COVID-19 Vaccination in Developing Nations: Challenges and Opportunities for Innovation

Learning from the COVID-19 pandemic: A systematic review of mathematical vaccine prioritization models

As the world becomes ever more connected, the chance of pandemics increases as well. The recent COVID-19 pandemic and the concurrent global mass vaccine roll-out provides an ideal setting to learn from and refine our understanding of infectious disease models for better future preparedness. In this review, we systematically analyze and categorize mathematical models that have been developed to design optimal vaccine prioritization strategies of an initially limited vaccine. As older individuals are disproportionately affected by COVID-19, the focus is on models that take age explicitly into account. The lower mobility and activity level of older individuals gives rise to non-trivial trade-offs. Secondary research questions concern the optimal time interval between vaccine doses and spatial vaccine distribution. This review showcases the effect of various modeling assumptions on model outcomes. A solid understanding of these relationships yields better infectious disease models and thus public health decisions during the next pandemic.

Zoonotic spillover and viral mutations from low and middle-income countries: improving prevention strategies and bridging policy gaps

The increasing frequency of zoonotic spillover events and viral mutations in low and middle-income countries presents a critical global health challenge. Contributing factors encompass cultural practices like bushmeat consumption, wildlife trade for traditional medicine, habitat disruption, and the encroachment of impoverished settlements onto natural habitats. The existing "vaccine gap" in many developing countries exacerbates the situation by allowing unchecked viral replication and the emergence of novel mutant viruses. Despite global health policies addressing the root causes of zoonotic disease emergence, there is a significant absence of concrete prevention-oriented initiatives, posing a potential risk to vulnerable populations. This article is targeted at policymakers, public health professionals, researchers, and global health stakeholders, particularly those engaged in zoonotic disease prevention and control in low and middle-income countries. The article underscores the importance of assessing potential zoonotic diseases at the animal-human interface and comprehending historical factors contributing to spillover events. To bridge policy gaps, comprehensive strategies are proposed that include education, collaborations, specialized task forces, environmental sampling, and the establishment of integrated diagnostic laboratories. These strategies advocate simplicity and unity, breaking down barriers, and placing humanity at the forefront of addressing global health challenges. Such a strategic and mental shift is crucial for constructing a more resilient and equitable world in the face of emerging zoonotic threats.

Learning from the COVID-19 pandemic: a systematic review of mathematical vaccine prioritization models

As the world becomes ever more connected, the chance of pandemics increases as well. The recent COVID-19 pandemic and the concurrent global mass vaccine roll-out provides an ideal setting to learn from and refine our understanding of infectious disease models for better future preparedness. In this review, we systematically analyze and categorize mathematical models that have been developed to design optimal vaccine prioritization strategies of an initially limited vaccine. As older individuals are disproportionately affected by COVID-19, the focus is on models that take age explicitly into account. The lower mobility and activity level of older individuals gives rise to non-trivial trade-offs. Secondary research questions concern the optimal time interval between vaccine doses and spatial vaccine distribution. This review showcases the effect of various modeling assumptions on model outcomes. A solid understanding of these relationships yields better infectious disease models and thus public health decisions during the next pandemic.

Vaccinating humanitarian workers against COVID-19

Objective

To describe the United Nations' (UN's) coronavirus disease 2019 (COVID-19) vaccination programme and its efforts to vaccinate frontline humanitarian personnel stationed in locations where access to COVID-19 vaccine was limited or absent.

Methods

The vaccination programme was structured as a two-level operation: a global vaccine deployment support team and local vaccine deployment teams in each participating country, territory or administrative area. The central group, led by a global vaccine coordinator, oversaw medical, legal, financial, logistical, data, technological and communication aspects. Local vaccine deployment teams were led by coordinators who managed registration, logistics, communication and vaccine administration. The programme used World Health Organization-approved COVID-19 vaccines and developed prioritization criteria for distributing vaccine supplies. The programme ensured that vaccines for the UN personnel were not diverted from the populations they were intended to serve.

Findings

The programme successfully formed 120 deployment teams across 152 eligible countries, territories and administrative areas, targeting approximately 673 000 individuals. By April 2023, 72 countries, territories and administrative areas had received over 470 000 doses, of which 337 072 doses were administered. Almost half of the doses administered (167 616) were to individuals in five UN hardship countries. Ninety-five severe adverse events were reported, but none led to any reported medical evacuation, permanent disability or death.

Conclusion

The programme demonstrated effective global coordination and local implementation, adapting to diverse contexts and operational challenges. The model can serve as a guide for global actors for future health emergencies, or for deploying health aid at a regional or global scale.

Evaluation of SARS-CoV-2-Positive Patients with Suspected Reinfection

The aim of this study was to investigate the reinfection rates and characteristics of SARS-CoV-2 in individuals with SARS-CoV-2 RNA present in their clinical specimens for COVID-19. Our data from the COVID-19 Laboratory of Istanbul University were analyzed for 27,240 cases between 27 March 2020 to 8 February 2022. Demographic characteristics, vaccination statuses, comorbidities, and laboratory findings were evaluated in cases with suspected reinfection, as determined by the presence of SARS-CoV-2 RNA at a rate of 0.3% in clinical specimens. When comparing laboratory values, leukocyte counts were lower in the second and third infections compared with the first infection (p = 0.035), and neutrophil counts were lower in the second infection (p = 0.009). Symptoms varied, with coughing being common in the first infection and malaise being common in subsequent infections. These results suggest that it is important to continue to monitor reinfection rates and develop strategies to prevent reinfection. Our results also suggest that clinicians should be aware of the possibility of reinfection and monitor patients for recurrent symptoms.

Understanding factors influencing healthcare workers' intention towards the COVID-19 vaccine

Globally, healthcare workers (HCWs) are at high risk of acquiring Coronavirus infection. In addition, they are role models for the general public concerning attitudes towards the COVID-19 vaccine. In addition, they play a critical role in successfully promoting practices aiming to reduce the transmission of COVID-19 infection. Therefore, this study broadly based on the theory of planned behavior (TPB) explores the factors influencing HCWs' intention to be vaccinated. An online survey was administered using Google Form to collect data from HCWs working in the public health sector of Pakistan. The sample included 813 participants, two-thirds were female, and one-third were male. In addition, 41.5% of them were aged between 26-35 years, 32.6% had master's level education, 25% were nurses, and 57.7% of them were living in urban areas. Data analysis was run using Partial Least Squares Structural Equation Modeling (PLS-SEM). The research findings reveal the positive and significant effect of the TPB factors (attitude, subjective norms, and perceived behavioral control) and the extended factor of vaccine confidence on HCWs' intention to be vaccinated. This study's model explains 66.4% of variations in HCWs' intention to be vaccinated.

An Advax-CpG55.2™ adjuvanted recombinant spike protein vaccine protects cynomolgus macaques from a homologous SARS-CoV-2 virus challenge

Traditional protein-based vaccine approaches to COVID-19 were overshadowed by the new mRNA and adenoviral vector vaccine approaches which were first to receive marketing authorization. The current study tested for the first time in repurposed aged (median 15.4 years) cynomolgus macaques, a novel Advax-CpG55.2™ adjuvanted recombinant extracellular domain spike protein trimer antigen for immunogenicity, protection and safety. Nine animals received two intramuscular injections 10 days apart of recombinant spike protein (25 μg) with Advax-CpG55.2™ (10 mg/200 μg) and 5 controls received saline injections. Serum antibody levels were followed for 3 months and then the animals were challenged with SARS-CoV-2 virus. Clinical signs, local reactions, body weight, food consumption and antibody levels were monitored till termination on either day 3 or 7 post-infection. Two weeks after the second dose, 8/9 immunized macaques had high serum spike and receptor binding domain binding antibodies that were able to cross-neutralize Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2) and, to a lesser extent, Omicron variants (B.1.1.529 ). Antibody levels decayed over the subsequent 3 months, and minimal neutralizing antibody was detectable immediately prior to the challenge which used a vaccine-homologous Wuhan-like ancestral virus. Of the nine vaccinated animals, only one 18-year-old female sacrificed at d3 had low levels of lung virus, versus 100 % of the control animals. Four of 5 (80 %) control animals had positive lung staining for SARS-CoV-2 virus versus just 1 of 9 (11 %) in the immunized group. The immunized animals exhibited better maintenance of appetite post-challenge. Neutralizing antibody levels rebounded rapidly in immunized animals, post-challenge. This data supports the benefits of Advax-CpG adjuvanted recombinant spike protein vaccine in protecting against a homologous SARS-CoV-2 infection.

Global report on COVID-19 vaccination and reasons not to vaccinate among adults with intellectual disabilities: Results from secondary analyses of Special Olympics' program planning

The COVID-19 pandemic has disproportionately affected people with intellectual disabilities worldwide. The objective of this study was to identify global rates of COVID-19 vaccination and reasons not to vaccinate among adults with intellectual disabilities (ID) associated with country economic income levels. The Special Olympics COVID-19 online survey was administered in January-February 2022 to adults with ID from 138 countries. Descriptive analyses of survey responses include 95% margins of error. Logistic regression and Pearson Chi-squared tests were calculated to assess associations with predictive variables for vaccination using R 4.1.2 software. Participants (n = 3560) represented 18 low (n = 410), 35 lower-middle (n = 1182), 41 upper-middle (n = 837), and 44 high (n = 1131) income countries. Globally, 76% (74.8-77.6%) received a COVID-19 vaccination while 49.5% (47.9-51.2%) received a COVID-19 booster. Upper-middle (93% (91.2-94.7%)) and high-income country (94% (92.1-95.0%)) participants had the highest rates of vaccination while low-income countries had the lowest rates (38% (33.3-42.7%)). In multivariate regression models, country economic income level (OR = 3.12, 95% CI [2.81, 3.48]), age (OR = 1.04, 95% CI [1.03, 1.05]), and living with family (OR = 0.70, 95% CI [0.53, 0.92]) were associated with vaccination. Among LLMICs, the major reason for not vaccinating was lack of access (41.2% (29.5-52.9%)). Globally, concerns about side effects (42%, (36.5-48.1%)) and parent/guardian not wanting the adult with ID to vaccinate (32% (26.1-37.0%)) were the most common reasons for not vaccinating. Adults with ID from low and low-middle income countries reported fewer COVID-19 vaccinations, suggesting reduced access and availability of resources in these countries. Globally, COVID-19 vaccination levels among adults with ID were higher than the general population. Interventions should address the increased risk of infection for those in congregate living situations and family caregiver apprehension to vaccinate this high-risk population.

Using dashboards to verify coronavirus (COVID-19) vaccinations can reduce fatality rates in countries/regions: Development and usability study

BACKGROUND

The new coronavirus disease 2019 (COVID-19) pandemic is raging worldwide. The administered vaccination has become a significant vehicle against the virus. Three hypotheses were made and required for validation: the number of vaccines administered is related to the country gross domestic product (GDP), vaccines can reduce the fatality rate (FR), and dashboards can present more meaningful information than traditionally static visualizations. Research data were downloaded from the GitHub website. The aims of this study are to verify that the number of vaccination uptakes is related to the country GDP, that vaccines can reduce FR, and that dashboards can provide more meaningful information than traditionally static visualizations.

METHODS

The COVID-19 cumulative number of confirmed cases (CNCCs) and deaths were downloaded from the GitHub website for countries/regions on November 6, 2021. Four variables between January 1, 2021, and November 6, 2021, were collected, including CNCCs and deaths, GDP per capita, and vaccine doses administered per 100 people (VD100) in countries/regions. We applied the Kano model, forest plot, and choropleth map to demonstrate and verify the 3 hypotheses using correlation coefficients (CC) between vaccination and FRs. Dashboards used to display the vaccination effects were on Google Maps.

RESULTS

We observed that the higher the GDP, the more vaccines are administered (Association = 0.68, t = 13.14, P < .001) in countries, the FR can be reduced by administering vaccinations that are proven except for the 4 groups of Asia, Low income, Lower middle income, and South America, as well as the application (app) with dashboard-type choropleth map can be used to show the comparison of vaccination rates for countries/regions using line charts.

CONCLUSION

This research uses the Kano map, forest plot, and choropleth map to verify the 3 hypotheses and provides insights into the vaccination effect against the FR for relevant epidemic studies in the future.

A scoping review of facilitators and barriers influencing the implementation of surveillance and oral cholera vaccine interventions for cholera control in lower- and middle-income countries

BACKGROUND

Cholera still affects millions of people worldwide, especially in lower- and middle-income countries (LMICs). The Global Task Force on Cholera Control (GTFCC) has identified surveillance and oral cholera vaccines as two critical interventions to actualise the global roadmap goals-reduction of cholera-related deaths by 90% and decreasing the number of cholera endemic countries by half by 2030. Therefore, this study aimed to identify facilitators and barriers to implementing these two cholera interventions in LMIC settings.

METHODS

A scoping review using the methods presented by Arksey and O'Malley. The search strategy involved using key search terms (cholera, surveillance, epidemiology and vaccines) in three databases (PubMed, CINAHL and Web of Science) and reviewing the first ten pages of Google searches. The eligibility criteria of being conducted in LMICs, a timeline of 2011-2021 and documents only in English were applied. Thematic analysis was performed, and the findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension.

RESULTS

Thirty-six documents met the predefined inclusion criteria, covering 2011 to 2021. There were two themes identified regarding the implementation of surveillance: timeliness and reporting (1); and resources and laboratory capabilities (2). As for oral cholera vaccines, there were four themes identified: information and awareness (1); community acceptance and trusted community leaders (2); planning and coordination (3); and resources and logistics (4). Additionally, adequate resources, good planning and coordination were identified to be operating at the interface between surveillance and oral cholera vaccines.

CONCLUSION

Findings suggest that adequate and sustainable resources are crucial for timely and accurate cholera surveillance and that oral cholera vaccine implementation would benefit from increased community awareness and engagement of community leaders.

A study on the willingness and influencing factors of novel coronavirus vaccination among medical personnel in North China

Aim

To understand the awareness of the willingness to be vaccinated and influencing factors of the new coronavirus vaccine (neo-crown vaccine) among medical personnel in North China and to provide a theoretical basis and application guidelines for the feasibility of coronavirus vaccination by medical personnel to guide the public to actively be vaccinated by taking initiative and obtaining a coronavirus vaccination as soon as possible.

Methods

From April 2021 to June 2021, medical staff in North China were selected to complete an online questionnaire survey using Questionnaire Star to analyze the willingness rate to be vaccinated with the new coronavirus vaccine, and the influencing factors were analyzed using binary logistic regression.

Results

Among 621 respondents, 85.7% were willing to be vaccinated after the launch of the new vaccine. In the questionnaire, respondents were asked to answer questions such as “Do you think it is better to receive as few vaccines as possible at the same time?,” “If I get the new coronavirus vaccine, I may have serious side effects.,” “The new coronavirus vaccine is safe.,” “Specifically, for the new coronavirus vaccine, do you think it is safe?,” and “Specifically, for the new coronavirus vaccine, do you think it is easy to administer?.” These beliefs have an important influence on the vaccination of medical staff with the new coronavirus vaccine in Northern China (OR = 1.610,95% CI: 1.055 ~ 2.456; OR = 1.715,95% CI: 1.164 ~ 2.526; OR = 0.401, 95% CI: 0.212 ~ 0.760; OR = 0.352,95% CI: 0.147 ~ 0.843; OR = 3.688,95% CI: 1.281 ~ 10.502, respectively; All P values < .05).

Conclusions

Medical staff have a high willingness to be vaccinated with the new coronavirus vaccine, which plays a positive role in the publicity of the vaccine.

Phase III randomized clinical trial of BV ‐4051, an Ayurvedic polyherbal formulation in moderate SARS‐CoV ‐2 infections and its impact on inflammatory biomarkers

SARS-CoV-2 virus and its variants continue to be a challenge inspite of widespread vaccination and preventive measures. We hypothesized an oral, safe polyherbal formulation with antiinflammatory properties may improve the clinical outcome of this disease. BV-4051, a formulation from four Ayurvedic plants namely Ashwagandha, Boswellia, Ginger and Turmeric was used for the treatment of hospitalized moderate COVID-19 patients along with standard of care (SOC). Patients were randomly assigned to receive BV-4051 or placebo tablets for 14 days, at four sites in India during late 2020 to early 2021. Among 208 randomized subjects, 175 completed the study. In BV-4051 group the mean reduction in duration of illness (p = 0.036), alleviation and severity scores of several symptoms like fever, cough, smell, and taste disorders were statistically significant (p ≤ 0.05). A sub-set analysis of subjects treated with or without Remdesivir as SOC showed mean reduction in duration of illness in BV-4051 (p = 0.030), and severity scores (p ≤ 0.05). Mean difference in Interleukin-6 was statistically significant (p = 0.042) on BV-4051 without Remdesivir. BV-4051 may reduce duration of illness, symptoms severity, Interleukin-6, and prevent the incidence of COVID-19 complications. It may have an adjunctive effect with other SOC. Larger extensive clinical testing may give a better understanding of its effect.

A queueing Network approach for capacity planning and patient Scheduling: A case study for the COVID-19 vaccination process in Colombia

This paper considers the problem of patient scheduling and capacity planning for the vaccination process during the COVID-19 pandemic. The proposed solution is based on a non-linear mathematical modeling approach representing the dynamics of an open Jackson Network and a Generalized Network. To test these models, we proposed three objective functions and analyzed different configurations of the process corresponding to various levels of the models' parameters as well as the conditions present in the case study. To assess the computational performance of the models, we also experimented with larger instances in terms of number of steps or stations used and number of patients scheduled. The computational results show how parameters such as the minimum percentage of patients served, the maximum occupation allowed per station and the objective functions used have an impact on the configuration of the process. The proposed approach can support the decision-making process in vaccination centers to efficiently assign human and material resources to maximize the number of patients vaccinated while ensuring reasonable waiting times, number of patients in queue and servers' utilization rates, which in turn are key to avoid overcrowding and other negative conditions in the system that could increase the risk of infections.

Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs

The outbreaks of infectious diseases that spread across countries have generally existed for centuries. An example is the occurrence of the COVID-19 pandemic in 2020, which led to the loss of lives and economic depreciation. One of the essential ways of handling the spread of viruses is the discovery and administration of vaccines. However, the major challenges of vaccination programs are associated with the vaccine cold chain management and cold storage facilities. This paper discusses how vaccine cold chain management and cold storage technology can address the challenges of vaccination programs. Specifically, it examines different systems for preserving vaccines in either liquid or frozen form to help ensure that they are not damaged during distribution from manufacturing facilities. Furthermore, A vaccine is likely to provide very low efficacy when it is not properly stored. According to preliminary studies, the inability to store vaccine properly is partly due to the incompetency of many stakeholders, especially in technical matters. The novelty of this study is to thoroughly explore cold storage technology for a faster and more comprehensive vaccine distribution hence it is expected to be one of the reference and inspiration for stakeholders.

Inframarginal externalities: COVID-19, vaccines, and universal mandates

COVID-19 vaccine mandates are in place or being debated across the world. Standard neoclassical economics argues that the marginal social benefit from vaccination exceeds the marginal private benefit; everyone vaccinated against a given infectious disease protects others by not transmitting the disease. Consequently, private levels of vaccination will be lower than the socially optimal levels due to free-riding, which requires mandates to overcome the problem. We argue that universal mandates based on free-riding are less compelling for COVID-19. We argue that because the virus can be transmitted even after receiving the vaccine, most of the benefits of the COVID-19 vaccine are internalized: vaccinated individuals are protected from the worst effects of the disease. Therefore, any positive externality may be inframarginal or policy irrelevant. Even when all the benefits are not internalized by the individual, the externalities mainly are local, mostly affecting family and closely associated individuals, requiring local institutional (private and civil society) arrangements to boost vaccine rates, even in a global pandemic. Economists and politicians must justify such universal vaccine mandates on some basis other than free-riding.

Recent Developments in the Understanding of Immunity, Pathogenesis and Management of COVID-19

Coronaviruses represent a diverse family of enveloped positive-sense single stranded RNA viruses. COVID-19, caused by Severe Acute Respiratory Syndrome Coronavirus-2, is a highly contagious respiratory disease transmissible mainly via close contact and respiratory droplets which can result in severe, life-threatening respiratory pathologies. It is understood that glutathione, a naturally occurring antioxidant known for its role in immune response and cellular detoxification, is the target of various proinflammatory cytokines and transcription factors resulting in the infection, replication, and production of reactive oxygen species. This leads to more severe symptoms of COVID-19 and increased susceptibility to other illnesses such as tuberculosis. The emergence of vaccines against COVID-19, usage of monoclonal antibodies as treatments for infection, and implementation of pharmaceutical drugs have been effective methods for preventing and treating symptoms. However, with the mutating nature of the virus, other treatment modalities have been in research. With its role in antiviral defense and immune response, glutathione has been heavily explored in regard to COVID-19. Glutathione has demonstrated protective effects on inflammation and downregulation of reactive oxygen species, thereby resulting in less severe symptoms of COVID-19 infection and warranting the discussion of glutathione as a treatment mechanism.

Effect of Molnupiravir on Biomarkers, Respiratory Interventions, and Medical Services in COVID-19 : A Randomized, Placebo-Controlled Trial

BACKGROUND

In the MOVe-OUT trial, molnupiravir showed a clinically meaningful reduction in the risk for hospitalization or death in adults with mild to moderate COVID-19 and risk factors for progression to severe disease.

OBJECTIVE

To identify other potential clinical benefits of molnupiravir versus placebo.

DESIGN

Secondary analysis of the randomized, double-blind, placebo-controlled phase 3 component of MOVe-OUT. (ClinicalTrials.gov: NCT04575597).

SETTING

107 sites globally.

PARTICIPANTS

1433 nonhospitalized adults aged 18 years or older with mild to moderate COVID-19.

INTERVENTION

Molnupiravir, 800 mg, or placebo every 12 hours for 5 days.

MEASUREMENTS

Changes from baseline in C-reactive protein (CRP) concentration and oxygen saturation (Spo ₂), need for respiratory interventions (including invasive mechanical ventilation), and need for medical services in all randomly assigned participants through day 29, and need for respiratory interventions and time to discharge in the subgroup of participants who were hospitalized after randomization.

RESULTS

Participants receiving molnupiravir showed faster normalization of CRP and Spo ₂, with improvements observed on day 3 of therapy, compared with placebo. Molnupiravir-treated participants had a decreased need for respiratory interventions versus placebo-treated participants (relative risk reduction [RRR], 34.3% [95% CI, 4.3% to 54.9%]), with similar findings in participants who were hospitalized after randomization (RRR, 21.3% [CI, 0.2% to 38.0%]). Hospitalized participants who received molnupiravir were discharged a median of 3 days before those who received placebo. Acute care visits (7.2% vs. 10.6%; RRR, 32.1% [CI, 4.4% to 51.7%]) and COVID-19-related acute care visits (6.6% vs. 10.0%; RRR, 33.8% [CI, 5.6% to 53.6%]) were less frequent in molnupiravir- versus placebo-treated participants.

LIMITATIONS

Some analyses were performed post hoc. Longer-term benefits of molnupiravir therapy were not evaluated. Participants were not immunized against SARS-CoV-2.

CONCLUSION

The findings suggest there are additional important clinical benefits of molnupiravir beyond reduction in hospitalization or death.

PRIMARY FUNDING SOURCE

Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.

Effectiveness of SARS-CoV-2 Vaccines for Short- and Long-Term Immunity: A General Overview for the Pandemic Contrast

Background: The recent COVID-19 pandemic produced a significant increase in cases and an emergency state was induced worldwide. The current knowledge about the COVID-19 disease concerning diagnoses, patient tracking, the treatment protocol, and vaccines provides a consistent contribution for the primary prevention of the viral infection and decreasing the severity of the SARS-CoV-2 disease. The aim of the present investigation was to produce a general overview about the current findings for the COVID-19 disease, SARS-CoV-2 interaction mechanisms with the host, therapies and vaccines’ immunization findings. Methods: A literature overview was produced in order to evaluate the state-of-art in SARS-CoV-2 diagnoses, prognoses, therapies, and prevention. Results: Concerning to the interaction mechanisms with the host, the virus binds to target with its Spike proteins on its surface and uses it as an anchor. The Spike protein targets the ACE2 cell receptor and enters into the cells by using a special enzyme (TMPRSS2). Once the virion is quietly accommodated, it releases its RNA. Proteins and RNA are used in the Golgi apparatus to produce more viruses that are released. Concerning the therapies, different protocols have been developed in observance of the disease severity and comorbidity with a consistent reduction in the mortality rate. Currently, different vaccines are currently in phase IV but a remarkable difference in efficiency has been detected concerning the more recent SARS-CoV-2 variants. Conclusions: Among the many questions in this pandemic state, the one that recurs most is knowing why some people become more seriously ill than others who instead contract the infection as if it was a trivial flu. More studies are necessary to investigate the efficiency of the treatment protocols and vaccines for the more recent detected SARS-CoV-2 variant.

Relationship between double covid-19 vaccine uptake and trust in effectiveness and safety of vaccination in 23 european member states: an ecological study

Introduction

The aim of this study was to assess the relationship between double COVID-19 vaccine uptake and trust in effectiveness and safety of vaccination in general in 23 European Union (EU) countries.

Methods

Ecological study. Data was retrieved from the Flash Eurobarometer 494 and Our World in Data. We estimated Pearson’s correlation coefficients and fitted multiple linear regression models.

Results

There is a negative linear correlation between the percentage of people doubly vaccinated and the percentage of low trust in vaccine effectiveness (r = -0.48, p-value = 0.021), and the percentage of low trust in vaccine safety (r = -0.43, p-value = 0.041). There is a negative adjusted relation between the percentage of low trust in vaccine safety and the percentage of people doubly vaccinated (aβ_{% low trust in vaccinesafety}:-0.25; 95% CI: −0.49,-0.01, p-value = 0.045).

Conclusion

An increase in health literacy of people living in certain countries in the EU may be needed to boost COVID-19 vaccine uptake.

Covax-19/Spikogen® vaccine based on recombinant spike protein extracellular domain with Advax-CpG55.2 adjuvant provides single dose protection against SARS-CoV-2 infection in hamsters

COVID-19 presents an ongoing global health crisis. Protein-based COVID-19 vaccines that are well-tolerated, safe, highly-protective and convenient to manufacture remain of major interest. We therefore sought to compare the immunogenicity and protective efficacy of a number of recombinant SARS-CoV-2 spike protein candidates expressed in insect cells. By comparison to a full length (FL) spike protein detergent-extracted nanoparticle antigen, the soluble secreted spike protein extracellular domain (ECD) generated higher protein yields per liter of culture and when formulated with either Alum-CpG55.2 or Advax-CpG55.2 combination adjuvants elicited robust antigen-specific humoral and cellular immunity in mice. In hamsters, the spike ECD when formulated with either adjuvant induced high serum neutralizing antibody titers even after a single dose. When challenged with the homologous SARS-CoV-2 virus, hamsters immunized with the adjuvanted spike ECD exhibited reduced viral load in day 1-3 oropharyngeal swabs and day 3 nasal turbinate tissue and had no recoverable infectious virus in day 3 lung tissue. The reduction in lung viral load correlated with less weight loss and lower lung pathology scores. The formulations of spike ECD with Alum-CpG55.2 or Advax-CpG55.2 were protective even after just a single dose, although the 2-dose regimen performed better overall and required only half the total amount of antigen. Pre-challenge serum neutralizing antibody levels showed a strong correlation with lung protection, with a weaker correlation seen with nasal or oropharyngeal protection. This suggests that serum neutralizing antibody levels may correlate more closely with systemic, rather than mucosal, protection. The spike protein ECD with Advax-CpG55.2 formulation (Covax-19® vaccine) was selected for human clinical development.

The potential role of resveratrol as supportive antiviral in treating conditions such as COVID-19 - A formulator's perspective

With an increased transmissibility but milder form of disease of the omicron variant of COVID-19 and the newer antivirals often still out of reach of many populations, a refocus of the current treatment regimens is required. Safe, affordable, and available adjuvant treatments should also be considered and known drugs and substances need to be repurposed and tested. Resveratrol, a well-known antioxidant of natural origin, shown to act as an antiviral as well as playing a role in immune stimulation, down regulation of the pro-inflammatory cytokine release and reducing lung injury by reducing oxidative stress, is such an option. New initiatives and collaborations will however need to be found to unleash resveratrol's full potential in the pharmaceutical market.

Prioritization of operational research questions on COVID-19 vaccination in the African Region

Introduction

a year after the start of COVID-19 vaccination, coverage remains very low in the African Region. Different challenges and operational barriers have been documented, but countries will need to supplement the available information with operational research in order to adequately respond to practical questions regarding how best to scale up COVID-19 vaccination. We conducted a survey among immunisation program staff working in the African Region, in order to identify the high priority operational research questions relevant to COVID-19 vaccination.

Methods

proposed operational research questions categorized into six topic areas were sent to resource persons, asking them to rate according to the relevance, urgency, feasibility, and potential impact of the research questions on the progress of COVID vaccination.

Results

a total of 25 research questions have been given an average weighted rating of 75% or more by the respondents. Nine of these top priority research questions were in the area of demand generation, risk communication and community engagement while 8 questions covered the area of service delivery.

Conclusion

countries should plan for and coordinate stakeholders to ensure that relevant operational research is done to respond to the top priority research questions, with a view to influence policies and implementation of strategies.

The first year of COVID-19 vaccine roll-out in Africa: challenges and lessons learned

Introduction

in the first year following the introduction of COVID-19 vaccines, only 6.8% of the total population in the 47 countries in the WHO African Region have received full vaccination. In an emergency context, the intra-action review helps countries to assess their progress and document what has worked and not worked.

Methods

we reviewed and identified the key lessons and challenges documented in the reports from intra-action review of COVID vaccine roll out in 22 African countries.

Results

all countries documented high level political commitment, but a serious shortage of COVID-19 vaccines and funding. Seven countries identified gaps in microplanning because of lack of funding or due to the unpredictability in the type and volume of vaccine supplies. The shortage of operational funding also affected training of health workers and hampered the expansion of service delivery. The countries implemented multi-channel communications and social mobilisation activities, alongside social media engagement and social listening. However, country capacity was limited in terms of timely responding to infodemics. Hesitancy among health workers and the general population was a challenge in most of the countries.

Conclusion

countries have gained valuable experiences exploring various COVID-19 vaccination delivery models, including implementing the integration of COVID-19 vaccination within routine health care programs. There is a need to regularly monitor or do studies measuring public perceptions towards COVID-19 vaccination in order to drive the demand generation efforts, as well as use evidence in addressing hesitancy.

Vaccine Efficacy Denial: A Growing Concern Affecting Modern Science, and Impacting Public Health

BACKGROUND

The discovery of the vaccination technique has been revealed by Edward Jenner in 1796: undoubtedly, it represents the first scientific attempt to control an infectious disease by vaccines, followed by other important studies carried out by Pasteur and Koch, and Sabin, who developed the first technique to attenuate the virus. In recent decades, numerous scholars have begun to create dangerous theories against the effectiveness of vaccines through scientifically invalid or fraudulent studies.

AIM

This critical review of the literature aims to analyse the main factors that have undermined the credibility of vaccines in the general population, to disprove false information and, on the other hand, emphasize the benefits of vaccines over the last 200 years.

DISCUSSIONS

Unfortunately, several studies have been carried out without the proper scientific rigour. The most impacting example is the study published by Andrew Wakefield in the Lancet journal that tried to correlate vaccines with the development of autism: this publication was withdrawn from the journal a few years after its publication, but the impact of incorrect scientific studies, fake news, and ambiguous healthcare policies has led to an adverse general opinion about the effectiveness of vaccines.

CONCLUSION

The excess of uncontrolled information is a serious concerning in the Coronavirus pandemic. The modern science must tackle this problem with a better willingness to communicate even the clinical studies to those people not able to understand the medical information autonomously. Nevertheless, a reliable science must also limit the dissemination of studies that do not meet the basic criteria of a methodological rigor and certainty of results, in order not to feed confusion in the scientific community.

Vaccination associated with gross domestic product and fewer deaths in countries and regions: A verification study

Background:

Vaccination can have a substantial impact on mitigating COVID-19 outbreaks. However, the vaccine rollout rates associated with the gross domestic product (GDP) and few deaths are required for verification. Three hypotheses were made:

Methods:

The corresponding CNCCs and deaths were downloaded from the GitHub website. Four variables, including IP days on CNCCs and deaths, GDP per capita, and vaccine doses administered per 100 people (VD100) in countries/regions, were collected. Correlation coefficients (CCs) between variables were computed to verify the association with vaccination rates. Four tasks were achieved:

Results:

We observed that

Conclusion:

Our results indicate that vaccination has a significant effect on mitigating COVID-19 outbreaks, even with limited protection against infection. Continued compliance with nonpharmaceutical interventions is essential to the fight against COVID-19 in the future.

Capacity Building for Vaccine Manufacturing Across Developing Countries: The Way Forward

Approved vaccines prevent 2 to 3 million deaths per year. There is a lack of equitable access to vaccines in the low- and middle-income developing nations. Challenges in the life cycle of vaccine production include process development, lead time, intellectual property, and local vaccine production. A robust and stable manufacturing process and constant raw material supplies over decades is critical. In a continuously evolving vaccine landscape, the need of the hour for developing nations is to manufacture their own vaccines besides having supply security, control over production scheduling and sustainability, control of costs, socio-economic development, and rapid response to local epidemics. There is a need for capacity building of workforce development, technology transfer, and financial support. Technology transfer has improved vaccine access and reduced prices of vaccines. Capacity building for the manufacturing of vaccines in developing countries has always been an area of paramount importance and more so in a pandemic situation.

COVID-19 phase 4 vaccine candidates, effectiveness on SARS-CoV-2 variants, neutralizing antibody, rare side effects, traditional and nano-based vaccine platforms: a review

The COVID-19 pandemic has endangered world health and the economy. As the number of cases is increasing, different companies have started developing potential vaccines using both traditional and nano-based platforms to overcome the pandemic. Several countries have approved a few vaccine candidates for emergency use authorization (EUA), showing significant effectiveness and inducing a robust immune response. Oxford-AstraZeneca, Pfizer-BioNTech's BNT162, Moderna's mRNA-1273, Sinovac's CoronaVac, Johnson & Johnson, Sputnik-V, and Sinopharm's vaccine candidates are leading the race. However, the SARS-CoV-2 is constantly mutating, making the vaccines less effective, possibly by escaping immune response for some variants. Besides, some EUA vaccines have been reported to induce rare side effects such as blood clots, cardiac injury, anaphylaxis, and some neurological effects. Although the COVID-19 vaccine candidates promise to overcome the pandemic, a more significant and clear understanding is needed. In this review, we brief about the clinical trial of some leading candidates, their effectiveness, and their neutralizing effect on SARS-CoV-2 variants. Further, we have discussed the rare side effects, different traditional and nano-based platforms to understand the scope of future development.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey

INTRODUCTION

Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap.

METHODS AND MATERIALS

This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis.

RESULTS

The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe).

CONCLUSIONS

Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

Methodology for Designing Humanitarian Supply Chains: Distribution of COVID-19 Vaccines in Mexico

This paper presents a methodology for designing a humanitarian supply chain (HSC) for immunization in Mexico. The study analyzes the abilities of HSCs provided in the literature and those that are relevant for the HSC vaccination in Mexico. In addition, the stakeholders involved in HSC for immunization were studied. A sentiment analysis of more than 900 newspaper articles was conducted to determine society’s perception of the government’s strategy for vaccine distribution. Considering these aspects and a review of the state-of-the-art in the design of supply chains, a methodology for HSC is proposed. Some of the findings are that resilience and agility, the most important abilities in HSCs in Mexico, can be achieved through government support and strong collaboration between different stakeholders, which was found to be the weakest point of the strategy. The problems observed in the vaccination strategy in Mexico were as follows: (1) a single physical space per municipality was defined for the application of the vaccine, (2) there is a shortage of vaccines, and (3) as far as we know, no methodology has been applied to carry out immunization. This approach considers the design of HSCs in terms of capabilities and stakeholders, which, to the best of our knowledge, is a novel aspect of the literature. This methodology can be used for various scenarios of HSCs in Mexico.

Frugal Science Powered by Curiosity

More than 60 years ago, Richard Feynman gave a lecture titled "There's Plenty of Room at the Bottom: An Invitation to Enter a New Field of Physics", where he called on others to join the then-nascent field of nanotechnology. In a similar spirit, we wish to invite chemists, biologists, physicists, bioengineers, educators, high school students, and inventors of all backgrounds to join us in the emerging field of frugal science. In this Review, we define frugal science and use six case studies to describe the broad applications of frugal science, from synthetic biology to disease diagnostics. We conclude by establishing an argument for curiosity-driven research through frugal science to enable broader access in chemical and bioengineering research and drive innovation.

Linarin, a Glycosylated Flavonoid, with Potential Therapeutic Attributes: A Comprehensive Review

Many flavonoids, as eminent phenolic compounds, have been commercialized and consumed as dietary supplements due to their incredible human health benefits. In the present study, a bioactive flavone glycoside linarin (LN) was designated to comprehensively overview its phytochemical and biological properties. LN has been characterized abundantly in the Cirsium, Micromeria, and Buddleja species belonging to Asteraceae, Lamiaceae, and Scrophulariaceae families, respectively. Biological assessments exhibited promising activities of LN, particularly, the remedial effects on central nervous system (CNS) disorders, whereas the remarkable sleep enhancing and sedative effects as well as AChE (acetylcholinesterase) inhibitory activity were highlighted. Of note, LN has indicated promising anti osteoblast proliferation and differentiation, thus a bone formation effect. Further biological and pharmacological assessments of LN and its optimized semi-synthetic derivatives, specifically its therapeutic characteristics on osteoarthritis and osteoporosis, might lead to uncovering potential drug candidates.

Controversy surrounding the Sputnik V vaccine

The Sputnik V COVID-19 vaccine is a member of the so-called vector vaccines and uses two different vectors (Ad26 priming and Ad5 boost) to reduce the risk of a reduction in the effectiveness of the vaccination. Real life data indicate an efficacy of the vaccine above 97%. Low cost and no need for ultra-cold storage temperature temperatures are other pluses of the Sputnik V vaccine. However, there are also several important shortcomings that must be considered such as the possible reduction of its immunogenicity in the presence of very high Ad5 neutralizing antibody titres and the decrease with age of the antibody titres neutralizing the virus. Furthermore, there is emerging documentation that Sputnik V has a reduced neutralizing capacity against the Beta variant and all variants with the spike protein carrying the E484K substitution. Nevertheless, due to its characteristics, Sputnik V could be another useful means of satisfying the need for mass vaccination. However, it is imperative to document the efficacy and safety of the Sputnik V vaccine in individuals with high pre-existing anti-Ad26 and Ad5-neutralizing antibody titres and in those under the age of 18 or older than 60 years and be certain that Sputnik V does not cause the rare development of immune thrombotic thrombocytopenia. It is hoped that the now widespread use of this vaccine will generate a large pragmatic real-world study with data accessible to anyone interested in verifying them.

The relationship between macro-socioeconomics determinants and COVID-19 vaccine distribution

Since coronavirus disease 2019 (COVID-19) has continued to spread globally, many countries have started vaccinations at the end of December 2020. This research examines the relationship between COVID-19 vaccine distribution and two macro-socioeconomics measures, including human development index and gross domestic product, among 25 countries for two points in time, including February and August 2021. The COVID-19 dataset is a collection of the COVID-19 data maintained by Our World in Data. It is a daily updated dataset and includes confirmed cases, vaccinations, deaths, and testing data. Ordinary Least Squares was applied to examine how macro-socioeconomic measures predict the distribution of the COVID-19 vaccine over time.

RESULTS

The results indicate that a higher gross domestic product per capita is positively associated with higher COVID-19 vaccine distribution, and this relationship becomes more robust over time. However, some countries may have more successful vaccine distribution results regardless of their gross domestic product. In addition, the result shows human development index does not have a significant relationship with vaccine distribution.

CONCLUSION

Economic measures may be counted as a more vital indicator for vaccine distribution as they have a more direct relationship distribution with health infrastructure than social measures such as human development index.

Disparities in COVID-19 Vaccination among Low-, Middle-, and High-Income Countries: The Mediating Role of Vaccination Policy

Inequity in the access to and deployment of the coronavirus disease 2019 (COVID-19) vaccines has brought about great challenges in terms of resolving the pandemic. Aiming to analyze the association between country income level and COVID-19 vaccination coverage and explore the mediating role of vaccination policy, we conducted a cross-sectional ecological study. The dependent variable was COVID-19 vaccination coverage in 138 countries as of May 31, 2021. A single-mediator model based on structural equation modeling was developed to analyze mediation effects in different country income groups. Compared with high-income countries, upper-middle- (β = -1.44, 95% CI: -1.86--1.02, p < 0.001), lower-middle- (β = -2.24, 95% CI: -2.67--1.82, p < 0.001), and low- (β = -4.05, 95% CI: -4.59--3.51, p < 0.001) income countries had lower vaccination coverage. Vaccination policies mediated 14.6% and 15.6% of the effect in upper-middle- (β = -0.21, 95% CI: -0.39--0.03, p = 0.020) and lower-middle- (β = -0.35, 95% CI: -0.56--0.13, p = 0.002) income countries, respectively, whereas the mediation effect was not significant in low-income countries (β = -0.21, 95% CI: -0.43-0.01, p = 0.062). The results were similar after adjusting for demographic structure and underlying health conditions. Income disparity remains an important cause of vaccine inequity, and the tendency toward "vaccine nationalism" restricts the functioning of the global vaccine allocation framework. Stronger mechanisms are needed to foster countries' political will to promote vaccine equity.

COVID-19 and the Impact on the Cranio-Oro-Facial Trauma Care in Italy: An Epidemiological Retrospective Cohort Study

The coronavirus disease 2019 (COVID-19) has deeply modified the organization of hospitals, health care centers, and the patient's behavior. The aim of this epidemiological retrospective cohort study is to evaluate if and how the COVID-19 pandemic has determined a modification in cranio-oro-facial traumatology service.

METHODS

The dataset included hospital emergency room access of a six-month pre-pandemic period and six months into pandemic outbreak. The variables collected were: patient age, gender, type of emergency access with relative color code, Glasgow Coma Scale Score, type of discharge.

RESULTS

537 vs. 237 (pre-pandemic vs. pandemic) patients accessed the hospital emergency room and the mean age decreased from 60.79 ± 25.34 to 56.75 ± 24.50 year. Yellow and green code access went from 28.9% and 66.1% to 37.5% and 57.7% (pre-pandemic vs. pandemic). Glasgow Coma Scale (GCS) shows an increase of 16.6% vs. 27.8% of 15 grade score, a 28.7% vs. 28.5% of the 14 grade score and reduction of 13 and 12 grade 40.2% and 14.5% vs. 37.1 and 9.7% (pre-pandemic vs. pandemic).

CONCLUSIONS

Since the COVID-19 outbreak continues, epidemiological data are still necessary to perform public health intervention strategies and to appropriately predict the population needs, in order to properly manage the COVID-19 related to oral pathologies as well as the most common health problems.