Socioeconomic gradient in COVID-19 vaccination: evidence from Israel

Life Science 2.0: reframing the life science sector for 'the benefit on mankind'

The COVID-19 pandemic put the life science sector to the test. Vaccines were developed at unprecedented speed, benefiting from decades of fundamental research and now honoured by a Nobel Prize. However, we saw that the fruits of science were inequitably distributed. Most low- and middle-income countries were left behind, deepening the inequalities that the Sustainable Development Goals were set to reduce. We argue that the life science sector must reinvent itself to be better and more equitably prepared for the next health crisis and to ensure fair access to health across current and future generations. Our recommendations include global governance, national strategies and the role of universities and corporations. Improved and more equitable health care should be centre stage for global health action and a core mission of a reframed Life Science sector - what we call Life Science 2.0.Paper ContextMain findings: During the COVID-19 pandemic the Life Science sector stepped up to the challenge, but vaccines and medicines were not equitably distributed.Added knowledge: Obstacles were identified that hindered global access to medical innovations.Global health impact for policy and action: Global and national governance, universities and the private sector should join forces to create a Life Science sector (Life Science 2.0) that affords equitable access to medical advances across geographical and generational boundaries and socio-economic strata.

Association between Socioeconomic Status and Vaccination Hesitancy, Reluctancy and Confidence among Asian-Americans Living in the State of New Jersey

BACKGROUD

Socioeconomic status (SES) plays a vital role in determining vaccination uptake and attitudes. Vaccine hesitancy varies among different communities, yet knowledge of vaccine attitudes among Asian-Americans is limited.

OBJECTIVE

This study aims to investigate the relationship between SES and vaccine attitudes among Asian-Americans in the State of New Jersey (NJ).

METHODS

Asian-Americans aged ≥ 18 years living in NJ were included (N = 157). SES was measured by education level, employment type, employment status, and household income. The primary outcomes were vaccine hesitancy, reluctance, and confidence for COVID-19, influenza, and pneumococcal vaccines. Descriptive and inferential statistics were performed. Multivariable logistic regression was used to identify associations between SES and vaccine hesitancy while controlling for confounders such as age, gender, birthplace, and religion.

RESULTS

Among 157 participants, 12.1% reported vaccine hesitancy. There was no statistically significant association between vaccine hesitancy and education level (p = 0.68), employment status (p = 1), employment type (p = 0.48), and household income (p = 0.15). Multivariable logistic regression modeling confirmed that none of the SES predictor variables were associated with vaccine hesitancy. However, as exploratory finding, gender was found to be a significant predictor, with males having lower odds of vaccine hesitancy than females (Adjusted OR = 0.14; p < 0.05). Confidence in influenza and pneumococcal vaccines increased during the pandemic, from 62.34% to 70.13% and from 59.2% to 70.51%, respectively. For the COVID-19 vaccine, 73.1% of participants reported having "a lot of confidence" in taking vaccine.

CONCLUSION

Most sampled Asian-Americans in NJ have high confidence in taking COVID-19 vaccines, and there is no significant association between vaccine hesitancy and SES.

Rationing, Responsibility, and Vaccination during COVID-19: A Conceptual Map

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics.

COVID-19 vaccination at a hospital in Paris: Spatial analyses and inverse equity hypothesis

Background

Vaccination against SARS-CoV-2 has been deployed in France since January 2021. Without specific action for different population subgroups, the inverse equity hypothesis postulates that people in the most deprived neighbourhoods will be the last to benefit. The article aims to study whether the inverse care law has been verified in the context of vaccination against SARS-CoV-2 from a vaccination centre of a hospital in the Paris region.

Methods

We performed a spatial analysis using primary data from the vaccination centre of the Avicenne Hospital in Bobigny from January 8th to September 30th, 2021. Primary data variables include the vaccinated person's date, age, and postal address. Secondary data calculates access times between residential neighbourhoods and the vaccination centre and social deprivation index. We performed flow analysis, k-means aggregation, and mapping.

Results

32,712 people were vaccinated at the study centre. Vaccination flow to the hospital shows that people living in the most disadvantaged areas were the last to be vaccinated. The number of people immunized according to the level of social deprivation then scales out with slightly more access to the vaccination centre for the most advantaged. The furthest have travelled more than 100 km, and more than 1h45 of transport time to get to this vaccination centre.

Conclusion

The study confirms the inverse equity hypothesis and shows that vaccination preparedness strategies must consider equity issues. Public health interventions should be implemented according to proportionate universalism and use community health, health mediation, and outreach activities for more equity.

Spatiotemporal variability in socioeconomic inequalities in COVID-19 vaccination in Catalonia, Spain

OBJECTIVES

Socioeconomic inequalities have played a significant role in the unequal coverage of the COVID-19 vaccine. The objectives of this study were to (1) assess the socioeconomic inequalities in COVID-19 vaccination coverage in Catalonia, Spain; (2) analyse the spatial variation over time of these inequalities; and (3) assess variations in time and space in the effect of vaccination on inequalities in COVID-19 outcomes.

STUDY DESIGN

A mixed longitudinal ecological study design was used.

METHODS

Catalonia is divided in to 373 Basic Health Areas. Weekly data from these Basic Health Areas were obtained from the last week of December 2020 until the first week of March of 2022. A joint spatio-temporal model was used with the dependent variables of vaccination and COVID-19 outcomes, which were estimated using a Bayesian approach. The study controlled for observed confounders, unobserved heterogeneity, and spatial and temporal dependencies. The study allowed the effect of the explanatory variables on the dependent variables to vary in space and in time.

RESULTS

Areas with lower socioeconomic level were those with the lowest vaccination rates and the highest risk of COVID-19 outcomes. In general, individuals in areas that were located in the upper two quartiles of average net income per person and in the lower two quartiles of unemployment rate (i.e., the least economically disadvantaged) had a higher propensity to be vaccinated than those in the most economically disadvantaged areas. In the same sense, the greater the percentage of the population aged ≥65 years, the higher the propensity to be vaccinated, while areas located in the two upper quartiles of population density and areas with a high percentage of poor housing had a lower propensity to be vaccinated. Higher vaccination rates reduced the risk of COVID-19 outcomes, while COVID-19 outcomes did not influence the propensity to be vaccinated. The effects of the explanatory variables were not the same in all areas or between the different waves of the pandemic, and clusters of excess risk of low vaccination in the most disadvantaged areas were detected.

CONCLUSIONS

COVID-19 vaccination inequalities in the most disadvantaged areas could be a result of structural barriers, such as the lack of access to information about the vaccination process, and/or logistical challenges, such as the lack of transportation, limited Internet access or difficulty in scheduling appointments. Public health strategies should be developed to mitigate these barriers and reduce vaccination inequalities.

Covid and the coalfield: Covid-19 vaccine hesitance in Wales and Appalachia

BACKGROUND

Vaccine hesitancy is a barrier to Covid-19 vaccine uptake and displays a social gradient, compounding health disparities. While social gradients are a vital concept in health, they flatten distinctions between types of disadvantaged community. This paper focuses on vaccine hesitance in post-industrial and de-industrialising coalfields. The social consequences of the decline of coal mining may present barriers to vaccine uptake.

METHODS

We ran parallel surveys in Wales (N = 4187) and US states overlapping with central Appalachia (N = 4864), to examine whether vaccine attitudes and uptake varied between areas with different coal mining histories. These surveys were accompanied by qualitative interviews of 36 residents of these coalfields to explore vaccination decisions and triangulate with survey data.

RESULTS

Factor analysis identified four axes of attitudes in the survey data: vaccine confidence, covid scepticism, vaccine individualism, and concerned confusion. These themes were echoed in the interviews. Vaccine confidence was lower; and covid scepticism, vaccine individualism, and concerned confusion higher, in residents of areas of Wales with greater mining extent and where pits closed during certain periods. Residents of former US coal counties had lower vaccine confidence and higher covid scepticism, while those in current coal counties had greater vaccine individualism and concerned confusion. In former US coal counties and Welsh areas where pits closed since 1980, vaccine uptake was lower. Differences could not be explained by respondents' income and education. In the interviews, norms of social solidarity were often invoked by vaccinated respondents, while unvaccinated respondents did not frame decisions in the context of the industrial history of their areas.

DISCUSSION

The legacy of coal-mining's decline presents barriers to public health campaigns. We show evidence of this across two historically significant coalfields. Attention is needed to avert negative public health consequences of global energy transition.

Caregiver's perceptions of COVID-19 vaccination, and intention to vaccinate their children against the disease: a questionnaire based qualitative study

Coronavirus disease 2019 (COVID-19) vaccine side effects have an important role in the hesitancy of the general population toward vaccine administration. Another reason for vaccine hesitancy might be that healthcare professionals may not address their concerns regarding vaccines appropriately. Regardless, hesitancy in the form of delay, refusal, or acceptance with doubts about its usefulness can limit the downward trajectory of the COVID-19 pandemic. Therefore, the authors conducted a national cross-sectional study (n=306) to assess causes and concerns for vaccine hesitancy in caregivers in Pakistan toward getting their children vaccinated. The questions identified caregivers by socioeconomic demographics, perceived COVID-19 pandemic severity, and concerns toward the COVID-19 vaccine. The majority of the participants were 45-59 years of age (42.8%) with a mean age of 36.11 years (SD: 7.81). A total of 80% of these participants were willing to vaccinate their child with any COVID-19 vaccine. Present comorbidities had a frequency of 28.4% (n=87/306) and only 26.9% (n=66/245) participants were willing to vaccinate their child. Participants with high social standing were 15.4% (n=47/306) with the majority of them being willing to vaccinate their children (45/47). Socioeconomic status (OR:2.911 [0.999-8.483]), and the child's vaccinations being up to date (OR:1.904 [1.078-3.365]) were found to be independent factors for caregivers to be willing to vaccinate their child. Around 62% (n=191/306) were not willing to vaccinate due to the concern for side effects, 67.6% (n=207/306) were not willing because they did not have ample information available, and 51% (n=156/306) were not willing as they were concerned about vaccine effectiveness. Further studies on vaccine safety in the pediatric population are required to improve caregivers' perceptions.

The Relationship of COVID-19 Vaccination Status with Health Literacy of Syrians Living in Istanbul

Health literacy is an important determinant of health care use among refugees and migrant communities. This present study aimed to evaluate the relationship between health literacy levels, sociodemographic characteristics, and the status of receiving the COVID-19 vaccine in Syrians under "Temporary Protection" in Istanbul. This study was conducted in February, March, and May 2022 in an Extended Migrant Health Center in Istanbul, with a survey prepared in Arabic under observation. A total of 571 questionnaires were analyzed. The mean age of the participants was 31.92 ± 6.14, and 80.7% were female and 26.6% were high school graduates. A total of 55.0% of Syrians have not had any of the COVID-19 vaccines. The health literacy level of 1.1% of the immigrants was determined as "excellent", 68.7% as "inadequate", 20.7% as "problematic/limited", and 9.6% as "adequate". According to the logistic regression model, being male, of elder age, middle and above economic status, and having a chronic disease in the family were determined as the variables associated with the status of being vaccinated against COVID-19. Refugees are a group often exposed to inequalities in access to health services. Increasing health literacy in these groups will provide a significant improvement in access to and use of health services.

Social inequalities and the early provision and dispersal of COVID-19 vaccinations in the United States: A population trends study

BACKGROUND

In December 2020 the U.S. began a massive COVID-19 vaccination campaign, an action that researchers felt could catalyze inequalities in COVID-19 vaccination utilization. While vaccines have the potential to be accessible regardless of social status, the objective of this study was to examine how and when socioeconomic status (SES) and racial/ethnic inequalities would emerge in vaccination distribution.

METHODS

Population vaccination rates reported at the county level by the Centers for Disease Control and Prevention across 46 states on 3/30/2021. Correlates included SES, the share of the population who were Black, Hispanic, Female, or aged ≥65 years, and urbanicity (thousands of residents per square mile). Multivariable-adjusted analyses relied on zero-inflated negative binomial regression to estimate the odds of providing any vaccine, and vaccination rate ratios (aVRR) comparing the distribution rate for vaccinations across the U.S.

RESULTS

Across the U.S., 16.3 % of adults and 37.9 % of adults aged 65 and older were vaccinated in lower SES counties, while 20.45 % of all adults and 48.15 % of adults aged 65 and older were vaccinated in higher SES counties. Inequalities emerged after 41 days, when < 2 % of Americans were vaccinated. Multivariable-adjusted analyses revealed that higher SES was associated with improved vaccination distribution (aVRR = 1.127, [1.100-1.155], p < 1E-06), while increases in the percent reporting Black or Hispanic race/ethnicity was associated with lower vaccination distribution (aVRR = 0.998, [0.996-0.999], p = 1.03E-04).

CONCLUSIONS

Social inequalities in COVID-19 vaccines reflect an inefficient and inequitable distribution of these technologies. Future efforts to improve health should recognize the central role of social factors in impacting vaccine delivery.

Disparities in access to COVID-19 vaccine in Verona, Italy: a cohort study using local health immunization data

Introduction

Migrant populations worldwide were disproportionately impacted by the COVID-19 pandemic. Although substantial resources have been invested in scaling COVID-19 vaccination campaigns, globally vaccine rate and uptake remained low among migrants from across many countries. This study aimed to explore the country of birth as a factor influencing access to the COVID-19 vaccine.

Methods

This retrospective cohort study included adults vaccinated against SARS-CoV-2 receiving at least one dose in the Verona province between 27 December 2020 and 31 December 2021. Time-to-vaccination was estimated as the difference between the actual date of each person's first dose of COVID-19 vaccination and the date in which the local health authorities opened vaccination reservations for the corresponding age group. The birth country was classified based on both the World Health Organization regions and the World Bank country-level economic classification. Results were reported as the average marginal effect (AME) with corresponding 0.95 confidence intervals (CI).

Results

During the study period, 7,54,004 first doses were administered and 5,06,734 (F = 2,46,399, 48.6%) were included after applying the exclusion criteria, with a mean age of 51.2 years (SD 19.4). Migrants were 85,989 (17.0%, F = 40,277, 46.8%), with a mean age of 42.4 years (SD 13.3). The mean time-to-vaccination for the whole sample was 46.9 days (SD 45.9), 41.8 days (SD 43.5) in the Italian population, and 71.6 days (SD 49.1) in the migrant one (p < 0.001). The AME of the time-to-vaccination compared to the Italian population was higher by 27.6 [0.95 CI 25.4-29.8], 24.5 [0.95 CI 24.0-24.9], 30.5 [0.95 CI 30.1-31.0] and 7.3 [0.95 CI 6.2-8.3] days for migrants from low-, low-middle-, upper-middle- and high-income countries, respectively. Considering the WHO region, the AME of the time-to-vaccination compared to the Italian group was higher by 31.5 [0.95 CI 30.6-32.5], 31.1 [0.95 CI 30.6-31.5], and 29.2 [0.95 CI 28.5-29.9] days for migrants from African, European, and East-Mediterranean regions, respectively. Overall, time-to-vaccination decreased with increasing age (p < 0.001). Although both migrants and Italians mainly used hub centers (>90%), migrants also used pharmacies and local health units as alternative sites (2.9% and 1.5%, respectively), while Italians (3.3%) and migrants from the European region (4.2%) relied more on family doctors.

Conclusion

The birth country of migrants influenced access to COVID-19 vaccine both in terms of time-to-vaccination and vaccination points used, especially for the LIC migrant group. Public health authorities should take socio-cultural and economic factors into consideration for tailored communication to people from migrant communities and for planning a mass vaccination campaign.

Socioeconomic status and disparities in COVID-19 vaccine uptake in Eastern Oslo, Norway

Objective

The objective of this study was to assess whether socioeconomic status still remain a barrier to COVID-19 vaccination in eastern Oslo, Norway.

Study design

A cross-section study.

Methods

We conducted a web-based survey among the residents of six eastern parishes in Oslo, Norway. Text (SMS) messages were sent to 59978 potential participants. 5447 surveys were completed for a response rate of 9.1%. After removing participants who had not been offered the COVID-19 vaccine, we ended up with a valid sample of 4000.

Results

We find a significant association between education and the likelihood of taking the COVID-19 vaccine in bivariate logistic regression. Further, we find a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group. However, when we add control variables to the regression, the significant results concerning both income and education are eliminated. In further analysis, we found that age worked as a moderator between socioeconomic status and vaccine uptake: In the youngest age group (18-29), we found a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group, and in the higher education group compared to the primary education group.

Conclusion

Socioeconomic status remains a barrier to COVID-19 vaccination in the eastern parishes of Oslo, Norway. Indicating that Norwegians of lower socioeconomic status still disproportionately face barriers such as transportation, language, flexible work hours, and paid sick time. However, our analysis shows that this association is only found in the age group 18-29.

Geographic and Socioeconomic Inequalities in Delays in COVID-19 Vaccinations: A Cross-Sectional Study in Indonesia

BACKGROUND

Previous studies have provided evidence of inequalities in the coverage of COVID-19 vaccination. However, evidence of such inequalities in delays in vaccinations is lacking. Our study examined the socioeconomic and geographic disparities in terms of days to get the first and second dose of COVID-19 vaccinations in Indonesia.

METHODS

We conducted a cross-sectional study using the WhatsApp messaging app and social media platforms during December 2021-February 2022. We distributed the questionnaire through our university network to reach all regions. We included 3592 adults aged 15+ years in our analysis. We used two main dependent variables: days to receive the first dose (after national vaccine rollout) and days to receive the second dose (after receiving the first dose). We examined a range of socioeconomic and geographic indicators, including education level, income level, formal employment, working in health facilities, being a health worker, and region. We controlled for sex, age, religion, and urbanicity. We performed multivariate logistic regressions in STATA 15.

RESULTS

Our findings show considerable delays in getting the first dose among participants (160.7 days or about 5.4 months on average) from Indonesia's national COVID-19 vaccination rollout on 13 January 2021. However, we found a shorter period to receive the second dose after receiving the first dose (41.1 days on average). Moreover, we found significant socioeconomic (i.e., education, income, formal employment, working in health facilities, and being a health worker) and geographic (i.e., in and out of the Java region) inequalities in terms of delays in getting the first dose. However, we did not find significant inequalities in getting the second dose for most inequality indicators, except for working in health facilities. By region, we found that participants living in more deprived areas (out of the Java region) received the second dose 4.9 days earlier. One of the study's key limitations is that there may be an inherent bias with respect to socioeconomics factors since it was conducted online (web-based).

CONCLUSIONS

While there were considerable delays in getting the first dose, especially among those of a lower socioeconomic status and those in more deprived areas, the waiting time for the second dose was relatively similar for everyone once they were in the system. Effective efforts to address inequalities are essential to ensuring the effectiveness of the national COVID-19 vaccination rollout.

Trends in COVID-19 Vaccine Acceptance in Spain, September 2020‒May 2021

Objectives. To analyze factors associated with COVID-19 vaccine acceptance in Spain, over time. Methods. We used data from a national study that included 5 online surveys carried out every 2 months from September 2020 to May 2021. Each round recruited a sample of 1000 participants aged 18 years or older. We performed a multivariable logistic regression with vaccination acceptance as the dependent variable. We evaluated time trends through the interaction terms of each of the explanatory variables and the time. Results. Vaccination acceptance increased from 43.1% in September 2020 to 84.5% in May 2021. Sex, age, concerns about disease severity, health services overload, and people not wearing a face mask, together with adherence to preventive behavior, health literacy, and confidence in scientists, health care professionals' information, and adequacy of governmental decisions, were variables associated with vaccination acceptance. Conclusions. In a changing situation, vaccine acceptance factors and time trends could help in the design of contextualized public health messages. It is important to strengthen the population's trust in institutions, health care professionals, and scientists to increase vaccination rates, as well as to ensure easy access to accurate information for those who are more reluctant. (Am J Public Health. 2022;112(11):1611-1619. https://doi.org/10.2105/AJPH.2022.307039).

Variables Associated With COVID-19 Vaccination Among Israeli Adolescents and the Need for Targeted Interventions

BACKGROUND

We aimed to elucidate variables associated with coronavirus disease 2019 (COVID-19) vaccine compliance in adolescents and devise targeted interventions. Our secondary aim was to compare the rates of severe acute respiratory syndrome coronavirus 2 infection, hospitalizations and deaths between vaccinated and unvaccinated adolescents.

METHODS

A retrospective review of electronic medical records was performed on all adolescents 12-17 years of age registered at Clalit Health District in Israel during January 1, 2021, to November 18, 2021, with characterization by vaccination status against COVID-19. Univariate and multivariable analyses were employed to identify predictors of vaccination.

RESULTS

Of the 43,919 subjects included in the study, 28,207 (64.2%) were vaccinated. Non-ultraorthodox Jewish adolescents had a higher vaccination rate than the minorities Arabs or ultraorthodox Jews (72.5%, 66.2% and 40.5%, respectively, P &lt; 0.001). Adolescents of high socioeconomic status had nearly 2-fold higher vaccination rates than those of low socioeconomic status (80.4% vs 42.3%; P &lt; 0.0001). Adolescents 16-17 years old had a higher rate of COVID-19 vaccination than those 12-15 years old (72.5% vs 60.6%, P &lt; 0.001), as were girls versus boys (64.7% vs 63.8%, P = 0.047). Multivariate analysis identified 3 independent variables that were significantly ( P &lt; 0.001) associated with low vaccination: ultraorthodox sector, Arab population, and underlying obesity (hazard rations 0.42, 0.72 and 0.84, respectively). Vaccination was significantly associated with reduced severe acute respiratory syndrome coronavirus 2 infection, hospitalization and death ( P &lt; 0.001).

CONCLUSION

This study highlights several pediatric populations with low COVID-19 vaccine compliance. Targeted interventions aimed at these populations are suggested with consideration of their special cultural, social and societal characteristics.

Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil

Background

There is limited information on the inequity of access to vaccination in low-and-middle-income countries during the COVID-19 pandemic. Here, we described the progression of the Brazilian immunisation program for COVID-19, and the association of socioeconomic development with vaccination rates, considering the potential protective effect of primary health care coverage.

Methods

We performed an ecological analysis of COVID-19 immunisation data from the Brazilian National Immunization Program from January 17 to August 31, 2021. We analysed the dynamics of vaccine coverage in the adult population of 5,570 Brazilian municipalities. We estimated the association of human development index (HDI) levels (low, medium, and high) with age-sex standardised first dose coverage using a multivariable negative binomial regression model. We evaluated the interaction between the HDI and primary health care coverage. Finally, we compared the adjusted monthly progression of vaccination rates, hospital admission and in-hospital death rates among HDI levels.

Findings

From January 17 to August 31, 2021, 202,427,355 COVID-19 vaccine doses were administered in Brazil. By the end of the period, 64·2% of adults had first and 31·4% second doses, with more than 90% of those aged ≥60 years with primary scheme completed. Four distinct vaccine platforms were used in the country, ChAdOx1-S/nCoV-19, Sinovac-CoronaVac, BNT162b2, Ad26.COV2.S, composing 44·8%, 33·2%, 19·6%, and 2·4% of total doses, respectively. First dose coverage differed between municipalities with high, medium, and low HDI (Median [interquartile range] 72 [66, 79], 68 [61, 75] and 63 [55, 70] doses per 100 people, respectively). Municipalities with low (Rate Ratio [RR, 95% confidence interval]: 0·87 [0·85-0·88]) and medium (RR [95% CI]: 0·94 [0·93-0·95]) development were independently associated with lower vaccination rates compared to those with high HDI. Primary health care coverage modified the association of HDI and vaccination rate, improving vaccination rates in those municipalities of low HDI and high primary health care coverage. Low HDI municipalities presented a delayed decrease in adjusted in-hospital death rates by first dose coverage compared to high HDI locations.

Interpretation

In Brazil, socioeconomic disparities negatively impacted the first dose vaccination rate. However, the primary health care mitigated these disparities, suggesting that the primary health care coverage guarantees more equitable access to vaccines in vulnerable locations.

Funding

This work is part of the Grand Challenges ICODA pilot initiative, delivered by Health Data Research UK and funded by the Bill & Melinda Gates Foundation and the Minderoo Foundation. This study was supported by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES) - Finance Code 001, Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) and the Pontifical Catholic University of Rio de Janeiro.

Social determinants and adherence to recommended COVID-19 vaccination among the Arab ethnic minority: A syndemics framework

Background

Since the mass vaccination against SARS-CoV-2 was launched in Israel, the Arab ethnicity minority had lower vaccine uptake. The syndemics theory suggests a closely interrelated complex of health and social crises among vulnerable societies results in an increased disease burden or in more adverse health conditions. Syndemics may explain the health disparities between different people or communities. Likewise, acculturation was found to be associated with different health outcomes among minority populations. The purpose of the study is to explore the association between syndemic construct, acculturation style, and adherence to recommended COVID-19 vaccination among the Arab ethnicity in Israel.

Methods

A cross-sectional study among 305 participants who completed a self-report questionnaire. Syndemic construct (syndemics score and syndemics severity) was calculated from the participants' health behavior index, self-rated health status, and adherence to flu vaccination. Four acculturation strategies were defined according to Barry's acculturation model: assimilation, integration, separation, and marginalization style. Linear regression (stepwise method) was conducted to determine the explanatory factors for COVID-19 vaccine adherence.

Results

Assimilation and separation acculturation styles and syndemics severity were significantly associated with higher adherence to the recommended COVID-19 vaccination (B = 1.12, 95%CI = 0.34-1.98; B = 0.45, 95%CI = 0.10-0.80; B = 0.18, 95%CI = 0.09-0.28; respectively). The explained variance of the model (R ²) was 19.9%.

Conclusion

Syndemics severity, assimilation and separation acculturation styles were associated with higher adherence to recommended COVID-19 vaccination in the Israeli Arab minority population. Syndemics score was not associated with recommended COVID-19 vaccination. To encourage COVID-19 vaccination among minority communities, campaigns should be tailored to the social determinants in a sensitive and individualized manner.

Covid-19 in children aged 5-11: Examining the issues surrounding vaccination and public health policy

BACKGROUND

Children under 12 are now the largest unvaccinated group. Following FDA approval, vaccination of 5-11 year olds is now being encouraged in some countries. We present data on child COVID-related morbidity in Israel and discuss the complexities surrounding vaccinating children aged 5-11.

METHODS

Data were obtained from Israel's open COVID database regarding new confirmed daily COVID-19 cases, severe hospitalized cases and deaths by age group in Israel from February 2020-November 2021, as well as vaccination rate and adverse events following vaccination.

RESULTS

In 5-11 year olds, there were 460 hospitalizations, including 72 moderate to critical (0.007% population rate), with 3 deaths (0.0003% population rate). Children (0-19) made up the largest proportion (41%) of cases, but comprised just <0.1% of deaths, and <1% of severe cases. Post-vaccine myocarditis was much lower than severe COVID risk except in boys aged 12-19 where it was equivalent to the risk of mechanical ventilation due to COVID in boys aged 10-19 (12 per 100,000). High numbers of children were quarantined.

CONCLUSIONS

COVID risk is minimal for most children though rare complications do occur. Israeli and US pediatric associations have recommended vaccinating children, particularly in high-incidence scenarios where risk-benefit balance is more clear-cut. However only a quarter of eligible parents have vaccinated their children. Parents may consider health grounds but also restrictions on children, population vaccination levels, waning immunity and new variants, and should be provided with clear information to help them make an informed decision. Policymakers should reevaluate the need for isolations, testing and mask-wearing in school age children, which are detrimental to their wellbeing.

Acceptance Rates of COVID-19 Vaccine Highlight the Need for Targeted Public Health Interventions

We aimed to examine rates of COVID-19 vaccination to elucidate the need for targeted public health interventions. We retrospectively reviewed the electronic medical files of all adults registered in a central district in Israel from 1 January 2021 to 31 March 2022. The population was characterized by vaccination status against COVID-19 and the number of doses received. Univariate and multivariable analyses were used to identify predictors of low vaccination rates that required targeted interventions. Of the 246,543 subjects included in the study, 207,911 (84.3%) were vaccinated. The minority groups of ultra-Orthodox Jews and Arabs had lower vaccination rates than the non-ultra-Orthodox Jews (68.7%, 80.5% and 87.7%, respectively, p < 0.001). Adults of low socioeconomic status (SES) had lower vaccination rates compared to those of high SES (74.4% vs. 90.8%, p < 0.001). Adults aged 20−59 years had a lower vaccination rate than those ≥60 years (80.0% vs. 92.1%, p < 0.0001). Multivariate analysis identified five independent variables that were significantly (p < 0.001) associated with low vaccination rates: minority groups of the ultra-Orthodox sector and Arab population, and underlying conditions of asthma, smoking and diabetes mellitus (odds ratios: 0.484, 0.453, 0.843, 0.901 and 0.929, respectively). Specific targeted public health interventions towards these subpopulations with significantly lower rates of vaccination are suggested.

Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review

Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.

COVID-19 vaccines coverage and effectiveness against SARS-CoV-2 infection among residents in the largest Health Authority of Lazio region (Italy): a population-based cohort study

BACKGROUND

The waning of the protective effect of COVID-19 vaccines and timing of booster doses are debated.

METHODS

Population-based cohort study in the largest Health Authority of Lazio region, Italy, on 946,156 residents aged 12+ (study period: January 1, 2021-January 10, 2022). Vaccine Effectiveness (VE) against any SARS-CoV-2 infection (symptomatic or asymptomatic) was estimated through multivariable negative binomial models using unvaccinated person-time as reference.

RESULTS

The primary vaccination cycle was completed by 81% of residents; of these, 45% received a booster dose. Vaccine coverages were lower for foreigners, deprived areas, families with children aged 0-11, and households of size 1 or 6+. Overall, VE waned from 71% (95% Confidence Interval (CI) 70-73%) 1 month after the second dose to 43% (CI 41-45%) after 4 months and 24% (CI 21-27%) after 6 months, especially in the elderly aged 70+. We observed a prompt restore of VE 15-19 days after the booster dose (69%, CI 67-70%).

CONCLUSIONS

Our results showed effectiveness of a booster dose four months after completion of the primary cycle, and support the recommendation of prioritizing elderly and fragile individuals. The lower vaccine coverage among social disadvantaged subgroups suggests the need of targeted communication and interventions.

Health Beliefs and Socioeconomic Determinants of COVID-19 Booster Vaccine Acceptance: An Indonesian Cross-Sectional Study

INTRODUCTION

The threat of new SARS-CoV-2 variants indicates the need to implement COVID-19 vaccine booster programs. The aim of this study was to identify the level of booster acceptance and its determinants.

METHODS

A cross-sectional online survey was conducted in Jakarta and Bali, Indonesia. Booster acceptance was divided into three categories: non-acceptor, planned acceptor, and actual acceptor. The primary independent variables were health beliefs, media influence, and trust in authoritative sources. Other covariates included demographics, socioeconomic status, and COVID-19 history. A primary analysis was conducted through multinomial logistic regression. The effects of the hypothetical situations on booster acceptance were tested using the Wilcoxon signed-rank test.

RESULTS

The final analysis included 2674 respondents with a booster acceptance rate of 56.3% (41.2% planned acceptors, 15.1% actual acceptors). Health beliefs, social media influence, and trust in authoritative information sources were identified as determinants for planned and actual booster acceptance. Socioeconomic status indicators were also identified as determinants for actual booster acceptance. Booster acceptance was increased in hypothetical scenarios involving booster requirements for work, travel, and accessing public places.

CONCLUSIONS

Booster acceptance was found to be lower than the predicted primary vaccine acceptance prior to its launch. The acceleration of booster coverage requires strategies that leverage health beliefs and focus on people with a lower socioeconomic status.

Sociodemographic disparities in COVID-19 burden: changing patterns over four pandemic waves in Israel

BACKGROUND

Worldwide, the COVID-19 pandemic hit weakest populations hardest, with socioeconomic (SE), racial and ethnic disparities in COVID-19 burden. The study aimed to analyse patterns of SE and ethnic disparities in morbidity, hospitalisation, and vaccination throughout four pandemic waves.

METHODS

A retrospective-archive study was conducted in Israel from 11 March 2020 to 1 December 2021, with data on confirmed cases, hospitalisations, mortality and vaccinations (three doses), obtained from the Israeli Ministry of Health's open COVID-19 database, covering 98.8% of the population, by SE and ethnic characteristics of localities.

FINDINGS

At the outbreak of the pandemic, there was a higher caseload in Jewish, compared with Arab localities. In the second and third waves, low SE and Arab minority populations suffered 2-3 times higher morbidity, with a similar but attenuated pattern in the fourth wave. A similar trend was observed in hospitalisation of confirmed patients. COVID-19-associated mortality did not demonstrate a clear SE gradient.A strong social gradient in vaccine uptake was demonstrated throughout the period, with 71% and 74% double vaccinated in the two highest SE clusters, and 43% and 27% in the two lowest clusters by December 2021. Uptake of the third dose was 57%-60% in the highest SE clusters and 31%-25% in the lowest clusters. SE disparities in vaccine uptake were larger among the younger age groups and gradually increased from first to third doses.

CONCLUSIONS

Israel was among the first to lead a rapid vaccination drive, as well as to experience a fourth wave fuelled by diminishing immunity and the delta variant. SE and ethnic disparities were evident throughout most of the pandemic months, though less so for mortality. Despite higher COVID-19 burden, vaccine uptake was lower in disadvantaged groups, with greater disparities in the younger population which widened with subsequent doses.

Availability of oral antivirals against SARS-CoV-2 infection and the requirement for an ethical prescribing approach

The first two oral antivirals, molnupiravir and nirmatrelvir–ritonavir, are now becoming available in many countries. These medicines will be indicated to treat mild-to-moderate COVID-19 in non-hospitalised patients who are at high risk of progressing to severe COVID-19. These antivirals should be prescribed within 5 days of symptom onset, and after SARS-CoV-2 infection has been confirmed. However, the availability of these antivirals will be scarce for some time due to manufacturing constraints. Each country should establish a policy on the conditions under which these antivirals can be prescribed. Such a policy should be based on the fulfilment of five ethical elements: transparency, relevance, appeals, enforcement, and fairness. Following the principles of distributive justice, molnupiravir and nirmatrelvir–ritonavir should be prescribed according to a hierarchy of predicted efficacy, ideally on the basis of an evidence-based scoring system. The placebo-controlled randomised trials that supported the temporary authorisation of these two antivirals were conducted in unvaccinated patients with COVID-19, so an evidence-based prescription practice would only use these drugs for unvaccinated patients until further data become available. However, in the countries that authorised these antivirals in 2021 (the UK and the USA), both vaccinated and unvaccinated patients meeting particular requirements have access to these antivirals. Due to the complexity of prioritisation, national health authorities should start issuing their draft policies as soon as possible and these policies should be regularly updated. The effectiveness of these antivirals against the omicron variant of SARS-CoV-2 must be urgently assessed. Once implemented, molnupiravir and nirmatrelvir–ritonavir must show their effectiveness and safety in the real world, and health systems must be adequately adapted for the correct use of these antivirals.