Clinical Outcomes Of A COVID-19 Vaccine: Implementation Over Efficacy

Socioeconomic determinants of COVID-19 vaccine acceptance

The aim of the paper is to evaluate the relative importance of the set of socioeconomic characteristics of population on collective decision on COVID-19 vaccine acceptance. We apply cross-section OLS methods to the municipal-level non-survey data for 145 municipalities in Serbia, on the COVID-19 vaccination rate and socioeconomic characteristics of the population, to evaluate the determinants of cross-municipal variation in vaccine uptake decision. Using the estimated coefficients from the OLS regressions, we apply the standardized beta method to evaluate the relative importance of each factor. Vaccine acceptance in municipalities rises with the average level of education (especially in the female population), age and employment, while being negatively linked to religiosity of people and the proportion of rural population. We also find some evidence on the positive impact of the overall trust in government. Education level has the single largest impact, shaping around 37% of (explained) variation in the vaccination rate across municipalities, a rise in the proportion of people with higher degree by 1% being associated with increase in vaccination rate by 0.36%. Age of population explains 21%, urban-rural structure 13% and religiosity 11% of variation in vaccine acceptance, while employment status and trust in government each explain around 9% of variation in vaccine uptake across municipalities. Effective vaccination promotion strategy should be focused on younger, less-educated, unemployed cohorts, as well as on rural areas and should involve representatives of mainstream religions. Fostering education and strengthening trust in government are some of the key structural factors that may promote efficient collective behaviour in this respect.

Expanding the use of mathematical modeling in healthcare epidemiology and infection prevention and control

During the coronavirus disease 2019 pandemic, mathematical modeling has been widely used to understand epidemiological burden, trends, and transmission dynamics, to facilitate policy decisions, and, to a lesser extent, to evaluate infection prevention and control (IPC) measures. This review highlights the added value of using conventional epidemiology and modeling approaches to address the complexity of healthcare-associated infections (HAI) and antimicrobial resistance. It demonstrates how epidemiological surveillance data and modeling can be used to infer transmission dynamics in healthcare settings and to forecast healthcare impact, how modeling can be used to improve the validity of interpretation of epidemiological surveillance data, how modeling can be used to estimate the impact of IPC interventions, and how modeling can be used to guide IPC and antimicrobial treatment and stewardship decision-making. There are several priority areas for expanding the use of modeling in healthcare epidemiology and IPC. Importantly, modeling should be viewed as complementary to conventional healthcare epidemiological approaches, and this requires collaboration and active coordination between IPC, healthcare epidemiology, and mathematical modeling groups.

Exploring the therapeutic potential of Thai medicinal plants: in vitro screening and in silico docking of phytoconstituents for novel anti-SARS-CoV-2 agents

BACKGROUND

The high virulence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease 2019 (COVID-19), has triggered global health and economic concerns. The absence of specific antiviral treatments and the side effects of repurposed drugs present persistent challenges. This study explored a promising antiviral herbal extract against SARS-CoV-2 from selected Thai medicinal plants based on in vitro efficacy and evaluated its antiviral lead compounds by molecular docking.

METHODS

Twenty-two different ethanolic-aqueous crude extracts (CEs) were rapidly screened for their potential activity against porcine epidemic diarrhea virus (PEDV) as a surrogate using a plaque reduction assay. Extracts achieving ≥ 70% anti-PEDV efficacy proceeded to the anti-SARS-CoV-2 activity test using a 50% tissue culture infectious dose method in Vero E6 cells. Molnupiravir and extract-free media served as positive and negative controls, respectively. Potent CEs underwent water/ethyl acetate fractionation to enhance antiviral efficacy, and the fractions were tested for anti-SARS-CoV-2 performance. The fraction with the highest antiviral potency was identified using liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Molecular docking analyses of these compounds against the main protease (Mpro) of SARS-CoV-2 (6LU7) were performed to identify antiviral lead molecules. The top three hits were further evaluated for their conformational stability in the docked complex using molecular dynamics (MD) simulation.

RESULTS

The water fraction of mulberry (Morus alba Linn.) leaf CE (WF-MLCE) exhibited the most potent anti-SARS-CoV-2 efficacy with low cytotoxicity profile (CC50 of ~ 0.7 mg/mL), achieving 99.92% in pre-entry mode and 99.88% in postinfection treatment mode at 0.25 mg/mL. Flavonoids and conjugates were the predominant compounds identified in WF-MLCE. Molecular docking scores of several flavonoids against SARS-CoV-2 Mpro demonstrated their superior antiviral potency compared to molnupiravir. Remarkably, myricetin-3-O-β-D-galactopyranoside, maragrol B, and quercetin 3-O-robinobioside exhibited binding energies of ~  - 9 kcal/mol. The stability of each ligand-protein complex of these compounds with the Mpro system showed stability during MD simulation. These three molecules were pronounced as antiviral leads of WF-MLCE. Given the low cytotoxicity and high antiviral potency of WF-MLCE, it holds promise as a candidate for future therapeutic development for COVID-19 treatment, especially considering its economic and pharmacological advantages.

An eye on equity: faricimab-driven health equity improvements in diabetic macular oedema using a distributional cost-effectiveness analysis from a UK societal perspective

BACKGROUND/OBJECTIVES

Diabetic macular oedema (DMO) is a leading cause of blindness in developed countries, with significant disease burden associated with socio-economic deprivation. Distributional cost-effectiveness analysis (DCEA) allows evaluation of health equity impacts of interventions, estimation of how health outcomes and costs are distributed in the population, and assessments of potential trade-offs between health maximisation and equity. We conducted an aggregate DCEA to determine the equity impact of faricimab.

METHODS

Data on health outcomes and costs were derived from a cost-effectiveness model of faricimab compared with ranibizumab, aflibercept and off-label bevacizumab using a societal perspective in the base case and a healthcare payer perspective in scenario analysis. Health gains and health opportunity costs were distributed across socio-economic subgroups. Health and equity impacts, measured using the Atkinson inequality index, were assessed visually on an equity-efficiency impact plane and combined into a measure of societal welfare.

RESULTS

At an opportunity cost threshold of £20,000/quality-adjusted life year (QALY), faricimab displayed an increase in net health benefits against all comparators and was found to improve equity. The equity impact increased the greater the concerns for reducing health inequalities over maximising population health. Using a healthcare payer perspective, faricimab was equity improving in most scenarios.

CONCLUSIONS

Long-acting therapies with fewer injections, such as faricimab, may reduce costs, improve health outcomes and increase health equity. Extended economic evaluation frameworks capturing additional value elements, such as DCEA, enable a more comprehensive valuation of interventions, which is of relevance to decision-makers, healthcare professionals and patients.

A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance

The UK Medical Research Council's widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.

Vaccine Refusal and Hesitancy among Iranians Participated in the National COVID-19 Vaccine Hesitancy Survey: A Qualitative Study

Background

Success in COVID-19 vaccination depends on understanding why people refuse or hesitate to take the vaccine. This study aims to explore vaccine refusal and hesitancy among Iranians who participated in the national COVID-19 vaccine hesitancy survey.

Methods

A qualitative content analysis approach was used. Twenty-six participants were selected by purposive sampling. In-depth, semi-structured telephone interviews were conducted during the year 2022. A directed content analysis approach was used for analyzing the data by extracting the codes, subcategories, and categories.

Results

Four major categories and their respective subcategories related to refusal and/ or hesitancy against COVID-19 vaccination emerged: "lack of confidence" (distrust in policymakers and pharmaceutical companies, distrust in national media, belief in conspiracy theory, and lack of confidence in the vaccine's safety and effectiveness), "complacency" (Fatalism and philosophical beliefs, low perceived risk, and belief in the adequacy of the precautionary principles), "constrains" (personal and psychological barriers), and "coercion" (coercion by relatives and unsteady imposed mandatory vaccination by the government).

Conclusion

Distrust, fatalism, low perceived risk, and overconfidence in traditional Persian medicine were important barriers to COVID-19 vaccine acceptability needing a variety of measures for improving COVID-19 vaccine uptake, including enhancing public trust in government and policymakers, clarifying vaccine safety and effectiveness, dealing with religious fatalism, and regulating anti-science messages on social media.

Operation CoVER Saint Louis (COVID-19 Vaccine in the Emergency Room): Impact of a Vaccination Program in the Emergency Department

Introduction

Coronavirus 2019 (COVID-19) inequitably impacted minority populations and regions with limited access to healthcare resources. The Barnes-Jewish Emergency Department in St. Louis, MO, serves such a population. The COVID-19 vaccine is an available defense to help achieve community immunity. The emergency department (ED) is a potential societal resource to provide access to a vaccination intervention. Our objective in this study was to describe and evaluate a novel ED COVID-19 vaccine program, including its impact on the local surrounding underserved community.

Methods

This was a retrospective, post-protocol implementation review of an ED COVID-19 vaccination program. Over the initial six-month period, we compiled data on all vaccinated patients out of the ED to evaluate demographic data and the impact on underserved regional areas.

Results

We report a successful ED-based COVID-19 vaccine program (with over 1,000 vaccines administered). This program helped raise regional and state vaccination rates. Over 50% of the population that received the COVID-19 vaccine from the ED were from defined socially vulnerable patient populations. No adverse effects were documented.

Conclusion

Operation CoVER (COVID-19 Vaccine in the Emergency Room) Saint Louis was able to successfully vaccinate a socially vulnerable patient population. This free, COVID-19 ED-based vaccine program with dedicated pharmacy support, was novel in emergency medicine practice. Similar ED-based vaccine programs could help with future vaccine distribution.

How can a behavioral economics lens contribute to implementation science?

BACKGROUND

Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work.

CONCLUSION

Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care.

An Epidemic Model with Infection Age and Vaccination Age Structure

A model of epidemic dynamics is developed that incorporates continuous variables for infection age and vaccination age. The model analyzes pre-symptomatic and symptomatic periods of an infected individual in terms of infection age. This property is shown to be of major importance in the severity of the epidemic, when the infectious period of an infected individual precedes the symptomatic period. The model also analyzes the efficacy of vaccination in terms of vaccination age. The immunity to infection of vaccinated individuals varies with vaccination age and is also of major significance in the severity of the epidemic. Application of the model to the 2003 SARS epidemic in Taiwan and the COVID-19 epidemic in New York provides insights into the dynamics of these diseases. It is shown that the SARS outbreak was effectively contained due to the complete overlap of infectious and symptomatic periods, allowing for the timely isolation of affected individuals. In contrast, the pre-symptomatic spread of COVID-19 in New York led to a rapid, uncontrolled epidemic. These findings underscore the critical importance of the pre-symptomatic infectious period and the vaccination strategies in influencing the dynamics of an epidemic.

Neuroinflammatory Findings of Corneal Confocal Microscopy in Long COVID-19 Patients, 2 Years after Acute SARS-CoV-2 Infection

OBJECTIVE

To describe corneal confocal microscopy findings in patients with long COVID-19 with persistent symptoms over 20 months after SARS-CoV-2 infection.

DESIGN

A descriptive cross-sectional study that included a total of 88 patients; 60 patients with Long COVID-19 and 28 controls. Long COVID-19 diagnosis was established according to the World Health Organization criteria. Corneal confocal microscopy using a Heidelberg Retina Tomograph II (Heidelberg Engineering, Heidelberg, Germany) was performed to evaluate sub-basal nerve plexus morphology (corneal nerve fiber density, nerve fiber length, nerve branch density, nerve fiber total branch density, nerve fiber area, and nerve fiber width). Dendritic cell density and area, along with microneuromas and other morphological changes of the nerve fibers were recorded.

RESULTS

Long COVID-19 patients presented with reduced corneal nerve density and branch density as well as shorter corneal nerves compared to the control group. Additionally, Long COVID-19 patients showed an increased density of dendritic cells also with a greater area than that found in the control group of patients without systemic diseases. Microneuromas were detected in 15% of Long COVID-19 patients.

CONCLUSIONS

Long COVID-19 patients exhibited altered corneal nerve parameters and increased DC density over 20 months after acute SARS-CoV-2 infection. These findings are consistent with a neuroinflammatory condition hypothesized to be present in patients with Long COVID-19, highlighting the potential role of corneal confocal microscopy as a promising noninvasive technique for the study of patients with Long COVID-19.

Event Study Design for Modeling Early Relaxation in Turkish Public with COVID-19 Vaccine

OBJECTIVE

Vaccination is crucial to fighting the coronavirus disease (COVID-19) pandemic. A large body of literature investigates the effect of the initiation of the COVID-19 vaccination in case numbers in Turkey, including the resistance and willingness to taking the vaccine. The effect of early relaxation in the Turkish public with the initiation of vaccination on new daily cases is unknown.

METHODS

This study performs an event study analysis to explore the pre-relaxation effect of vaccination on the Turkish public by using daily data of new cases, stringency index, and residential mobility. Two events are comparatively defined as the vaccination of the health personnel (Event 1) and the citizens age 65 and over (Event 2). The initial dates of these events are January 13 and February 12, 2021, respectively. The length of the estimation window is determined as 14 days for the 2 events. To represent only the early stages of the vaccination, the study period ends on April 12, 2021. Thus, whereas the event window of Event 1 includes 90 observations, Event 2 covers 60 observations.

RESULTS

While average values of residential mobility, stringency index, and daily numbers of cases are 15.36, 71.03, and 11 978.93 in the estimation window for Event 1, these averages are 8.89, 70.88, and 17 303.20 in the event window. For Event 2, the same average values are 9.14, 69.38, and 7 664.93 in the estimation window and 8.25, 71.12, and 22 319.10 in the event window. When 14-day abnormal growth rates of the daily number of cases for Event 1 and Event 2 are compared, it is observed that Event 1 has negative growth rates initially and reaches a 7.59% growth at most. On the other hand, Event 2 starts with a 1.11% growth rate, and having a steady increase, it reaches a 23.70% growth in the last 14 days of the study period.

CONCLUSION

The preliminary result shows that, despite taking more strict governmental measures, while residential mobility decreases, the daily number of COVID-19 cases increases in the early stages of vaccination compared to short pre-periods of it. This indicates that the initiation of vaccination leads to early behavioral relaxation in public. Moreover, the effect of Event 2 on the case numbers is more significant and immediate, compared to that of Event 1, which may be linked to the characteristic of the Turkish culture being more sensitive to the older adult population.

The interplay of social constraints and individual variation in risk tolerance in the emergence of superspreaders

Individual host behaviours can drastically impact the spread of infection through a population. Differences in the value individuals place on both socializing with others and avoiding infection have been shown to yield emergent homophily in social networks and thereby shape epidemic outcomes. We build on this understanding to explore how individuals who do not conform to their social surroundings contribute to the propagation of infection during outbreaks. We show how non-conforming individuals, even if they do not directly expose a disproportionate number of other individuals themselves, can become functional superspreaders through an emergent social structure that positions them as the functional links by which infection jumps between otherwise separate communities. Our results can help estimate the potential success of real-world interventions that may be compromised by a small number of non-conformists if their impact is not anticipated, and plan for how best to mitigate their effects on intervention success.

Nanoadjuvants Produced by Advanced Nanochelating Technology in the Inactivated-Severe Acute Respiratory Syndrome Coronavirus-2 Vaccine Formulation: Preliminary Results on Cytokines and IgG Responses

Despite the great success of vaccines in various infectious diseases, most current vaccines are not effective enough, and on the contrary, clinically approved alum adjuvants cannot induce sufficient immune responses, including a potent cellular immune response to confer protection. In this study, we used Nanochelating Technology to develop novel nanoadjuvants to boost the potency of the alum-adjuvanted inactivated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine. BALB/c mice were immunized twice over 2 weeks with different doses of adjuvanted-vaccine formulations and immune responses were assessed. The analysis results of IFN-γ and IL-17 cytokines demonstrated the effectiveness of the nanoadjuvants produced by the Nanochelating Technology in shifting the alum-based vaccine toward a stronger Th1 pattern. In addition, these nanoadjuvants improved IL-2 cytokine response, which shows the efficacy of these novel formulations in inducing specific T lymphocyte proliferation. Using these nanoadjuvants increased IL-10 cytokine secretion that may be representative of a better immunoregulatory impact and may also potentially prevent immunopathology responses. Moreover, specific IgG titer analysis revealed the potency of these nanoadjuvants in improving humoral immune responses. The enzyme-linked immunosorbent assay of receptor-binding domain (RBD)-specific IgG response showed that the developed novel formulations induced strong IgG responses against this protein. This study shows that the nanostructures produced by the Advanced Nanochelating Technology have potent adjuvant effects on alum-based SARS-CoV-2 vaccines to not only compensate for alum weakness in inducing the cellular immune responses by smart regulation of the immune system but also significantly improve the humoral and cellular immune responses simultaneously.

The role of implementation organizations in scaling evidence-based psychosocial interventions

BACKGROUND

To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention.

MAIN BODY

We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs.

CONCLUSION

We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs.

Distributional Cost-Effectiveness Analysis of Treatments for Non-Small Cell Lung Cancer: An Illustration of an Aggregate Analysis and its Key Drivers

BACKGROUND AND OBJECTIVE

Distributional cost-effectiveness analysis (DCEA) facilitates quantitative assessments of how health effects and costs are distributed among population subgroups, and of potential trade-offs between health maximisation and equity. Implementation of DCEA is currently explored by the National Institute for Health and Care Excellence (NICE) in England. Recent research conducted an aggregate DCEA on a selection of NICE appraisals; however, significant questions remain regarding the impact of the characteristics of the patient population (size, distribution by the equity measure of interest) and methodologic choices on DCEA outcomes. Cancer is the indication most appraised by NICE, and the relationship between lung cancer incidence and socioeconomic status is well established. We aimed to conduct an aggregate DCEA of two non-small cell lung cancer (NSCLC) treatments recommended by NICE, and identify key drivers of the analysis.

METHODS

Subgroups were defined according to socioeconomic deprivation. Data on health benefits, costs, and target populations were extracted from two NICE appraisals (atezolizumab versus docetaxel [second-line treatment following chemotherapy to represent a broad NSCLC population] and alectinib versus crizotinib [targeted first-line treatment to represent a rarer mutation-positive NSCLC population]). Data on disease incidence were derived from national statistics. Distributions of population health and health opportunity costs were taken from the literature. A societal welfare analysis was conducted to assess potential trade-offs between health maximisation and equity. Sensitivity analyses were conducted, varying a range of parameters.

RESULTS

At an opportunity cost threshold of £30,000 per quality-adjusted life-year (QALY), alectinib improved both health and equity, thereby increasing societal welfare. Second-line atezolizumab involved a trade-off between improving health equity and maximising health; it improved societal welfare at an opportunity cost threshold of £50,000/QALY. Increasing the value of the opportunity cost threshold improved the equity impact. The equity impact and societal welfare impact were small, driven by the size of the patient population and per-patient net health benefit. Other key drivers were the inequality aversion parameters and the distribution of patients by socioeconomic group; skewing the distribution to the most (least) deprived quintile improved (reduced) equity gains.

CONCLUSION

Using two illustrative examples and varying model parameters to simulate alternative decision problems, this study suggests that key drivers of an aggregate DCEA are the opportunity cost threshold, the characteristics of the patient population, and the level of inequality aversion. These drivers raise important questions in terms of the implications for decision making. Further research is warranted to examine the value of the opportunity cost threshold, capture the public's views on unfair differences in health, and estimate robust distributional weights incorporating the public's preferences. Finally, guidance from health technology assessment organisations, such as NICE, is needed regarding methods for DCEA construction and how they would interpret and incorporate those results in their decision making.

Severity and Vaccine Effectiveness in Patients With the Omicron Variant of COVID-19 in Suzhou: A Retrospective Single-Center Study

Background The Omicron variant of the coronavirus disease 2019 (COVID-19) virus has spread rapidly worldwide, even in areas with high vaccination rates. Consequently, it has further exacerbated the current global pandemic. In this study, we aimed to characterize the clinical severity of patients with the COVID-19 variant Omicron and analyze vaccine effectiveness in predicting clinical severity. Methodology A total of 142 patients who contracted the COVID-19 virus in the Omicron era were retrospectively studied, and differences in their clinical severity were analyzed. They were stratified as follows: unvaccinated vs. vaccinated, unvaccinated vs. one to two vaccine doses vs. three vaccine doses, and cycle threshold (CT) values ≤ 28 vs. CT > 28. Results Of the 142 patients, 27 were asymptomatic, 83 had mild disease, and 32 had moderate disease. The median age was 32 years for asymptomatic patients vs. 31 years for those with mild disease vs. 59 years for those with moderate disease (P＜0.05), and the direct medical hospitalization costs were ¥4901 for asymptomatic patients vs. ¥5259 for those with mild disease vs. ¥8378 for those with moderate disease (P＜0.05). Of the 142 patients, 112 (78.8%) were vaccinated, 11 (7.7%) had one vaccine dose, 63 (44.4%) had two vaccine doses, and 38 (26.7%) received three vaccine doses. The median direct medical cost in the vaccinated group was significantly lower than that in the unvaccinated group (¥5470.5 vs. ¥7535.5, P＜0.05). For ORF1ab and N genes, hospital stay length and direct medical cost significantly decreased in the group with CT values > 28 compared with those in the group with CT values ≤ 28 (P＜0.05). Multiple regression analysis showed that being ≥ 60 years old could be a predictor of moderate disease severity in patients, and three vaccine doses could be effective against moderate COVID-19. Conclusion Mild infection is the main clinical manifestation of the Omicron variant. Vaccination can significantly decrease direct Omicron-associated medical costs. Although vaccination cannot provide protection against severe disease caused by this variant, three vaccine doses are highly effective in preventing moderate COVID-19.

Study of optimal vaccination strategies for early COVID-19 pandemic using an age-structured mathematical model: A case study of the USA

In this paper we study different vaccination strategies that could have been implemented for the early COVID-19 pandemic. We use a demographic epidemiological mathematical model based on differential equations in order to investigate the efficacy of a variety of vaccination strategies under limited vaccine supply. We use the number of deaths as the metric to measure the efficacy of each of these strategies. Finding the optimal strategy for the vaccination programs is a complex problem due to the large number of variables that affect the outcomes. The constructed mathematical model takes into account demographic risk factors such as age, comorbidity status and social contacts of the population. We perform simulations to assess the performance of more than three million vaccination strategies which vary depending on the vaccine priority of each group. This study focuses on the scenario corresponding to the early vaccination period in the USA, but can be extended to other countries. The results of this study show the importance of designing an optimal vaccination strategy in order to save human lives. The problem is extremely complex due to the large amount of factors, high dimensionality and nonlinearities. We found that for low/moderate transmission rates the optimal strategy prioritizes high transmission groups, but for high transmission rates, the optimal strategy focuses on groups with high CFRs. The results provide valuable information for the design of optimal vaccination programs. Moreover, the results help to design scientific vaccination guidelines for future pandemics.

Rethinking standards on prison cell size in a (post)pandemic world: a scoping review

OBJECTIVE

To describe the current international, regional and national standards on prison cell spatial density and the evidence for the association between COVID-19 transmission and prison crowding measures to provide recommendations on prison cell spatial density standards for a (post) pandemic world.

DESIGN

Scoping review.

DATA SOURCES

PubMed, ProQuest, Informit, Criminal Justice Abstracts, Cochrane, Web of Science, Scopus, EMBASE, Google Scholar and Google were searched up to November 2021.

ELIGIBILITY CRITERIA

Guidelines were included provided they described standards of prison accommodation with respect to prison cells. Studies were included provided they examined an association between COVID-19 cases and a crowding measure.

DATA EXTRACTION AND SYNTHESIS

Data were extracted by one reviewer and cross-checked by another. Quantitative and qualitative data on prison cell standards and characteristics of studies examining an association between COVID-19 and prison crowding were collected.Findings were synthesised qualitatively.

RESULTS

Seventeen reports and six studies met eligibility criteria. International and regional standards on cell spatial density were mostly qualitative, with two quantifiable international standards located (3.4 m² and 3.5 m² per person for multiple occupancy cells), and two quantifiable regional standards located (4 m² per person (Europe) and 5.75 m² or 4 m² per person (Australia and New Zealand)). Country-based standards varied substantially, ranging from 1.25 m² per person (Pakistan) to 10 m² per person (Netherlands). Consideration of airborne transmission of disease in prisons were mostly overlooked or absent to rationalise standards. There was consistent evidence that prison crowding measures were associated with COVID-19 transmission/cases.

CONCLUSION

Considering the physics of respiratory emissions, we recommend prison cell spatial density standards be updated to reflect graded levels of risk that consider other factors that combine to inform airborne transmission risk. Decarceration strategies should be considered and become vital if standards are not met.

Testing psychosocial interventions in the contexts they are meant to be delivered

This article discusses psychosocial interventions in the contexts they are meant to be delivered. Prevention and intervention science often follow the linear pathway of preclinical or pre-intervention research-efficacy trials, effectiveness trials, and implementation studies-with the assessment of translation into public and population health impact occurring at the end. This linear translational pathway follows stages developed for ascertaining safe, efficacious, and effective dosages for biological compounds. This approach has created limitations in the need to rapidly deploy complex, multi-component, multilevel approaches to change behavior and improve health into widespread practice for diverse clinical and public health settings. While it is important to use efficacy trials when safety is yet to be established, when the risks are identified to be low, as is often the case for psychosocial interventions, we can go faster to achieve equitable population health impact. The authors recommend that clinical trialists engaged in intervention development incorporate two considerations in the next generation of prevention and intervention research. First, consider moving right to effectiveness or pragmatic trials, as the most valid test of an intervention is the est of that intervention in the context(s) in which it is intended. Second, when designing effectiveness studies, consider investigating questions related to both effectiveness (i.e., does the intervention improve clinical outcomes) and implementation (i.e., what supports are needed to deploy the intervention routinely in that context) to accelerate impact. As a matter of both ethics and equity, there is a need to expedite the research-to-practice pipeline at a pace faster than is made available through current approaches. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The COVID-19 vaccination decision-making preferences of elderly people: a discrete choice experiment

COVID-19 is a continuing threat to global public health security. For elderly people, timely and effective vaccination reduces infection rates in this group and safeguards their health. This paper adopted an offline Discrete Choice Experiment (DCE) to research the preference for COVID-19 vaccination amongst Chinese adults aged 50 years and above. Through multinomial logistic regression analysis, our DCE leverages five attributes-the risk of adverse reactions, protective duration, injection doses, injection period, and effectiveness-each of which is split into three to four levels. The risk of adverse reaction and the protective duration were demonstrated to be determinants of vaccination preference. Moreover, it was found that socio demographic factors like region, self-health assessment and the number of vaccinated household members can strengthen or weaken the effects of vaccine attributes. In conclusion, the preferences of the elderly population should be considered when developing COVID-19 vaccination programs for this population in China. Accordingly, the results may provide useful information for policymakers to develop tailored, effectively vaccination strategies.

Research on Korean Translation in the Context of Epidemic Prevention and Control

An emergency like COVID-19 requires a theoretical framework for policy implementation that involves public and private sector collaborations. After policy failures, new institutions have formed that trigger PPP's later, allowing the incumbent administration to continue in office longer. It focuses on novel approaches to dealing with pandemics. The present administration put these rules in place to keep COVID-19 under control. When it comes to Real Time - polymerase chain reaction (RT-PCR) testing, South Korea's government and corporations partnered to swiftly raise the quantity of testing in the country. Models of policy change are shown to be dynamic, cyclical, and recursive. During the COVID-19 outbreak in South Korea, an empirical content research was conducted. Even though South Korea's leader was at risk of losing public support to the point where impeachment was mentioned as a possible option, he dramatically reversed public mood to win general elections by a wide margin in April 2020, while the pandemic scenario persisted. To win reelection, democratic administrations are under more pressure to effectively perform crisis management when faced with a crisis. As a result, they are under even more pressure to immediately mobilize public and private resources. The emergency use authorization (EUA) protocol for test kits is an example of "leapfrogging actors" – up-and-coming innovators – who helped turn a pandemic tragedy into a possibility for sustained leadership and for them. The results based on infected premises culling rate ratio is 82.3%, number of measles cases report is 86.4%, spread and epidemic ratio is 84.2%, important of epidemiology is 89.35%, transmission potential of COVID-19 is 91.24% and illustration of epidemic control is 92.45. The results based on infected premises culling rate ratio is 82.3%, number of measles cases report is 86.4%, spread and epidemic ratio is 84.2%, important of epidemiology is 89.35%, transmission potential of COVID-19 is 91.24% and illustration of epidemic control is 92.45.

Adverse Reactions of COVID-19 Vaccines: A Scoping Review of Observational Studies

The COVID-19 pandemic had a severe global impact. A range of campaigns and activities, including vaccines, are being implemented to counteract this pandemic. Using observational data, the goal of this scoping review is to identify adverse events connected with COVID-19 vaccinations. We conduct a scoping study and searched three databases from the start of the COVID-19 pandemic in 2020 through June 2022. Based on our criteria and searched keywords, the review included eleven papers in total, with the majority of the studies being conducted in developed countries. The study populations varied and included general community populations, healthcare professionals, military forces, and patients with systemic lupus and cancer. This study includes vaccines from Pfizer-BioNTech, Oxford-AstraZeneca, Sinopharm, and Moderna. The COVID-19 vaccine-related adverse events were classified into three types: local side effects, systemic side effects, and other side effects such as allergies. The adverse reactions to COVID-19 vaccines are mild to moderate in severity, with no significant influence or interference in individual daily activities and no unique patterns in cause of death among vaccine-related deaths. According to the findings of these investigations, the COVID-19 vaccine is safe to administer and induces protection. It is vital to convey accurate information to the public about vaccination side effects, potential adverse responses, and the safety level of the vaccines supplied. Multiple strategies must be implemented at the individual, organizational, and population levels to eliminate vaccine hesitance. Future studies could investigate the vaccine's effect on people of various ages and medical conditions.

Management and Control Issues Related to Two Mumps Outbreaks in Houston: Future Implications

BACKGROUND

Mumps is a highly contagious disease spread by airborne droplets, making control especially difficult in congregate, crowded settings such as shelters and jails. A mumps outbreak in Honduras, starting in 2018 among adults who were unvaccinated, spread northward with Central Americans migrating to the United States. We describe 2 mumps outbreaks in Houston during 2019 among migrants at the Houston Contract Detention Facility (HCDF) and among inmates at the Harris County Jail (HCJ).

METHODS

We investigated cases of acute onset parotitis. Three or more mumps cases in a facility was considered an outbreak. Confirmed cases had positive polymerase chain reactions (PCR). Probable cases were linked epidemiologically to a confirmed case in the same unit and a positive serology for serum anti-mumps immunoglobulin M (IgM) antibody. Outbreak control measures included enhanced surveillance, isolation of housing units, educational outreach, and immunization with Measles, Mumps, Rubella (MMR) vaccine.

RESULTS

At HCDF, during a 10-month period, we investigated 42 possible cases. Of the possible cases, 28 were lab-confirmed with 9 probable, 4 ruled out, and 1 vaccine reaction. All were migrants. At HCJ, during a 3-month period, we investigated 60 suspect cases; 20 cases were lab-confirmed, 13 probable and 27 ruled out. All but 2 were inmates. Only about a third of those offered MMR vaccination accepted.

CONCLUSIONS

Successful outbreak resolution required close cooperation with HCDF and HCJ with ongoing surveillance, isolation of units with cases and MMR vaccination. Such facilities will have outbreaks; regular communications with local public health could improve response.

Effect of COVID-19 Vaccine Messaging Platforms in Emergency Departments on Vaccine Acceptance and Uptake: A Cluster Randomized Clinical Trial

IMPORTANCE

Large segments of the US population's primary health care access occurs in emergency departments (EDs). These groups have disproportionately high COVID-19 vaccine hesitancy and lower vaccine uptake.

OBJECTIVE

To determine whether provision of COVID-19 vaccine messaging platforms in EDs increases COVID-19 vaccine acceptance and uptake in unvaccinated patients.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cluster randomized clinical trial was conducted at 7 hospital EDs in 4 US cities from December 6, 2021, to July 28, 2022. Noncritically ill adult patients who had not previously received COVID-19 vaccines were enrolled.

INTERVENTIONS

A 3-pronged COVID-19 vaccine messaging platform (an English- or Spanish-language 4-minute video; a 1-page informational flyer; and a brief, scripted message from an ED physician or nurse) was delivered during patient waiting times.

MAIN OUTCOMES AND MEASURES

The 2 primary outcomes were (1) COVID-19 vaccine acceptance, assessed by survey responses in the ED, and (2) receipt of a COVID-19 vaccine within 30 days, ascertained by ED confirmation of vaccination, electronic health record review, and telephone follow-up.

RESULTS

Of the 496 participants enrolled (221 during intervention weeks and 275 during control weeks), the median (IQR) age was 39 (30-54) years, 205 (41.3%) were female, 193 (38.9%) were African American, 97 (19.6%) were Latinx, and 218 (44.0%) lacked primary care physicians. More intervention group participants, compared with control participants, stated that they would accept the vaccine in the ED (57 [25.8%] vs 33 [12.0%]; adjusted difference, 11.9 [95% CI, 4.5-19.3] percentage points; number needed to treat [NNT], 8 [95% CI, 5-22]). More intervention group participants than control participants received a COVID-19 vaccine within 30 days of their ED visit (44 [20.0%] vs 24 [8.7%]; adjusted difference, 7.9 [95% CI, 1.7-14.1] percentage points; NNT, 13 [95% CI, 7-60]). The intervention group had greater outcome effect sizes than the control group in participants who lacked a primary care physician (acceptance, 38 of 101 [37.6%] vs 16 of 117 [13.7%] [P for interaction = .004]; uptake, 31 of 101 [30.7%] vs 11 of 117 [9.4%] [P for interaction = .006]), as well as in Latinx persons (acceptance, 23 of 52 [44.2%] vs 5 of 48 [10.4%] [P for interaction = .004]; uptake, 22 of 52 [42.3%] vs 4 of 48 [8.3%] [P for interaction < .001]).

CONCLUSIONS AND RELEVANCE

Results of this cluster randomized clinical trial showed that with low NNT, implementation of COVID-19 vaccine messaging platforms in EDs leads to greater vaccine acceptance and uptake in unvaccinated ED patients. Broad implementation in EDs could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05142332.

Association between face covering policies and the incidence of coronavirus disease 2019 in European countries

OBJECTIVES

This study was conducted to determine the impact of the strengthening or relaxation of face covering mandates on the subsequent national case incidence of coronavirus disease 2019 (COVID-19) in Europe as the full vaccination rate was increasing.

METHODS

European countries in which case incidence increased for 3 consecutive weeks were monitored and analyzed using COVID-19 incidence data shared by the World Health Organization (WHO). The epidemic trend of COVID-19 in Europe was compared with that of countries elsewhere in the world based on WHO weekly epidemiological reports from June 20 to October 30, 2021. In addition, this study provided insight into the impact of government mask mandates on COVID-19 incidence in Europe by measuring the index scores of those facial covering policies before and after mandate relaxation or strengthening. The effects of the vaccination rate and the speed of vaccination on COVID-19 incidence were also analyzed.

RESULTS

The incidence of COVID-19 after the relaxation of face covering mandates was significantly higher than before relaxation. However, no significant difference was observed in vaccination rate between countries with increased and decreased incidence. Instead, rapid vaccination delayed the resurgence in incidence.

CONCLUSIONS

The findings suggest that face covering policies in conjunction with rapid vaccination efforts are essential to help mitigate the spread of COVID-19.

Mathematical Modeling of SARS-CoV-2 Omicron Wave under Vaccination Effects

Over the course of the COVID-19 pandemic millions of deaths and hospitalizations have been reported. Different SARS-CoV-2 variants of concern have been recognized during this pandemic and some of these variants of concern have caused uncertainty and changes in the dynamics. The Omicron variant has caused a large amount of infected cases in the US and worldwide. The average number of deaths during the Omicron wave toll increased in comparison with previous SARS-CoV-2 waves. We studied the Omicron wave by using a highly nonlinear mathematical model for the COVID-19 pandemic. The novel model includes individuals who are vaccinated and asymptomatic, which influences the dynamics of SARS-CoV-2. Moreover, the model considers the waning of the immunity and efficacy of the vaccine against the Omicron strain. This study uses the facts that the Omicron strain has a higher transmissibility than the previous circulating SARS-CoV-2 strain but is less deadly. Preliminary studies have found that Omicron has a lower case fatality rate compared to previous circulating SARS-CoV-2 strains. The simulation results show that even if the Omicron strain is less deadly it might cause more deaths, hospitalizations and infections. We provide a variety of scenarios that help to obtain insight about the Omicron wave and its consequences. The proposed mathematical model, in conjunction with the simulations, provides an explanation for a large Omicron wave under various conditions related to vaccines and transmissibility. These results provide an awareness that new SARS-CoV-2 variants can cause more deaths even if their fatality rate is lower.

A Comparison of Strategies to Improve Uptake of COVID-19 Vaccine among High-Risk Adults in Nairobi, Kenya in 2022

BACKGROUND

COVID-19 vaccine uptake in Kenya is still low compared to other countries, especially in Europe and North America. In most parts of the country, a large percentage of the Kenyan population remains unvaccinated. As of October 2022, the Ministry of Health (Kenya) estimates that only 36.2% of the adult population had been fully vaccinated.

METHODS

We conducted an experimental study in April 2022 targeting unvaccinated adults who had a history of hypertension and/or diabetes and those in the 60+ age group. We tested various messaging approaches using two different intervention channels.

RESULTS

Although the overall rate of vaccinated individuals according to national records is low, responses from the study group collected through phone call conversations show that higher-risk adults such as those older than 60 or those with chronic illnesses have a remarkably high vaccination rate of 89%. After the study, four participants received a COVID-19 vaccine within 1 month of the intervention. These four participants all received a loss-messaging intervention approach during the study.

CONCLUSION

This study supports a national approach to increasing COVID-19 vaccination rates using loss-messaging directed at unvaccinated, high-risk individuals.

SARS-CoV-2: An Analysis of the Vaccine Candidates Tested in Combatting and Eliminating the COVID-19 Virus

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), better known as COVID-19, is a highly contagious virus, transferable via air droplets from close human-human contact. The pandemic has led to over 6.5 million deaths worldwide, making it the largest global health crisis since the influenza pandemic in 1918. SARS-CoV-2 rapidly spread around the world, forcing the World Health Organization (WHO) to deem it a global health pandemic after three months of its initiation. The virus has wreaked havoc on many countries worldwide, overwhelming healthcare systems, hence damaging many economies. Even though research has progressed the understanding of the SARS-CoV-2 virus, the information gathered about the vaccine trials and their findings have been scarcely distributed to the public in a single study. The information available to scientists has therefore given researchers a pathway to building an efficacious vehicle to substantially decrease the spread of the virus. The vaccines formulated had many challenges due to multiple factors such as viral mutations and clinical trial delays. This paper will aim to educate readers on the processes that the vaccine candidates took, and better understand the procedures; additionally, we'll look at all candidates' findings that went into clinical trials, assessing, analyzing, and evaluating the 27 vaccine candidates that went into phase III trials and the 13 candidates that went into either phase I/II trials.

Association between health and safety perceptions of COVID-19 vaccine and its uptake in Ghana

Background

Attitudes towards vaccines have affected COVID-19 vaccination programs in many countries. This study sought to evaluate the effects of general perceptions on the safety and health concerns and the confidence in COVID-19 vaccines on its uptake in Ghana.

Methods

A cross-sectional online survey was conducted between January and March 2021. The outcome variables for this study were "Taking mandatory COVID-19 vaccine" and "Taking voluntary COVID-19 vaccine". The data were subjected to both descriptive (frequency, percentages, and chi-square tests) and inferential (complementary log-log logistic regression) analyses.

Results

Out of 620 Ghanians who participated in the survey, about 80% of the participants believed that vaccines were good for one's health and 73% had confidence on COVID-19 vaccine safety; although 81% of the respondents were particularly concerned about the source of the vaccine. 79% and 71% of respondents indicated their willingness for mandatory and voluntary COVID-19 vaccination, respectively. In all operationalized regression models, Ghanaians who believed that vaccines are healthy (OR = 1.998, Cl = 1.345-2.968; OR = 1.652, Cl = 1.050-2.601) and those who had confidence in a COVID-19 vaccine safety (OR = 4.405, Cl = 3.136-6.188; OR = 8.340, Cl = 5.471-12.713) were more likely to take a mandatory or voluntary COVID-19 vaccine compared to those who thought and believed otherwise. Individual preferences and/or intentions towards COVID-19 vaccine uptake and uptake route (i.e., mandatory, voluntary) were influenced by multifaceted determinants: biosocial (age, marital status, education), socio-cultural (religion, source of vaccine as a concern), and location (geographical zone) factors.

Conclusion

To consolidate and possibly increase vaccine uptake in response to the COVID-19 pandemic in Ghana, health education and promotion programs should aim at creating awareness on the benefits of vaccine uptake while addressing the health and safety concerns on the potential side effects through evidence-based community messaging from credible sources. It is important to show specific commitment to transparency and reliable information to build public trust by decision-makers.

Risk factors for severe Covid-19 breakthrough infections: an observational longitudinal study

Background

The drive to vaccinate large populations is nowadays the main instrument for combating the pandemic and preventing serious disease and death. However, breakthrough infection (post-vaccination infection) still happens after vaccination among fully vaccinated people. We aimed to assess the severity outcomes and to determine its associated factors among vaccinated COVID-19 cases in the governorate of Sousse, Tunisia.

Methods

We carried out a five-month observational longitudinal study including all the population of Sousse. Confirmed infections of SARS-CoV-2 and the vaccination status are recorded in the daily COVID- 19 database of the Regional Office of the Tunisian Ministry of Health. We included all post-vaccination COVID-19 cases for the analysis of the COVID-19 serious outcomes. Data were collected via 15-min telephonic call interviews conducted by trained interviewers. Descriptive analysis with calculating incidence rates of confirmed COVID-19 cases per 100,000 inhabitants was conducted. In binary logistic regression, adjusted odds ratios along with 95% intervals confidence were performed to determine factors related to severe or critical COVID-19.

Results

As of 31 July 2021, 107,545 persons over 19 years old have received at least one dose of COVID-19 vaccination. Among the vaccinated population, we traced and included 765 breakthrough infection cases, and the incidence rate was 711.3 per week. The majority were female (sex-ratio = 0.8), and the average age of the overall cases was 55.7 years. The prevalence of severe or critical cases in vaccinated COVID-19 patients occurs in 10.8% of cases. Patients with a medical history of cardiovascular diseases had more than two times increased odds to have a severe or critical disease. We also found the highest self-estimation of adherence to preventive measures was inversely correlated to serious cases and having an incomplete vaccination schema was strongly associated with complications.

Conclusions

We tried to provide evidence about the breakthrough infections to improve measures of prevention and control of COVID-19. Boosting immunity for vulnerable patients added to maintaining and promoting preventive measures are not only essential to prevent severe cases of breakthrough infections of COVID-19, but also other influenza-like diseases.

Supply, then demand? Health expenditure, political leanings, cost obstacles to care, and vaccine hesitancy predict state-level COVID-19 vaccination rates

OBJECTIVES

To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021.

METHODS

Using publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout.

RESULTS

We identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications.

CONCLUSIONS

Both supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time.

POLICY IMPLICATIONS

Investing in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages.

Multiple Evanescent White Dot Syndrome Following COVID-19 mRNA Vaccination

PURPOSE

To report two cases of multiple evanescent white dot syndrome (MEWDS) following COVID-19 vaccination with the BNT162b2 mRNA vaccine.

METHODS

Two case reports. Case-1: A 40-yo Caucasian male, complained of blurred and decrease of vision in his left eye (OS) one week after the first dose of the BNT162b2 mRNA SARS-CoV-2 vaccine. Funduscopic examination OS showed multiple granular white dots with an aspect of foveal granularity. Case-2: A 23-yo woman also presented with defective and decrease of vision OS. She received her first dose of the BNT162b2 mRNA SARS-CoV-2 vaccine ten days before. Dilated fundus examination OS showed altered macular reflex with an aspect of foveal granularity.

RESULTS

Multimodal imaging showed features of MEWDS in both cases. The anomalies found resolved spontaneously after 6 weeks.

CONCLUSION

Inflammation and immune dysregulation induced by COVID-19 mRNA vaccine or its adjuvants could be involved in ocular adverse effects.

Relationship of spirituality, health engagement, health belief and attitudes toward acceptance and willingness to pay for a COVID-19 vaccine

PURPOSE

To explore the wider determinant factor of citizens' spirituality, health engagement, health belief model, and attitudes towards vaccines toward acceptance and willingness to pay for a Coronavirus disease 2019 (COVID-19) vaccination.

METHODS

A community-based cross-sectional online investigation with convenience sampling was utilized to recruit 1423 citizens from 18 districts across Indonesia between December 14, 2020 and January 17, 2021. Descriptive statistics, One-way analysis of variance, Pearson correlation, Independent t-tests, and multiple linear regression were examined.

RESULTS

Spirituality, health engagement and attitude toward vaccines, as well as health beliefs constructs (all scores of perceived benefits and barriers) were significant key factors of acceptance of vaccines. Interestingly, the spirituality, attitude toward vaccine, and health beliefs constructs including perceived susceptibility, and benefits indicated a significantly higher willingness.

CONCLUSIONS

Results demonstrated the utility of spirituality, health engagement, health belief model, and attitudes towards vaccines in understanding acceptance and willingness to pay for a vaccine. Specifically, a key obstacle to the acceptance of and willingness to pay COVID-19 vaccination included a high score of the perceived barrier construct. Moreover, the acceptance of and willingness to pay could be impaired by worries about the side-effects of a COVID-19 vaccination.

Managing two-dose COVID-19 vaccine rollouts with limited supply: Operations strategies for distributing time-sensitive resources

Distributing scarce resources such as COVID-19 vaccines is often a highly time-sensitive and mission-critical operation. Our research was prompted by a significant obstacle that the United States and other nations encountered during the early months of the COVID-19 vaccination campaign: Most COVID-19 vaccines require two doses given 3 or 4 weeks apart. Given the severely limited supply and mounting pressure on many countries to reduce hospitalizations and mortality, how to effectively roll out two-dose vaccines was a critical policy decision. In this paper, we first model and analyze inventory dynamics of the rollout process under three rollout strategies: (1) holding back second doses, (2) releasing second doses, and (3) stretching the lead time between doses. Then we develop an SEIR (susceptible, exposed, infectious, recovered) model that incorporates COVID-19 asymptomatic and symptomatic infections to evaluate these strategies in terms of infections, hospitalizations, and mortality. Among our findings, we show releasing second doses reduces infections but creates uneven vaccination patterns. In addition, to ensure second doses are given on time without holding back inventory, strictly less than half of the supply can be allocated to first-dose appointments. Stretching the between-dose lead time flattens the infection curve and reduces both hospitalizations and mortality compared with the strategy of releasing second doses. We also consider an alternative single-dose vaccine with lower efficacy and show that the vaccine can be more effective than its two-dose counterparts in reducing infections and mortality. We conduct extensive sensitivity analyses related to age composition, risk-based prioritization, supply disruptions, and disease transmissibility. Our paper provides important implications for policymakers to develop effective vaccine rollout strategies in developed and developing countries alike. More broadly, our paper sheds light on how to develop effective operations strategies for distributing time-sensitive resources in times of crisis.

One vaccine to counter many diseases? Modeling the economics of oral polio vaccine against child mortality and COVID-19

Introduction

Recent reviews summarize evidence that some vaccines have heterologous or non-specific effects (NSE), potentially offering protection against multiple pathogens. Numerous economic evaluations examine vaccines' pathogen-specific effects, but less than a handful focus on NSE. This paper addresses that gap by reporting economic evaluations of the NSE of oral polio vaccine (OPV) against under-five mortality and COVID-19.

Materials and methods

We studied two settings: (1) reducing child mortality in a high-mortality setting (Guinea-Bissau) and (2) preventing COVID-19 in India. In the former, the intervention involves three annual campaigns in which children receive OPV incremental to routine immunization. In the latter, a susceptible-exposed-infectious-recovered model was developed to estimate the population benefits of two scenarios, in which OPV would be co-administered alongside COVID-19 vaccines. Incremental cost-effectiveness and benefit-cost ratios were modeled for ranges of intervention effectiveness estimates to supplement the headline numbers and account for heterogeneity and uncertainty.

Results

For child mortality, headline cost-effectiveness was $650 per child death averted. For COVID-19, assuming OPV had 20% effectiveness, incremental cost per death averted was $23,000-65,000 if it were administered simultaneously with a COVID-19 vaccine <200 days into a wave of the epidemic. If the COVID-19 vaccine availability were delayed, the cost per averted death would decrease to $2600-6100. Estimated benefit-to-cost ratios vary but are consistently high.

Discussion

Economic evaluation suggests the potential of OPV to efficiently reduce child mortality in high mortality environments. Likewise, within a broad range of assumed effect sizes, OPV (or another vaccine with NSE) could play an economically attractive role against COVID-19 in countries facing COVID-19 vaccine delays.

Funding

The contribution by DTJ was supported through grants from Trond Mohn Foundation (BFS2019MT02) and Norad (RAF-18/0009) through the Bergen Center for Ethics and Priority Setting.

Effect of mandating vaccination on COVID-19 cases in colleges and universities

BACKGROUND

With the introduction of COVID-19 vaccines, many colleges and universities decided to mandate vaccination for all students and employees. The objective of this paper is to empirically investigate the effect of the mandate policy on Fall 2021 COVID-19 cases in institutions of higher education.

METHOD

We construct a unique dataset of a sample of 94 colleges and universities in the east and southeast regions of the United States, 41 of which required vaccination prior to Fall 2021. A difference-in-differences analysis is conducted, considering vaccine requirement as a policy implemented only in a sub-group of these institutions. We control for several factors, including state-level case per capita and student population.

RESULTS

Our analysis shows that mandatory vaccination substantially decreased cases in institutions of higher education by 1,473 cases per 100,000 student population (95 CI: 132, 2813).

CONCLUSIONS

The results suggest that a COVID-19 vaccine requirement is an effective policy in decreasing cases in such institutions, leading to a safer educational experience.

COVID-19 vaccine acceptance and hesitancy among the general population of Pakistan: a population-based survey

OBJECTIVES

This study aims to determine the COVID-19 vaccination coverage and the factors associated with vaccine acceptance and hesitancy in the general population of Pakistan.

SETTING

This population-based study covers all major areas of Pakistan, including Sindh, Punjab, Khyber Pakhtunkhwa and Baluchistan provinces and the capital Islamabad.

PARTICIPANTS

A total of 541 male and female Pakistani adults above 18 years were interviewed to determine the COVID-19 vaccination coverage and understand the factors associated with vaccine acceptance and hesitancy.

OUTCOME

The outcome was COVID-19 vaccination status (not vaccinated or vaccinated).

RESULTS

Of 541 participants, 227 (41.96%) were non-vaccinated and 314 (58.04%) were vaccinated. Two-thirds of the participants from both the non-vaccinated and vaccinated groups (185 (81.50%) vs 236 (75.16%), p=0.008) reside in Sindh. Nearly one-third of participants from both groups were ever infected with COVID-19 (77 (33.92%) and 90 (28.66%)). The odds of COVID-19 vaccination among the age group 34-42 years were 1.75 times higher (95% CI 1.35 to 2.09, p=0.008) than the other age groups. The odds of COVID-19 vaccination among those with COVID-19 ever-infected family members were 1.87 times higher (95% CI 1.56 to 2.34, p=0.032) than those with uninfected family members.

CONCLUSIONS

Targeted interventions for subsets of populations reluctant to vaccination can improve vaccine coverage. Moreover, advocacy and explaining the public health benefits of vaccination can enhance the coverage in Pakistan.

A comprehensive review of BBV152 vaccine development, effectiveness, safety, challenges, and prospects

The world has responded to the COVID-19 pandemic with unprecedented speed and vigor in the mass vaccination campaigns, targeted to reduce COVID-19 severity and mortality, reduce the pressure on the healthcare system, re-open society, and reduction in disease mortality and morbidity. Here we review the preclinical and clinical development of BBV152, a whole virus inactivated vaccine and an important tool in the fight to control this pandemic. BBV152, formulated with a TLR7/8 agonist adjuvant generates a Th1-biased immune response that induces high neutralization efficacy against different SARS-CoV-2 variants of concern and robust long-term memory B- and T-cell responses. With seroconversion rates as high as 98.3% in vaccinated individuals, BBV152 shows 77.8% and 93.4% protection from symptomatic COVID-19 disease and severe symptomatic COVID-19 disease respectively. Studies in pediatric populations show superior immunogenicity (geometric mean titer ratio of 1.76 compared to an adult) with a seroconversion rate of >95%. The reactogenicity and safety profiles were comparable across all pediatric age groups between 2-18 yrs. as in adults. Like most approved vaccines, the BBV152 booster given 6 months after full vaccination, reverses a waning immunity, restores the neutralization efficacy, and shows synergy in a heterologous prime-boost study with about 3-fold or 300% increase in neutralization titers against multiple SARS-CoV-2 variants of concern. Based on the interim Phase III data, BBV152 received full authorization for adults and emergency use authorization for children from ages 6 to 18 years in India. It is also licensed for emergency use in 14 countries globally. Over 313 million vaccine doses have already been administered in India alone by April 18th, 2022.

Relationship between knowledge, attitudes, and practices and COVID-19 vaccine hesitancy: A cross-sectional study in Taizhou, China

Objective

This study aimed to explore COVID-19 vaccine hesitancy in Chinese adults and analyzed the relationship between knowledge, attitudes, practices (KAP), and COVID-19 vaccine hesitancy.

Methods

A population-based self-administered online survey was conducted in Taizhou, China to evaluate the population's hesitancy to receive COVID-19 vaccination. A total of 2.463 adults received the invitation for the survey through WeChat (A Chinese app that is used for chat, social media, and mobile payment), and 1.788 interviewees answered the structured questionnaire. The overall response rate was 72.6%.

Results

Total 45.2% of people were hesitant about the COVID-19 vaccination. Using binary logistic regression analysis, we found low perception of safety (Model 3: Odds ratio = 2.977, Confidence interval: 2.237–3.963) and efficacy (Model 3: OR = 1.904, 95%CI: 1.462–2.479) of the COVID-19 vaccine in adults is the most important risk factor for COVID-19 vaccine hesitation. People who know more about COVID-19 vaccination are less hesitant (Model 2: OR = 0.967, 95% CI: 0.951–0.983). People who did not seek information independently about the COVID-19 vaccine are more likely to be skeptical (Model 4: OR = 1.300, 95% CI: 1.058–1.598, P = 0.013).

Conclusion

In China, the population had higher levels of COVID-19 vaccine hesitation, and their knowledge of the COVID-19 vaccine, perceptions of safety and efficacy, and physical health status were significantly associated with vaccine hesitation. These results provide ideas for promoting COVID-19 vaccination and intervention and have far-reaching implications for further strengthening research on vaccine hesitancy in COVID-19 and exploring strategies for COVID-19 vaccine promotion.

Community Health Resources, Globalization, Trust in Science, and Voting as Predictors of COVID-19 Vaccination Rates: A Global Study with Implications for Vaccine Adherence

The COVID-19 global pandemic requires, not only an adequate supply of, but public adherence to safe and effective vaccinations. This study analyzes the human and economic resources and political and public attitudinal factors that influence widely varying country-level coronavirus vaccination rates. Using data on up to 95 countries, we found that countries’ strength of community health training and research (CHTR), education index, globalization, and vaccine supply are associated with a greater COVID-19 vaccination rate. In a separate analysis, certain political factors, and public attitudes (perceived government effectiveness, government fiscal decentralization, trust in science, and parliamentary voter turnout) predicted vaccination rates. Perceived corruption and actual freedoms (political rights and civil liberties) related to vaccination rates in prior studies were not significantly predictive when controlling for the above factors. The results confirm our prior findings on the importance of CHTR resources for increasing COVID-19 vaccination rates. They also suggest that to motivate vaccine adherence countries need, not only an adequate vaccine supply (which depends on a country having either its own resources or effective global political, social, and economic connections) and community health workforce training and research, but also a population that trusts in science, and is actively engaged in the political process.

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

BACKGROUND

Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers.

MAIN BODY

Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches.

CONCLUSION

We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.

Impact of local mask mandates upon COVID-19 case rates in Oklahoma

Use of face coverings has been shown to reduce transmission of SARS-CoV-2. Despite encouragements from the CDC and other public health entities, resistance to usage of masks remains, forcing government entities to create mandates to compel use. The state of Oklahoma did not create a state-wide mask mandate, but numerous municipalities within the state did. This study compares case rates in communities with mandates to those without mandates, at the same time and in the same state (thus keeping other mitigation approaches similar). Diagnosed cases of COVID-19 were extracted from the Oklahoma State Department of Health reportable disease database. Daily case rates were established based upon listed city of residence. The daily case rate difference between each locality with a mask mandate were compared to rates for the portions of the state without a mandate. All differences were then set to a d0 point of reference (date of mandate implementation). Piecewise linear regression analysis of the difference in SARS-CoV-2 infection rates between mandated and non-mandated populations before and after adoption of mask mandates was then done. Prior to adopting mask mandates, those municipalities that eventually adopted mandates had higher transmission rates than the rest of the state, with the mean case rate difference per 100,000 people increasing by 0.32 cases per day (slope of difference = 0.32; 95% CI 0.13 to 0.51). For the post-mandate time period, the differences are decreasing (slope of -0.24; 95% CI -0.32 to -0.15). The pre- and post- mandate slopes differed significantly (p<0.001). The change in slope direction (-0.59; 95% CI -0.80 to -0.37) shows a move toward reconvergence in new case diagnoses between the two populations. Compared to rates in communities without mask mandates, transmission rates of SARS-CoV-2 slowed notably in those communities that adopted a mask mandate. This study suggests that government mandates may play a role in reducing transmission of SARS-CoV-2, and other infectious respiratory conditions.

COVID-19 vaccine-induced recovery and the implications of vaccine apartheid on the global tourism industry

According to United Nations, World Tourism Organization COVID-19 has had the most devastating impact on the entire global tourism value chain, which resulted in a 74% decline in international passenger arrival, a US$1.3 trillion loss in international tourism receipts, over the US $ 2trillion loss of global domestic product and placing between 100 and 120 million jobs at risk globally. While the initial impact of the pandemic was uniform across the world, the recovery was expected to be varied across the region due to inequitable access to the COVID-19 vaccine. This study seeks to examine the implications of vaccination inequity on tourism recovery in the global tourism market. The study uses secondary, archival data and harnesses the advantages of big data generated from online activities from tourists and tourism companies obtained from authoritative sources. The study found that inequitable access to vaccinations produced a skewed recovery favouring vaccinated regions concentrated in the developed world, leaving poor regions such as Africa behind. The robot system characterising the vaccine-induced recovery had also created a vaccine diplomatic nightmare that scuttled global tourism recovery efforts. To ensure sustainable recovery, there is a need to ensure global vaccination access by rechannelling some of the excess vaccines in developed countries to countries that needs them to ensure the opening up of the entire tourism global market and reduce vulnerabilities that are coming from COVID-19 variants, which poses a threat to the gains made from the current vaccination program. The study concludes that there will not be any meaningful economic recovery without a wholesale approach covering the entire global population.

The Effect of Perceived Vaccination on Students’ Online Learning Intentions: A Moderated Mediation Model

The current study proposed and tested a moderated mediation model to reveal the effect of perceived vaccination (PV) on students’ online learning intentions (SOLI) during the COVID-19 pandemic. A questionnaire was distributed to 663 full- and part-time students at Vietnamese universities, and 632 responses were analyzed. SPSS 20 software and Hayes SPSS Process Macro (model 5) were used to test five hypotheses, all of which were supported. The study found that students’ online learning intentions decreased after being fully vaccinated against COVID-19 and that perceived invulnerability played a mediating role in the relationship between perceived vaccination and students’ online learning intentions. The study also revealed that student age moderated a negative association between perceived vaccination and online learning intention, as this negative relationship was stronger for younger students than for older students. Theoretical and practical implications from our research contribute recommendations for governments, policymakers, and educators to consider adjusting educational management strategy, as well as adopting appropriate forms of learning in different epidemic contexts and vaccine coverage rates.

Importance of vaccine action and availability and epidemic severity for delaying the second vaccine dose

Following initial optimism regarding potentially rapid vaccination, delays and shortages in vaccine supplies occurred in many countries during spring 2021. Various strategies to counter this gloomy reality and speed up vaccination have been set forth, of which the most popular has been to delay the second vaccine dose for a longer period than originally recommended by the manufacturers. Controversy has surrounded this strategy, and overly simplistic models have been developed to shed light on this issue. Here we use three different epidemic models, all accounting for then actual COVID-19 epidemic in the Czech Republic, including the real vaccination rollout, to explore when delaying the second vaccine dose by another 3 weeks from 21 to 42 days is advantageous. Using COVID-19-related deaths as a quantity to compare various model scenarios, we find that the way of vaccine action at the beginning of the infection course (preventing infection and symptoms appearance), mild epidemic and sufficient vaccine supply rate call for the original inter-dose period of 21 days regardless of vaccine efficacy. On the contrary, for the vaccine action at the end of infection course (preventing severe symptoms and death), severe epidemic and low vaccine supply rate, the 42-day inter-dose period is preferable, at any plausible vaccine efficacy.

Association of Online Search Trends With Vaccination in the United States: June 2020 Through May 2021

Stagnating COVID-19 vaccination rates and vaccine hesitancy remain a threat to public health. Improved strategies for real-time tracking and estimation of population-level behavior regarding vaccinations are needed. The aim of this study was to evaluate whether online search trends for COIVD-19 and influenza mirror vaccination rates. State-level weekly fraction of online searches for top vaccination-related search terms and CDC vaccination data were obtained from June 1, 2020, to May 31, 2021. Next, trends in online search and vaccination data for COVID-19 and influenza were analyzed for visual and quantitative correlation patterns using Spearman’s rank correlation analysis. Online searches in the US for COVID-19 vaccinations increased 2.71-fold (95% CI: 1.98-3.45) in the 4 weeks after the FDA emergency authorization compared to the precedent 4 weeks. In March-April 2021, US online searches reached a plateau that was followed by a decline of 83.3% (95% CI: 31.2%-135.3%) until May 31, 2021. The timing of peaks in online searches varied across US states. Online searches were strongly correlated with vaccination rates (r=0.71, 95% CI: 0.45 - 0.87), preceding actual reported vaccination rates in 44 of 51 states. Online search trends preceded vaccination trends by a median of 3.0 weeks (95% CI: 2.0-4.0 weeks) across all states. For influenza vaccination searches, seasonal peaks in September-October between 2016-2020 were noted. Influenza search trends highly correlated with the timing of actual vaccinations for the 2019-2020 (r=0.82, 95% CI: 0.64 – 0.93) and 2020-2021 season (r=0.91, 95% CI: 0.78 – 0.97). Search trends and real-world vaccination rates are highly correlated. Temporal alignment and correlation levels were higher for influenza vaccinations; however, only online searches for COVID-19 vaccination preceded vaccination trends. These findings indicate that US online search data can potentially guide public health efforts, including policy changes and identifying geographical areas to expand vaccination campaigns.

The balancing role of distribution speed against varying efficacy levels of COVID-19 vaccines under variants

During a pandemic, vaccination plays an important role in reducing the infection spread or adverse outcomes such as hospitalizations and deaths. However, a vaccine's overall public health impact depends not only on its initial efficacy, but also its efficacy against emerging variants and ease and speed of distribution. For example, mutations in SARS-CoV-2 raised concerns about diminishing vaccine effectiveness against COVID-19 caused by particular variants. Furthermore, due to supply-chain challenges, the accessibility and distribution of the vaccines have been hindered in many regions, especially in low-income countries, while the second or third wave of the COVID-19 pandemic has occurred due to the variants. Hence, we evaluated the interactions between the speed of distribution and efficacy against infection of multiple vaccines when variants emerge by utilizing a Susceptible-Infected-Recovered-Deceased model and assessing the level of infection attack rate. Our results show that speed is a key factor to a successful immunization strategy to control the pandemic even when the emerging variants may reduce the efficacy of a vaccine. Understanding the interactions between speed and efficacy and distributing vaccines that are available as quickly as possible are crucial to eradicate the pandemic before new variants spread.

Analysis of Clinical Course and Vaccination Influence on Serological Response in COVID-19 Convalescents

Our goal was to assess the anti-SARS-CoV-2 antibodies presence in COVID-19 convalescents and assess the differences in anti-SARS-CoV-2 antibodies production regarding the disease severity, sex, vaccination, and assess the correlation between anti-SARS-CoV-2 antibodies production and inflammatory parameters. Three hundred twenty-two COVID-19 patients (282 hospitalized and 40 patients with oligosymptomatic COVID-19 isolated at homes) were included in the study. Blood was taken at 4 time points: during hospitalization, 1 month, 3 months, and 6 months. Detection of SARS-CoV-2 antibodies was performed with LIAISON SARS-CoV-2 S1/S2 IgG tests (DiaSorin, Italy). Clinical and laboratory parameters were compared. Significant differences between higher anti-SARS-CoV-2 antibodies titer in symptomatic patients 3 months after infection (III sample) and significantly higher ratio II/I in symptomatic patients were observed. Subgroup analysis based on sex showed differences only in laboratory tests, not in serological. Analysis of the results of serological tests showed significant differences in ratio IV/I and a significant increase in antibodies level after vaccination. The most significant rise was observed between the 3rd and 6th month when the patients received a vaccination. Immunological response after COVID-19 infection lasted over 6 months in all patients, although antibodies titers were significantly higher in patients with a history of severe COVID-19 and vaccinated patients. Immunological response after COVID-19 infection did not depend on sex. There was a significant correlation between anti-SARS-CoV-2 antibodies production and the degree of inflammation in the acute phase of the disease (inflammatory parameters in blood and severity of lung affection in CT). IMPORTANCE The results of our study confirm the knowledge on immune response in the Polish population and add new information regarding correlations with the severity of the disease. The data in the literature concerning the correlation between antibodies response and sex are ambiguous, and we did not observe differences between antibodies production and gender, which also adds new information.