Factors impacting COVID-19 vaccine decision making in older adults and people with underlying conditions in Victoria, Australia: A cross-sectional survey.

Australia's COVID-19 vaccine rollout included prioritizing older adults and those with underlying conditions. However, little was known around the factors impacting their decision to accept the vaccine. This study aimed to assess vaccine intentions, information needs, and preferences of people prioritized to receive the COVID-19 vaccine at the start of the Australian vaccine rollout. A cross-sectional online survey of people aged ≥70 years or 18-69 with chronic or underlying conditions was conducted between 12 February and 26 March 2021 in Victoria, Australia. The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework and items informed the survey design and framing of results. Bivariate logistic regression was used to investigate the association between intention to accept a COVID-19 vaccine and demographic characteristics. In total, 1828 eligible people completed the survey. Intention to vaccinate was highest among those ≥70 years (89.6%, n = 824/920) versus those aged 18-69 years (83.8%, n = 761/908), with 91% (n = 1641/1803) of respondents agreeing that getting a COVID-19 vaccine was important to their health. Reported vaccine safety (aOR 1.4, 95% CI 1.1 to 1.8) and efficacy (aOR 1.9, 95% CI 1.5 to 2.3) were associated with intention to accept a COVID-19 vaccine. Concerns around serious illness, long-term effects, and insufficient vaccine testing were factors for not accepting a COVID-19 vaccine. Preferred communication methods included discussion with healthcare providers, with primary care providers identified as the most trusted information source. This study identified factors influencing the prioritized public's COVID-19 vaccine decision-making, including information preferences. These details can support future vaccination rollouts.

Costing of an Australian general practice COVID-19 drive-through testing and respiratory clinic.

BACKGROUND: Responding to the COVID-19 pandemic requires safe and efficient testing on a large scale over a prolonged period. Outpatient testing facilities can clinically assess and test symptomatic individuals and test asymptomatic contacts. This study identified the resources required to establish and maintain an Australian general practitioner (GP) led testing facility that combined a respiratory clinic for clinical assessment and testing with a drive-through testing facility. METHODS: Data were taken from clinic administrative records to identify the number of patients tested over the period April-June 2020. An independent auditor's report identified the resources used in establishing, running, and staffing both clinics for the same period. Analyses were performed using the minimum and maximum daily throughput to understand the effect of demand on price per sample collected. RESULTS: The respiratory clinic tested an average of 19 patients per day, at an estimated cost of $340.04 AUD. This varied to $687.99 AUD during the lowest demand scenario, and $281.04 AUD during the high demand scenario. The drive-through clinic tested an average of 47 patients per day, at an estimated cost of $153.57 AUD. This varied to $279.51 AUD during the lowest demand scenario, and $99.92 AUD during the high demand scenario. CONCLUSION: This study provides insight into the cost of testing at a drive through and respiratory clinic in Australia. The evidence highlights importance of considering variation in demand and the impact on efficiency, particularly where resource use is fixed in the short term.

Factors Influencing Australian Healthcare Workers' COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey.

Healthcare workers' COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February-26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.

Qualitative exploration of intentions, concerns and information needs of vaccine-hesitant adults initially prioritised to receive COVID-19 vaccines in Australia.

OBJECTIVE: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine. METHOD: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. RESULTS: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.

Strengthening respiratory protection from SARS-CoV-2 in certain general practice contexts.

We recommend a precautionary approach to respiratory protection for healthcare workers potentially exposed to SARS-CoV-2 until the efficacy of surgical masks can be proven.

Preparing the public for COVID-19 vaccines

[...]as has been shown in previous mass vaccination programs, planning for vaccine program rollout and community engagement to optimise vaccine confidence and uptake in Australia needs to commence beforehand, not when the vaccines become available.5 Consistent with its existing role in vaccination programs, primary care professional are anticipated to play a key part in educating patients and carers about the vaccine, administering the vaccine, recording uptake and reporting adverse events following immunisation. There are currently 17 vaccines in phase I trials and 10 vaccines in phase II/III clinical trials (28 August 2020).6 Traditional vaccine development is a lengthy process, usually taking 10-15 years or more, with a distinct, linear sequence of steps and high attrition rate.7 The usual steps include pre-clinical development, safety testing (phase I), safety and immunogenicity testing (phase II) and then safety and efficacy testing (phase III), prior to licensure, production at scale and introduction into the population (Figure 1). Comprehensive post-marketing surveillance to track vaccine safety for these expected adverse events, as well as to detect postulated rarer adverse events such as antibody-enhanced disease, will also be essential to maintain vaccine confidence and achieve high vaccine acceptance and uptake. The WHO10 and the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunisation Practice (ACIP)11 are currently advising a risk- and aged-based approach for prioritisation of COVID-19 vaccine target groups.