Balancing incentives and disincentives for vaccination in a pandemic

Managing Fear During Pandemics: Risks and Opportunities

Fear is an emotion triggered by the perception of danger and motivates safety behaviors. Within the context of the COVID-19 pandemic, there were ample danger cues (e.g., images of patients on ventilators) and a high need for people to use appropriate safety behaviors (e.g., social distancing). Given this central role of fear within the context of a pandemic, it is important to review some of the emerging findings and lessons learned during the COVID-19 pandemic and their implications for managing fear. We highlight factors that determine fear (i.e., proximity, predictability, and controllability) and review several adaptive and maladaptive consequences of fear of COVID-19 (e.g., following governmental health policies and panic buying). Finally, we provide directions for future research and make policy recommendations that can promote adequate health behaviors and limit the negative consequences of fear during pandemics.

Simple economics of vaccination: public policies and incentives

This paper focuses on the economics of vaccination and, more specifically, analyzes the vaccination decision of individuals using a game-theoretic model combined with an epidemiological SIR model that reproduces the infection dynamics of a generic disease. We characterize the equilibrium individual vaccination rate, and we show that it is below the rate compatible with herd immunity due to the existence of externalities that individuals do not internalize when they decide on vaccination. In addition, we analyze three public policies consisting of informational campaigns to reduce the disutility of vaccination, monetary payments to vaccinated individuals and measures to increase the disutility of non-vaccination. If the public authority uses only one type of policy, herd immunity is not necessarily achieved unless monetary incentives are used. When the public authority is not limited to use only one policy, we find that the optimal public policy should consist only of informational campaigns if they are sufficiently effective, or a combination of informational campaigns and monetary incentives otherwise. Surprisingly, the requirement of vaccine passports or other restrictions on the non-vaccinated are not desirable.

Assessment of the impact of the vaccine pass policy on COVID-19 vaccine hesitancy and uptake among Chinese adults in Hong Kong

BACKGROUND

Recognising the importance of attaining high vaccine coverage to mitigate the COVID-19 impact, a Vaccine Pass scheme was implemented during and after the first large Omicron wave with high mortality in older ages in Hong Kong in early 2022 requiring three doses by June 2022. We did not identify any studies evaluating the policy impact of vaccination mandates with vaccine uptake over whole policy period of time in a Chinese population. We aim to evaluate the impact of the Vaccine Pass policy on COVID-19 vaccine uptake in adults in a Chinese population in Hong Kong.

METHODS

We analysed patterns in vaccine uptake and hesitancy using local data from population vaccine registry and 32 cross-sectional telephone surveys conducted from October 2021 to December 2022. The association of Vaccine Pass phases with vaccine uptake was examined using logistic regression analyses, taking into account covariates including self-risk perception, perceived self-efficacy in preventing COVID-19 and trust in government in pandemic control as well as physical distancing measures and demographics.

RESULTS

The uptake of primary series and third doses was positively significantly associated with the successive stages of Vaccine Pass implementation (adjusted odds ratios ranged from 2.41 to 7.81). Other statistically significant drivers of uptake included age group, chronic condition, higher perceived personal susceptibility to COVID-19, higher trust in government, and higher educational attainment.

CONCLUSION

Vaccine uptake in older adults was observed to have increased by a greater extent after the policy annoucement and implementation, under the contextual changes during and after a large Omicron wave with high mortality in Hong Kong in early 2022. Since the policy withdrawal the uptake of further booster doses has been very low in all ages. We suggest that improving voluntary booster uptake in older adults should be prioritized.

Epidemiological contemplation for a currently pragmatic COVID-19 health passport: a perspective

The coronavirus disease 2019 (COVID-19) has caused a global pandemic that has wreaked havoc on the lives of millions of people around the world. Confinement measures aim to reduce the epidemic's spread and minimize the burden of morbidity and mortality. In response to the challenges caused by the pandemic, digital health passports have been developed exponentially. We highlight the latent epidemiological barriers to health passports to achieve standardized digital care platforms. This review paper not only highlights the epidemiological barriers but also articulates the possible infrastructure required to make the International Standard for a multi-factor authenticated and validated health passport.

Balancing Routine and Pandemic: The Synergy of India's Universal Immunization Program and COVID-19 Vaccination Program

The COVID-19 pandemic posed substantial challenges to healthcare systems globally and severely disrupted essential health services, including routine immunization programs. In India, these disruptions were exacerbated due to the sudden emergence of the pandemic and lockdown measures, leading to mass migrations and a shortage of healthcare workers. Caregivers' concerns about routine immunization sessions further compounded the problem, resulting in a sharp increase in zero-dose children. This review paper examines India's strategies for conducting one of the world's largest COVID-19 vaccination programs while effectively restoring and perpetuating its Universal Immunization Program (UIP). The UIP played a pivotal role in sustaining immunization services during the pandemic, ultimately improving immunization coverage compared to pre-pandemic levels. India's accomplishments in this regard are highlighted through key performance indicators, the reach of immunization services, a reduction in zero-dose children, and antigen-wise coverage. The paper also discusses the successful integration of COVID-19 vaccination within the UIP framework, underscoring the significance of existing infrastructure, technology, and capacity building. India's dedication to concurrently managing routine immunization and COVID-19 vaccination showcases the adaptability and resilience of its healthcare system. India's journey serves as a global example of efficient mass immunization during challenging times, emphasizing the importance of political will, healthcare infrastructure investment, skilled healthcare workforces, and comprehensive vaccination programs. In a world grappling with the dual challenge of COVID-19 and routine immunization, India's experience provides a roadmap for strengthening healthcare systems and promoting public health as the critical agenda in challenging times.

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

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.

The harm principle, personal identity and identity-relative paternalism

Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit's arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe different forms of paternalism arising from a reductionist view of personal identity. I outline an Identity Relative Paternalistic Intervention Principle for determining when we should disallow refusal of treatment where the harm will be accrued by a future self, and consider objections including vagueness and non-identity.Identity relative paternalism does not always justify intervention to prevent harm to future selves. However, there is a stronger ethical case for doing so than is often recognised.

Vaccination games and imitation dynamics with memory

In this paper, we model dynamics of pediatric vaccination as an imitation game, in which the rate of switching of vaccination strategies is proportional to perceived payoff gain that consists of the difference between perceived risk of infection and perceived risk of vaccine side effects. To account for the fact that vaccine side effects may affect people's perceptions of vaccine safety for some period of time, we use a delay distribution to represent how memory of past side effects influences current perception of risk. We find disease-free, pure vaccinator, and endemic equilibria and obtain conditions for their stability in terms of system parameters and characteristics of a delay distribution. Numerical bifurcation analysis illustrates how stability of the endemic steady state varies with the imitation rate and the mean time delay, and this shows that it is not just the mean duration of memory of past side effects, but also the actual distribution that determines whether disease will be maintained in the population at some steady level, or if sustained periodic oscillations around this steady state will be observed. Numerical simulations illustrate a comparison of the dynamics for different mean delays and different distributions, and they show that even when periodic solutions are observed, there are differences in their amplitude and period for different distributions. We also investigate the effect of constant public health information campaigns on vaccination dynamics. The analysis suggests that the introduction of such campaigns acts as a stabilizing factor for endemic equilibrium, allowing it to remain stable for larger values of mean time delays.

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

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

Social expectations and government incentives in Malaysia’s COVID-19 vaccine uptake

High vaccination rates are integral to reducing infection and severity rates of COVID-19 infections within a community. We examine the role of social expectations in COVID-19 vaccination take-ups and its interaction with potential government actions in Malaysia. We find that individuals’ expectations of others in their social groups towards vaccination predicts those individuals’ vaccination registrations. Using a vignette experiment, we examine the extent of normative expectations in normalizing pro-vaccination behavior beyond an individual’s reference group. We find that unless moderated by a high level of public trust, individuals prefer punitive policies as a way to increase vaccination rates in their communities.

The median age of a city's residents and population density influence COVID 19 mortality growth rates: policy implications

Background

SARS-CoV-2 is an infectious virus, which has generated a global pandemic. Israel was one of the first countries to vaccinate its population, inaugurating the program on December 20, 2020. The objective of the current study is to investigate the projected daily COVID19 mortality growth rate with higher median age and population size of cities under two scenarios: with and without the BNT162b2 Pfizer vaccination against the SAR-COV2 virus.

Methods

This study employs a panel data-set. We follow the COVID19 mortality growth rate in each of the 173 Israeli cities and towns starting from March 21, 2020 (10 days after the first documentation of COVID19 cases in Israel) until September 21, 2021, where the BNT162b2 Pfizer vaccinations were available starting from December 20, 2020.

Results

Referring to the median age of municipal residents, findings suggest that the BNT162b2 Pfizer vaccinations attenuate the rise in anticipated daily mortality growth rate for cities and towns in which the median population age is 30 years old (the range in median age among the residents in the municipalities surveyed is 11–41 years). Moreover, referring to population size of cities, findings demonstrate that while under the scenario without vaccination, the daily mortality growth rate is anticipated to rise, under a comparable scenario with vaccination, daily mortality growth rate is anticipated to drop.

Conclusions

In crowded cities, where the median age is high, two perspectives of early and intensive public policy interventions are clearly required. The first perspective is extensive medical treatment, namely, extension of availability of medical physical and online services; dispensing designated medications; expansion of hospitalization facilities and information services particularly to susceptible populations. All measures will be taken with attention to age accessibility of these means. The second perspective is prevention via establishment of testing and vaccination complexes; elevation of dedicated health services, generating selective lockdowns; education for increasing awareness to social distancing, wearing masks and other preventive means.

Perceived risk and vaccine hesitancy: Quasi-experimental evidence from Italy

In March 2021, Italian health authorities suspended the Vaxzevria vaccine (VA) for 4 days over reports of very rare blood disorders among recipients. We exploit the quasi-experimental setting arising from this break to study the drivers of vaccine hesitancy. Before the suspension, the VA vaccination trend followed the same pattern as Pfizer-Biontech (PB). After the suspension, VA and PB injections started to diverge, with VA daily decreasing by almost 60 doses per 100,000 inhabitants for the following 3 weeks. The resulting vaccination rate was 60 percent lower than the value that would have stemmed from the VA pre-suspension pattern. We show that the slowdown was weaker and less persistent in regions with higher COVID penetration and steadier and more pronounced in regions displaying greater attention to vaccine side effects as detected through Google searches. The public's interest in vaccine adverse events negatively correlates with COVID cases and deaths across regions.

Open Debates Conducive for Vaccination Rate Flatlines: A Scoping Review and Convergent Cross Mapping

COVID-19 pandemic is fueling digital health transformation—accelerating innovations of digital health services, surveillance, and interventions, whereas hastening social contagion of deliberate infodemic. The USA and many other countries are experiencing a resurgent wave of the COVID-19 pandemic with vaccination rate slowdown, making policymaking fraught with challenges. Political leaders and scientists have publicly warned of a “pandemic of the unvaccinated,” reinforcing their calls for citizens to get jabs. However, some scientists accused elites of stigmatizing the unvaccinated people and undermining the moral pillars of public health. Following the PRISMA-ScR guidelines, we first reviewed the nuances of stakeholders involved in the ongoing debates and revealed the potential consequences of divisive pronouncements to provide perspectives to reframe extensible discussions. Then, we employed the convergent cross mapping (CCM) model to reveal the uncharted knock-on effects of the contentious tsunami in a stakeholders-oriented policymaking framework, coupled with rich metadata from the GDELT project and Google Trends. Our experimental findings suggest that current news coverage may shape the mindsets of the vaccines against the unvaccinated, thereby exacerbating the risk of dualistic antagonism in algorithmically infused societies. Finally, we briefly summarized how open debates are conducive to increasing vaccination rates and bolstering the outcomes of impending policies for pandemic preparedness.

Filipinos' health information-seeking behaviors and their implications for COVID-19 vaccination

OBJECTIVES

This study examined Filipinos' health information-seeking behaviors, specifically their information engagement and apprehension of getting the COVID-19 vaccine, the reasons for vaccination, and how these factors influenced their decision to get vaccinated.

DESIGN

Quantitative, cross-sectional, and predictive approaches.

SAMPLE

This study conducted a national online survey using convenience sampling (n = 2709).

MEASUREMENT

The Health Information Orientation Scale (HIOS) and Statista.com's "reasons for not getting a COVID-19 vaccination" were used to collect data. Demographic characteristics that predict information engagement and apprehension were identified using multivariate linear regression analysis.

RESULTS

Responses to information engagement and apprehension revealed "often true" and "sometimes true," respectively. The majority of participants intended to receive the COVID-19 vaccine. "Concerned about the vaccine's safety" is the most common reason for not getting vaccinated. Female gender, college graduate, employed, and using social media to obtain COVID-19 vaccine information were all significant predictors of information engagement and apprehension. Information engagement and apprehension were predicted by age and religion, respectively.

CONCLUSIONS

Policymakers should consider how people seek information regarding the COVID-19 vaccine and why some people refuse to get vaccinated. Additionally, public health nurses should educate the public about the safety of COVID-19 vaccines.

Cash incentives, ethics, and COVID-19 vaccination

[Figure: see text].

Intimate ecosystems: the microbiome and the ecological determinants of health

The ecological determinants of health make explicit the ways in which human health and well-being depend on the biosphere and its systems. Water, oxygen, and food are listed along with soil systems, water systems, material for shelter, energy, the ozone layer and a stable climate. Research in the sciences is uncovering the critical role that the earth microbiome, including the human microbiome, plays in human health. The relationship between commensal microbiota and the systems of the human body, as well as the ways in which these systems are interdependent with other ecosystems such as food systems, invites revisiting the ecological determinants of health. In this commentary, I argue that microbiota, including the human microbiome, should be considered ecological determinants of health. Such a characterization would recognize the importance of the microbiome to human health. It would also frame this as a public health issue and raise questions about health equity, including who benefits from the knowledge produced through biomedical research.