvaccinated benefitting from a highly vaccinated population. Staggered vaccine uptake led to unsynchronized high immunity, which contributed to the fourth pandemic wave. Population vaccination within a shorter timeframe or shorter intervals between boosters may be important to reduce viral transmission.

Behind the Scenes of COVID-19 Vaccine Hesitancy: Psychological Predictors in an Italian Community Sample

Psychological variables may be crucial in favoring or discouraging health-related behaviors, including vaccine acceptance. This study aimed to extend the previous literature by outlining the psychological profile associated with COVID-19 vaccine hesitancy in a sample of Italian citizens. Between April and May 2021, 1122 Italian volunteers completed a web survey on COVID-19 vaccine acceptance, also including several self-reported psychological measures. A multiple hierarchical logistic regression analysis was performed to identify the psychological variables associated with vaccine hesitancy. Low confidence in COVID-19 vaccine efficacy and safety, low collective responsibility, high complacency, and high calculation (i.e., extensive information searching, and costs–benefit estimates) predicted higher hesitancy. Our results suggest that to be effective, vaccine-related communications should be as clear, understandable, and sound as possible, preventing the spreading of misunderstandings, or even fake information, that may foster people’s insecurities and distrust. Furthermore, the advantages and necessity of vaccination, both at the individual and community-level, should be clearly emphasized. Efficacious vaccine-related communications may be crucial, not only to maintain an adequate immunity rate for COVID-19, but also to inform policymakers and public authorities in the case of possible future infectious outbreaks.

The Impact of COVID-19 Vaccination on the Italian Healthcare System: A Scenario Analysis

Background and Objective

During 2020, the only instruments for fighting against the pandemic peaks were lockdowns, physical distancing, closure of schools and non-essential businesses, and travel restrictions. The new vaccination strategy adopted in Italy in 2021 represented a new perspective for policymakers.

Objective

The aim of this study was to estimate the effects of the national immunisation strategy for coronavirus disease 2019 (COVID-19) in Italy on the national healthcare system.

Methods

An epidemiological scenario analysis was developed in order to simulate the impact of the COVID-19 pandemic on the Italian national healthcare system in 2021. Hospitalisations, intensive care unit (ICU) admissions and death rates were modelled based on 2020 data. Costs were estimated using hospital admissions from the Policlinico of Tor Vergata Hospital in Rome. Two scenarios were tested, one with vaccination and the second without.

Results

The roll-out of vaccinations to protect against COVID-19 was estimated to prevent 52,115 deaths in 2021, 45.2% less than what was expected in the absence of immunisation. Based on the assumptions underlying the two epidemiological scenarios, our model predicted an overall reduction of 2.4 million hospital admissions and 259,000 ICU admissions (74.9% and 71.3% less, respectively, than the world without vaccinations between June and December 2021). Overall, in Italy, the model estimated over €3.0 billion costs of hospitalisations due to COVID-19 in 2020. In 2021, vaccines prevented around 36% of the overall costs.

Conclusions

This is the first study highlighting the effect of vaccines on the Italian healthcare system in terms of avoided cases, hospitalisations and costs. Our results have the potential to inform policymakers and the general population on the benefits of vaccinations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40261-022-01127-9.