The fastest national COVID vaccination in Europe - Malta's strategies

Hybrid immunity and protection against infection during the Omicron wave in Malta

By December 2021, administration of the third dose of COVID-19 vaccinations coincided with the spread of the Omicron variant in Europe. Questions had been raised on protection against infection conferred by previous vaccination and/or infection. Our study population included 252,433 participants from the COVID-19 vaccination registry in Malta. Data were then matched with the national testing database. We collected vaccination status, vaccine brand, vaccination date, infection history, and age. Using logistic regression, we examined different combinations of vaccine dose, prior infection status and time, and the odds of infection during the period when the Omicron variant was the dominant variant in Malta. Participants infected with Sars-Cov-2 prior to the Omicron wave had a significantly lower odds of being infected with the Omicron variant. Additionally, the more recent the infection and the more recent the vaccination, the lower the odds of infection. Receiving a third dose within 20 weeks of the start of the Omicron wave in Malta offered similar odds of infection as receiving a second dose within the same period. Time since vaccination was a strong determinant against infection, as was previous infection status and the number of doses taken. This finding reinforces the importance of future booster dose provision especially to vulnerable populations.

A cross-sectional study exploring the Covid-19 vaccination landscape in Malta through social media: An insight into experiences, attitudes, and perspectives

Background and Aims

Covid-19 vaccines were disseminated across Europe from the end of 2020. Malta had one of the fastest vaccination rollouts in Europe and by March 2022 most adults had their booster dose. The aim was to investigate adult's perspectives, experiences, and attitudes regarding vaccination in Malta.

Methods

An anonymous online survey targeting adult social media users living in Malta was disseminated through social media, with a snowball technique. Demographic information, vaccination uptake, side-effects, perceptions, and experiences were gathered through quantitative and qualitative means. Participants were sub-grouped according to their vaccination status and descriptive analysis through frequency was performed. χ ²/Fisher test testing followed by logistic regressions were performed to assess the vaccination perspectives according to vaccination status.

Results

Out of 611 participants 79.87% had the booster, 4.91% had two doses awaiting booster, 6.55% refused booster while, 8.67% refused any dose. Booster sub-group when compared to vaccine hesitant sub-group exhibited an association with the perception for the need to "continue wearing masks, maintaining physical distance and hand washing following vaccination" (odds ratio [OR]: 5.97 confidence interval [CI] 95%: 1.09-32.36 p = 0.04). Those waiting for the booster dose when compared to those refusing booster, exhibited an association with the perspective that "COVID-19 vaccine is the solution to returning to normality" (OR: 5.00 CI 95%: 1.12-22.35 p = 0.04). The commonest reason for inoculation was to protect against severe disease (63.08% CI 95%: 58.91-67.07). More pronounced booster adverse effects raised concern about future booster doses uptake. Unwillingness among anti-booster and vaccine hesitant arose among high socioeconomic background participants, with concern for vaccine safety and adverse effects.

Conclusion

Vaccine hesitancy is low yet, vaccination unwillingness even among highly educated may act as a barrier to control the pandemic. Clear, transparent public health communication which targets concerns is crucial, with unified messages from governing bodies optimizing population safety.

Bi-objective optimization of a stochastic resilient vaccine distribution network in the context of the COVID-19 pandemic

This paper develops an approach to optimize a vaccine distribution network design through a mixed-integer nonlinear programming model with two objectives: minimizing the total expected number of deaths among the population and minimizing the total distribution cost of the vaccination campaign. Additionally, we assume that a set of input parameters (e.g., death rate, social contacts, vaccine supply, etc.) is uncertain, and the distribution network is exposed to disruptions. We then investigate the resilience of the distribution network through a scenario-based robust-stochastic optimization approach. The proposed model is linearized and finally validated through a real case study of the COVID-19 vaccination campaign in France. We show that the current vaccination strategies are not optimal, and vaccination prioritization among the population and the equity of vaccine distribution depend on other factors than those conceived by health policymakers. Furthermore, we demonstrate that a vaccination strategy mixing the population prioritization and the quarantine restrictions leads to an 8.5% decrease in the total number of deaths.

Assessing the impact of the four COVID-19 variants and the vaccine coverage on mortality in Malta over 2 years: An observational case study

Background

Mortality may quantify a population's disease burden. Malta, like other European countries, experienced COVID-19 surges in cases and mortality across the pandemic. This study assesses COVID-19's mortality impact, while exploring the effects of the four dominant COVID-19 variants and that of the vaccination coverage on the Maltese population.

Methods

COVID-19 data (cases, mortality, positivity, and vaccination rates) was obtained from the websites of the European Center for Disease Prevention and Control and the Malta Ministry of Health. Data was categorized into the four periods according to reported dominant COVID-19 variant. Years of life lost (YLL) and Case-Fatality-Ratio (CFR) for each period were estimated. CFR was also estimated for the pre-vaccine and post-vaccine periods.

Results

The original COVID-19 period (36 weeks) had the highest YLL (4,484), followed by the Omicron variant period (12 weeks; 1,398). The Alpha variant period (7 weeks) had the highest CFR (1.89%) followed by the Original COVID-19 (1.35%). The pre-vaccine (1.59%) period had higher CFR than the post-vaccine period (0.67%).

Conclusion

Various factors contributed to mortality, but the variant's infectivity, transmissibility, and the effectiveness of the vaccine against the variant play an important role. Reducing mortality by embracing mass vaccination that targets current variants along with other non-pharmaceutical interventions remains paramount.

COVID-19 vaccination roll-outs in eleven small countries within the WHO European region; Lessons learned

The development and administration of COVID-19 vaccines has been an essential element in controlling the COVID-19 pandemic. However, countries worldwide have faced challenges in planning and implementing vaccination strategies. The aim of the current paper is to describe the situation faced by small countries in the WHO European Region in implementing their national vaccination strategies during the first stages of the planned roll-out (up to May 2021). This paper uses information from the WHO Small Countries Initiative (SCI), which includes a network of 11 countries with populations of ≤ 2 million (Andorra, Cyprus, Estonia, Iceland, Latvia, Luxembourg, Malta, Monaco, Montenegro, San Marino, and Slovenia). The SCI countries faced many challenges including: a lack of appropriate vaccination centers, adequate workforce, and registration/booking systems to cope with the unprecedented vaccine storage and administration demands; difficulties for high-risk groups (e.g., older individuals and those with health problems or cognitive impairment) to access vaccination sites or use digital registration/booking systems; vaccine wastage due to canceled appointments; and inequalities in vaccine uptake. Innovative programmatic interventions were implemented to facilitate the vaccination uptake of the populations such as: the creation of non-medical vaccination sites and mobile vaccination units; on-site vaccination of people in long-term residential facilities and long-term medical wards; diversifying health workforce like redeployment of healthcare professionals and use of medical students and retired medical professionals; campaigns with clear information to the general public (in multiple languages where necessary) both offline and online; use of digital registration/booking systems and alternative (non-digital) registration/booking systems for relevant individuals; and administration of excess vaccine doses to non-priority groups to avoid wastage.

Excess Mortality on Italian Small Islands during the SARS-CoV-2 Pandemic: An Ecological Study

Small islands have been considered at an advantage when dealing with infectious diseases, including COVID-19, but the evidence is still lacking. Crude mortality rates (CMRs) and excess mortality rates (EMRs) were calculated for 35 municipalities on the Italian small islands for 2020 and 2021, and the corresponding estimates were compared to those of the parent provinces and the national estimates. Notification rates for COVID-19 were retrieved, but detailed data at the municipality level were not available. A relatively low CMR (1.069 per 100 per year, 95% confidence interval [95% CI] 0.983−1.164) was identified in 2020, compared to 1.180, 95% CI 1.098−1.269 for 2021. EMRs of small islands ranged between −25.6% and +15.6% in 2020, and between −13.0% and +20.9% in 2021, with an average gain of +0.3% (95% CI −5.3 to +5.8) for the entirety of the assessed timeframe, and no substantial differences between 2020 and 2021 (pooled estimates of −4.1%, 95% CI −12.3 to 4.1 vs. 4.6%, 95% CI −3.1 to 12.4; p = 0.143). When dealing with COVID-19 notification rates, during the first wave, parent provinces of Italian small islands exhibited substantially lower estimates than those at the national level. Even though subsequent stages of the pandemic (i.e., second, third, and fourth waves) saw a drastic increase in the number of confirmed cases and CMR, estimates from small islands remained generally lower than those from parent provinces and the national level. In regression analysis, notification rates and mortality in the parent provinces were the main effectors of EMRs in the small islands (β = 0.469 and β = 22.768, p < 0.001 and p = 0.007, respectively). Contrarily, the management of incident cases in hospital infrastructures and ICUs was characterized as a negative predictor for EMR (β = −11.208, p = 0.008, and −59.700, p = 0.003, respectively). In summary, the study suggests a potential role of small geographical and population size in strengthening the effect of restrictive measures toward countering the spread and mortality rate of COVID-19.

Patient Outcomes from Student-Run Health Services: An Integrative Review

Background

Student-run clinics (SRCs) offer an innovative approach to expand healthcare access and equity and increase clinical placement opportunities for students. However, research on the health benefits and/or outcomes of such clinics is currently fragmented.

Methods

An integrative review was conducted to capture and synthesize findings across a range of study types involving varied student disciplines, student delivered intervention types, and health conditions addressed or care areas of focus. Only published and peer reviewed studies were included. Studies needed to report outcomes in a defined study group measured over time, or report SRC data with explicit comparisons to non-SRC settings. Data were analyzed using inductive content analysis to identify major themes and natural clustering of health outcomes measured.

Results

Fifty-one articles were selected for review based on the eligibility criteria. Studies were predominantly from the United States, and most (n = 34, 67%) adopted a case review methodology for measuring outcomes. Health outcomes were evaluated in relation to a range of health conditions that, for the purposes of this review, were considered to naturally cluster into eight categories: diabetes, hypertension, functional health/quality of life, depression, hospital utilization, substance use, weight, health screening/vaccinations, and others.

Conclusion

This integrative review sought to evaluate the health outcomes accrued by patients in student-run health clinics. Taken as a whole, the literature suggests positive health outcomes resulting from student-run clinics across a range of health conditions. Greater confidence in care-related findings would be achieved from future research utilizing more robust and prospective study designs.