Public opinion on a mandatory COVID-19 vaccination policy in France: a cross-sectional survey

OBJECTIVES

Reaching the last pockets of unvaccinated people is challenging, and has led to the consideration of mandatory vaccination for coronavirus disease 2019 (COVID-19). Our aim was to assess attitudes toward mandatory COVID-19 vaccination in France before the announcement of-and factors associated with opposition to-this type of policy.

METHODS

Between the 10th and 23rd May 2021, we conducted a cross-sectional online survey among a representative sample of the French population aged 18 and over, and a specific sample of the French senior population aged over 65.

RESULTS

Among 3056 respondents, 1314 (43.0%) were in favour of mandatory COVID-19 vaccination, 1281 (41.9%) were opposed to such a policy, and 461 (15.1%) were undecided. Among opponents to mandatory COVID-19 vaccination for the general population, 385 (30.05%) were in favour of mandatory COVID-19 vaccination for healthcare workers (HCWs). In multivariate analysis, the age groups 18-24 and 25-34 years were significantly more opposed than the reference group (>75 years old) with respective adjusted odds ratio (aOR) and 95% confidence interval (95%CI) 4.67 (1.73-12.61) and 3.74 (1.57-8.93). Having no intention of getting COVID-19 vaccination was strongly associated with opposition to mandatory vaccination (aOR 10.67, 95%CI 6.41-17.76). In comparison with partisans of the centre, partisans of the far left and green parties were more likely to be opposed to mandatory COVID-19 vaccine, with respective aORs (95%CI) of 1.89 (1.06-3.38) and 2.08 (1.14-3.81).

CONCLUSION

Attitudes toward mandatory COVID-19 vaccination are split in the French general population, and the debate might become politicized.

Acceptance of childhood and adolescent vaccination against COVID-19 in France: a national cross-sectional study in May 2021

The French health authorities extended vaccination against COVID-19 to adolescents in June 2021, during the epidemic resurgence linked to the delta variant and because of insufficient vaccination coverage to ensure collective protection. In May 2021, we conducted a national online cross-sectional survey of 2533 adults in France to study their attitudes toward COVID-19 vaccines and their acceptance of child/adolescent vaccination according to targeted age groups (<6 years; 6-11; 12-17) and its determinants. We applied a multi-model averaged logistic regression for each of these age groups to study the determinants of favorability to vaccination. Among the respondents, 62.7% (1597) accepted COVID-19 vaccination for adolescents, 48.3% (1223) for children aged 6-11 years, and only 31% (783) for children under 6 years. Acceptance increased with fear of contracting COVID-19 and trust in institutions and decreased as the COVID-19 vaccine risk perception score increased. People favorable to vaccination in general and those sensitive to social pressure were also more often favorable to vaccinating children/adolescents than those who were not. Drivers of acceptance were ranked differently for the different age groups. Understanding these differences is essential to anticipating obstacles to vaccination of these age groups and designing appropriate information and motivational strategies to support it.

Factors associated with COVID-19 vaccine uptake among French population aged 65 years and older: results from a national online survey

Background

In France, the increase in COVID-19 vaccine uptake among older adults slowed down between May and June 2021. Using the data from a national survey, we aimed to assess COVID-19 vaccine uptake among French residents aged 65 years and older, particularly at risk of severe form of the infection, and identify factors associated with non-vaccination.

Methods

A cross-sectional online survey collected the immunization status/intention to get the COVID-19 vaccine, reasons for vaccination/non-vaccination and factors potentially associated with vaccine uptake between May 10 and 23, 2021 among a large sample of French residents. Characteristics of participants were compared according to immunization status. Factors potentially associated with non-vaccination were computed into a multivariate logistic regression.

Results

Among the 1941 survey participants, 1612 (83%) reported having received at least one dose of COVID-19 vaccine. Among the 329 unvaccinated, 197 (60%) declared having the intention to get vaccinated. Younger age (adjusted odds ratio (aOR) = 1.50; 95% confidence interval (CI), 1.05–2.14), thinking previously having COVID-19 (aOR = 4.01; 95% CI, 2.17–7.40), having suffered economic impact due to the pandemic (aOR = 2.63; 95% CI, 1.71–4.04), reporting an “unsafe” opinion about COVID-19 vaccine safety (aOR = 6.79; 95% CI, 4.50–10.26), reporting an “unsupportive” opinion about vaccination in general (aOR = 4.24; 95% CI, 2.77–6.49) were independent risk factors for non-vaccination. On the other hand, trust in COVID-19 vaccine information delivered by the doctor (aOR = 0.28; 95% CI, 0.16–0.48) and trust in the government’s actions (aOR = 0.50; 95% CI, 0.34–0.74) were independent protective factors for non-vaccination. Political affiliation also remained significantly associated with vaccine uptake.

Conclusions

Despite high overall COVID-19 vaccine uptake among the study participants, differences in vaccine uptake according to the level of concerns regarding COVID-19 vaccine safety, socioeconomic profile and trust in the government were observed. Our results reinforce the importance of “reaching out” vaccination strategy that specifically targets the most vulnerable fringe of older adult population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03338-3.

Are vaccinated measles cases protected against severe disease?

OBJECTIVES

We aimed to estimate vaccine effectiveness against severe measles based on the number of vaccine doses administered and the time since last vaccination.

PATIENTS AND METHODS

We included measles cases aged at least 2 years and born since 1980 who were notified in France between 2006 and mid-2019. We considered two severity levels (moderate, severe) and calculated adjusted relative risks (aRR) using multinomial logistic regression.

RESULTS

We included 10,399 cases. The risk of severe measles in two-dose vaccine recipients was 71% (aRR = 0.29 [95%CI 0.12-0.72]) and 83% (aRR = 0.17 [95%CI 0.04-0.70]) lower than in unvaccinated cases, if the time since last dose was less or more than 15 years, respectively. The risk of moderate disease followed a similar pattern.

CONCLUSIONS

Two-dose measles vaccination provided long-term protection against severe cases, even after vaccine failures. These findings underscore the need for compliance to the recommended measles vaccination schedule to prevent severe cases.

Healthcare workers' knowledge and perceptions of the risks associated with emerging extensively drug-resistant bacteria

OBJECTIVE

Guidelines have been issued in 2010 to prevent the spread of emerging extensively resistant bacteria (eXDR), but their implementation is difficult. We aimed to evaluate healthcare workers' (HCW) knowledge and their risk perception to identify barriers to the implementation of guidelines.

METHODS

Semi-structured interviews were conducted at a University Hospital, where case patients are regularly admitted. The interviews focused on HCW's knowledge, risk perception, and challenges met. The evaluation of HCW's knowledge and contagiousness and perception of severity of eXDR carriage were analyzed statistically. Risk perception and opinion about guidelines were analyzed by qualitative description.

RESULTS

One hundred and twenty-one HCWs were interviewed. The category of HCW, having searched for information on resistant bacteria, and having taken care of case patients were associated with better knowledge. The HCW category, age, type of unit, seniority, and having taken care of case patients were associated with risk perceptions. Qualitative analysis identified 61 themes. HCWs were extremely concerned by the spread of bacteria within the hospital. The main challenges identified were organizational and communication issues.

CONCLUSION

HCWs reported a lack of knowledge and a lack of resources to implement guidelines. Strategies to improve guidelines implementation must be based on a better availability of resources, better communication, and new educational methods.

Bacterial vaginosis and other infections in pregnant women in Senegal

Background

Bacterial vaginosis (BV) is associated with a higher risk of preterm delivery and spontaneous abortion. Yet little data on BV prevalence exist for sub-Saharan countries. The aim of this study was to estimate the prevalence of bacterial vaginosis and associated risk factors among pregnant women in Senegal.

Methods

From October 2013 to December 2018, pregnant women in their third trimester were recruited in two primary health centers (one suburban, one rural) in Senegal. Healthcare workers interviewed women and collected a lower vaginal swab and a blood sample. Vaginal flora were classified into four categories using vaginal smear microscopic examination and Gram’s coloration. In our study, BV was defined as vaginal flora with no Lactobacillus spp. Variables associated with BV were analyzed using STATA® through univariate and multivariate analysis.

Results

A total of 457 women provided a vaginal sample for analysis. Overall, BV prevalence was 18.6% (85/457) [95% CI 15.4–22.6]) and was similar in suburban and rural areas (18.9% versus 18.1%, p = 0.843). Multivariate analysis showed that primigravidity was the only factor independently associated with a lower risk of BV (aOR 0.35 [95% CI 0.17–0.72]).

Conclusions

Our study showed significant BV prevalence among pregnant women in Senegal. Although the literature has underscored the potential consequences of BV for obstetric outcomes, data are scarce on BV prevalence in sub-Saharan African countries. Before authorities consider systematic BV screening for pregnant women, a larger study would be useful in documenting prevalence, risk factors and the impact of BV on pregnancy outcomes.

Un volontaire aux essais vaccinaux COVID-19 serait-il prêt à participer à un essai clinique vaccinal non COVID-19 ?

Introduction

Matériels et méthodes

Résultats

Conclusion

A national platform for Covid-19 vaccine studies recruitment in France: Covireivac volunteer's characteristics

During the Covid-19 pandemic, the urgent need for safe and effective vaccines has led to many vaccine trials, implying fast and extensive recruitment of volunteers. In France, until 2020, vaccine clinical research participants were usually recruited locally, through center-based pools of volunteers, and local communication plans. Covireivac is a French public online platform launched on 10/01/2020 that enables national, large-scale recruitment of volunteers for Covid-19 vaccine studies. On the Covireivac website, all adult participants registered online, gave their informed consent, and filled out two online forms with information on their identity, health status (comorbidities, treatments), and known exposure to SARS-CoV-2. Since July 2021, volunteers could mention if their children are interested in participating in a Covid-19 vaccine trial. The objective of this work is to describe Covireivac's volunteer characteristics registered from 10/01/2020 to 11/02/2022. To identify independent volunteer characteristics associated with a period of registration we performed a multivariate logistic regression. Among 54,424 registrations, 52,391 (96%) were analysed; 61% were male (n = 31,893), median age was 50 y; 13% (n = 6586) were healthcare workers. At registration, 15,879 volunteers (33%) reported at least one comorbidity, among whom 16% (n = 7349) were obese and 17% (n = 8346) had hypertension. Most volunteers registered during the first month (n = 35,876, 66%). The Covireivac platform allowed quick and large recruitment of potential volunteers for Covid-19 vaccine trials and could be used on a larger scale for vaccine trials in France. It could facilitate recruitment in vaccine trials and provide sponsors with better visibility of the recruitment capacities of clinical research centers.

What Is the Optimal Community-Based Tuberculosis Screening Algorithm for People Who Inject Drugs in a High-Burden Setting?

Background

Although people who inject drugs (PWID) are a high-risk group for tuberculosis (TB), current case-finding strategies fail to identify most TB cases. There is a need for an optimized community-based algorithm to improve TB detection in such disproportionately affected populations.

Methods

Using respondent-driven sampling, we recruited PWID at community sites in Hai Phong, Vietnam, screening for classic TB symptoms, C-reactive protein blood measurement, portable on-site chest x-ray with CAD4TB software (Computer-Aided Detection for Tuberculosis version 7; Delft Imaging Systems BV), and Xpert MTB/RIF on sputum. Any participants suspected of TB by on-site physicians were referred to the infectious disease hospital for confirmatory testing, and external experts validated final diagnoses, which were then used as the TB gold standard. We aimed to identify the screening algorithm with the highest case detection at the lowest cost among different on-site testing combinations. Ingredients-based costing was used to evaluate the cost per test and cost per case detected for each algorithm.

Results

Among the 1080 PWID enrolled, 47 (4.4%; 95% CI, 2.8%-6.4%) were diagnosed with TB disease. When compared with the current symptom-based TB screening strategy in Vietnam (double D), systematic chest x-ray with CAD4TB, Xpert MTB/RIF for those with CAD4TB ≥50, and referral to care for those with either CAD4TB ≥70 or a positive Xpert test result doubled the sensitivity (82.9% vs 43.9%) and yield (3.2% vs 1.7%) while maintaining a reasonable cost per TB case detected (US $439 vs $309 for standard of care).

Conclusions

We defined an acceptable and moderate cost algorithm that improves efficiency for community-based TB screening among PWID in Vietnam. To reflect real TB prevalence, we make the case that active case finding and systematic screening strategies should not limit testing to those with a positive symptom screen.

Caractéristiques des volontaires inscrits sur la plateforme nationale dédiée aux essais vaccinaux COVID-19

Introduction

La conduite des essais vaccinaux COVID-19 nécessite le recrutement d’un nombre important de participants dans un délai court. Dans ce contexte, une plateforme nationale informatisée permettant l’auto-inscription de volontaires a été mise en place. Ce concept inédit en France permet de cibler les populations correspondant aux critères d’inclusion, d’assurer une répartition géographique et de garantir aux promoteurs, industriels ou académiques, le recrutement rapide dans les essais. L’objectif du travail présenté ici est de décrire les caractéristiques des volontaires inscrits.

Matériels et méthodes

Un appel à volontaires a été lancé le 01/10/2020 sous la forme d’une conférence de presse. Il a aussi été relayé par les médecins généralistes. Tout adulte pouvait s’inscrire sur une plateforme déclarée à la CNIL accessible à partir d’un site internet contenant des informations sur le développement des vaccins COVID-19. Le volontaire devait renseigner son identité et ses coordonnées, donner expressément son consentement puis des informations concernant :

– son poids, sa taille et l’existence d’une ou plusieurs comorbidités (diabète, hypertension artérielle, maladie cardiaque et/ou respiratoire, insuffisance rénale, transplantation d’organe solide, maladie auto-immune et cancer) ;

– la prise d’un traitement au long cours, notamment d’un immunosuppresseur ;

– son exposition à la COVID-19 (professionnel de santé, métier au contact du public) ou un antécédent de COVID-19 ;

– sa participation antérieure à un essai clinique.

Les données des volontaires inscrits entre le 01/10/2020 et le 21/12/2020 ayant donné leur consentement et dont les données d’identité étaient complètes ont fait l’objet de cette analyse, effectuée avec le logiciel STATA®.

Résultats

Au total, 45503 inscriptions ont été enregistrées, dont 44611 (98%) analysées ici. Il s’agit d’hommes dans 63% des cas (n = 28049, sexratio : 1,7); l’âge médian est de 51 ans (IQR : 35-63 ans). Les personnes âgées de 65 ans et plus représentent 22% (n = 9551) des volontaires; 1,2% (n = 507) ont 80 ans et plus. Au moins une comorbidité est présente chez 14609 (39%) volontaires: 16% d’obésité (n = 6054), 16,5 % d’hypertension artérielle (n = 6243), 6% de diabète (n = 2251), 6,6% de maladie cardiaque (n = 2493), 9,9% de maladie respiratoire (n = 3747), 0,4 % d’insuffisance rénale (n = 160), 5,2 % de maladie auto-immune (n = 1976), 0,8% de cancer (n = 306) et 0,3% de transplantés (n = 117). Cinq pour cent (n = 2284) ont déclaré un antécédent de COVID-19 et 13% (n = 5654) sont des professionnels de santé.

Conclusion

La mise en place d’une plateforme nationale dédiée aux essais vaccinaux COVID-19 est une première en France et a permis l’inscription d’un grand nombre de participants potentiels grâce à un fort relais par la presse nationale et un accueil positif des français de tous les âges. Cet outil doit garantir un recrutement rapide dans les essais vaccinaux COVID-19 en cours et pourrait constituer de façon plus générale une approche efficace pour dynamiser le recrutement des essais cliniques en France.

Intention to participate in COVID-19 vaccine clinical trials in May 2021: a cross-sectional survey in the general French population

In May 2021, while the immunization campaign was in progress, the emergence of new SARS-CoV-2 variants led us to assess attitudes toward participation in a COVID-19 vaccine clinical trial (VCT) in France. Between the 10th and the 23rd of May 2021, we conducted a cross-sectional online survey among a representative sample of the French population aged 18 and over and a specific sample of the French population over 65. Among the 3,056 respondents, 28.0% (856) would consider participation in a COVID-19 VCT. Factors independently negatively associated with willingness to participate in a COVID-19 VCT were female gender with an adjusted odd ratio (aOR) 0.42 and 95% confidence interval (95% CI) 0.35–0.51, and mistrust in health actors (in their own physician and pharmacists, health ministry, government, scientists in medias, medias and pharmaceutical companies) with aOR 0.86 (95% CI 0.84–0.88) by one-point increase in mistrust in health actors score. Factors positively associated with willingness to participate in a COVID-19 VCT were COVID-19 vaccination or intention to get vaccinated with aOR 4.89 (95% CI 3.15–7.61), being a healthcare worker with aOR 2.051 (95% CI 1.51–2.80), being at risk for severe COVID-19 with aOR 1.39 (95% CI 1.14–1.69) and altruism as the main reason for getting vaccination with aOR 1.56 (95% CI 1.29–1.88). In May 2021, despite COVID 19 vaccine availability, 28% of the French population would agree to participate in a COVID-19 VCT. Mistrust in health actors contributes to a reduction in the intention to participate. Attitudes toward COVID-19 vaccination predict attitudes toward participation in a COVID-19 VCT.

Factors, motivations and barriers associated with eagerness to volunteer in COVID-19 vaccine clinical trials in France: A mixed-method study

INTRODUCTION

During the COVID-19 pandemic, there was an unprecedented effort to engage people in clinical vaccine research. Most of the French volunteers registered in the first weeks after the launch in October 2020 of COVIREIVAC, an electronic platform dedicated to COVID-19 vaccine clinical trials (VCT). In the context of pandemic preparedness, identifying factors associated with eagerness or hesitancy to participate in VCT may help to increase recruitment of volunteers from diverse backgrounds.

METHODS

We used a mixed-method survey offered to the volunteers registered on the COVIREIVAC platform, and semi-directed interviews in participants to COVID-19 VCTs. Volunteers were divided into three categories: early volunteers (EV), registered before the launch of the COVID-19 vaccination campaign, middle volunteers (MV) registered between the first of January 2021 and the generalization of the COVID-19 vaccination to the entire population in May 2021, and late volunteers (LV) registered afterward.

RESULTS

Among the 56,101 COVIREIVAC registered volunteers, 2,741 (4.9 %) completed the survey, 1,915 (69.6%) were EV, 301 (11.0%) were MV and 525 (19.2 %) were LV. Sixteen were face-to-face interviewed. Age, educational level, attitudes toward vaccination evaluated with the 5C-model did not differ between EV and MV. Women gender and the possibility to choose the vaccine platform was associated with being a MV. LV were significantly younger, had a lower educational level and had less positive attitudes toward vaccines than EV and MV. The main motivations for participation in VCTs were altruistic notably in EV and MV. For LV, they registered in the hope to choice the vaccine technology. Among the respondents, 2,041 (74.5 %) would consider to participate in a non-COVID-19 VCT.

CONCLUSION

LV on the COVIREIVAC platform had a distinct profile from EV and MV, and were less confident in vaccines. Restoring confidence in vaccines and clinical may help to engage more diverse populations in VCTs.