Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada.

BACKGROUND: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination.

During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.

Waking Up to Monkeypox in the Midst of COVID-19.

The first incidence of the monkeypox virus (MPXV) was reported in a Danish research facility. Even though first discovered in monkeys, rodents account for the largest reservoir of the disease. It is an encapsulated, brick-shaped double-stranded DNA virus strongly related to the smallpox virus. The risk of acquiring MPXV has been found to be inversely related to smallpox vaccination. Although the cases were initially restricted to African countries, they were first reported outside Africa in the early 2000s. MPXV is transmitted through close personal contact, most commonly through direct skin-skin contact. The fatality rates associated with the MPXV tend to vary in different regions, with Congo clad basin having the highest mortality rate. The majority of the cases of MPXV have been reported in men who have sex with men. Although optimal infection control and treatment strategies are under investigation, the current management focus is on immunization and the isolation of patients. Effective control strategies are based on implementing a method of contact tracing, quarantining exposed and infected individuals, and using vaccines. There is no proven cure for MPXV, and most infected patients recover without medical intervention. Extensive studies are being conducted to determine the efficacy of antivirals in managing MPXV, with tecovirimat being the first antiviral medication approved by the Food and Drug Administration (FDA) to manage MPXV. The smallpox vaccine has traditionally been thought of as the most effective method of controlling the infection, possibly due to the similarities between the two viruses. However, numerous obstacles prevent the effective control of MPXV, including social isolation and stigma, poor understanding of the disease dynamics, lack of adequate patient education, and public health strategies.

The Ethical Significance of Post-Vaccination COVID-19 Transmission Dynamics.

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle.

The United Kingdom legislative response to coronavirus: Shotgun or machine gun

The United Kingdom's (UK) response to the coronavirus pandemic has been rooted in law. The legislation has covered a huge scope of social and commercial life in the UK, from lockdown measures, international travel, financial support, and vaccines. This chapter assesses the British response to the pandemic in the context of the UK's legal system and legislative processes. It describes the nature of the legal and institutional frameworks and the legislative response to the pandemic. The chapter addresses the use of emergency powers, and assesses restrictions on civil liberties and vaccination policy. It then details some problems posed by the manner in which the British pandemic response was handled within the framework of British law. A sunset clause is a provision in legislation that states that it will end or expire on a particular date. There are several variations on this general theme. © 2023 John Wiley & Sons, Inc.

Understanding and Improving Vaccine Effectiveness Estimates in the Age of Widespread Background Immunity: A Step Toward Improved Science Communication.

Medical decision making and scientific communication around coronavirus disease 2019 (COVID-19) vaccines and booster doses requires proper understanding of how vaccine effectiveness estimates are determined and the potential biases inherent in current estimates. The importance of background immunity from prior infection is reviewed along with ideas for improving the vaccine effectiveness estimates.

Strategia vaccinale in un contesto incerto e in costante evoluzione.

Politics is facing the need to make important decisions about anti-COVID-19 vaccination campaign in uncertain and changing contexts. With reference to the time frame between the administration of the first and second dose, the scientific evidence is still weak and comes from different contexts. New ways to collect and synthesize expert knowledge and opinions are needed with the direct involvement of the citizens in order to explain the uncertainties and maintain trust in institutions and their decisions.

The third vaccine dose significantly reduces susceptibility to the B.1.1.529 (Omicron) SARS-CoV-2 variant.

The main coronavirus disease 2019 (COVID-19) vaccine formulations used today are mainly based on the wild-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein as an antigen. However, new virus variants capable of escaping neutralization activity of serum antibodies elicited in vaccinated individuals have emerged. The Omicron (B.1.1.529) variant caused epidemics in regions of the world in which most of the population has been vaccinated. In this study, we aimed to understand what determines individual's susceptibility to Omicron in a scenario of extensive vaccination. For that purpose, we collected nasopharynx swab (n = 286) and blood samples (n = 239) from flu-like symptomatic patients, as well as their vaccination history against COVID-19. We computed the data regarding vaccine history, COVID-19 diagnosis, COVID-19 serology, and viral genome sequencing to evaluate their impact on the number of infections. As main results, we showed that vaccination in general did not reduce the number of individuals infected by Omicron, even with an increased immune response found among vaccinated, noninfected individuals. Nonetheless, we found that individuals who received the third vaccine dose showed significantly reduced susceptibility to Omicron infections. A relevant evidence that support this finding was the higher virus neutralization capacity of serum samples of most patients who received the third vaccine dose. In summary, this study shows that boosting immune responses after a third vaccine dose reduces susceptibility to COVID-19 caused by the Omicron variant. Results presented in this study are useful for future formulations of COVID-19 vaccination policies.

Factors of influenza vaccine inoculation and non-inoculation behavior of community-dwelling residents in Japan: Suggestions for vaccine policy and public health ethics after COVID-19.

The aim of this study is to provide basic information that contributes to vaccine inoculation policy after COVID-19. We used the secondary data of the influenza vaccine inoculation behavior survey for community-dwelling adults conducted in 2011, before the COVID-19 pandemic, but after the 2009 novel influenza A (H1N1) pdm 09 pandemic. All factors such as socio-demographic characteristics, health-related behaviors, family environment, physical and social environment, and area of residence were adjusted, and factors related to vaccine inoculation behavior were analyzed. Those living with pregnant women had a significantly higher odds ratio of inoculation; this was self-evident in that those people considered infection to their family. Regarding the social environment, those aged 20-64 years with a significantly higher adjusted odds ratio of inoculation were those with "at least five people with which they interacted in the neighborhood". This result can be interpreted in two ways relating to altruism in Japan. Finally, we indicated the importance of learning from the past, including the case of 2009.

A Novel Modeling and Analysis of Fractional-Order COVID-19 Pandemic Having a Vaccination Strategy

Recently, many illustrative studies have been performed on the mathematical modeling and analysis of COVID-19. Due to the uncertainty in the process of vaccination and its efficiency on the disease, there have not been taken enough studies into account yet. In this context, a mathematical model is developed to reveal the effects of vaccine treatment, which has been developed recently by several companies, on COVID-19 in this study. In the suggested model, as well as the vaccinated individuals, a five-dimensional ordinary differential equation system including the susceptible, infected, exposed and recovered population is constructed. This mentioned system is considered in the fractional order to investigate and point out more detailed analysis in the disease and its future prediction. Moreover, besides the positivity, existence and uniqueness of the solution, biologically feasible region are provided. The basic reproduction number, known as expected secondary infection which means that expected infection among the susceptible populations caused by this infection, is computed. In the numerical simulations, the parameter values taken from the literature and estimated are used to perform the solutions of the proposed model. In the numerical simulations, Adams-Bashforth algorithm which is a well-known numerical scheme is used to obtain the results. © 2022 American Institute of Physics Inc.. All rights reserved.

Effectiveness of Bacille Calmette-Guerin vaccination policies in reducing infection and mortality of COVID-19: a systematic review.

BACKGROUND: COVID-19 vaccination has been advocated as the most effective way to curb the pandemic. But with its inequitable distribution and slow rollout, especially in low- to middle- income countries, it will still take a long time before herd immunity is achieved. Alternative measures must therefore be explored to bolster current COVID-19 vaccination efforts. In particular, the Bacille Calmette-Guerin vaccine has been studied extensively as to its proposed conferment of non-specific immunity against different infections, including COVID-19. The aim of this study, therefore, is to evaluate the current evidence on the effectiveness of national BCG vaccination policies in reducing infection and mortality of COVID-19. METHODS: A systematic review was conducted between April to August 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA-P) guidelines. Literature was retrieved from PubMed, Cochrane, HERDIN, Web of Science, EBSCO, and Western Pacific Region Index Medicus (WPRIM). Studies conducted from January 2020 to August 2021 that fell within Level 1A to 2C of the Oxford Center for Evidence-Based Medicine were included in the review. Quality assessment was performed using the appropriate Joanna Briggs Institute critical appraisal tool and a quality assessment checklist for ecological studies adapted from Betran et al. RESULTS: A total of 13 studies were included in this review. Nine studies reported significant association between BCG vaccination policies and COVID-19 outcomes, even when controlling for confounding variables. In addition, among other mandated vaccines, such as pneumococcal, influenza, diphtheria-tetanus-pertussis, and measles, only BCG vaccination showed significant association with decreased COVID-19 adverse outcomes. However, other factors also showed positive association with COVID-19 outcomes, particularly markers of high economic status of countries, higher median age, and greater population densities. CONCLUSION: The lower incidence and mortality of COVID-19 in countries with mandated BCG vaccination may not solely be attributable to BCG vaccination policies, but there is still some evidence that demonstrates a possible protective effect. Clinical trials must be continued before recommendations of BCG vaccinations are to be used as an alternative or booster vaccine against COVID-19.

Effectiveness of COVID-19 Vaccination Mandates and Incentives in Europe.

During 2021-2022 many countries in the European region of the World Health Organization (WHO) adopted mandatory and incentive-based vaccination measures to stimulate immunization against COVID-19. The measures ranged from positive incentive-based programs (i.e., cash incentives, meal discounts, and lotteries) to introducing COVID-19 certificates and enforcing the universal mandatory vaccination with fines. We assessed the effect of such interventions on COVID-19 vaccine uptake in the population of eight countries within the region. An interrupted time series (ITS) analysis was performed using an autoregressive integrated moving average (ARIMA) approach to account for autocorrelation and seasonality. The results showed the immediate positive impact of vaccination incentives on vaccine uptake in most cases, with the highest impact being cash incentives for the population (1197 per million population per day). Discount incentives did not show any significant impact. The introduction of COVID-19 certificates was associated with a significant immediate or gradual increase in daily administered vaccine doses in all the countries included in the study, up to 117,617 doses gained per million per month. The effect of mandatory vaccination for all or some groups of the population varied from a continuous decrease in daily administered doses (332 per million capita per day), no significant effect, or a delayed or temporary increase (1489 per million capita per day).

A policy review of the introduction of the MenACWY vaccine in toddlers across multiple countries.

INTRODUCTION: Immunization is the best strategy to protect individuals from invasive meningococcal disease (IMD). To support decision-making around immunization, this paper considers what has led four countries and regions of two more to introduce the quadrivalent MenACWY vaccine in toddlers (ages 12-24 months). AREAS COVERED: A narrative literature review was conducted to identify countries that have introduced a MenACWY vaccination program for toddlers. Information from peer-reviewed publications, reports, and policy documents for each identified country was extracted. Australia, Chile, the Netherlands, Switzerland, and regions of Italy and Spain have introduced the MenACWY vaccine in their toddler programs, driven by the rising incidence of MenW and MenY and the vaccine's ability to provide protection against other serogroups. Australia and the Netherlands considered the economic impacts of implementing a MenACWY toddler vaccination program. Vaccination uptake and effects are reported for three countries; however, in two, isolating the vaccine's effect from the collateral effect of COVID-related measures is difficult. EXPERT OPINION: Increased convergence of vaccination policies and programs is needed internationally, as IMD recognizes no borders.PL AIN LANGUAGE SUMMARYVaccination is the best defense against meningitis, a deadly disease. While someone of any age can contract it, children 0-24 months of age are disproportionately affected. The increasing number of cases of meningitis has led four countries plus regions of two more to introduce into their vaccination schedules for toddlers (ages 12-24 months) a vaccine that protects against four different serogroups rather than one serogroup alone. This paper considers what has driven that shift.

Impact of Vaccination and Testing in an Urban Campus Model for the SARS-CoV-2 Pandemic

The crisis induced by the Coronavirus pandemic severely impacted educational institutes. Even with vaccination efforts underway in 2021, it was not clear that sufficient confidence will be achieved for schools to reopen soon. This paper considers the impact of testing rates in addition to vaccination rates in order to reduce infections and hospitalizations and evaluates strategies that allow educational institute in urban settings to remain open. These strategies are also applicable to big campus style businesses and would help planning to keep the businesses open and help the economy. Our analysis is based on a graph model where nodes represent population groups and edges represent population exchanges due to commuting populations. The commuting population is associated with edges and is associated with one of the end nodes of the edge during part of the time period and with the other node during the remainder of the time period. The progression of the disease at each node is determined via compartment models, that include vaccination rates and testing to place infected people in quarantine along with consideration of asymptomatic and symptomatic populations. Applying this to a university population in Chicago with a substantial commuter population, chosen to be 80% of the school's population as an illustration, provides an analysis which specifies benefits of testing and vaccination strategies over a time period of 150 days. © 2022 Owner/Author.

Anticipating hopes, fears and expectations towards COVID-19 vaccines: A qualitative interview study in seven European countries.

Vaccine uptake is essential to managing the ongoing COVID-19 pandemic, and vaccine hesitancy is a persistent concern. At the same time, both decision-makers and the general population have high hopes for COVID-19 vaccination. Drawing from qualitative interview data collected in October 2020 as part of the pan-European SolPan study, this study explores early and anticipatory expectations, hopes and fears regarding COVID-19 vaccination across seven European countries. We find that stances towards COVID-19 vaccines were shaped by personal lived experiences, but participants also aligned personal and communal interests in their considerations. Trust, particularly in expert institutions, was an important prerequisite for vaccine acceptance, but participants also expressed doubts about the rapid vaccine development process. Our findings emphasise the need to move beyond the study of factors driving vaccine hesitancy, and instead to focus on how people personally perceive vaccination in their particular social and political context.

Impact of prioritized vaccinations for the elderly on the COVID-19 pandemic in Japan.

The Japanese government implemented a large-scale vaccination policy against the coronavirus disease 2019 (COVID-19) pandemic, primarily using messenger RNA vaccines in 2021. Its hallmark was prioritized vaccination for the elderly after healthcare workers in a short period of time. Vaccination for the elderly, vulnerable to infection and severe disease, was carried out rapidly in approximately 4 months since April 2021. We evaluated the impact of Japan's vaccination policy against COVID-19 during the pandemic, with a particular focus on how prioritized vaccination for the elderly affected the pandemic. We observed a remarkable decrease in the number of infections, cluster events in long-term care facilities, and severe disease among the elderly during the fifth wave (August 2021) despite rising incidence of infections in the overall population. In conclusion, we think that prioritized vaccination for the elderly was efficacious in preventing infections and severe COVID-19 among the elderly during the fifth wave in Japan.

Level of Acceptance of Mandatory Vaccination and Legal Sanctions for Refusing Mandatory Vaccination of Children.

A preventive vaccination program is in operation in Poland. There are mandatory vaccinations for Polish residents under the age of 19 years. The law provides for financial penalties for parents who refuse to vaccinate their children. The aim of this study was to describe the attitudes of Polish residents aged 15-39 years to mandatory preventive vaccination and the level of acceptance for legal and financial sanctions for refusing mandatory vaccination of children. MATERIALS AND METHODS: A face-to-face questionnaire-based study of a representative sample of 1560 residents of Poland aged 15-39 years. Data was collected in the fourth quarter of 2021. RESULTS: In the study group, 51.5% of the respondents believed that preventive vaccination should be mandatory, and parents should have the right to decide only about additional vaccinations. Multivariate analyses (logistic regression) revealed a significant association between acceptance of mandatory vaccination and the following factors: positive COVID-19 vaccination status, self-declared religiosity, and having children. Of the 1560 respondents, 25.3% declared support for legal or financial sanctions for those refusing to vaccinate their children. In this group (n = 394), the highest percentage of respondents (59.4%) supported sanctions in the form of refusal to admit an unvaccinated child to a nursery or kindergarten. CONCLUSIONS: Despite preventive (mandatory) vaccination programs having been in operation in Poland since the 1960's, only a little over 50% of adolescent Poles and young adults accept the vaccine mandate. Only 25% of this group declare their support for sanctions for refusing mandatory vaccination of children.

A nonlinear optimal control method against the spreading of epidemics

To define a vaccination policy and antiviral treatment against the spreading of viral infections a nonlinear optimal (H-infinity) control approach is proposed. Actually, because of the scarcity of the resources for treating infectious diseases in terms of vaccines, antiviral drugs and other medical facilities, there is need to implement optimal control against the epidemics deployment. In this approach, the state-space model of the epidemics dynamics undergoes first approximate linearization around a temporary operating point which is recomputed at each time-step of the control method. The linearization is based on Taylor series expansion and on the computation of the associated Jacobian matrices. Next, an optimal (H-infinity) feedback controller is developed for the approximately linearized model of the epidemics. To compute the controller's feedback gains an algebraic Riccati equation is solved at each iteration of the control algorithm. Furthermore, the global asymptotic stability properties of the control scheme are proven through Lyapunov stability analysis. This paper's results confirm that optimal control of the infectious disease dynamics allows for eliminating its spreading while also keeping moderate the consumption of the related medication, that is vaccines and antiviral drugs.

Does Bacillus Calmette-Guerin vaccination protects from COVID-19? A Uni-center Study

Bacillus Calmette-Guerin (BCG) is a vaccine for tuberculosis and is administered at birth in several countries, however there are many countries that have no BCG vaccination policy and coincidently they are worst hit by Covid-19 pandemic in terms of disease severity and mortality.The study was conducted to determine the association between BCG vaccine and COVID-19 severity. Study included total 150 participants visiting Department of Medicine, Mayo Hospital, Lahore, Pakistan. Data regarding BCG vaccination, comorbidity, demographics, disease severity were collected through self-structured questionnaire using non-probability convenient sampling. Prior written informed consents were taken from the participants. Male and female were in equal proportion. 68.6% were married, only 3.9% were smokers. Analysis revealed that only 10 (6.5%) were hypertensive and10 (6.5%) were diabetic. There was no BCG vaccine protection against Covid-19 in the current study. Severity of disease was similar in vaccinated and non-vaccinated patients. But it can not be applicable to whole population. Another fact is that most of Pakistani population is BCG vaccinated due to national policy and coincidently Pakistan suffered less as compared to high hit countries. There maybe some association between BCG vaccination and Covid-19 or some other environmental factor and genetics that need to be explored.