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Doherty TM, Ecarnot F, Gaillat J, Privor-Dumm L. Nonstructural barriers to adult vaccination. Hum Vaccin Immunother 2024; 20:2334475. [PMID: 38629573 PMCID: PMC11028002 DOI: 10.1080/21645515.2024.2334475] [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: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Adult vaccination coverage remains low, despite vaccine recommendations, improved access, and reimbursement. Low vaccination coverage and an aging population at higher risk from vaccine-preventable diseases lead to preventable disability and deaths, straining healthcare systems. An Advisory Board meeting was, therefore, held to identify non-structural barriers to adult vaccination and discuss potential solutions to increase uptake. Many non-structural factors can influence vaccine uptake, such as heterogeneity in the population, (fear of) vaccine shortages, incentives, or mandates for vaccination, understanding of disease burden and personal risks, time and opportunity for healthcare providers (HCPs) to discuss and deliver vaccines during general practice or hospital visits, trust in the health system, and education. To address these barriers, push-pull mechanisms are required: to pull patients in for vaccination and to push HCP performance on vaccination delivery. For patients, the focus should be on lifelong prevention and quality of life benefits: personal conversations are needed to increase confidence and knowledge about vaccination, and credible communication is required to build trust in health services and normalize vaccination. For providers, quality measurements are required to prioritize vaccination and ensure opportunities to check vaccination status, discuss and deliver vaccines are not missed. Financial and quality-based incentives may help increase uptake.
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Affiliation(s)
| | | | | | - Lois Privor-Dumm
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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2
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Gerussi V, Peghin M, Palese A, De Martino M, Graziano E, Chiappinotto S, Fonda F, Bontempo G, Semenzin T, Martini L, Isola M, Tascini C. SARS-CoV-2 and influenza vaccine hesitancy during the COVID-19 pandemic in a dynamic perspective. Hum Vaccin Immunother 2024; 20:2358565. [PMID: 38825984 DOI: 10.1080/21645515.2024.2358565] [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: 01/23/2024] [Accepted: 05/18/2024] [Indexed: 06/04/2024] Open
Abstract
To investigate the dynamic evolution of vaccine hesitancy toward both COVID-19 and influenza in a context characterized by the compresence of SARS-CoV-2 pandemic and seasonal flu epidemics, a two times repeated cross-sectional exploratory design was performed at Udine Hospital (Italy) following a cohort of 479 adult patients with a previous history of SARS-CoV-2 infection in 2020. Vaccine attitude was assessed through standardized telephone interviews performed at 12 and 18 months after the acute illness. The first interview reported the success of the 2020/21 seasonal influenza immunization with 46.8% (224/479) of the participants showing a positive attitude, especially the elderly and people with comorbidities (p < .001), but the investigation conducted at 18 months showed a drastic drop in flu shot acceptance (30/166, 18.1%). On the other hand, a great increase in vaccinations against SARS-CoV-2 occurred after the introduction of Green Pass (26.7% vs 72.9%). The major drivers of flu vaccine skepticism were represented by the feeling of protection regardless of prevention and by concerns regarding vaccines safety and efficacy; conversely compulsory strategies seemed to play a secondary role, since only a minority of the participants identified in the restrictions induced by the certification the major incentive to get immunized against SARS-CoV-2. The focus on this peculiar historical period helps to take a step forward in the comprehension of the complexity and dynamicity of the vaccine hesitancy phenomenon. Future vaccination campaigns will need to consider the role of personal opinions and emotions, interpreted according to the social and political context.
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Affiliation(s)
- Valentina Gerussi
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Alvisa Palese
- Department of Medicine, School of Nursing, University of Udine, Udine, Italy
| | - Maria De Martino
- Department of Medicine, Institute of Statistics, University of Udine, Udine, Italy
| | - Elena Graziano
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | | | - Federico Fonda
- Department of Medicine, School of Nursing, University of Udine, Udine, Italy
| | - Giulia Bontempo
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Tosca Semenzin
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Luca Martini
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Miriam Isola
- Department of Medicine, Institute of Statistics, University of Udine, Udine, Italy
| | - Carlo Tascini
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
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Sum Z, Sofija E, Sebar B. Exploring COVID-19 vaccine hesitancy among young adults in Australia. A qualitative study. Vaccine X 2024; 19:100515. [PMID: 39040885 PMCID: PMC11260859 DOI: 10.1016/j.jvacx.2024.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background COVID-19 vaccine hesitancy among young adults in Australia is still poorly understood. Young adults aged 25-34 years have been identified as a population subgroup where COVID-19 vaccine-hesitant views are highly prevalent. Objective Exploring the attitudes, thoughts, feelings and social environments affecting the decision to have or not have the vaccine can provide vital transferrable lessons in future health campaigns. Methods A qualitative phenomenological study was conducted using semi-structured phone interviews between June 2021 and July 2021. Interview questions were adopted from the World Health Organization's guidance document 'Data for Action: Achieving High Uptake of COVID-19 Vaccines'. Participants aged 25-34 years (n = 26) were recruited via purposive and snowball sampling methods. Data were analysed thematically. Results Overall, participants presented themselves as highly vaccine literate, understanding their social contract with society. Many participants also did not display traditional vaccine-hesitant views. Six themes specifically regarding COVID-19 vaccine hesitancy were identified, namely (1) decision-making complexities, (2) perceived risk of COVID-19 infection, (3) media's misrepresentation of COVID-19, (4) vaccine-related issues, (5) inconsistent government messaging and program execution, and (6) social benefits assessment. In addition, motivators to COVID-19 vaccine uptake were classified into three categories: (1) tangible benefits, (2) protecting others, and (3) mandates and incentives. Findings suggest the motivators for COVID-19 vaccine uptake in young adults depend on individual benefits, highlighting the importance of recognising and addressing personal concerns. Conclusion There is a need to re-examine and redefine the meaning of vaccine hesitancy in young Australian adults. We offer an understanding of prospective challenges with vaccine hesitancy and potential solutions to address them. These include carefully tailored approaches regarding ongoing vaccine safety concerns and the expected personal benefits following vaccination. Combining these factors can aid in developing new methods of public engagement in the next public health crisis.
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Affiliation(s)
- Zachary Sum
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
| | - Bernadette Sebar
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
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Owaraganise A, Beesiga B, Okiring J, Roh ME, Kakande E, Nangendo J, Akatukwasa C, Lee JJ, Mwangwa F, Kabami J, Semitala FC, Kamya MR. Low COVID-19 vaccine uptake in people living with HIV and those with hypertension and diabetes without HIV at Mbarara and Masaka regional referral hospitals: A cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003270. [PMID: 38781200 PMCID: PMC11115231 DOI: 10.1371/journal.pgph.0003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
Chronic diseases such as HIV, hypertension, and diabetes increase the risk of severe coronavirus disease 2019 (COVID-19) and death. Thus, COVID-19 vaccine uptake data among these priority populations are needed to inform immunization programs. We assessed COVID-19 vaccine uptake among people living with HIV (PLWH) and those with hypertension/diabetes without HIV (PWoH) in Southwestern and Southcentral Uganda and determined factors influencing vaccination. We conducted a cross-sectional study from January to April 2023. We enrolled a random sample of participants aged 18 years and older seeking HIV, hypertension, or diabetes care at two regional referral hospitals (RRHs) in Mbarara and Masaka in Uganda. Using vaccination records abstraction and interviewer-administered questionnaires, we collected data on COVID-19 vaccine uptake, sociodemographic data, and reasons for non-uptake in unvaccinated persons. We compared COVID-19 vaccination uptake between PLWH and PWoH and applied modified Poisson regression to determine sociodemographic factors associated with vaccine uptake. The reasons for non-vaccine uptake were presented as percentages. Of the 1,376 enrolled participants, 65.6% were fully vaccinated against COVID-19. Vaccination coverage was 65% among PWLH versus 67% among PWoH. Higher education attainment and older age were associated with COVID vaccination. Participants with secondary education and those aged ≥50 years achieved >70% coverage. Fear of side effects was the most cited reason (67%) for non-vaccination among 330 unvaccinated participants, followed by vaccine mistrust (24.5%). People with chronic diseases in Southwestern Uganda had slightly lower than 70% COVID-19 vaccine coverage as recommended by WHO. Higher educational attainment and older age were linked to increased vaccine uptake. However, mistrust and fear of vaccine side effects were the main reasons for non-vaccination. To increase COVID-19 vaccine uptake, programs must reach those with lower educational attainment and younger age groups, and address the fear of vaccine side effects and mistrust among persons with underlying diseases in Uganda.
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Affiliation(s)
- Asiphas Owaraganise
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Michelle E. Roh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States America
| | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Joan Nangendo
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | | | - Jordan John Lee
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Santa Clara, California, United States of America
- Department of Epidemiology and Population Health, Stanford University, Santa Clara, California, United States of America
| | | | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - Fred C. Semitala
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
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5
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Aghaeeyan A, Ramazi P, Lewis MA. Revealing Decision-Making Strategies of Americans in Taking COVID-19 Vaccination. Bull Math Biol 2024; 86:72. [PMID: 38727916 DOI: 10.1007/s11538-024-01290-4] [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: 11/10/2023] [Accepted: 04/03/2024] [Indexed: 05/23/2024]
Abstract
Efficient coverage for newly developed vaccines requires knowing which groups of individuals will accept the vaccine immediately and which will take longer to accept or never accept. Of those who may eventually accept the vaccine, there are two main types: success-based learners, basing their decisions on others' satisfaction, and myopic rationalists, attending to their own immediate perceived benefit. We used COVID-19 vaccination data to fit a mechanistic model capturing the distinct effects of the two types on the vaccination progress. We proved the identifiability of the population proportions of each type and estimated that 47 % of Americans behaved as myopic rationalists with a high variation across the jurisdictions, from 31 % in Mississippi to 76 % in Vermont. The proportion was correlated with the vaccination coverage, proportion of votes in favor of Democrats in 2020 presidential election, and education score.
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Affiliation(s)
- Azadeh Aghaeeyan
- Department of Mathematics and Statistics, Brock University, St. Catharines, ON, Canada.
| | - Pouria Ramazi
- Department of Mathematics and Statistics, Brock University, St. Catharines, ON, Canada
| | - Mark A Lewis
- Department of Mathematics and Statistics and Department of Biology, University of Victoria, Victoria, BC, Canada
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6
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Steinmayr A, Rossi M. Vaccine-skeptic physicians and patient vaccination decisions. HEALTH ECONOMICS 2024; 33:509-525. [PMID: 38015034 DOI: 10.1002/hec.4781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
What is the role of general practitioners (GPs) in supporting or hindering public health efforts? We investigate the influence of vaccine-skeptic GPs on their patients' decisions to get a COVID-19 vaccination. We identify vaccine-skeptic GPs from the signatories of an open letter in which 199 Austrian physicians expressed their skepticism about COVID-19 vaccines. We examine small rural municipalities where patients choose a GP primarily based on geographic proximity. These vaccine-skeptic GPs reduced the vaccination rate by 5.6 percentage points. This estimate implies that they discouraged 7.9% of the vaccinable population. The effect appears to stem from discouragement rather than rationing vaccine access.
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Krajewski T, Hudgens M. The augmented synthetic control method in public health and biomedical research. Stat Methods Med Res 2024; 33:376-391. [PMID: 38320801 PMCID: PMC10981189 DOI: 10.1177/09622802231224638] [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] [Indexed: 03/28/2024]
Abstract
Estimating treatment (or policy or intervention) effects on a single individual or unit has become increasingly important in health and biomedical sciences. One method to estimate these effects is the synthetic control method, which constructs a synthetic control, a weighted average of control units that best matches the treated unit's pre-treatment outcomes and other relevant covariates. The intervention's impact is then estimated by comparing the post-intervention outcomes of the treated unit and its synthetic control, which serves as a proxy for the counterfactual outcome had the treated unit not experienced the intervention. The augmented synthetic control method, a recent adaptation of the synthetic control method, relaxes some of the synthetic control method's assumptions for broader applicability. While synthetic controls have been used in a variety of fields, their use in public health and biomedical research is more recent, and newer methods such as the augmented synthetic control method are underutilized. This paper briefly describes the synthetic control method and its application, explains the augmented synthetic control method and its differences from the synthetic control method, and estimates the effects of an antimalarial initiative in Mozambique using both the synthetic control method and the augmented synthetic control method to highlight the advantages of using the augmented synthetic control method to analyze the impact of interventions implemented in a single region.
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Affiliation(s)
- Taylor Krajewski
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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Kobayashi T, Tokiya M, Matsumoto A, Nakano T, Hirota Y, Hara M. Predictive factors of coronavirus disease (COVID-19) vaccination series completion: a one-year longitudinal web-based observational study in Japan. Front Public Health 2024; 12:1348170. [PMID: 38487189 PMCID: PMC10937344 DOI: 10.3389/fpubh.2024.1348170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Addresing vaccine hesitancy is considered an important goal in management of the COVID-19 pandemic. We sought to understand what factors influenced people, especially those initially hesitant, to receive two or more vaccine doses within a year of the vaccine's release. Methods We conducted longitudinal Web-based observational studies of 3,870 individuals. The surveys were conducted at four different time points: January 2021, June 2021, September 2021, and December 2021. In the baseline survey (January 2021), we assessed vaccination intention (i.e., "strongly agree" or "agree" [acceptance], "neutral" [not sure], and "disagree" or "strongly disagree" [hesitance]), and assumptions about coronavirus disease (COVID-19), COVID-19 vaccine, COVID-19-related health preventive behavior, and COVID-19 vaccine reliability. In subsequent surveys (December 2021), we assessed vaccination completion (i.e., ≥2 vaccinations). To investigate the relationship between predictors of COVID-19 vaccination completion, a multivariable logistic regression model was applied. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated while adjusting for gender, age, marital status, presence of children, household income category, and presence of diseases under treatment. In a stratified analysis, predictors were determined based on vaccination intention. Results Approximately 96, 87, and 72% of those who demonstrated acceptance, were not sure, or hesitated had been vaccinated after 1 year, respectively. Overall, significant factors associated with COVID-19 vaccine compliance included the influence of others close to the index participant (social norms) (AOR, 1.80; 95% CI, 1.56-2.08; p < 0.001), vaccine confidence (AOR, 1.39; 95% CI, 1.18-1.64; p < 0.001) and structural constraints (no time, inconvenient location of medical institutions, and other related factors) (AOR, 0.80; 95% CI, 0.70-0.91; p = 0.001). In the group of individuals classified as hesitant, significant factors associated with COVID-19 vaccine compliance included social norms (AOR, 2.43; 95% CI, 1.83-3.22; p < 0.001), confidence (AOR, 1.44; 95% CI, 1.10-1.88; p = 0.008), and knowledge (AOR, 0.69; 95% CI, 0.53-0.88; p = 0.003). Discussion We found that dissemination of accurate information about vaccines and a reduction in structural barriers to the extent possible enhanced vaccination rates. Once the need for vaccination becomes widespread, it becomes a social norm, and further improvements in these rates can then be anticipated. Our findings may help enhance vaccine uptake in the future.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Preventive Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Mikiko Tokiya
- Department of Social and Environmental Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Akiko Matsumoto
- Department of Social and Environmental Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, SOUSEIKAI Medical Group (Medical Co. LTA), Fukuoka, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
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Awunor NS, Lar LA, Isara AR. Views of Nigerian civil servants about compulsory COVID-19 vaccination: A qualitative study. Afr J Prim Health Care Fam Med 2024; 16:e1-e8. [PMID: 38426775 PMCID: PMC10913142 DOI: 10.4102/phcfm.v16i1.4208] [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: 06/24/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND COVID-19 caused unforeseen global burden, although vaccine strategy rapidly stalled transmission and protected those at risk. Many governments made vaccination mandatory for public space access. AIM This study aimed to elucidate perception of Nigerian civil servants towards mandatory COVID-19 vaccination and elicited their recommendations. SETTING This study was conducted in twelve purposively selected states in the six geopolitical zones and the Federal Capital Territory (FCT), Nigeria. Relevant ministries, departments and agencies were selected within the study sites. METHODS It was a qualitative study that interviewed consenting civil servants. Ethical approval was obtained from the National Health Research Ethics Committee. Interviews were conducted in person, following a pre-test. Data was analysed using NVivo software version 12. RESULTS Most participants were willing to take the vaccine if their safety was assured. However, enforcement to do so was a hindrance. Most participants commended the government for the effort to curb COVID-19 transmission and create awareness but were displeased with planning and handling of misconceptions. They recommended a more committed approach to vaccine production and funding by the government. CONCLUSION Participants were willing to take the COVID-19 vaccines because the gains of protection outweighed the risks. They suggested a less involuntary approach through reinforcing awareness creation and avoiding threats.Contribution: There is limited qualitative research on perception of Nigerian civil servants regarding mandatory COVID-19 vaccination. Being the main driving force of Nigeria's public service, their views are invaluable. Findings could contribute to future policies in times of emergency.
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Affiliation(s)
- Nyemike S Awunor
- Department of Community Medicine, Faculty of Clinical Sciences, Delta State University, Abraka, Nigeria; and, Department of Community Medicine, Delta State University Teaching Hospital, Oghara.
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10
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Koenig R, Savani MM, Lee-Whiting B, McAndrews J, Banerjee S, Hunter A, John P, Loewen PJ, Nyhan B. Public support for more stringent vaccine policies increases with vaccine effectiveness. Sci Rep 2024; 14:1748. [PMID: 38242974 PMCID: PMC10798948 DOI: 10.1038/s41598-024-51654-y] [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: 06/27/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
Under what conditions do citizens support coercive public policies? Although recent research suggests that people prefer policies that preserve freedom of choice, such as behavioural nudges, many citizens accepted stringent policy interventions like fines and mandates to promote vaccination during the COVID-19 pandemic-a pattern that may be linked to the unusually high effectiveness of COVID-19 vaccines. We conducted a large online survey experiment (N = 42,417) in the Group of Seven (G-7) countries investigating the relationship between a policy's effectiveness and public support for stringent policies. Our results indicate that public support for stringent vaccination policies increases as vaccine effectiveness increases, but at a modest scale. This relationship flattens at higher levels of vaccine effectiveness. These results suggest that intervention effectiveness can be a significant predictor of support for coercive policies but only up to some threshold of effectiveness.
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Affiliation(s)
- Richard Koenig
- Department of Political Economy, King's College London, London, WC2R 2LS, UK
| | - Manu Manthri Savani
- Department of Social and Political Sciences, Brunel University London, London, UB8 3PH, UK.
| | - Blake Lee-Whiting
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, M5S 3K9, Canada
- Department of Political Science, University of Toronto, Toronto, M5S 3G3, Canada
| | - John McAndrews
- Digital Society Lab, McMaster University, Hamilton, L8S 4L8, Canada
| | - Sanchayan Banerjee
- Institute for Environmental Studies (IVM), Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Andrew Hunter
- Department of Political Economy, King's College London, London, WC2R 2LS, UK
| | - Peter John
- Department of Political Economy, King's College London, London, WC2R 2LS, UK
| | - Peter John Loewen
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, M5S 3K9, Canada
- Department of Political Science, University of Toronto, Toronto, M5S 3G3, Canada
| | - Brendan Nyhan
- Department of Government, Dartmouth College, Hanover, 03755, USA
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11
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Amanda I, Graffin S, Grando MA. Scoping review of data privacy risks in COVID-19 apps with digital vaccination certifications. Digit Health 2024; 10:20552076241239171. [PMID: 38505280 PMCID: PMC10949543 DOI: 10.1177/20552076241239171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
The goal was to review mobile apps with COVID-19 digital vaccination certificates between November 2022 and March 2023 and evaluate: (a) compliance with the WHO Proof of Vaccination Scenario requirements, (b) risk levels of app permissions using a Permission Accumulated Risk Score (PARS), and (c) readability and transparency of the app's privacy policies using a Privacy Transparency Index (PTI) score. We found 49 mobile apps with COVID-19 digital vaccination certificates from across 32 countries. Most apps were developed by governments (37/49, 75.51%). We discovered a high positive correlation between the country-wide app total installs and the people vaccinated with at least one dose in the country (r = 0.93, P = <.001). Most apps (97.96%) had sources of information available for compliance with WHO Proof of Vaccination Scenario requirements. Only two apps included all the required data items, while most apps (75%) included five or more data out of nine items. We found that most (97.96%) apps had a Google Play link to generate the Exodus platform permission report, and most (95.92%) apps had an associated privacy policy available. We identified 80 unique permissions; some (23.75%) were dangerous or special. We also found 28 types of trackers. The average PARS was 28.58 (IQR 23.25, range 15-38.25). Most of the apps' privacy policies documents were difficult or very difficult to read (median grade level 14, IQR 2.6, range 13-15.6). The average PTI was 50.43 (SD 14.73; range 22.5-75). In conclusion, higher compliance with the WHO Proof of Vaccination Scenario requirements is desirable to support interoperability. Developers should limit the number of permissions for essential needs and disclose their purpose. Developers should write privacy policies that a wider audience can understand.
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Affiliation(s)
- Isca Amanda
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Savannah Graffin
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Maria Adela Grando
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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12
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Assad Z, Valtuille Z, Rybak A, Kaguelidou F, Lazzati A, Varon E, Pham LL, Lenglart L, Faye A, Caseris M, Cohen R, Levy C, Vabret A, Gravey F, Angoulvant F, Koehl B, Ouldali N. Unique Changes in the Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Unravel the Role of Respiratory Pathogens: A Time Series Analysis. Chest 2024; 165:150-160. [PMID: 37544426 DOI: 10.1016/j.chest.2023.07.4219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that the incidence of ACS followed the unprecedented population-level changes in respiratory pathogen dynamics after COVID-19-related nonpharmaceutical interventions (NPIs). RESEARCH QUESTION What is the respective role of respiratory pathogens in ACS epidemiology? STUDY DESIGN AND METHODS This study was an interrupted time series analysis of patient records from a national hospital-based surveillance system. All children aged < 18 years with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1,000 children with SCD over time was analyzed by using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen. RESULTS Among the 55,941 hospitalizations of children with SCD, 2,306 episodes of ACS were included (median [interquartile range] age, 9 [5-13] years). A significant decrease was observed in ACS incidence after NPI implementation in March 2020 (-29.5%; 95% CI, -46.8 to -12.2; P = .001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2 to 41.6; P = .007). Using population-level incidence of several respiratory pathogens, Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9 to 56.9; P = .02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3 to 11.3; P = .004); other respiratory pathogens had only a minor role. INTERPRETATION NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiologic situation allowed determination of the contribution of these respiratory pathogens, in particular S pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France.
| | - Zaba Valtuille
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Alexis Rybak
- INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France; Urgences Pédiatriques, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France
| | - Florentia Kaguelidou
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre de Recherche Clinique et Biologique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luu-Ly Pham
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Léa Lenglart
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Service d'Accueil des Urgences Pédiatriques, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Astrid Vabret
- Department of Virology, Caen University Hospital, Caen, France; Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Gravey
- Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Angoulvant
- Paris Sorbonne University, Centre de Recherche des Cordeliers, INSERM UMRS 1138, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR S1134, Integrated Biology of Red Blood Cells, Paris Cité University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
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13
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Kundu R, Datta J, Ray D, Mishra S, Bhattacharyya R, Zimmermann L, Mukherjee B. Comparative impact assessment of COVID-19 policy interventions in five South Asian countries using reported and estimated unreported death counts during 2020-2021. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002063. [PMID: 38150465 PMCID: PMC10752546 DOI: 10.1371/journal.pgph.0002063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/09/2023] [Indexed: 12/29/2023]
Abstract
There has been raging discussion and debate around the quality of COVID death data in South Asia. According to WHO, of the 5.5 million reported COVID-19 deaths from 2020-2021, 0.57 million (10%) were contributed by five low and middle income countries (LMIC) countries in the Global South: India, Pakistan, Bangladesh, Sri Lanka and Nepal. However, a number of excess death estimates show that the actual death toll from COVID-19 is significantly higher than the reported number of deaths. For example, the IHME and WHO both project around 14.9 million total deaths, of which 4.5-5.5 million were attributed to these five countries in 2020-2021. We focus our gaze on the COVID-19 performance of these five countries where 23.5% of the world population lives in 2020 and 2021, via a counterfactual lens and ask, to what extent the mortality of one LMIC would have been affected if it adopted the pandemic policies of another, similar country? We use a Bayesian semi-mechanistic model developed by Mishra et al. (2021) to compare both the reported and estimated total death tolls by permuting the time-varying reproduction number (Rt) across these countries over a similar time period. Our analysis shows that, in the first half of 2021, mortality in India in terms of reported deaths could have been reduced to 96 and 102 deaths per million compared to actual 170 reported deaths per million had it adopted the policies of Nepal and Pakistan respectively. In terms of total deaths, India could have averted 481 and 466 deaths per million had it adopted the policies of Bangladesh and Pakistan. On the other hand, India had a lower number of reported COVID-19 deaths per million (48 deaths per million) and a lower estimated total deaths per million (80 deaths per million) in the second half of 2021, and LMICs other than Pakistan would have lower reported mortality had they followed India's strategy. The gap between the reported and estimated total deaths highlights the varying level and extent of under-reporting of deaths across the subcontinent, and that model estimates are contingent on accuracy of the death data. Our analysis shows the importance of timely public health intervention and vaccines for lowering mortality and the need for better coverage infrastructure for the death registration system in LMICs.
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Affiliation(s)
- Ritoban Kundu
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jyotishka Datta
- Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States of America
| | - Debashree Ray
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Swapnil Mishra
- School of Public Health National University of Singapore, Singapore, Singapore
| | - Rupam Bhattacharyya
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Lauren Zimmermann
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
- Biostatistics Unit, Medical Research Council, University of Cambridge, Cambridge, United Kingdom
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
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14
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Fayaz-Farkhad B, Jung H. Do COVID-19 Vaccination Policies Backfire? The Effects of Mandates, Vaccination Passports, and Financial Incentives on COVID-19 Vaccination. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023:17456916231178708. [PMID: 38048051 DOI: 10.1177/17456916231178708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Faced with the challenges of motivating people to vaccinate, many countries have introduced policy-level interventions to encourage vaccination against COVID-19. For example, mandates were widely imposed requiring individuals to vaccinate to work and attend school, and vaccination passports required individuals to show proof of vaccination to travel and access public spaces and events. Furthermore, some countries also began offering financial incentives for getting vaccinated. One major criticism of these policies was the possibility that they would produce reactance and thus undermine voluntary vaccination. This article therefore reviews relevant empirical evidence to examine whether this is indeed the case. Specifically, we devote separate sections to reviewing and discussing the impacts of three major policies that were implemented during the COVID-19 pandemic: vaccination mandates, vaccination passports, and the provision of financial incentives. A careful analysis of the evidence provides little support that these policies backfire but instead can effectively promote vaccination at the population level. The policies are not without limitations, however, such as their inability to mobilize those that are strongly hesitant to vaccines. Finally, we discuss how policy-level interventions should be designed and implemented to address future epidemics and pandemics.
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Affiliation(s)
| | - Haesung Jung
- Annenberg School for Communication, University of Pennsylvania
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15
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Morbée S, Vansteenkiste M, Waterschoot J, Klein O, Luminet O, Schmitz M, Van den Bergh O, Van Oost P, Yzerbyt V. The Role of Communication Style and External Motivators in Predicting Vaccination Experiences and Intentions: An Experimental Vignette Study. HEALTH COMMUNICATION 2023; 38:2894-2903. [PMID: 36162986 DOI: 10.1080/10410236.2022.2125012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This vignette-based study examined in a sample of unvaccinated Belgian citizens (N = 1918; Mage = 45.99) how health care workers could foster reflection about and intentions to get vaccinated against COVID-19 by experimentally varying their communication style (i.e., autonomy-supportive vs. controlling) and the reference to external motivators (i.e., use of a monetary voucher or corona pass vs. the lack thereof). Each participant was randomly assigned to one of six conditions and rated a vignette in terms of anticipated autonomy satisfaction, perceived effectiveness, reflection, and vaccination intention. An autonomy-supportive, relative to a controlling, communication style predicted greater autonomy need satisfaction, which in turn related positively to perceived effectiveness, reflection, and vaccination intention. External motivators failed to generate positive effects compared to the control condition. The findings highlight the critical role of autonomy support in promoting a self-endorsed decision to get vaccinated.
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Affiliation(s)
- Sofie Morbée
- Department of Developmental, Personality and Social Psychology, Ghent University
| | | | - Joachim Waterschoot
- Department of Developmental, Personality and Social Psychology, Ghent University
| | - Olivier Klein
- Faculty of Psychological Sciences and Education, Université libre de Bruxelles
| | - Olivier Luminet
- Institute for Research in Psychological Sciences, Université catholique de Louvain
| | - Mathias Schmitz
- Institute for Research in Psychological Sciences, Université catholique de Louvain
| | | | - Pascaline Van Oost
- Institute for Research in Psychological Sciences, Université catholique de Louvain
| | - Vincent Yzerbyt
- Institute for Research in Psychological Sciences, Université catholique de Louvain
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16
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Mills F, Carter H, Benny L, Barnard M, Symons C. An online RCT on behavioural expectations effects of COVID-19 certification policies in England. Vaccine X 2023; 15:100389. [PMID: 37829554 PMCID: PMC10565557 DOI: 10.1016/j.jvacx.2023.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
Objective The aim of this study was to compare the effects of different types of COVID-19 certification policy on subsequent behavioural expectations. Design 4 × 2 between-subjects pre-registered randomised controlled trial. Method In August 2022, participants (n = 2726) in England were presented with a scenario describing a rise in COVID-19 infections and the introduction of new protective measures. The protective measures described varied with regards to the setting (healthcare vs. recreational) and the type of policy (no certification vs. vaccination vs. vaccination or free Lateral Flow test vs. vaccination or Lateral Flow test at personal cost). Participants then answered questions on their expectations to receive another dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine and to adhere to other protective behaviours following the announcement, as well as questions based on Self-Determination Theory, COVID-19 vaccine hesitancy and broader vaccine hesitancy. Results We found no main effects of setting or type of certification on expectation to receive the next dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine, or to adhere to other protective measures, when controlling for baseline expectations. Conclusions These findings suggest that it is unlikely that the concept of certification, however it is framed, alters inclinations in the English population towards COVID-19 and seasonal flu vaccination or inclinations towards adhering to other protective behaviours within settings to which certification would apply. These findings are based on a hypothetical scenario and should be interpreted with caution.
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Affiliation(s)
- Freya Mills
- Behavioural Science and Insights Unit, UK Health Security Agency, United Kingdom
- School of Psychology, University of Sussex, United Kingdom
| | - Holly Carter
- Behavioural Science and Insights Unit, UK Health Security Agency, United Kingdom
| | - Liza Benny
- Evaluation and Social Research Unit, UK Health Security Agency, United Kingdom
| | - Matt Barnard
- Evaluation and Social Research Unit, UK Health Security Agency, United Kingdom
| | - Charles Symons
- Behavioural Science and Insights Unit, UK Health Security Agency, United Kingdom
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17
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Giwa A, Adeagbo M, Tate SA, Tulli-Shah M, Salami B. COVID-19 Vaccine Mandates and Vaccine Hesitancy among Black People in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7119. [PMID: 38063549 PMCID: PMC10706298 DOI: 10.3390/ijerph20237119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES COVID-19 vaccine mandates increased vaccination rates globally. Implemented as a one-size-fits-all policy, these mandates have unintended harmful consequences for many, including Black Canadians. This article reports findings on the interconnectedness of vaccine mandates and vaccine hesitancy by describing a range of responses to mandatory COVID-19 vaccination policies among Black people in Canada. METHODS Using qualitative research methods, semi-structured interviews with 36 Black people living in Canada aged 18 years and over across 6 provinces in Canada were conducted. Participants were selected across intersectional categories including migration status, income, religion, education, sex, and Black ethnicity. Thematic analysis informed the identification of key themes using Foucauldian notions of biopower and governmentality. RESULTS Our results show how the power relations present in the ways many Black people actualize vaccine intentions. Two main themes were identified: acceptance of the COVID-19 vaccine in the context of governmentality and resistance to vaccine mandates driven by oppression, mistrust, and religion. CONCLUSION COVID-19 vaccine mandates may have reinforced mistrust of the government and decreased confidence in the COVID-19 vaccine. Policy makers need to consider non-discriminatory public health policies and monitor how these policies are implemented over time and across multiple sectors to better understand vaccine hesitancy.
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Affiliation(s)
- Aisha Giwa
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
| | - Morolake Adeagbo
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
| | - Shirley Anne Tate
- Department of Sociology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Mia Tulli-Shah
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
| | - Bukola Salami
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
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18
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Natalia YA, Delporte M, De Witte D, Beutels P, Dewatripont M, Molenberghs G. Assessing the impact of COVID-19 passes and mandates on disease transmission, vaccination intention, and uptake: a scoping review. BMC Public Health 2023; 23:2279. [PMID: 37978472 PMCID: PMC10656887 DOI: 10.1186/s12889-023-17203-4] [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: 06/07/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Policymakers have struggled to maintain SARS-CoV-2 transmission at levels that are manageable to contain the COVID-19 disease burden while enabling a maximum of societal and economic activities. One of the tools that have been used to facilitate this is the so-called "COVID-19 pass". We aimed to document current evidence on the effectiveness of COVID-19 passes, distinguishing their indirect effects by improving vaccination intention and uptake from their direct effects on COVID-19 transmission measured by the incidence of cases, hospitalizations, and deaths. METHODS We performed a scoping review on the scientific literature of the proposed topic covering the period January 2021 to September 2022, in accordance with the PRISMA-ScR guidelines for scoping reviews. RESULTS Out of a yield of 4,693 publications, 45 studies from multiple countries were retained for full-text review. The results suggest that implementing COVID-19 passes tends to reduce the incidence of cases, hospitalizations, and deaths due to COVID-19. The use of COVID-19 passes was also shown to improve overall vaccination uptake and intention, but not in people who hold strong anti-COVID-19 vaccine beliefs. CONCLUSION The evidence from the literature we reviewed tends to indicate positive direct and indirect effects from the use of COVID-19 passes. A major limitation to establishing this firmly is the entanglement of individual effects of multiple measures being implemented simultaneously.
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Affiliation(s)
| | - Margaux Delporte
- I-BioStat, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Dries De Witte
- I-BioStat, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Mathias Dewatripont
- I3h, ECARES and Solvay Brussels School of Economics and Management, Université Libre de Bruxelles, Brussels, Belgium
| | - Geert Molenberghs
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- I-BioStat, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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19
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Fitzpatrick T, Camillo CA, Hillis S, Habbick M, Roerig M, Muhajarine N, Allin S. The Impact Of Provincial Proof- Of-Vaccination Policies On Age-Specific First-Dose Uptake Of COVID-19 Vaccines In Canada. Health Aff (Millwood) 2023; 42:1595-1605. [PMID: 37931201 DOI: 10.1377/hlthaff.2022.01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Requirements of proof of COVID-19 vaccination were mandated for nonessential businesses and venues by Canada's ten provinces throughout the fall of 2021. Leveraging variations in the timing of these measures across the provinces, we applied event study regression to estimate the impact the announcement of these measures had nationally on age-specific first-dose uptake in the subsequent seven-week period. Proof-of-vaccination mandate announcements were associated with a rapid, significant increase in first-dose uptake, particularly in people younger than age fifty. However, these behavioral changes were short-lived, with uptake returning to preannouncement levels-or lower-in all age groups within six weeks, despite mandates remaining in place for at least four months; this decline occurred earlier and was more apparent among adolescents ages 12-17. We estimated that nationally, 290,168 additional people received their first dose in the seven weeks after provinces announced proof-of-vaccination policies, for a 17.5 percent increase over the number of vaccinations estimated in the absence of these policies. This study provides novel age-specific evidence showing that proof-of-vaccination mandates led to an immediate, significant increase in national first-dose uptake and were particularly effective for increasing vaccination uptake in younger to middle-aged adults. Proof-of-vaccination mandates may be effective short-term policy measures for increasing population vaccination uptake, but their impact may differ across age groups.
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Affiliation(s)
| | - Cheryl A Camillo
- Cheryl A. Camillo, University of Regina, Regina, Saskatchewan, Canada
| | - Shelby Hillis
- Shelby Hillis, Coronavirus Variants Rapid Response Network, Ottawa, Ontario, Canada
| | - Marin Habbick
- Marin Habbick, Coronavirus Variants Rapid Response Network
| | | | - Nazeem Muhajarine
- Nazeem Muhajarine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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20
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Welsh J, Biddle N, Butler DC, Korda RJ. Discretion in decision to receive COVID-19 vaccines and associated socio-economic inequalities in rates of uptake: a whole-of-population data linkage study from Australia. Public Health 2023; 224:82-89. [PMID: 37741156 DOI: 10.1016/j.puhe.2023.08.020] [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: 01/18/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE In Australia, first and second compared to third dose of a COVID-19 vaccine were implemented under different policies and contexts, resulting in greater discretion in decisions to receive a third compared to first and second dose. We quantified socio-economic inequalities in first and third dose to understand how discretion is associated with differences in uptake. STUDY DESIGN Whole-of-population cohort study. METHODS Linked immunisation, census, death and migration data were used to estimate weekly proportions who received first and third doses of a COVID-19 vaccine until 31 August 2022 for those with low (no formal qualification) compared to high (university degree) education, stratified by 10-year age group (from 30 to 89 years). We estimated relative rates using Cox regression, including adjustment for sociodemographic factors. RESULTS Among 13.1 million people in our study population, 94% had received a first and 80% a third dose by 31 August 2022. Rates of uptake of first and third dose were around 50% lower for people with low compared to high education. Gaps were small in absolute terms for first dose, and at the end of the study period ranged from 1 to 11 percentage points across age groups. However, gaps were substantial for third dose, particularly at younger ages where the socio-economic gap was as wide as 32 percentage-points. CONCLUSION Education-related inequalities in uptake were larger where discretion in decisions was larger. Policies that limited discretion in decisions to receive vaccines may have contributed to achieving the dual aims of maximising uptake and minimising inequalities.
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Affiliation(s)
- J Welsh
- National Centre for Epidemiology and Population Health, Australian National University, Australia.
| | - N Biddle
- ANU Centre for Social Research and Methods, Australia National University, Australia
| | - D C Butler
- National Centre for Epidemiology and Population Health, Australian National University, Australia
| | - R J Korda
- National Centre for Epidemiology and Population Health, Australian National University, Australia
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21
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Graells T, Lambraki IA, Cousins M, Léger A, Henriksson PJG, Troell M, Carson CA, Parmley EJ, Majowicz SE, Wernli D, Jørgensen PS. Exploring the factors that contribute to the successful implementation of antimicrobial resistance interventions: a comparison of high-income and low-middle-income countries. Front Public Health 2023; 11:1230848. [PMID: 37900049 PMCID: PMC10612146 DOI: 10.3389/fpubh.2023.1230848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a challenge to modern medicine. Interventions have been applied worldwide to tackle AMR, but these actions are often not reported to peers or published, leading to important knowledge gaps about what actions are being taken. Understanding factors that influence the implementation of AMR interventions and what factors are relevant in low-middle-income countries (LMICs) and high-income countries (HICs) were the key objectives of this exploratory study, with the aim to identifying which priorities these contexts need. Methods A questionnaire was used to explore context, characteristics, and success factors or obstacles to intervention success based on participant input. The context was analyzed using the AMR-Intervene framework, and success factors and obstacles to intervention success were identified using thematic analysis. Results Of the 77 interventions, 57 were implemented in HICs and 17 in LMICs. Interventions took place in the animal sector, followed by the human sector. Public organizations were mainly responsible for implementation and funding. Nine themes and 32 sub-themes emerged as important for intervention success. The themes most frequently reported were 'behavior', 'capacity and resources', 'planning', and 'information'. Five sub-themes were key in all contexts ('collaboration and coordination', 'implementation', 'assessment', 'governance', and 'awareness'), two were key in LMICs ('funding and finances' and 'surveillance, antimicrobial susceptibility testing and preventive screening'), and five were key in HICs ('mandatory', 'multiple profiles', 'personnel', 'management', and 'design'). Conclusion LMIC sub-themes showed that funding and surveillance were still key issues for interventions, while important HIC sub-themes were more specific and detailed, including mandatory enforcement, multiple profiles, and personnel needed for good management and good design. While behavior is often underrated when implementing AMR interventions, capacity and resources are usually considered, and LMICs can benefit from sub-themes captured in HICs if tailored to their contexts. The factors identified can improve the design, planning, implementation, and evaluation of interventions.
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Affiliation(s)
- Tiscar Graells
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Irene A. Lambraki
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Melanie Cousins
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Anaïs Léger
- Global Studies Institute, University of Geneva, Genève, Switzerland
| | - Patrik J. G. Henriksson
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden
- WorldFish, Penang, Malaysia
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Carolee A. Carson
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases; Public Health Agency of Canada, Guelph, ON, Canada
| | - Elizabeth Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Shannon E. Majowicz
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Genève, Switzerland
| | - Peter Søgaard Jørgensen
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
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22
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Ferranna M, Robinson LA, Cadarette D, Eber MR, Bloom DE. The benefits and costs of U.S. employer COVID-19 vaccine mandates. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:2053-2068. [PMID: 36649917 DOI: 10.1111/risa.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
In 2021, the Biden Administration issued mandates requiring COVID-19 vaccinations for U.S. federal employees and contractors and for some healthcare and private sector workers. These mandates have been challenged in court; some have been halted or delayed. However, their costs and benefits have not been rigorously appraised. This study helps fill that gap. We estimate the direct costs and health-related benefits that would have accrued if these vaccination requirements had been implemented as intended. Compared with the January 2022 vaccination rates, we find that the mandates could have led to 15 million additional vaccinated individuals, increasing the overall proportion of the fully vaccinated U.S. population from 64% to 68%. The associated net benefits depend on the subsequent evolution of the pandemic-information unavailable ex ante to analysts or policymakers. In scenarios involving the emergence of a novel, more transmissible variant, against which vaccination and previous infection offer moderate protection, the estimated net benefits are potentially large. They reach almost $20,000 per additional vaccinated individual, with more than 20,000 total deaths averted over the 6-month period assessed. In scenarios involving a fading pandemic, existing vaccination-acquired or infection-acquired immunity provides sufficient protection, and the mandates' benefits are unlikely to exceed their costs. Thus, mandates may be most useful when the consequences of inaction are catastrophic. However, we do not compare the effects of mandates with alternative policies for increasing vaccination rates or for promoting other protective measures, which may receive stronger public support and be less likely to be overturned by litigation.
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Affiliation(s)
- Maddalena Ferranna
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
| | - Lisa A Robinson
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | - Michael R Eber
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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23
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Goto R, Kawachi I, Kondo N, Inoue K. Contribution of vaccinations to reducing socioeconomic disparities in COVID-19 deaths across U.S. counties. Ann Epidemiol 2023; 86:65-71.e3. [PMID: 37454832 DOI: 10.1016/j.annepidem.2023.07.003] [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: 02/21/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Although increasing vaccine uptake is a key strategy to minimize Coronavirus Disease 2019 (COVID-19) deaths, evidence of the role of vaccination rates in attenuating the socioeconomic disparity in COVID-19 deaths is limited. We thus aimed to quantify the extent to which vaccination rates contribute to the association between U.S. county-level poverty rates and COVID-19 mortality rates. METHODS This nationwide study analyzed data on 3142 U.S. counties. We conducted mediation analyses to calculate the proportions eliminated (PE) of the association between poverty rate and COVID-19 deaths per 100,000 population by setting the COVID-19 vaccination rate (the proportion of fully vaccinated individuals as of December 31, 2021) to different observed values. RESULTS Adjusted for county-level characteristics, we estimate an additional 25.3 COVID-19 deaths per 100,000 population for each 10% increase in a county's poverty rate. When we set the vaccination rate at its maximum, 90th percentile, and 75th percentile of the observed values, the PE was estimated to be 81% (P < .001), 37% (P < .001), and 21% (P < .001), respectively. CONCLUSIONS Higher county-level poverty rates and lower vaccination rates were associated with greater COVID-19 mortality rates in the United States. Aggressive interventions to increase vaccine uptake could substantially reduce the social disparity in COVID-19 mortality.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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24
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Goldenberg MJ, Adhikari B, von Seidlein L, Cheah PY, Larson HJ. Vaccine mandates and public trust do not have to be antagonistic. Nat Hum Behav 2023; 7:1605-1606. [PMID: 37752211 DOI: 10.1038/s41562-023-01720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Maya J Goldenberg
- Department of Philosophy, University of Guelph, Guelph, Ontario, Canada
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
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25
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Zhu DT, Serhan M, Mithani SS, Smith D, Ang J, Thomas M, Wilson K. The barriers, facilitators and association of vaccine certificates on COVID-19 vaccine uptake: a scoping review. Global Health 2023; 19:73. [PMID: 37759306 PMCID: PMC10537206 DOI: 10.1186/s12992-023-00969-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Globally, COVID-19 vaccines have proven to be instrumental for promoting population health by reducing illness from SARS-CoV-2. Vaccine certificates emerged as a potentially promising solution for encouraging vaccination and facilitating the safe reopening of society, however, they were controversial due to criticisms of infringing upon individual rights. While there is extensive literature describing the ethical, legal, and public health implications of vaccine certificates, there is currently a gap in knowledge about the association of vaccine certificates on vaccine uptake during the COVID-19 pandemic and barriers and facilitators to their use. OBJECTIVES The objectives of this scoping review are to (i) describe the existing literature on the association of vaccine certificates on the rates of COVID-19 vaccine uptake across several countries and (ii) describe the intrinsic and extrinsic barriers or facilitators that moderate this relationship. METHODS We conducted a scoping review based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. We searched three bibliographic databases (APA PsychInfo, Embase Classic + Embase, OVID-Medline) and preprint severs during the first week of July 2023. Three reviewers independently screened the studies based on pre-specified eligibility criteria and performed quality assessments of the primary literature and data extraction. RESULTS Sixteen studies met the inclusion criteria. 14 or these were surveys and 2 were modelling studies. The majority documented that vaccine certificates were significantly associated with increased rates of COVID-19 vaccine uptake (n = 12), motivated by factors such as travel/employer requirements, influence from the government/peers, and trust in the safety, efficacy, and science behind COVID-19 vaccines. Three studies had non-significant or mixed findings. Only one study found a significant decrease in COVID-19 vaccine uptake, motivated by pervasive distrust in the QR code-based system of digital vaccine certificates in Russia. Quality of survey studies was generally high. CONCLUSION Our findings provide insights into the existing literature on vaccine certificates association with vaccine uptake in several different jurisdictions and barriers and facilitators to their uptake. This information can be used to guide future examinations of the implementation of vaccine certificates and more effective implementations.
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Affiliation(s)
- David T Zhu
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Medical Scientist Training Program, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mohamed Serhan
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Salima S Mithani
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Smith
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Joyce Ang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Maya Thomas
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Department of Medicine, University of Ottawa, Ottawa, Canada.
- Bruyère Research Institute, Ottawa, Canada.
- O'Neill Institute, Georgetown University, Washington DC, USA.
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26
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Walkowiak MP, Walkowiak D, Walkowiak J. To vaccinate or to isolate? Establishing which intervention leads to measurable mortality reduction during the COVID-19 Delta wave in Poland. Front Public Health 2023; 11:1221964. [PMID: 37744498 PMCID: PMC10513426 DOI: 10.3389/fpubh.2023.1221964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background During the Delta variant COVID-19 wave in Poland there were serious regional differences in vaccination rates and discrepancies in the enforcement of pandemic preventive measures, which allowed us to assess the relative effectiveness of the policies implemented. Methods Creating a model that would predict mortality based on vaccination rates among the most vulnerable groups and the timing of the wave peak enabled us to calculate to what extent flattening the curve reduced mortality. Subsequently, a model was created to assess which preventive measures delayed the peak of infection waves. Combining those two models allowed us to estimate the relative effectiveness of those measures. Results Flattening the infection curve worked: according to our model, each week of postponing the peak of the wave reduced excess deaths by 1.79%. Saving a single life during the Delta wave required one of the following: either the vaccination of 57 high-risk people, or 1,258 low-risk people to build herd immunity, or the isolation of 334 infected individuals for a cumulative period of 10.1 years, or finally quarantining 782 contacts for a cumulative period of 19.3 years. Conclusions Except for the most disciplined societies, vaccination of high-risk individuals followed by vaccinating low-risk groups should have been the top priority instead of relying on isolation and quarantine measures which can incur disproportionately higher social costs. Our study demonstrates that even in a country with uniform policies, implementation outcomes varied, highlighting the importance of fine-tuning policies to regional specificity.
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Affiliation(s)
- Marcin Piotr Walkowiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznań, Poland
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27
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Qiu H, Zhao S, Cheung AWL, Yeoh EK, Wong ELY. Association of Vaccine Pass policy and Omicron incidence with COVID vaccine uptakes in Hong Kong. J Travel Med 2023; 30:taad061. [PMID: 37166362 DOI: 10.1093/jtm/taad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/12/2023]
Abstract
We observed the association of vaccine coverage with the implementation of the Vaccine Pass policy and the intensity of the Omicron outbreak in Hong Kong. Vaccine policy and transparent information dissemination are indispensable interventions promoting vaccination uptake.
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Affiliation(s)
- Hong Qiu
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shi Zhao
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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28
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Anato JLF, Ma H, Hamilton MA, Xia Y, Harper S, Buckeridge D, Brisson M, Hillmer MP, Malikov K, Kerem A, Beall R, Wagner CE, Racine É, Baral S, Dubé È, Mishra S, Maheu-Giroux M. Impact of a vaccine passport on first-dose SARS-CoV-2 vaccine coverage by age and area-level social determinants of health in the Canadian provinces of Quebec and Ontario: an interrupted time series analysis. CMAJ Open 2023; 11:E995-E1005. [PMID: 37875315 PMCID: PMC10609911 DOI: 10.9778/cmajo.20220242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND In Canada, all provinces implemented vaccine passports in 2021 to reduce SARS-CoV-2 transmission in non-essential indoor spaces and increase vaccine uptake (policies active September 2021-March 2022 in Quebec and Ontario). We sought to evaluate the impact of vaccine passport policies on first-dose SARS-CoV-2 vaccination coverage by age, and area-level income and proportion of racialized residents. METHODS We performed interrupted time series analyses using data from Quebec's and Ontario's vaccine registries linked to census information (population of 20.5 million people aged ≥ 12 yr; unit of analysis: dissemination area). We fit negative binomial regressions to first-dose vaccinations, using natural splines adjusting for baseline vaccination coverage (start: July 2021; end: October 2021 for Quebec, November 2021 for Ontario). We obtained counterfactual vaccination rates and coverage, and estimated the absolute and relative impacts of vaccine passports. RESULTS In both provinces, first-dose vaccination coverage before the announcement of vaccine passports was 82% (age ≥ 12 yr). The announcement resulted in estimated increases in coverage of 0.9 percentage points (95% confidence interval [CI] 0.4-1.2) in Quebec and 0.7 percentage points (95% CI 0.5-0.8) in Ontario. This corresponds to 23% (95% CI 10%-36%) and 19% (95% CI 15%-22%) more vaccinations over 11 weeks. The impact was larger among people aged 12-39 years. Despite lower coverage in lower-income and more-racialized areas, there was little variability in the absolute impact by area-level income or proportion racialized in either province. INTERPRETATION In the context of high vaccine coverage across 2 provinces, the announcement of vaccine passports had a small impact on first-dose coverage, with little impact on reducing economic and racial inequities in vaccine coverage. Findings suggest that other policies are needed to improve vaccination coverage among lower-income and racialized neighbourhoods and communities.
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Affiliation(s)
- Jorge Luis Flores Anato
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Huiting Ma
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Mackenzie A Hamilton
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Yiqing Xia
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Sam Harper
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - David Buckeridge
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Marc Brisson
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Michael P Hillmer
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Kamil Malikov
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Aidin Kerem
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Reed Beall
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Caroline E Wagner
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Étienne Racine
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Stefan Baral
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Ève Dubé
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Sharmistha Mishra
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont.
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Murmann M, Reed AC, Scott M, Presseau J, Heer C, May K, Ramzy A, Huynh CN, Skidmore B, Welch V, Little J, Wilson K, Brouwers M, Hsu AT. Exploring COVID-19 education to support vaccine confidence amongst the general adult population with special considerations for healthcare and long-term care staff: A scoping review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1352. [PMID: 37581103 PMCID: PMC10423318 DOI: 10.1002/cl2.1352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Background Despite the demonstrated efficacy of approved COVID-19 vaccines, high levels of hesitancy were observed in the first few months of the COVID-19 vaccines' rollout. Factors contributing to vaccine hesitancy are well-described in the literature. Among the various strategies for promoting vaccine confidence, educational interventions provide a foundationally and widely implemented set of approaches for supporting individuals in their vaccine decisions. However, the evidence around the measurable impact of various educational strategies to improve vaccine confidence is limited. We conducted a scoping review with the aim of exploring and characterizing educational interventions delivered during the pandemic to support COVID-19 vaccine confidence in adults. Methods We developed a search strategy with a medical information scientist and searched five databases, including Ovid MEDLINE and Web of Science, as well as grey literature. We considered all study designs and reports. Interventions delivered to children or adolescents, interventions on non-COVID-19 vaccines, as well as national or mass vaccination campaigns without documented interaction(s) between facilitator(s) and a specific audience were excluded. Articles were independently screened by three reviewers. After screening 4602 titles and abstracts and 174 full-text articles across two rounds of searches, 22 articles met our inclusion criteria. Ten additional studies were identified through hand searching. Data from included studies were charted and results were described narratively. Results We included 32 studies and synthesized their educational delivery structure, participants (i.e., facilitators and priority audience), and content. Formal, group-based presentations were the most common type of educational intervention in the included studies (75%). A third of studies (34%) used multiple strategies, with many formal group-based presentations being coupled with additional individual-based interventions (29%). Given the novelty of the COVID-19 vaccines and the unique current context, studies reported personalized conversations, question periods, and addressing misinformation as important components of the educational approaches reviewed. Conclusions Various educational interventions were delivered during the COVID-19 pandemic, with many initiatives involving multifaceted interventions utilizing both formal and informal approaches that leveraged community (cultural, religious) partnerships when developing and facilitating COVID-19 vaccine education. Train-the-trainer approaches with recognized community members could be of value as trust and personal connections were identified as strong enablers throughout the review.
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Affiliation(s)
- Maya Murmann
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
| | - Anna Cooper Reed
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Mary Scott
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
| | - Justin Presseau
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteThe Ottawa HospitalOttawaOntarioCanada
| | - Carrie Heer
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
| | - Kathryn May
- Civic CampusThe Ottawa HospitalOttawaOntarioCanada
| | - Amy Ramzy
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
| | - Chau N. Huynh
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
| | | | - Vivian Welch
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Julian Little
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Kumanan Wilson
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Melissa Brouwers
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Amy T. Hsu
- Bruyère Research InstituteBruyèreOttawaOntarioCanada
- Ottawa Hospital Research InstituteThe Ottawa HospitalOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
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Jamalidoust M, Eilami O, Ashkan Z, Ziyaeyan M, Aliabadi N, Habibi M. The rates and symptoms of natural and breakthrough infection pre- and post- Covid-19 non-mRNA vaccination at various peaks amongst Iranian healthcare workers. Virol J 2023; 20:182. [PMID: 37596593 PMCID: PMC10436397 DOI: 10.1186/s12985-023-02156-2] [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: 06/03/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND/AIMS The aim of this study was to determine the rate of natural and breakthrough infection and related symptoms of Covid-19 amongst Iranian healthcare workers (HCWs) who were vaccinated by different non-mRNA-based vaccines at peak points. METHODS In this cross-sectional study, the RT-PCR test was performed for a total of 10,581 HCWs suspicious of Covid-19 infection. For each HCW, the frequency of SARS-CoV-2 infection and the time of transmission based on vaccination administration time and schedule were examined during different waves of the pandemic. Based on these findings, the study patients were divided into three groups: natural, natural/breakthrough, and breakthrough. RESULTS In total, 53% of the HCWs were exposed to SARS-CoV-2 infection between 1 and 5 times within two years after the current pandemic, while 20.7% and 32.3% experienced natural and breakthrough SARS-CoV-2 infection, respectively. Only 6% of the breakthrough-infected HCWs had naturally contracted SARS-CoV-2 infection during the initial waves. The highest natural peaks of infection occurred during the interval administration of the first and second dose of the first vaccination series, while the single highest peak of breakthrough infection belonged to the Omicron wave. It occurred simultaneously with the administration of the third vaccination dose. On the other hand, the highest rate of reinfection was observed amongst people who had received the Sinopharm and Bharat vaccines full-doses. CONCLUSION This study compared the clinical differences between the two peaks of Omicron and Delta. This study indicates the rates of natural and breakthrough SARS-CoV-2 infections according to vaccination schedules and different waves of the pandemic.
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Grants
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz- Iran
- Department of Family Medicine and infectious disease, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Biology, Faculty of Basic Science, Shahrekord University, Shahrekord, Iran.
- Statistics and Information Technology Management, Shiraz University of Medical Sciences, Shiraz, Iran
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Affiliation(s)
- Marzieh Jamalidoust
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran.
| | - Owrang Eilami
- Department of Family Medicine and Infectious Disease, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Ashkan
- Department of Biology, Faculty of Basic Science, Shahrekord University, Shahrekord, Iran
| | - Mazyar Ziyaeyan
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran
| | - Nasrin Aliabadi
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran
| | - Mohammad Habibi
- Statistics and Information Technology Management, Shiraz University of Medical Sciences, Shiraz, Iran
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31
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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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32
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Kongo E, Shpati K, Dama A, Ymeraj S, Murati E, Veliaj U, Xinxo S. Determinant Factors of Voluntary or Mandatory Vaccination against COVID-19: A Survey Study among Students at Albanian University. Vaccines (Basel) 2023; 11:1215. [PMID: 37515031 PMCID: PMC10385280 DOI: 10.3390/vaccines11071215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The world faced serious health and socioeconomic issues with the advent of COVID-19. Along with handwashing, social distancing, and the wearing of masks, vaccination was considered by medical authorities as a key way to curb the spread of the virus. One of the measures that have been proposed to increase vaccinations is the mandatory policy. The purpose of this study was to compare the determinants of voluntary and mandatory vaccination among students at Albanian University. METHODOLOGY This cross-sectional study, conducted by means of an online survey, was conducted among students enrolled at the private Albanian University, Tirana, Albania during the last week of the winter semester, 7-14 February 2022. RESULTS In sum, 878 students participated in this study, among whom 612 (69.7%) were females and 266 (30%) were males. Of the participants, 506 (57%) were enrolled in medical science (MS) and 372 (42.3%) were in the non-medical science (Non-MS) group. A total of 773 (88%) were vaccinated against COVID-19, and 105 (11.8%) were not vaccinated. A total of 466 (53%) reported voluntary vaccination, and 412 (46.9%) reported mandatory vaccination. Among the students who were vaccinated voluntarily, 266 (57%) were from the MS group and 200 (42.9%) were from the Non-MS group. A total of 237 (57.5%) of students in the mandatory vaccination group were from the MS group, and 175 (42.4%) were from the Non-MS group. CONCLUSIONS Vaccine safety and efficacy were hindering factors in vaccination. Additionally, based on the results of this study, the students felt encouraged by the academic staff to vaccinate. This clearly demonstrates that the staff does not lack the skills to enhance students' knowledge about the risk of infectious diseases and the importance of vaccination. Therefore, to influence students' attitudes as much as possible toward vaccination, comprehensive educational programs, including modifications of existing curricula, should be considered.
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Affiliation(s)
- Elona Kongo
- Dentistry Department, Faculty of Medical Science, Albanian University, 1017 Tirana, Albania
| | - Kleva Shpati
- Pharmacy Department, Faculty of Medical Science, Albanian University, 1017 Tirana, Albania
| | - Aida Dama
- Pharmacy Department, Faculty of Medical Science, Albanian University, 1017 Tirana, Albania
| | - Sibela Ymeraj
- Department of Psychology, Faculty of Social Science, Albanian University, 1017 Tirana, Albania
| | - Ema Murati
- Department of Psychology, Faculty of Social Science, Albanian University, 1017 Tirana, Albania
| | - Uels Veliaj
- IT Department, Albanian University, 1017 Tirana, Albania
| | - Sonela Xinxo
- Dentistry Department, Faculty of Medical Science, Albanian University, 1017 Tirana, Albania
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Mongin D, Buclin CP, Cullati S, Courvoisier DS. COVID-19 Vaccination Rate under Different Political Incentive: A Counterfactual Trend Approach Using Nationwide Data. Vaccines (Basel) 2023; 11:1149. [PMID: 37514965 PMCID: PMC10385043 DOI: 10.3390/vaccines11071149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: France implemented a COVID-19 certificate in July 2021 to incentivize the population to uptake COVID-19 vaccines. However, little is known about the variation in its impact across age groups and its dependence on socio-demographic, economic, logistic, or political factors. (2) Methods: Using France's weekly first dose vaccination rate, a counterfactual trend approach allowed for the estimation of the vaccination rate across age groups at a small geographical level before and after the implementation of the health pass. The effect of the health pass was operationalized as the vaccination rate among those who would not be vaccinated without it. (3) Results: Vaccination before the health pass varied greatly among age groups and was mainly influenced by territory (lower in rural and overseas territories when compared to urban and metropolitan ones), political beliefs, and socio-economic disparities. Vaccine logistics played a minor but significant role, while the impact of COVID-19 did not affect the vaccination rate. The health pass increased the vaccination overall but with varying efficiency across groups. It convinced mainly young people politically close to the governmental vaccination strategy and living in urban metropolitan areas with low socio-economical discrepancies. The selected variables explained most of the variability of the vaccination rate before the health pass; they explained, at most, a third of the variation in the health pass effect on vaccination. (4) Conclusions: From a public health perspective, the French health pass increased the overall vaccination, but failed to promote preventive behaviours in all segments of society, particularly in vulnerable communities.
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Affiliation(s)
- Denis Mongin
- Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
| | - Clement P Buclin
- Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
| | - Stephane Cullati
- Division Quality of Care, Geneva University Hospitals, CH-1211 Geneva, Switzerland
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Delphine S Courvoisier
- Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
- Division Quality of Care, Geneva University Hospitals, CH-1211 Geneva, Switzerland
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Santolini R. The COVID-19 green certificate's effect on vaccine uptake in French and Italian regions. JOURNAL OF POLICY MODELING 2023; 45:S0161-8938(23)00053-4. [PMID: 38620110 PMCID: PMC10290179 DOI: 10.1016/j.jpolmod.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/12/2023] [Accepted: 05/08/2023] [Indexed: 04/17/2024]
Abstract
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.
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Affiliation(s)
- Raffaella Santolini
- Department of Economics and Social Sciences Università Politecnica delle Marche Piazzale Martelli 8, 60121 Ancona Italy
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Barello S, Acampora M, Paleologo M, Palamenghi L, Graffigna G. Providing freedom or financial remuneration? A cross-sectional study on the role of monetary and legal incentives on COVID-19 further booster vaccination intention in the Italian context. Front Public Health 2023; 11:1186429. [PMID: 37408739 PMCID: PMC10318153 DOI: 10.3389/fpubh.2023.1186429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
Vaccine hesitancy became a more and more important issue during the COVID-19 pandemic. Due to the emergence of new variants, many international health agencies have already begun administering booster doses of the vaccine in response to these threats. Studies have emphasized the effectiveness of different types of incentive-based strategies to increase vaccination behaviors. The purpose of the present study was to identify the correlation between different types of incentives (legal or financial) with people's intentions to get a COVID-19 booster vaccine. We conducted a cross-sectional study between 29 January 2022 and 03 February 2022. An online quantitative survey was carried out in Italy. One thousand and twenty-two Italian adults were recruited by a professional panel provider. Descriptive statistics were computed for the five variables concerning the incentives (monetary, tax, fee, health certification, travel) toward vaccination. A general linear model (GLM) was then computed to compare the scores of the five different variables within the subjects. The general linear model showed a significant within-subjects main effect. Post-hoc comparisons showed that among the financial incentive, the monetary reward is rated lower than all the others. Tax and fees both resulted lower than both the legal incentives. Finally, COVID-19 health certification and travel did not result significantly different from each other. This study offers an important contribution to public policy literature and to policymakers in their efforts to explain and steer booster vaccination acceptance while facing an ongoing pandemic.
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Affiliation(s)
- Serena Barello
- EngageMinds HUB—Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Marta Acampora
- EngageMinds HUB—Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Michele Paleologo
- EngageMinds HUB—Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Lorenzo Palamenghi
- EngageMinds HUB—Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy
| | - Guendalina Graffigna
- EngageMinds HUB—Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy
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Madran B, Kayı İ, Beşer A, Ergönül Ö. Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study. Vaccine 2023:S0264-410X(23)00688-6. [PMID: 37336661 PMCID: PMC10250152 DOI: 10.1016/j.vaccine.2023.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, vaccination of healthcare workers (HCWs) has a critical role because of their high-risk exposure and being a role model. Therefore, we aimed to investigate vaccine hesitancy and the role of mandatory polymerase chain reaction (PCR) testing and education for vaccine uptake. METHODS We conducted an explanatory sequential designed observational mixed-methods study, including quantitative and qualitative sections consecutively in two different pandemic hospitals between 15 September 2021 and 1 April 2022. The characteristics of vaccinated and unvaccinated HCWs were compared. The vaccine hesitancy scales were applied, and the effect of nudging, such as mandatory PCR and education, were evaluated. In-depth interviews were performed to investigate the COVID-19 vaccine hesitancy among HCWs according to Health Belief Model. RESULTS In total, 3940 HCWs were included. Vaccine hesitancy was more common among males than females, the ancillary workers than other health professions, and nonmedical departments than other departments. After the mandatory weekly PCR request nudge, 83.33 % (130/156) vaccine-hesitant HCWs were vaccinated, and 8.3 % (13/156) after the small group seminars and mandatory PCR every two days. The rate of COVID-19 vaccination was raised from 95.5 % to 99.67 % (3927/3940). At the end of in-depth interviews (n = 13), the vaccine hesitancy determinants were distrust, fear of uncertainty, immune confidence and spirituality, the media effect, social pressure, and obstinacy. CONCLUSIONS The nudging interventions such as mandatory PCR testing and small group seminars helped raise the rate of COVID-19 vaccination; the most effective one is mandatory PCR.
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Affiliation(s)
- Bahar Madran
- Koç University, School of Nursing, Public Health Nursing, Istanbul, Turkey.
| | - İlker Kayı
- Koç University, School of Medicine, Department of Public Health, Istanbul, Turkey; Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Turkey.
| | - Ayşe Beşer
- Koç University, School of Nursing, Public Health Nursing, Istanbul, Turkey.
| | - Önder Ergönül
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Turkey; Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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Profeti S, Toth F. Climbing the 'ladder of intrusiveness': the Italian government's strategy to push the Covid-19 vaccination coverage further. POLICY SCIENCES 2023:1-23. [PMID: 37361645 PMCID: PMC10183224 DOI: 10.1007/s11077-023-09509-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
In all Western countries, the vaccination campaign against COVID-19 encountered some resistance. To overcome vaccine inertia and hesitancy, governments have used a variety of strategies and policy instruments. These instruments can be placed on a 'ladder of intrusiveness', starting from voluntary tools based on simple information and persuasion, through material incentives and disincentives of varying nature and magnitude, to highly coercive tools, such as lockdown for the unvaccinated and the introduction of the vaccination mandate. Italy's experience during the vaccination campaign against Covid provides an ideal observational point for starting to investigate this issue: not only was Italy among the top countries with the highest percentage of people vaccinated at the beginning of 2022, but-at least compared to other European countries-it was also one of the countries that had gradually introduced the most intrusive measures to increase vaccination compliance. In the article the different steps of the 'intrusiveness ladder' are presented, providing examples from various countries, and then tested on the Italian Covid-19 vaccination campaign between 2021 and the first months of 2022. For each phase of the campaign, the instrument mixes adopted by the Italian government are described, as well as the contextual conditions that led to their adoption. In the final section, an assessment of the composition and evolution of the Italian vaccination strategy is provided, based on the following criteria: legitimacy, feasibility, effectiveness, internal consistency and strategic coherence. Conclusions highlight the pragmatic approach adopted by the Italian government and underline the effects-both positive and negative-of scaling up the intrusiveness ladder.
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Affiliation(s)
- Stefania Profeti
- Dipartimento di Scienze Politiche e Sociali, University of Bologna, Strada Maggiore 45, 40125 Bologna, Italy
| | - Federico Toth
- Dipartimento di Scienze Politiche e Sociali, University of Bologna, Strada Maggiore 45, 40125 Bologna, Italy
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Veldwijk J, van Exel J, de Bekker-Grob EW, Mouter N. Public Preferences for Introducing a COVID-19 Certificate: A Discrete Choice Experiment in the Netherlands. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:603-614. [PMID: 37155007 PMCID: PMC10165281 DOI: 10.1007/s40258-023-00808-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Here we investigate public preferences for coronavirus disease 2019 (COVID-19) certificates in the Netherlands, and whether these preferences differ between subgroups in the population. METHODS A survey including a discrete choice experiment was administered to 1500 members of the adult population of the Netherlands. Each participant was asked to choose between hypothetical COVID-19 certificates that differed in seven attributes: the starting date, and whether the certificate allowed gathering with multiple people, shopping without appointment, visiting bars and restaurants, visiting cinemas and theatres, attending events, and practising indoor sports. Latent class models (LCMs) were used to determine the attribute relative importance and predicted acceptance rate of hypothetical certificates. RESULTS Three classes of preference patterns were identified in the LCM. One class a priori opposed a certificate (only two attributes influencing preferences), another class was relatively neutral and included all attributes in their decision making, and the final class was positive towards a certificate. Respondents aged > 65 years and those who plan to get vaccinated were more likely to belong to the latter two classes. Being allowed to shop without appointment and to visit bars and restaurants was most important to all respondents, increasing predicted acceptance rate by 12 percentage points. CONCLUSIONS Preferences for introduction of a COVID-19 certificate are mixed. A certificate that allows for shopping without appointment and visiting bars and restaurants is likely to increase acceptance. The support of younger citizens and those who plan to get vaccinated seems most sensitive to the specific freedoms granted by a COVID-19 certificate.
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Affiliation(s)
- J Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - J van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - E W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - N Mouter
- Faculty of Technology, Policy and Management, Transport and Logistics Group, Delft University of Technology, Delft, The Netherlands
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The effect of vaccine mandate announcements on vaccine uptake in Canada: An interrupted time series analysis. Vaccine 2023; 41:2932-2940. [PMID: 37019696 PMCID: PMC10068515 DOI: 10.1016/j.vaccine.2023.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
Introduction In 2021, the ten provinces in Canada enacted COVID-19 vaccine mandates that restricted access to non-essential businesses and services to those that could provide proof of full vaccination to decrease the risk of transmission and provide an incentive for vaccination. This analysis aims to examine the effects of vaccine mandate announcements on vaccine uptake over time by age group and province. Methods Aggregated data from the Canadian COVID-19 Vaccination Coverage Surveillance System (CCVCSS) were used to measure vaccine uptake (defined as the weekly proportion of individuals who received at least one dose) among those 12 years and older following the announcement of vaccination requirements. We performed an interrupted time series analysis using a quasi-binomial autoregressive model adjusted for the weekly number of new COVID-19 cases, hospitalizations, and deaths to model the effect of mandate announcements on vaccine uptake. Additionally, counterfactuals were produced for each province and age group to estimate vaccine uptake without mandate implementation. Results The times series models demonstrated significant increases in vaccine uptake following mandate announcement in BC, AB, SK, MB, NS, and NL. No trends in the effect of mandate announcements were observed by age group. In AB and SK, counterfactual analysis showed that announcement were followed by 8 % and 7 % (310,890 and 71,711 people, respectively) increases in vaccination coverage over the following 10 weeks. In MB, NS, and NL, there was at least a 5 % (63,936, 44,054, and 29,814 people, respectively) increase in coverage. Lastly, BC announcements were followed by a 4 % (203,300 people) increase in coverage. Conclusion Vaccine mandate announcements could have increased vaccine uptake. However, it is difficult to interpret this effect within the larger epidemiological context. Effectiveness of the mandates can be affected by pre-existing levels of uptake, hesitancy, timing of announcements and local COVID-19 activity.
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Zhang R, Yan J, Jia H, Luo X, Lin J, Liu Q. Nationalism, conspiracy theories and vaccine mandates: Exploring the statism determinants for attitudes to COVID-19 control in China. Vaccine X 2023; 13:100263. [PMID: 36683778 PMCID: PMC9847324 DOI: 10.1016/j.jvacx.2023.100263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction China's loosening its COVID-19 controls highlighted its insufficiency in vaccination protection. Mandatory vaccination might be necessary if the gap cannot be filled over a short time. However, few studies have explored how Chinese people view the COVID-19 vaccine mandates, let alone placing such views in the country's highly politicized context. Material and methods The current study utilizes data from a national survey adopting quota sampling to analyze the Chinese public's medical and non-medical considerations when judging compulsory COVID-19 vaccination (n = 1,523). The survey was conducted between 1 and 8 April 2021. All adults aged 18 years and older were eligible to take part. The survey included sociodemographic details, perceived susceptibility to infection, perceived vaccine benefit, attitudes to vaccination policies, nationalism, beliefs in various conspiracy theories and science literacy. Multiple regression analyses were done to examine factors associated with the attitude to COVID-19 vaccine mandates. Results The study reveals that personal risk and benefit perceptions did not dominate the Chinese public's attitude toward vaccination mandates. Instead, nationalism was relatively strongly associated with their willingness to accept mandatory vaccination. Contrary to studies in the West, various conspiracy beliefs and conspiratorial thinking were robustly related to the support for mandatory vacciniation. Science literacy didn't link to the attitude to vaccination mandates. It only had a weak moderating effect on the influence of conspiratorial thinking on attitudes to the vaccination policies. Conclusions The results indicated that Chinese people's attitude to the COVID-19 vaccination policy is highly politicized and influenced by conspiracy theories. Given the potentially massive impacts of the COVID-19 infection, we need to educate the Chinese public with more medically valuable and relevant information to help them make sound decisions regarding vaccination. Meanwhile, we can adopt nationalistic tones to improve the persuasion effect, but misinformation during the process must be overcome.
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Affiliation(s)
- Ruifen Zhang
- School of Communication, Soochow University, Suzhou 215127, China
| | - Jun Yan
- School of Journalism and Information Communication, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Hepeng Jia
- School of Communication, Soochow University, Suzhou 215127, China,School of Public Health, Soochow University, Suzhou 215127, China,Corresponding author at: School of Communication, Soochow University, Suzhou 215127, China
| | - Xi Luo
- School of Communication, Soochow University, Suzhou 215127, China
| | - Jingke Lin
- School of Journalism and Communication, Sun Yat-sen University, Guangzhou 510006, China
| | - Qinliang Liu
- School of Communication, Soochow University, Suzhou 215127, China
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Yassi A, Barker S, Lockhart K, Taylor D, Harris D, Hundal H, Grant JM, Okpan AI, Pollock S, Sprague S, Sing CK. Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada. CANADIAN JOURNAL OF RURAL MEDICINE 2023; 28:47-58. [PMID: 37005988 DOI: 10.4103/cjrm.cjrm_24_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Introduction Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs. Methods We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear. Conclusions As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Stephen Barker
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lockhart
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Devin Harris
- Interior Health, Kelowna, British Columbia; Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harsh Hundal
- Interior Health, Kelowna, British Columbia, Canada
| | - Jennifer M Grant
- Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arnold Ikedichi Okpan
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sue Pollock
- School of Population and Public Health, University of British Columbia, Vancouver; Interior Health, Kelowna, British Columbia, Canada
| | - Stacy Sprague
- Employee Safety, Health and Wellness, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Chad Kim Sing
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia; Medicine, Quality and Safety, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Stamm TA, Partheymüller J, Mosor E, Ritschl V, Kritzinger S, Alunno A, Eberl JM. Determinants of COVID-19 vaccine fatigue. Nat Med 2023; 29:1164-1171. [PMID: 36973410 DOI: 10.1038/s41591-023-02282-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
There is growing concern that Coronavirus Disease 2019 (COVID-19) vaccine fatigue will be a major obstacle in maintaining immunity in the general population. In this study, we assessed vaccine acceptance in future scenarios in two conjoint experiments, investigating determinants such as new vaccines, communication, costs/incentives and legal rules. The experiments were embedded in an online survey (n = 6,357 participants) conducted in two European countries (Austria and Italy). Our results suggest that vaccination campaigns should be tailored to subgroups based on their vaccination status. Among the unvaccinated, campaign messages conveying community spirit had a positive effect (0.343, confidence interval (CI) 0.019-0.666), whereas offering positive incentives, such as a cash reward (0.722, CI 0.429-1.014) or voucher (0.670, CI 0.373-0.967), was pivotal to the decision-making of those vaccinated once or twice. Among the triple vaccinated, vaccination readiness increased when adapted vaccines were offered (0.279, CI 0.182-0.377), but costs (-0.795, CI -0.935 to -0.654) and medical dissensus (-0.161, CI -0.293 to -0.030) reduced their likelihood to get vaccinated. We conclude that failing to mobilize the triple vaccinated is likely to result in booster vaccination rates falling short of expectations. For long-term success, measures fostering institutional trust should be considered. These results provide guidance to those responsible for future COVID-19 vaccination campaigns.
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Affiliation(s)
- Tanja A Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
| | | | - Erika Mosor
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | | | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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COVID-19 Vaccination Program Data Analysis Based on Regional Status and Day Type: A Study from West Java Province, Indonesia. Healthcare (Basel) 2023; 11:healthcare11050772. [PMID: 36900777 PMCID: PMC10001228 DOI: 10.3390/healthcare11050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Vaccination is a strategy to control the COVID-19 pandemic and holds a crucial impact on global health. A better understanding of factors associated with vaccination is needed to establish a good vaccination program in a population. The purpose of this study is to analyze COVID-19 vaccination program data based on regional status and day type in the West Java Province of Indonesia and contribute to discovering other characteristics of the COVID-19 vaccination program. This study is a cross-sectional study using secondary data (N = 7922) from West Java's COVID-19 Information and Coordination Center (PIKOBAR) from January to November 2021. Independent t-test with an alternative non-parametric Mann-Whitney U test (p-value < 0.05) is used as a statistical test in this study. The result reported significant differences in vaccination coverage between the city area and the regency area (p < 0.001). Significant differences in vaccination on working day and holiday were also found in both settings (p < 0.001). Vaccination was confirmed to be higher in the city compared to the regency and decreased on holiday compared to the working day. In conclusion, factors linked to regional status and day type must be considered as important factors for developing and accelerating vaccination programs.
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Chirico F, Teixeira da Silva JA. Evidence-based policies in public health to address COVID-19 vaccine hesitancy. Future Virol 2023; 18:10.2217/fvl-2022-0028. [PMID: 37034451 PMCID: PMC10079004 DOI: 10.2217/fvl-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023]
Abstract
A fundamental basis for effective health-related policymaking of any democratic nation should be open and transparent communication between a government and its citizens, including scientists and healthcare professionals, to foster a climate of trust, especially during the ongoing COVID-19 mass vaccination campaign. Since misinformation is a leading cause of vaccine hesitancy, open data sharing through an evidence-based approach may render the communication of health strategies developed by policymakers with the public more effective, allowing misinformation and claims that are not backed by scientific evidence to be tackled. In this narrative review, we debate possible causes of COVID-19 vaccine hesitancy and links to the COVID-19 misinformation epidemic. We also put forward plausible solutions as recommended in the literature.
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Affiliation(s)
- Francesco Chirico
- Post-graduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Ortiz-Millán G. COVID-19 Health Passes: Practical and Ethical Issues. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:125-138. [PMID: 36630062 PMCID: PMC9832398 DOI: 10.1007/s11673-022-10227-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/28/2022] [Indexed: 05/04/2023]
Abstract
Several countries have implemented COVID-19 health passes or certificates to promote a safer return to in-person social activities. These passes have been proposed as a way to prove that someone has been vaccinated, has recovered from the disease, or has negative results on a diagnostic test. However, many people have questioned their ethical justification. This article presents some practical and ethical problems to consider in the event of wishing to implement these passes. Among the former, it is questioned how accurate diagnostic tests are as a means of ensuring that a person is not contagious, whether vaccination guarantees immunity, the fact that health passes can be forged, whether they encourage vaccination, and the problem that there is no universally recognized health pass. Among the ethical issues, it is discussed whether health passes promote discrimination and inequality and whether they violate rights to privacy and freedom. It is concluded that health passes have enough ethical justification to be implemented.
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Affiliation(s)
- Gustavo Ortiz-Millán
- Instituto de Investigaciones Filosóficas, Universidad Nacional Autónoma de México (UNAM), Circuito Mario de la Cueva s/n, Ciudad Universitaria, Coyoacán, 04510, Mexico City, Mexico.
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Muacevic A, Adler JR. ChatGPT Output Regarding Compulsory Vaccination and COVID-19 Vaccine Conspiracy: A Descriptive Study at the Outset of a Paradigm Shift in Online Search for Information. Cureus 2023; 15:e35029. [PMID: 36819954 PMCID: PMC9931398 DOI: 10.7759/cureus.35029] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Being on the verge of a revolutionary approach to gathering information, ChatGPT (an artificial intelligence (AI)-based language model developed by OpenAI, and capable of producing human-like text) could be the prime motive of a paradigm shift on how humans will acquire information. Despite the concerns related to the use of such a promising tool in relation to the future of the quality of education, this technology will soon be incorporated into web search engines mandating the need to evaluate the output of such a tool. Previous studies showed that dependence on some sources of online information (e.g., social media platforms) was associated with higher rates of vaccination hesitancy. Therefore, the aim of the current study was to describe the output of ChatGPT regarding coronavirus disease 2019 (COVID-19) vaccine conspiracy beliefs. and compulsory vaccination. METHODS The current descriptive study was conducted on January 14, 2023 using the ChatGPT from OpenAI (OpenAI, L.L.C., San Francisco, CA, USA). The output was evaluated by two authors and the degree of agreement regarding the correctness, clarity, conciseness, and bias was evaluated using Cohen's kappa. RESULTS The ChatGPT responses were dismissive of conspiratorial ideas about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origins labeling it as non-credible and lacking scientific evidence. Additionally, ChatGPT responses were totally against COVID-19 vaccine conspiracy statements. Regarding compulsory vaccination, ChatGPT responses were neutral citing the following as advantages of this strategy: protecting public health, maintaining herd immunity, reducing the spread of disease, cost-effectiveness, and legal obligation, and on the other hand, it cited the following as disadvantages of compulsory vaccination: ethical and legal concerns, mistrust and resistance, logistical challenges, and limited resources and knowledge. CONCLUSIONS The current study showed that ChatGPT could be a source of information to challenge COVID-19 vaccine conspiracies. For compulsory vaccination, ChatGPT resonated with the divided opinion in the scientific community toward such a strategy; nevertheless, it detailed the pros and cons of this approach. As it currently stands, the judicious use of ChatGPT could be utilized as a user-friendly source of COVID-19 vaccine information that could challenge conspiracy ideas with clear, concise, and non-biased content. However, ChatGPT content cannot be used as an alternative to the original reliable sources of vaccine information (e.g., the World Health Organization [WHO] and the Centers for Disease Control and Prevention [CDC]).
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Vermeulen N, Guyomarch M, Jidovtseff B, Oleffe A, Labat A, Paul E. Expectations and disappointments relative to COVID-19 passes: results from a voluntary mixed-methods study in French-speaking Belgium. IJID REGIONS 2023; 6:146-151. [PMID: 36741983 PMCID: PMC9884140 DOI: 10.1016/j.ijregi.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 01/30/2023]
Abstract
Objectives Belgium enacted a coronavirus disease 2019 (COVID-19) pass - the 'COVID Safe Ticket' (CST) - in October 2021. This study aimed to understand the expectations and reasons given by those supporting this policy measure. Methods This mixed methods study was based on a voluntary online survey among 9444 French-speaking residents in Belgium. Results Most respondents were not very supportive of the CST, with only 617 respondents (7%) being pro-CST. Compared with other respondents, the pro-CST sample comprised more males, older people, people scared of COVID-19, people who had confidence in the COVID-19 vaccines, and highly educated people. A qualitative analysis was undertaken to identify the reasons why respondents supported the CST. Two lines of argument were related to personal comfort (individual protection and means of 'recovering freedom'), and two other lines were related to collective protection (controlling the pandemic and incentivizing vaccination). Pro-CST respondents also indicated some limitations of the CST. Conclusions The expectations regarding the CST were high, diverse and not entirely rational. Some contradictions and frustration emerged from the respondents' comments. The CST may have exacerbated the social divide in society. The high expectations risk leading to comparably high levels of disappointment, resulting in potential distrust towards future public health interventions.
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Affiliation(s)
- Nicolas Vermeulen
- Université catholique de Louvain, Psychological Sciences Research Institute (IPSY), Louvain-la-Neuve, Belgium,Fund for Scientific Research, Brussels, Belgium
| | - Morgane Guyomarch
- Université libre de Bruxelles, School of Public Health, Brussels, Belgium
| | - Boris Jidovtseff
- Université de Liège, Research Unit for a Life-Course Perspective on Health and Education, Liège, Belgium
| | - Amandine Oleffe
- Université libre de Bruxelles, School of Public Health, Brussels, Belgium
| | - Aline Labat
- Université libre de Bruxelles, School of Public Health, Brussels, Belgium
| | - Elisabeth Paul
- Université libre de Bruxelles, School of Public Health, Brussels, Belgium,Corresponding author. Address: Université libre de Bruxelles, School of Public Health, Campus Erasme, Route de Lennik 808, 1070 Brussels, Belgium. Tel.: +32 555 40 12. (E. Paul).
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Serrano-Alarcón M, Wang Y, Kentikelenis A, Mckee M, Stuckler D. The far-right and anti-vaccine attitudes: lessons from Spain's mass COVID-19 vaccine roll-out. Eur J Public Health 2023; 33:215-221. [PMID: 36655519 PMCID: PMC10066477 DOI: 10.1093/eurpub/ckac173] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Manuel Serrano-Alarcón
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Yuxi Wang
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Alexander Kentikelenis
- Department of Social & Political Sciences, Bocconi University, Milan, Italy.,Centre for Business Research, University of Cambridge, Cambridge, UK
| | - Martin Mckee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - David Stuckler
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.,Department of Social & Political Sciences, Bocconi University, Milan, Italy
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Erev I, Marx A. Humans as intuitive classifiers. Front Psychol 2023; 13:1041737. [PMID: 36710808 PMCID: PMC9879355 DOI: 10.3389/fpsyg.2022.1041737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
Mainstream decision research rests on two implicit working assumptions, inspired by subjective expected utility theory. The first assumes that the underlying processes can be separated into judgment and decision-making stages without affecting their outcomes. The second assumes that in properly run experiments, the presentation of a complete description of the incentive structure replaces the judgment stage (and eliminates the impact of past experiences that can only affect judgment). While these working assumptions seem reasonable and harmless, the current paper suggests that they impair the derivation of useful predictions. The negative effect of the separation assumption is clarified by the predicted impact of rare events. Studies that separate judgment from decision making document oversensitivity to rare events, but without the separation people exhibit the opposite bias. The negative effects of the assumed impact of description include masking the large and predictable effect of past experiences on the way people use descriptions. We propose that the cognitive processes that underlie decision making are more similar to machine learning classification algorithms than to a two-stage probability judgment and utility weighting process. Our analysis suggests that clear insights can be obtained even when the number of feasible classes is very large, and the effort to list the rules that best describe behavior in each class is of limited value.
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Affiliation(s)
- Ido Erev
- Faculty of Data and Decisions Sciences, Technion Israel Institute of Technology, Haifa, Israel,*Correspondence: Ido Erev,
| | - Ailie Marx
- Department of Computer Science, Technion Israel Institute of Technology, Haifa, Israel
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