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Attwell K, Roberts L, Rizzi M. From speculative to real: community attitudes towards government COVID-19 vaccine mandates in Western Australia from May 2021 to April 2022. HEALTH ECONOMICS, POLICY, AND LAW 2024:1-20. [PMID: 38766815 DOI: 10.1017/s1744133124000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Many governments employed mandates for COVID-19 vaccines, imposing consequences upon unvaccinated people. Attitudes towards these policies have generally been positive, but little is known about how discourses around them changed as the characteristics of the disease and the vaccinations evolved. Western Australia (WA) employed sweeping COVID-19 vaccine mandates for employment and public spaces whilst the state was closed off from the rest of the country and world, and mostly with no COVID-19 in the community. This article analyses WA public attitudes during the mandate policy lifecycle from speculative to real. Qualitative interview data from 151 adults were analysed in NVivo 20 via a novel chronological analysis anchored in key policy phases: no vaccine mandates, key worker vaccine mandates, vaccine mandates covering 75% of the workforce and public space mandates. Participants justified mandates as essential for border reopening and, less frequently, for goals such as protecting the health system. However, public discourse focusing on 'getting coverage rates up' may prove counter-productive for building support for vaccination; governments should reinforce end goals in public messaging (reducing suffering and saving lives) because such messaging is likely to be more meaningful to vaccination behaviour in the longer term.
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Affiliation(s)
- Katie Attwell
- VaxPolLab, School of Social Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Leah Roberts
- VaxPolLab, School of Social Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Marco Rizzi
- UWA Law School, The University of Western Australia, Perth, Western Australia, Australia
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2
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Yap WK, Attwell K. Medical exemptions to mandatory vaccinations: The state of play in Australia and a pressure point to watch. Epidemiol Infect 2024; 152:e40. [PMID: 38384194 PMCID: PMC10945935 DOI: 10.1017/s0950268824000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
Australia's mandatory vaccination policies have historically allowed for non-medical exemptions (NMEs), but this changed in 2016 when the Federal Government discontinued NMEs for childhood vaccination requirements. Australian states introduced further mandatory vaccination policies during the COVID-19 pandemic for a range of occupations including healthcare workers (HCWs). There is global evidence to suggest that medical exemptions (MEs) increase following the discontinuation of NMEs; the new swathe of COVID-19 mandatory vaccination policies likely also placed further pressure on ME systems in many jurisdictions. This paper examines the state of play of mandatory vaccination and ME policies in Australia by outlining the structure and operation of these policies for childhood vaccines, then for COVID-19, with a case study of HCW mandates. Next, the paper explores HCWs' experiences in providing vaccine exemptions to patients (and MEs in particular). Finally, the paper synthesizes existing literature and reflects on the challenges of MEs as a pressure point for people who do not want to vaccinate and for the clinicians who care for them, proposing areas for future research and action.
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Affiliation(s)
- William Kouji Yap
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | - Katie Attwell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Social Sciences, The University of Western Australia, Perth, WA, Australia
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3
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Roger C, Ling L, Petrier M, Elotmani L, Atchade E, Allaouchiche B, Aubrun F, Constantin JM, Dahyot-Fizelier C, Delhaye N, Dupont H, Fischer MO, Garnier M, Gayat E, Ichai C, Jaber S, Morel J, Plaud B, Rimmelé T, Robin S, Saba R, Joynt GM, Lefrant JY, Fabbro-Peray P, Lipman J, Conejero I, Laupland K. Occurrences of post-traumatic stress disorder, anxiety, depression, and burnout syndrome in ICU staff workers after two-year of the COVID-19 pandemic: the international PSY-CO in ICU study. Ann Gen Psychiatry 2024; 23:3. [PMID: 38172994 PMCID: PMC10765831 DOI: 10.1186/s12991-023-00488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic. MATERIALS AND METHODS An international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively. A personal questionnaire was used to isolate independent associated factors with these disorders. RESULTS PCL-5, HADS, and MBI questionnaires were completed by 585, 570, and 539 responders, respectively (525 completed all questionnaires). PTSD was diagnosed in 98/585 responders (16.8%). Changing familial environment, being a non-caregiver staff worker, having not being involved in a COVID-19 patient admission, having not been provided with COVID-19-related information were associated with PTSD. Anxiety was reported in 130/570 responders (22.8%). Working in a public hospital, being a woman, being financially impacted, being a non-clinical healthcare staff member, having no theoretical or practical training on individual preventive measures, and fear of managing COVID-19 patients were associated with anxiety. Depression was reported in 50/570 responders (8.8%). Comorbidity at risk of severe COVID-19, working in a public hospital, looking after a child, being a non-caregiver staff member, having no information, and a request for moving from the unit were associated with depression. Having received no information and no adequate training for COVID-19 patient management were associated with all 3 dimensions of BOS. CONCLUSION The present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders.
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Affiliation(s)
- Claire Roger
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France
| | - Lowel Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Mélissa Petrier
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
- Biostatistics Department, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Loubna Elotmani
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France
| | - Enora Atchade
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Bernard Allaouchiche
- Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Frédéric Aubrun
- Department of Anesthesiology and Critical Care, Hôpital de la Croix Rousse, 69317, Lyon, France
| | - Jean-Michel Constantin
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Paris, France
| | - Claire Dahyot-Fizelier
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France
| | - Nathalie Delhaye
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Hervé Dupont
- Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire d'Amiens Picardie, Amiens, France
| | - Marc-Olivier Fischer
- Normandy University, UNICAEN, CHU de Caen Normandie, Ecole Doctorale NBISE 497, Service d'Anesthésie Réanimation, Caen, France
- Institut Aquitain du Coeur, Clinique Saint Augustin, Elsan, 114 Avenue d'Arès, 33074, Bordeaux Cedex, France
| | - Marc Garnier
- Département Médico-Universitaire DREAM, Sorbonne Université, GRC 29, AP-HP, Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire Rive Droite Tenon-Saint Antoine, Paris, France
- CHU de Clermont-Ferrand, Université Clermont Auvergne, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care, APHP. Nord, DMU Parabol, Université de Paris, Paris, France
- UMR-S 942 "MASCOT," Inserm, Paris, France
| | - Carole Ichai
- Département Anesthésie-Réanimation, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France
| | - Jérome Morel
- Surgical ICU, Saint-Etienne University Hospital, Saint-Etienne, France
- Jacques Lisfranc Medical School, Saint-Etienne University, Saint-Etienne, France
| | - Benoit Plaud
- Université Paris Cité, AP-HP. Nord, Hôpital Saint-Louis, DMU PARABOL, Service d'Anesthésie-Réanimation-CTB, 75010, Paris, France
| | - Thomas Rimmelé
- Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France
- EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sylvaine Robin
- Department of Anesthesia and Critical Care, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Renee Saba
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jean-Yves Lefrant
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France.
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
| | - Jeffrey Lipman
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, 4029, Australia
| | - Ismael Conejero
- Department of Psychiatry, Nimes University Hospital, Nimes, France
- Laboratory of Biochemistry and Molecular Biology, Nimes University Hospital, University of Montpellier, Nimes, France
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS-INSERM, Montpellier, France
| | - Kevin Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Wong E, Sutton B, McLaughlin T, McGrath C, Baptista M, Stripp A, Stuart RL. Achieving COVID-19 vaccination equity in South Eastern Metropolitan Victoria, Australia: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100900. [PMID: 37928002 PMCID: PMC10625028 DOI: 10.1016/j.lanwpc.2023.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023]
Abstract
Background We describe COVID-19 first and second vaccine uptake across Local Government Areas (LGAs) in Victoria using southeast metropolitan Melbourne catchment as a case study. We explore key policy and implementation strategies that contributed to equitable uptake. Methods Population level data within the South East Public Health Unit (SEPHU) was used to compare trends in COVID-19 vaccination first and second dose uptake for each of the 11 LGAs in year 2021. Changes in vaccination uptake over the year were reviewed against social and public health measures used during the COVID-19 pandemic in Victoria and strategies in the SEPHU vaccination program. Findings By September 2021, 57% of the eligible population in the least disadvantaged LGA, Bayside, had received their second dose vaccination compared to 32% in the most disadvantaged LGA, Greater Dandenong. By end of 2021, the gap had narrowed with 95% in Bayside and 92% in Greater Dandenong having received their second dose. The increase in vaccination uptake for both LGAs was bimodal. Government policies on vaccine eligibility and the opening of mass vaccination sites preceded the first peak in vaccination uptake. Strong community engagement, addressing misinformation, providing culturally appropriate vaccination services and mass outbreaks preceded the second peak in vaccination uptake. Interpretation Vaccine equity across culturally and economically diverse populations can be achieved through a combination of robust, targeted community engagement, mass deployment of appropriate workforce, vaccination services tailored to cultural needs and sensitivities and accessibility to mass vaccination sites on a backdrop of state-wide policies that incentivise vaccination. Funding None.
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Affiliation(s)
- Evelyn Wong
- Monash Health, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Brett Sutton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Department of Health, Victoria, Australia
| | | | | | - Mohana Baptista
- Monash Health, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Andrew Stripp
- Monash Health, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Rhonda L. Stuart
- Monash Health, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Wanger S, Weber E. Sickness absence due to mandatory COVID-19 certificates in the workplace. BMC Public Health 2023; 23:1482. [PMID: 37537556 PMCID: PMC10401870 DOI: 10.1186/s12889-023-16415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 07/27/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND As vaccines for COVID-19 became available, many countries introduced an obligation in 2021 for employees to prove their COVID-19 status at work, known in Germany as the 3G rule (vaccinated, recovered, tested). In view of the controversial debate, there was concern that employees might try to avoid providing mandatory COVID-19 certificates by taking sick leave. The aim of this study was to investigate whether mandatory COVID-19 tests in the workplace led to such an evasive response. METHOD For an empirical panel analysis, we collected data from official sources and combined aggregated health insurance data on sick leave, epidemiological data on laboratory-confirmed COVID-19 infections, and vaccination rates for the German states from September 2021 to January 2022. We used a regional panel data analysis to estimate the impact of the mandatory COVID-19 certificates at the workplace on workers' sick leave. The regional vaccination rate reflected differences in treatment intensity. RESULTS This study contributes to the limited evidence on the potential impact of introducing mandatory COVID-19 certificates at the workplace on sickness absence rates. In fact, our results showed that after controlling for infection rates, a one percentage point lower vaccination rate led to a 0.021 percentage point increase in the sickness absence rate when the 3G rule came into effect. This effect was measured with high statistical precision. In addition, in robustness checks, we controlled for a number of other possible influencing factors that may have affected sickness behaviours, such as time-varying labour market situations. However, the results remained robust. CONCLUSIONS The results of our empirical panel analysis implied that mandatory COVID-19 certificates in the workplace led to evasive responses and to additional days of sick leave of a relevant magnitude. Testing obligations were meant to help contain the epidemic. However, when introducing controversial obligations, it is important to consider evasive responses and to design the rules appropriately and communicate them convincingly.
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Affiliation(s)
- Susanne Wanger
- Research Department 'Forecasts and Macroeconomic Analyses', Institute for Employment Research (IAB), Regensburger Straße 100, 90478, Nuremberg, Germany.
| | - Enzo Weber
- Research Department 'Forecasts and Macroeconomic Analyses', Institute for Employment Research (IAB), Regensburger Straße 100, 90478, Nuremberg, Germany
- Chair of Empirical Economics, University of Regensburg, Regensburg, Germany
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Karlsson LC, Garrison A, Holford D, Fasce A, Lewandowsky S, Taubert F, Schmid P, Betsch C, Rodrigues F, Fressard L, Verger P, Soveri A. Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries. Hum Vaccin Immunother 2023; 19:2256442. [PMID: 37724556 PMCID: PMC10512846 DOI: 10.1080/21645515.2023.2256442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.
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Affiliation(s)
- Linda C. Karlsson
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Amanda Garrison
- Faculté des Sciences Médicales et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS-PACA), Marseille, France
| | - Dawn Holford
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Potsdam, Potsdam, Germany
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Frederike Taubert
- Institute for Planetary Health Behavior, Health Communication, University of Erfurt, Erfurt, Germany
- Health Communication Working Group, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, University of Hamburg, Hamburg, Germany
| | - Philipp Schmid
- Institute for Planetary Health Behavior, Health Communication, University of Erfurt, Erfurt, Germany
- Health Communication Working Group, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, University of Hamburg, Hamburg, Germany
- Centre for Language Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Cornelia Betsch
- Institute for Planetary Health Behavior, Health Communication, University of Erfurt, Erfurt, Germany
- Health Communication Working Group, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, University of Hamburg, Hamburg, Germany
| | | | - Lisa Fressard
- Faculté des Sciences Médicales et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS-PACA), Marseille, France
| | - Pierre Verger
- Faculté des Sciences Médicales et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS-PACA), Marseille, France
| | - Anna Soveri
- Department of Clinical Medicine, University of Turku, Turku, Finland
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Kreps SE, Kriner DL. Resistance to COVID-19 vaccination and the social contract: evidence from Italy. NPJ Vaccines 2023; 8:60. [PMID: 37087511 PMCID: PMC10122449 DOI: 10.1038/s41541-023-00660-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
Confronted with stalled vaccination efforts against COVID-19, many governments embraced mandates and other measures to incentivize vaccination that excluded the unvaccinated from aspects of social and economic life. Even still, many citizens remained unvaccinated. We advance a social contract framework for understanding who remains unvaccinated and why. We leverage both observational and individual-level survey evidence from Italy to study the relationship between vaccination status and social context, social trust, political partisanship, and adherence to core institutional structures such as the rule of law and collective commitments. We find that attitudes toward the rule of law and collective commitments outside the domain of vaccination are strongly associated with compliance with vaccine mandates and incentives. Partisanship also corresponds with vaccine behaviors, as supporters of parties whose leaders criticized aggressive policies to incentivize or mandate vaccination and emphasized individual liberty are least likely to comply. Our findings suggest appeals emphasizing individual benefits may be more effective than appeals emphasizing collective responsibility.
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Affiliation(s)
- Sarah E Kreps
- Department of Government, Cornell University, Ithaca, NY, USA
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8
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Viskupič F, Wiltse DL. Political Partisanship and Trust in Government Predict Popular Support for COVID-19 Vaccine Mandates for Various Professions and Demographic Groups: A Research Note. AMERICAN POLITICS RESEARCH 2023; 51:139-146. [PMID: 38603210 PMCID: PMC9364069 DOI: 10.1177/1532673x221118888] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Due to the slow rate of COVID-19 vaccine uptake and the spread of the highly contagious Omicron variant, governments are considering mandating COVID-19 vaccination for specific professions and demographic groups. This study evaluates popular attitudes toward such policies. We fielded a survey of 535 registered voters in South Dakota to examine popular attitudes towards vaccine mandates for five groups-children 12 and older, K-12 teachers, medical staff, nursing homes staff, and police personnel. We estimated a series of logistic regression models and presented predicted probabilities to find the primary determinants of these attitudes. Results revealed that political partisanship and trust in government are strong predictors of support for vaccine mandates across all models. Should government and public health officials wish to increase the proportion of people vaccinated for COVID-19, they must recognize the limitations of current public health campaigns, and reshape their efforts in congruence with scientific findings.
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9
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Attwell K, Hannah A. Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates. Int J Health Policy Manag 2022; 11:2660-2671. [PMID: 35397484 PMCID: PMC9818102 DOI: 10.34172/ijhpm.2022.6518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is a global problem with diverse local policy responses, from voluntaristic to coercive. Between 2015 and 2017, California, Australia, France, and Italy increased the coerciveness of their childhood vaccine regimes. Despite this apparent convergence, there is little evidence of imposition, policy learning, or diffusion - the drivers that are usually discussed in scholarly literature on policy convergence. The fact that the four governments were oriented across the political spectrum, with quite different political and institutional systems, further indicates an empirical puzzle. METHODS To better understand the drivers of enhanced vaccine mandates, a crucial issue during the coronavirus disease 2019 (COVID-19) global rollout, this article engages with four case studies assembled from qualitative analysis of semi-structured in-country interviews and document analysis between November 2018 and November 2020. Key informants had specific expert knowledge or played a role in the introduction or implementation of the new policies. Interview transcripts were coded inductively and deductively, augmented with extensive analysis of legal, policy, academic and media documents. RESULTS The case analysis identifies two key and interacting elements in government decisions to tighten vaccine mandates: functional and political pressures. Policy-makers in Italy and France were primarily driven by functional challenges, with their vaccination governance systems under threat from reduced population compliance. California and Australia did not face systemic threats to the functioning of their systems, but activists utilised local opportunities to heighten political pressure on decision makers. CONCLUSION In four recent cases of high-income jurisdictions making childhood vaccination policies more coercive, vaccine hesitancy alone could not explain why the policies arose in these jurisdictions and not others, while path dependency alone could not explain why some jurisdictions with mandates made them more coercive. Explanation lies in restrictive mandates being attractive for governments, whether they face systemic functional problems in vaccine governance, or political pressures generated by media and activists. Mandates can be framed as targeting whole populations or localised groups of refusers, and implemented without onerous costs or policy complexity.
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Affiliation(s)
- Katie Attwell
- Political Science and International Relations, School of Social Sciences, University of Western Australia, Perth, WA, Australia
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10
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Kreps SE, Kriner DL. How do COVID-19 vaccine mandates affect attitudes toward the vaccine and participation in mandate-affected activities? Evidence from the United States. Vaccine 2022; 40:7460-7465. [PMID: 35249774 PMCID: PMC8888038 DOI: 10.1016/j.vaccine.2022.02.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/15/2021] [Accepted: 02/24/2022] [Indexed: 01/28/2023]
Abstract
The spread of COVID-19 has prompted many governments, schools, and companies to institute vaccine mandates. Proponents suggest that mandates will enhance public health and increase vaccination rates. Critics suggest that evidence of mandates' effectiveness is unclear and warn that mandates risk increasing societal inequalities if unvaccinated minority groups opt out of educational, commercial, and social activities where mandates are required. We conduct an original survey experiment on a nationally representative sample of 1,245 Americans to examine the efficacy and effect of COVID-19 mandates. Our findings suggest that mandates are unlikely to change vaccination behavior overall. Further, they may increase the likelihood that sizable percentages of the population opt out of activities where vaccines are mandated. We conclude that mandates that do go into effect should be accompanied by persuasive communications targeted to specific information needs and identities.
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Affiliation(s)
- S E Kreps
- Cornell University, Department of Government, White Hall, Ithaca, NY 14853, United States
| | - D L Kriner
- Cornell University, Department of Government, White Hall, Ithaca, NY 14853, United States.
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11
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Casey SM, Burrowes SAB, Hall T, Dobbins S, Ma M, Bano R, Yarrington C, Schechter-Perkins EM, Garofalo C, Drainoni ML, Perkins RB, Pierre-Joseph N. Healthcare workers' attitudes on mandates, incentives, and strategies to improve COVID-19 vaccine uptake: A mixed methods study. Hum Vaccin Immunother 2022; 18:2144048. [PMID: 36411988 DOI: 10.1080/21645515.2022.2144048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Healthcare workers are a trusted health information source and are uniquely positioned to reduce the burden of the COVID-19 pandemic. The purpose of this sequential exploratory mixed methods study was to understand attitudes of healthcare workers working in Massachusetts during the COVID-19 pandemic regarding strategies to improve COVID-19 vaccine utilization, including vaccine mandates and incentives. Fifty-two individuals completed one-on-one interviews between April 22nd and September 7th, 2021. The survey was developed based on findings from the interviews; 209 individuals completed the online survey between February 17th and March 23rd, 2022. Both the interview and survey asked about attitudes toward COVID-19 vaccine and booster mandates, incentives, and strategies to improve vaccination rates. Most participants were female (79%-interview, 81%-survey), Caucasian (56%, 73%), and worked as physicians (37%, 34%) or nurses (10%, 18%). Overall, nuanced attitudes regarding vaccine and booster mandates were expressed; many supported mandates to protect their patients' health, others emphasized personal autonomy, while some were against mandates if job termination was the consequence of declining vaccines. Similarly, views regarding vaccine incentives differed; some considered incentives helpful, yet many viewed them as coercive. Strategies believed to be most effective to encourage vaccination included improving accessibility to vaccination sites, addressing misinformation, discussing vaccine safety, tailored community outreach via trusted messengers, and one-on-one conversations between patients and healthcare workers. Healthcare workers' experiences with strategies to improve utilization of COVID-19 vaccines and boosters have implications for public health policies. Generally, efforts to improve access and education were viewed more favorably than incentives and mandates.
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Affiliation(s)
- Sharon M Casey
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Taylor Hall
- Graduate of Medical Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sidney Dobbins
- Epidemiology and Statistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mengyu Ma
- Epidemiology and Statistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ruqiyya Bano
- Epidemiology and Statistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christina Yarrington
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Christopher Garofalo
- Department of Family Medicine and Department of Obstetrics and Gynecology, Sturdy Memorial Hospital, Attleboro, Massachusetts, USA.,Family Medicine Associates of South Attleboro, South Attleboro, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.,Department of Health Law Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Natalie Pierre-Joseph
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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12
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Attwell K, Roberts L, Blyth CC, Carlson SJ. Western Australian health care workers' views on mandatory COVID-19 vaccination for the workplace. HEALTH POLICY AND TECHNOLOGY 2022; 11:100657. [PMID: 35910408 PMCID: PMC9314263 DOI: 10.1016/j.hlpt.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Health care workers (HCWs) are at an increased risk of catching and spreading Coronavirus Disease 2019 (COVID-19) compared with the general community, putting health systems at risk. Several jurisdictions globally have mandated or are looking to mandate COVID-19 vaccines for this cohort, but little is known about the acceptability of this measure, especially in different contexts, and there is little qualitative data to explore nuance, depth, and the reasons behind HCWs’ opinions. Methods In-depth semi-structured qualitative interviews were undertaken with 39 HCWs in Western Australia (WA) between February-August 2021, ascertaining their views on the prospective introduction and implementation of mandates for COVID-19 vaccines. Data were thematically analysed using NVivo 20. Results There was broad support for COVID-19 vaccine mandates for HCWs amongst our participants, but also different views about what such a mandate would mean (redeployment versus termination) and how it would impact the rest of the workforce. One vaccine hesitant participant said that mandates would be their prompt to get vaccinated. Other participants invoked an informal code whereby HCWs have an obligation to be seen to support vaccination and to protect public health more broadly. However, they also raised concerns about implementation and procedural and policy fairness. Conclusion Policymakers should consider how to mobilise the informal code of health promotion and public health support if introducing mandates. They should also consider whether HCWs will bring the same attitudes and approaches to mandates for additional vaccine doses.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
| | - Leah Roberts
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
| | - Samantha J Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
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13
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Attwell K, Drislane S. Australia's 'No Jab No Play' policies: history, design and rationales. Aust N Z J Public Health 2022; 46:640-646. [PMID: 35980171 DOI: 10.1111/1753-6405.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Since 2014, five Australian states have enacted 'No Jab, No Play' policies requiring children to be fully vaccinated to attend childcare and early education services. We review the five policies and their implications for implementers - including healthcare and childcare service providers - and analyse factors that shaped the design of state policies. METHODS We employed documentary analysis and analysed key informant interviews in NVivo 12. RESULTS Our findings reveal similarities and differences between state provisions regarding exemptions, grace periods, responsibilities of service providers and sanctions for non-compliance. We elaborate on five factors of influence that have shaped No Jab, No Play policies: i) impetus for change; ii) policy normalisation, growing concurrence and stringency; iii) increased co-optation of childcare providers into vaccination governance; iv) policy influence and lessons; and v) partisan politics and the development of party ideologies over time. CONCLUSION A range of factors contribute to how and why Australia's NJNPlay policies have taken their current forms. IMPLICATIONS FOR PUBLIC HEALTH NJNPlay policies impact families and healthcare providers as part of the broader policy ecosystem concerned with maintaining high immunisation rates in Australia. Increased coercion of parents over time has been tempered by partisan positions on exemptions for disadvantage.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, University of Western Australia
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14
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Attwell K, Roberts L, Ji J. COVID-19 Vaccine Mandates: Attitudes and Effects on Holdouts in a Large Australian University Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10130. [PMID: 36011769 PMCID: PMC9408755 DOI: 10.3390/ijerph191610130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Many governments and institutions mandated COVID-19 vaccines. In late 2021, we sought to ascertain the perspectives of staff and students from The University of Western Australia about the State or the University mandating COVID-19 vaccines. The survey captured vaccination status and intentions along with attitudes towards mandates and potential types of exemptions with 2878 valid responses which were quantitatively analysed and 2727 which were qualitatively analysed. The study found generally high levels of vaccination or intent, and strong support for mandates, underpinned by beliefs that vaccination is a moral duty and that mandates make campus feel safer. These sentiments were not more prevalent amongst individuals with comorbidities; often healthy individuals supported mandates to reduce their risk of transmitting disease to vulnerable family members. Individuals with comorbidities were, however, more supportive of excluding the unvaccinated from campus. Most opponents were unvaccinated, and many indicated that mandate policies would backfire, making them less likely to vaccinate. Despite the strong overall support, 41% of respondents did not want to see non-compliant staff or students lose their positions, and only 35% actively sought this. Institutions or governments introducing mandates should emphasise community concerns about catching COVID-19 and becoming sick or transmitting the disease to vulnerable loved ones.
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Affiliation(s)
- Katie Attwell
- School of Social Science, University of Western Australia, Crawley, WA 6009, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA 6008, Australia
- Immunisation Alliance of Western Australia, Cockburn Integrated Health and Community Facility, Suite 14, 11 Wentworth Parade, Success, WA 6164, Australia
| | - Leah Roberts
- School of Social Science, University of Western Australia, Crawley, WA 6009, Australia
| | - Julie Ji
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA 6008, Australia
- School of Psychological Science, University of Western Australia, Crawley, WA 6009, Australia
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15
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Harper T, Tomkinson S, Attwell K. Communication Is Not a Virus: COVID-19 Vaccine-Critical Activity on Facebook and Implications for the 'Infodemic' Concept. JOURNAL OF HEALTH COMMUNICATION 2022; 27:563-573. [PMID: 36250528 DOI: 10.1080/10810730.2022.2136307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In February 2020 the World Health Organization declared an 'infodemic' in relation to COVID-19. The label infers that people are being contaminated by 'misinformation' as they would be by a virus. However, this metaphor conveys a simplistic empirical understanding of communication, which may encourage 'information control' responses. This article argues for the importance of understanding the diverse factors that impact the effectiveness of communication - including the context in which it is received, and the emergent properties created through communication processes. Analyzing 'vaccine-critical' Facebook activity in Australia between 1 December 2020 and 28 February 2022, we find that controlling access to or censoring vaccine-critical misinformation does not lead to a reduction in vaccine-critical narratives. Rather, discussions continue based on more tenable political and social arguments. Further, bans antagonize vaccine-critical Facebook users and encourage them to move to other platforms where they may be radicalized. Crucially, recruitment to vaccine-critical sites accelerated following both bans of 'misinformation' and the introduction of vaccine mandates, suggesting that such responses can lead to increased discontentment. Accordingly, we call for researchers, policy makers and media platforms to engage with a more nuanced view of communication, acknowledging the powerful role of audiences' uses and gratifications in determining the effectiveness of public health messaging.
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Affiliation(s)
- Tauel Harper
- School of Media, Creative Arts and Social Inquiry, Curtin University, Perth, Western Australia, Australia
| | - Sian Tomkinson
- School of Social Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Katie Attwell
- School of Social Sciences, The University of Western Australia, Perth, Western Australia, Australia
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16
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The Effects of COVID-19 Vaccine Mandates in Hawaii. Vaccines (Basel) 2022; 10:vaccines10050773. [PMID: 35632529 PMCID: PMC9144874 DOI: 10.3390/vaccines10050773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
Having been affected by the highest increase in COVID-19 cases since the start of the pandemic, Honolulu and Maui counties in Hawaii implemented vaccine passport mandates for select industries in September 2021. However, the degree to which such mandates impacted COVID-19 mitigation efforts and economics remains poorly understood. Herein, we describe the effects of these mandates on changes in three areas using difference-in-difference regression models: (1) business foot traffic; (2) number of COVID-19 cases per 100,000 individuals, and (3) COVID-19 vaccination rates across counties affected or unaffected by the mandates. We observed that although businesses affected by mandates experienced a 6.7% decrease in foot traffic over the 14 weeks after the mandates were implemented, the number of COVID-19 cases decreased by 19.0%. Notably, the vaccination rate increased by 1.41% in counties that implemented mandates. In addition, towards the end of the studied period, the level of foot traffic at impacted businesses converged towards the level of that of non-impacted businesses. As such, the trade-off in temporary losses at businesses was met with significant gains in public health and safety.
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17
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Zachreson C, Shearer FM, Price DJ, Lydeamore MJ, McVernon J, McCaw J, Geard N. COVID-19 in low-tolerance border quarantine systems: Impact of the Delta variant of SARS-CoV-2. SCIENCE ADVANCES 2022; 8:eabm3624. [PMID: 35394833 PMCID: PMC8993115 DOI: 10.1126/sciadv.abm3624] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/16/2022] [Indexed: 05/25/2023]
Abstract
In controlling transmission of coronavirus disease 2019 (COVID-19), the effectiveness of border quarantine strategies is a key concern for jurisdictions in which the local prevalence of disease and immunity is low. In settings like this such as China, Australia, and New Zealand, rare outbreak events can lead to escalating epidemics and trigger the imposition of large-scale lockdown policies. Here, we develop and apply an individual-based model of COVID-19 to simulate case importation from managed quarantine under various vaccination scenarios. We then use the output of the individual-based model as input to a branching process model to assess community transmission risk. For parameters corresponding to the Delta variant, our results demonstrate that vaccination effectively counteracts the pathogen's increased infectiousness. To prevent outbreaks, heightened vaccination in border quarantine systems must be combined with mass vaccination. The ultimate success of these programs will depend sensitively on the efficacy of vaccines against viral transmission.
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Affiliation(s)
- Cameron Zachreson
- School of Computing and Information Systems, The University of Melbourne, Parkville, Victoria, Australia
| | - Freya M. Shearer
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - David J. Price
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael J. Lydeamore
- Department of Econometrics and Business Statistics, Monash University, Clayton, Victoria, Australia
| | - Jodie McVernon
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Laboratory Epidemiology Unit, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - James McCaw
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- School of Mathematics and Statistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas Geard
- School of Computing and Information Systems, The University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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18
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Greyling T, Rossouw S. Positive attitudes towards COVID-19 vaccines: A cross-country analysis. PLoS One 2022; 17:e0264994. [PMID: 35271637 PMCID: PMC8912241 DOI: 10.1371/journal.pone.0264994] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022] Open
Abstract
COVID-19 severely impacted world health and, as a consequence of the measures implemented to stop the spread of the virus, also irreversibly damaged the world economy. Research shows that receiving the COVID-19 vaccine is the most successful measure to combat the virus and could also address its indirect consequences. However, vaccine hesitancy is growing worldwide and the WHO names this hesitancy as one of the top ten threats to global health. This study investigates the trend in positive attitudes towards vaccines across ten countries since a positive attitude is important. Furthermore, we investigate those variables related to having a positive attitude, as these factors could potentially increase the uptake of vaccines. We derive our text corpus from vaccine-related tweets, harvested in real-time from Twitter. Using Natural Language Processing (NLP), we derive the sentiment and emotions contained in the tweets to construct daily time-series data. We analyse a panel dataset spanning both the Northern and Southern hemispheres from 1 February 2021 to 31 July 2021. To determine the relationship between several variables and the positive sentiment (attitude) towards vaccines, we run various models, including POLS, Panel Fixed Effects and Instrumental Variables estimations. Our results show that more information about vaccines’ safety and the expected side effects are needed to increase positive attitudes towards vaccines. Additionally, government procurement and the vaccine rollout should improve. Accessibility to the vaccine should be a priority, and a collective effort should be made to increase positive messaging about the vaccine, especially on social media. The results of this study contribute to the understanding of the emotional challenges associated with vaccine uptake and inform policymakers, health workers, and stakeholders who communicate to the public during infectious disease outbreaks. Additionally, the global fight against COVID-19 might be lost if the attitude towards vaccines is not improved.
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Affiliation(s)
- Talita Greyling
- School of Economics, College of Business and Economics, University of Johannesburg, Gauteng, South Africa
| | - Stephanié Rossouw
- School of Social Science & Public Policy, Faculty of Culture and Society, Auckland University of Technology, Auckland, New Zealand
- * E-mail:
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