"I Want People to Be Able to Make an Informed Choice": How Quebec naturopaths discuss vaccination in their practice.

Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients.

From high hopes to disenchantment: A qualitative analysis of editorial cartoons on COVID-19 vaccines in Canadian newspapers.

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake.

COVID vaccine evaluation of barriers and resources among families of children with diagnosed allergies.

Background: We aimed to determine vaccine hesitancy and the main barriers associated with the 2019 novel coronavirus, SARS-CoV-2 (COVID-19) vaccination among families of children diagnosed with food/drug/environmental allergies. Methods: Between May and June 2021, we approached 146 families seen at the outpatient allergy clinic at the Montreal Children's Hospital and a community allergy practice were invited to complete an anonymous online survey on COVID-19 and vaccination attitudes and behaviour. Uni and multivariable logistic regressions were compared to estimate factors associated with vaccine hesitancy. Results: Among all patients, 24.1% reported vaccine hesitancy. The large majority of parents (95.2%) believed that vaccines work. The most common barrier to vaccination was fear of adverse side effects (57.0%). One-third of participants (31.5%) reported that a history of food, venom and drug allergy was a contraindication for COVID-19 vaccination. Fifty-nine (60.8%) participants stated that the dissemination of additional information would increase their willingness to be vaccinated. Most (96.9%) parents reported that their children's vaccinations were up to date. Hesitant families were more likely to be parents of children aged 6-10 years, be of Asian descent, report that mRNA vaccines are riskier than traditional vaccines, and report that the vaccine should not be given if the child has a history of allergic reaction to vaccines. Conclusion: Vaccine hesitancy exists mainly among certain ethnic groups and families with young children. Allergies to food, venom and drug allergy are commonly perceived as contraindications for COVID-19 vaccination. Knowledge translation activities addressing parental concerns will help increase vaccination rates.

Empowering Health Workers to Build Public Trust in Vaccination: Experience from the International Pediatric Association's Online Vaccine Trust Course, 2020-2021.

BACKGROUND: The quality of interactions between health workers (HWs) and caregivers is key in vaccine acceptance. To optimize this, HWs need knowledge about best vaccine communication practices in person and on social media. Most pre-service curricula do not include such approaches. COVID-19 necessitated the International Pediatric Association (IPA) to shift from in-person train the trainer workshops to developing an online Vaccine Trust Course to address these gaps. METHOD: The seven-module, 8-hour Vaccine Trust Course was offered online in seven languages and promoted globally. Course outcomes for participants between September 1, 2020 and September 30, 2021 were assessed using enrollment, participation, and completion data; pre-and post-training surveys of attitudes, knowledge, and practice skills; and follow-up practice surveys 3 months post course completion. RESULTS: Of the 4,926 participants across 137 countries who registered; 2,381 (48.3 %) started the course, with 1,217 (51.1 %) completing. The majority were 25 - 39 years (57 %), female (57 %), and in pediatrics (70 %); 31 % came from India. 62 % of completers rated course structure/design as excellent, 36 % as good. Over 80 % rated the content as the most valuable aspect. Three months post training, 61 % HWs reported increased empathy towards caregivers, confidence while counseling and increased vaccine acceptance amongst their patients. 21 % identified the course as the only factor in these positive changes. CONCLUSION: Shifting from face-to-face to online training due to the COVID-19 pandemic helped increase the global reach of HWs course engagement and uptake. Trained HWs reported increased empathy towards caregivers and confidence while counseling and increased patient vaccine acceptance.

Letting kids play their CARDs (Comfort, Ask, Relax, Distract) to help cope with needle-related fear and pain: Results from user testing.

This study examined perceptions of children and parents about a new web-based CARD (Comfort, Ask, Relax, Distract) game that teaches children how to cope with needle-related pain and fear. A convenience sample of 15 child-parent dyads (children, 6-12 years) participated. Children played the game on a handheld device while being virtually monitored. Activity tracking revealed most children engaged with multiple components. Children reported they understood the game, it was easy to play, they learned coping strategies and believed they could implement them. Children reported lower fear of needles after playing. Parents liked the simplicity and variety of game activities. Most children and parents reported they would use the game or its coping strategies for future needles and would recommend the game. In summary, children and parents found the CARD web game acceptable and appropriate. Future studies can evaluate its effectiveness when integrated into upcoming needle procedures like COVID-19 vaccinations.

Integration of CARD (Comfort Ask Relax Distract) for COVID-19 community pharmacy vaccination in children: Effect on implementation outcomes.

Introduction: Community pharmacists report that providing vaccinations can be challenging, particularly if the vaccine recipient is a child, because of heightened levels of fear. The objective of this study was to determine acceptability and feasibility of the CARD (Comfort Ask Relax Distract) system as a vaccination delivery framework for children receiving COVID-19 vaccinations in a community pharmacy setting. CARD incorporates evidence-based interventions that reduce fear and immunization stress-related responses in vaccine recipients and was demonstrated to be effective and feasible in other vaccination settings providing vaccinations to children and adults. Methods: This mixed-methods study involved 5 independent pharmacies (with 6 vaccinators) offering COVID-19 vaccinations to children between 5 and 11 years of age. Vaccinating staff and implementation leads from the pharmacy organization participated in a small-scale CARD implementation project (before-and-after design). Afterwards, they filled in quantitative surveys and provided qualitative feedback about their perceptions and experiences in focus group discussions. Qualitative data were analyzed deductively, using the Consolidated Framework for Implementation Research (CFIR). Results: The study was conducted between January 16 and March 20, 2022. Across both quantitative and qualitative measures, vaccinating staff reported positive attitudes about CARD and alignment with their professional roles. They reported that CARD reduced children's fear and improved the vaccination experiences in children and parents and for themselves. Vaccinators reported increased confidence due to CARD. They reported compatibility of CARD interventions within their practice and that it was time neutral. They maintained use of some interventions after the study. They also provided suggestions and shared concerns about fidelity and future feasibility of continuing various components of the program. Conclusion: CARD was demonstrated to be acceptable and feasible by vaccinators performing vaccinations in children in community pharmacies.

Unmasking the Twitter Discourses on Masks During the COVID-19 Pandemic: User Cluster-Based BERT Topic Modeling Approach.

Background: The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure's political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation. Objective: We aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework. Methods: We first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals. Results: This study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users. Conclusions: We conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts.

CARD (Comfort Ask Relax Distract) for community pharmacy vaccinations in children: Effect on immunization stress-related responses and satisfaction.

Introduction: CARD (Comfort Ask Relax Distract) is a vaccine delivery program demonstrated to reduce pain, fear and associated immunization stress-related responses (ISRR) in children undergoing vaccinations at school. This study evaluated CARD's clinical impact when integrated into community pharmacy-based pediatric vaccinations. Methods: This was a before-and-after CARD implementation study in 5 independent pharmacies offering COVID-19 vaccinations to children aged 5-11 years. No changes were made to practices in the "before" phase. CARD interventions were integrated in the "after" phase (e.g., children prepared a coping plan using a checklist, distraction toolkits were placed in waiting and vaccination spaces, vaccinations were performed with privacy, needles were obscured). Children self-reported ISRR, including fear, pain and dizziness during vaccination, and both children and parents/caregivers (herein, parents) compared the child's experience to their last needle (better, same, worse). In the "after" phase, parents and children reported how much CARD helped (not at all, a little bit, a moderate amount, a lot). Results: The study was conducted between January 16 and March 20, 2022. Altogether, 152 children participated (71 before and 81 after CARD); demographic characteristics did not differ. Children's self-reported fear was lower after CARD, when assessed continuously (2.5 vs 3.7 out of 10; p = 0.02) or dichotomously, using a cut-off of 0 vs >0 (58% vs 80%; p = 0.01). Pain was lower when assessed dichotomously (<2 vs ≥2; p = 0.03). There was no difference in dizziness. After CARD, children and parents reported more positive experiences compared to the child's last needle (p = 0.01, both analyses) and more children and parents reported that distraction and child participation in the process were helpful (p < 0.001, both analyses). Overall, 92% of children and 91% of parents said CARD helped. Conclusion: CARD reduced children's fear and improved vaccination experiences for children and parents when integrated in community pharmacy-based vaccinations.

Building and sustaining public and political commitment to the value of vaccination: Recommendations for the Immunization Agenda 2030 (Strategic Priority Area 2).

Vaccines have contributed to substantial improvements in health and social development outcomes for millions in recent decades. However, equitable access to immunization remains a critical challenge that has stalled progress toward improving several health indicators around the world. The COVID-19 pandemic has also negatively impacted routine immunization services around the world further threatening universal access to the benefits of lifesaving vaccines. To overcome these challenges, the Immunization Agenda 2030 (IA2030) focuses on increasing both commitment and demand for vaccines. There are three broad barriers that will need to be addressed in order to achieve national and subnational immunization targets: (1) shifting leadership priorities and resource constraints, (2) visibility of disease burden, and (3) social and behavioral drivers. IA2030 proposes a set of interventions to address these barriers. First, efforts to ensure government engagement on immunization financing, regulatory, and legislative frameworks. Next, those in subnational leadership positions and local community members need to be further engaged to ensure local commitment and demand. Governance structures and health agencies must accept responsibility and be held accountable for delivering inclusive, quality, and accessible services and for achieving national targets. Further, the availability of quality immunization services and commitment to adequate financing and resourcing must go hand-in-hand with public health programs to increase access to and demand for vaccination. Last, strengthening trust in immunization systems and improving individual and program resilience can help mitigate the risk of vaccine confidence crises. These interventions together can help ensure a world where everyone, everywhere has access to and uses vaccines for lifesaving vaccination.

COVID-19 vaccine policy development in a sample of 44 countries - Key findings from a December 2021 survey of National Immunization Technical Advisory Groups (NITAGs).

National Immunization Technical Advisory Committees (NITAGs) are tasked with the responsibility of guiding ministries of health and national immunization programmes in their policy development processes. Many NITAGs rely on evidence reviewed by the World Health Organization's (WHO) Strategic Group of Experts(SAGE) on immunization and aim to adapt WHO's recommendations to their respective contexts. This relationship took on exceptional importance since the onset of the COVID-19 pandemic, during which NITAGs have expressed a notable struggle to craft appropriate policies on population prioritization and vaccine utilization in the face of supply constraints and complex programmatic and delivery logistics. This online survey was conducted to assess the usefulness of the SAGE guidance documents for COVID-19 vaccine policies and to examine the persisting needs and challenges facing NITAGs. Results confirmed that SAGE recommendations concerning COVID-19 vaccines are easy to access, understand, and adapt. They have been found to be comprehensive and timely under the data and time constrained circumstances confronting SAGE. The Global NITAG Network (GNN) appears to be the most popular vehicle for addressing questions among high income countries, in contrast to lower income countries who favour WHO Country or Regional Offices. NITAGs place much value on interaction with other NITAGs, which requires facilitation and could benefit from increased opportunities, especially within regions. It is further noted that some NITAGs have had to tackle issues during the pandemic not typically considered by SAGE, such as supply chain logistics and vaccine demand. Learning from the COVID-19 experience offers opportunities to strengthen NITAGs and the pandemic recovery effort through the development of more concrete procedures and consideration of more varied types of data, including implementation effectiveness and uptake data. There is also an opportunity for an increasing involvement of Country Office WHO personnel to support NITAGs, while ensuring information and evidence needs of countries are adequately reflected in SAGE deliberations.

Report of the 2nd workshop of the International Collaboration on advanced vaccinology training.

At a workshop on 22-24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This included: an update to the landscape analysis of advanced vaccinology courses conducted in 2018, sharing experiences and good practices in the implementation of virtual training, reviewing the training needs of target audiences, informing courses of the principles, challenges, and added value of accreditation, discussing course evaluations and measurement of course impact, reviewing principles and support needed for quality cascade training, reviewing COVID-19 impact on training and identifying remaining related training needs, and identifying solutions to facilitate refresher courses and ways to facilitate networking of courses' alumni (particularly for virtual courses). The aims were to identify needs and impediments and implement necessary actions to facilitate sharing of information and resources between courses, to identify need for further developments of the e-Portal of the Collaboration (icavt.org) established to facilitate communication between the different courses and assist future course participants identify the most suitable course for them, and to discuss the formalization of the Collaboration. During the workshop, participants looked at several reports of surveys completed by courses and courses' alumni or partners. The COVID-19 pandemic impacted the delivery of some vaccinology courses leading to postponement, delivery online or hybrid training events. Lack of sustainable funding remained a major constraint for advanced vaccinology training and needs to be addressed. The Collaboration was consolidated with responsibilities and benefits for the members better defined. There was strong support for the Collaboration to continue with the organization of educational sessions at future workshops. The meeting re-enforced the view that there was much enthusiasm and commitment for the Global Collaboration and its core values.

Vaccines, Politics and Mandates: Can We See the Forest for the Trees? Comment on "Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates".

Under-vaccination is a complex problem that is not simple to address whether this is for routine childhood immunization or for coronavirus disease 2019 (COVID-19) vaccination. Vaccination mandates has been one policy instrument used to try to increase vaccine uptake. While the concept may appear straight forward there is no standard approach. The decision to shift to a more coercive mandated program may be influenced by both functional and/or political needs. With mandates there may be patient and/or public push back. Anti-mandate protests and increased public polarization has been seen with COVID-19 vaccine mandates. This may negatively impact on vaccine acceptance ie, be counterproductive, causing more harm than overall good in the longer term. We need a better understanding of the political and functional needs that drive policy change towards mandates as well as cases studies of the shorter- and longer-term outcomes of mandates in both routine and pandemic settings.

A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada.

Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.

Understanding the Influence of Web-Based Information, Misinformation, Disinformation, and Reinformation on COVID-19 Vaccine Acceptance: Protocol for a Multicomponent Study.

BACKGROUND: The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people's decision to refuse or delay recommended vaccination for themselves or their children. OBJECTIVE: The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines. METHODS: Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature. RESULTS: As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months. CONCLUSIONS: The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41012.

Transition to endemic: acceptance of additional COVID-19 vaccine doses among Canadian adults in a national cross-sectional survey.

BACKGROUND: Additional doses of COVID-19 vaccine have been proposed as solutions to waning immunity and decreased effectiveness of primary doses against infection with new SARS-CoV-2 variants. However, the effectiveness of additional vaccine doses relies on widespread population acceptance. We aimed to assess the acceptance of additional COVID-19 vaccine doses (third and annual doses) among Canadian adults and determine associated factors. METHODS: We conducted a national, cross-sectional online survey among Canadian adults from October 14 to November 12, 2021. Weighted multinomial logistic regression analyses were used to identify sociodemographic and health-related factors associated with third and annual dose acceptance and indecision, compared to refusal. We also assessed influences on vaccine decision-making, and preferences for future vaccine delivery. RESULTS: Of 6010 respondents, 70% reported they would accept a third dose, while 15.2% were undecided. For annual doses, 64% reported acceptance, while 17.5% were undecided. Factors associated with third dose acceptance and indecision were similar to those associated with annual dose acceptance and indecision. Previous COVID-19 vaccine receipt, no history of COVID-19 disease, intention to receive an influenza vaccine, and increasing age were strongly associated with both acceptance and indecision. Chronic illness was associated with higher odds of acceptance, while self-reported disability was associated with higher odds of being undecided. Higher education attainment and higher income were associated with higher odds of accepting additional doses. Minority first language was associated with being undecided about additional doses, while visible minority identity was associated with being undecided about a third dose and refusing an annual dose. All respondents reported government recommendations were an important influence on their decision-making and identified pharmacy-based delivery and drop-in appointments as desirable. Co-administration of COVID-19 and influenza vaccines was viewed positively by 75.5% of the dose 3 acceptance group, 12.3% of the undecided group, and 8.4% of the refusal group. CONCLUSIONS: To increase acceptance, targeted interventions among visible minority and minority language populations, and those with a disability, are required. Offering vaccination at pharmacies and through drop-in appointments are important to facilitate uptake, while offering COVID-19/influenza vaccine co-administration may have little benefit among those undecided about additional doses.

COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers.

Objectives: CARD (comfort, ask, relax, distract) is a vaccine delivery framework that includes interventions to improve the patient's experience. CARD has not been previously implemented in long-term care (LTC) settings. This study evaluated drivers to implementation for COVID-19 vaccinations in an LTC facility. Methods: Postimplementation interpretive evaluation including qualitative interviews and quantitative surveys with eight participants. The Consolidated Framework for Implementation Research (CFIR) was used for analysis. Adverse reactions to vaccinations and CARD interventions, including local reactogenicity and systemic reactions, were abstracted from medical charts of residents. Results: Eight CFIR constructs emerged. Staff perceived CARD was complex because it added steps to vaccination delivery. Motivated to meet residents' needs, a receptive implementation climate of support among staff led to using strategies within CARD, such as administering topical anesthetics and omitting alcohol skin antisepsis prior to injections. Having an effective network like the residents council positively influenced implementation by allowing residents to voice their opinions. Facilitators to implementation included staff knowledge and beliefs and staff's commitment to their organization, which was focused on person-centered care. Barriers included lack of available resources (inadequate staffing), insufficient communication between management and staff and lack of awareness of CARD, and external policies not aligned with CARD. Chart reviews conducted for 93 vaccinated residents corroborated perceptions of vaccination and CARD intervention safety, revealing a low rate of local and systemic adverse reactions and no cases of skin infection. Discussion: We identified positive and negative implementation drivers. Future research is recommended to expand the strategies employed and involve residents more directly.

Objectifs: Le système CARD (confort, aide, relaxation, distraction) est un cadre d'administration de vaccins qui comprend des interventions pour amèliorer l'expérience du patient. Le système CARD n'a pas été mis en œuvre précédemment dans les établissements de soins de longue durée. Cette étude a évalué les facteurs de sa mise en œuvre pour la vaccination contre la COVID-19 dans un établissement de soins de longue durée.Méthodes: Évaluation interprétative après la mise en œuvre, y compris des entretiens qualitatifs et des enquêtes quantitatives auprès de huit participants. Le Cadre consolidé pour la recherche sur la mise en œuvre (CFIR) a été utilisé pour l'analyse. Les effets indésirables à la vaccination et aux interventions CARD, y compris la réactogénicité locale et les réactions systémiques, ont été extraites des dossiers médicaux des résidentsRésultats: Huit construits du CFIR ont émergé. Le personnel a perçu que le système CARD était complexe car il ajoutait des étapes à la vaccination. Motivé à répondre aux besoins des résidents, un climat de mise en œuvre réceptif suscitant le soutien du personnel a conduit à l'utilisation de stratégies propres au système CARD, telles que l'administration d'anesthésiques topiques et l'omission de l'antisepsie cutanée à l'alcool avant les injections. Le fait d'avoir un réseau efficace comme le conseil des résidents a influencé positivement la mise en œuvre en permettant à ces derniers d'exprimer leurs opinions. Les facilitateurs de la mise en œuvre comprenaient les connaissances et les croyances du personnel et l'engagement de celui-ci envers l'organisation, qui mettait l'accent sur les soins centrés sur la personne. Les obstacles comprenaient le manque de disponibilité des ressources (effectifs insuffisants), l'insuffisance de la communication entre la direction et le personnel et le manque de connaissances au sujet de CARD, de même que les politiques externes non alignées avec le système CARD. Un examen des dossiers effectué pour 93 résidents vaccinés a corroboré les perceptions de la sécurité de la vaccination et de l'intervention CARD tout en révélant un faible taux d'effets indésirables locaux et systémiques et aucun cas d'infection cutanée.Discussion: Nous avons identifié des facteurs de mise en œuvre positifs et négatifs. Des recherches futures sont recommandées pour élargir les stratégies utilisées et impliquer plus directement les résidents.

Advanced vaccinology training globally: Update and impact of the COVID-19 crisis.

The rapid development of innovations and new technologies, the focus on the life-course approach to immunization and equity, and the prevalent hesitancy towards vaccines requires immunization staff to be well-trained and updated regularly in order to deliver quality immunization services to the public. The need for advanced vaccinology training is therefore paramount. In preparation for a second Global Workshop on Advanced Vaccinology Training that took place in March 2022, this paper presents the results of a survey aiming to provide a thorough update of a landscape analysis on advanced vaccinology courses conducted in 2018 and a look at the impact of the COVID-19 crisis. Thirty-three course organizers responded to a survey to provide information on their respective course. Of those, 17 courses are short courses, 11 post-graduate courses and 5 are Master level courses. Most courses are organized on an annual basis. Even though some courses were not sustained overtime, the number of courses has been increasing during the last few years, and at least one vaccinology course is now being offered in each WHO region. Although the training capacity has increased tremendously, the need still exceeds the capacity and many courses have way more applicants than they can select. The most frequent challenges reported included sustainable funding and identifying faculty. The COVID-19 pandemic impacted the delivery of several vaccinology courses, which have been postponed or reformatted to an online or hybrid training event. An e-portal of the global collaboration has been established to facilitate communication between the different courses and to assist future course participants to identify the most suitable course for their needs.