Vaccination Mandates-An Old Public Health Tool Faces New Challenges.

This Viewpoint discusses how federal vaccine requirements have helped thwart vaccine-preventable diseases as well as how growing public resistance to vaccines and judicial and legislative limits to vaccination mandates may change that.

Recomendação nº 027, de 17 de setembro de 2021: recomenda ao Ministério da Saúde a manutenção da vacinação de todos os adolescentes de 12 a 17 anos no Plano Nacional de Vacinação contra a Covid-19 para toda a população brasileira, entre outras medidas / Recommendation No. 027, of September 17, 2021: recommends that the Ministry of Health maintain the vaccination of all adolescents between 12 and 17 years old in the National Vaccination Plan against Covid-19 for the entire Brazilian population, among other measures

Recomenda ad referendum do Pleno do Conselho Nacional de Saúde ao Ministério da Saúde: I - Tornar sem efeito, com base em dados de segurança definidos pela Anvisa e nas evidências científicas, a Nota Informativa no 1/2021- SECOVID/GAB/SECOVID/MS; II - Manter a vacinação de todos os adolescentes de 12 a 17 anos no Plano Nacional de Vacinação contra a Covid-19, sem desconsiderar a necessidade de priorizar, neste momento, aqueles com comorbidade, deficiência permanente e em situação de vulnerabilidade, inclusive socioeconômica; III - Realizar uma campanha de mídia reforçando: a) a segurança das vacinas contra a Covid-19 incorporadas no PNI, inclusive em adolescentes de 12 a 17 anos, e, b) a importância da conclusão do esquema vacinal completo (2a dose ou dose única); e IV - Disponibilizar, de forma imediata, a quantidade suficiente de doses para a vacinação completa contra a Covid-19 de toda a população de 12 anos e mais.

Perceived enablers and barriers of community engagement for vaccination in India: Using socioecological analysis.

BACKGROUND: There is high level policy consensus in India that community engagement (CE) improves vaccination uptake and reduces burden of vaccine preventable diseases. However, to date, vaccination studies in the country have not explicitly focused on CE as an outcome in and of itself. Therefore, this study sought to examine the barriers and enablers of community engagement for vaccination in India. METHODS: Employing qualitative methods, twenty-five semi-structured elite interviews among vaccine decisionmakers' were triangulated with twenty-four national-level vaccine policy documents and researcher field notes (December 2017 to February 2018). Data collected for this study included perceptions and examples of enablers of and barriers to CE for vaccination uptake. Concepts, such as the absence of formal procedures or data collection approaches related to CE, were confirmed during document review, and a final convening to review study results was conducted with study respondents in December 2018 and January 2019 to affirm the general set of findings from this study. The Social Ecological Model (SEM) was used to organize and interpret the study findings. RESULTS: Although decisionmakers and policy documents generally supported CE, there were more CE barriers than facilitators in the context of vaccination, which were identified at all social-ecological levels. Interviews with vaccine decisionmakers in India revealed complex systemic and structural factors which affect CE for vaccination and are present across each of the SEM levels, from individual to policy. Policy-level enablers included decisionmakers' political will for CE and policy documents and interviews highlighted social mobilization, whereas barriers were lack of a CE strategy document and a broad understanding of CE by decisionmakers. At the community level, dissemination of Social-behavioral Change Communication (SBCC) materials from the national-level to the states was considered a CE facilitator, while class, and caste-based power relations in the community, lack of family-centric CE strategies, and paternalistic attitude of decisionmakers toward communities (the latter reported by some NGO heads) were considered CE barriers. At the organizational level, partnerships with local organizations were considered CE enablers, while lack of institutionalized support to formalize and incentivize these partnerships highlighted by several decisionmakers, were barriers. At the interpersonal level, SBCC training for healthcare workers, sensitive messaging to communities with low vaccine confidence, and social media messaging were considered CE facilitators. The lack of strategies to manage vaccine related rumors or replicate successful CE interventions during the during the introduction and rollout of new vaccines were perceived as CE barriers by several decisionmakers. CONCLUSION: Data obtained for this study highlighted national-level perceptions of the complexities and challenges of CE across the entire SEM, from individual to systemic levels. Future studies should attempt to associate these enablers and barriers with actual CE outcomes, such as participation or community support in vaccine policy-making, CE implementation for specific vaccines and situations (such as disease outbreaks), or frequency of sub-population-based incidents of community resistance and community facilitation to vaccination uptake. There would likely be value in developing a population-based operational definition of CE, with a step-by-step manual on 'how to do CE.' The data from this study also indicate the importance of including CE indicators in national datasets and developing a compendium documenting CE best-practices. Doing so would allow more rigorous analysis of the evidence-base for CE for vaccination in India and other countries with similar immunization programs.

Is the tuberculosis vaccine BCG an alternative weapon for developing countries to defeat COVID-19?

BACKGROUD: Coronavirus disease (COVID-19) is a new respiratory infectious disease, and there is no vaccine currently. Previous studies have found that BCG vaccination can provide extensive protection against respiratory infectious diseases. METHODS: Herein, we obtained the latest data from the World Health Organization (WHO) as of August 12, 2020, and determined the relationship between three parameters (including the BCG vaccination coverage, human development index (HDI), and transmission classifications) and the incidence rate and mortality of COVID-19. RESULTS: The results showed that the morbidity and mortality of COVID-19 in countries with BCG vaccination recommendation were significantly lower than these in countries without BCG vaccination recommendation, and countries with lower HDI have lower morbidity and mortality. In addition, we also found that the mode of virus transmission is also related to the morbidity and mortality of COVID-19. CONCLUSIONS: Although our data supports the hypothesis that BCG vaccination is beneficial in reducing the morbidity and mortality of COVID-19, the data supporting this result may be inaccurate due to many confounders such as PCR testing rate, population characteristics, and protection strategies, the reliability of this result still needs to be verified by clinical trials.

In the Wake of a Pandemic: Revisiting School Approaches to Nonmedical Exemptions to Mandatory Vaccination in the US.

Mandatory school vaccination policies with exclusion of unvaccinated students can be a powerful tool in ensuring high vaccination rates. Some parents may object to mandatory vaccination policies, claiming exemptions based on medical, religious, or philosophical reasons. Individual schools, school systems, or local or regional governments have different policies with respect to whether, and what kind of, exemptions may be allowed. In the setting of the current pandemic, questions regarding the acceptability of exemptions have resurfaced, as schools and local governments struggle with how to safely return children to school. Anticipating that school attendance will be facilitated by the development of a vaccine, school systems will face decisions about whether to mandate vaccination and whether to permit exemptions. The American Academy of Pediatrics promulgates policy favoring the elimination of nonmedical exemptions generally in schools. This discussion considers whether schools should eliminate nonmedical exemptions to vaccination as proposed in the American Academy of Pediatrics policy, ultimately concluding that broad elimination of exemptions is not justified and advocating a more nuanced approach that encourages school attendance while promoting vaccination and broader public health goals.

Increasing influenza vaccination coverage in healthcare workers: a review on campaign strategies and their effect.

PURPOSE: Increasing influenza vaccination coverage in healthcare workers is a challenge. Especially during the ongoing COVID-19 pandemic, high vaccination coverage should be attained. This review analyzed strategies to increase influenza vaccination coverage in healthcare workers. METHODS: A literature search using PubMed was conducted and 32 publications on influenza vaccination campaigns for healthcare workers were reviewed for key interventions and resulting vaccination coverage. RESULTS: Among key interventions analyzed, mandatory vaccination policies or multifaceted campaigns including a vaccinate-or-wear-a-mask policy as well as mandatory declination reached vaccination coverage in healthcare workers of over 90%. Although campaigns solely based on education and promotion or on-site-vaccination did not regularly exceed an absolute vaccination coverage of 40%, a substantial relative increase in vaccination coverage was reached by implementation of these strategies. CONCLUSION: Mandatory vaccination policies are effective measures to achieve high overall vaccination coverage. In clinics where policies are infeasible, multifaceted campaigns comprising on-site vaccination, vaccination stands and educational and promotional campaigns as well as incentives should be implemented. Lessons learned from influenza campaigns could be implemented in future SARS-CoV-2 vaccination campaigns.

WebPalestra: Lei estadual nº 10.913/2018 – O cartão de vacina nas escolas

Lei estadual nº 10.913/2018 – operacionalização sobre a apresentação do cartão de vacinação na matrícula das escolas públicas e privadas.

The last strategy for re-dissemination of HPV vaccination in Japan while still under the suspension of the governmental recommendation.

In Japan, the governmental recommnendation of HPV vaccine has been suspended since June 2013, due to media reports of alleged adverse vaccination events. Although evidence of effectiveness and safety of the HPV vaccine has been universally demonstrated, and the medical and academic organizations across Japan have requested the resumption of the government's recommendation, the Japanese government has not changed their official stance towards the HPV vaccine. Under the current suspension of the national government's recommendation, one local government Isumi City started sending a leaflet containing information of cervical cancer and HPV vaccine, but not recommendation for the vaccine, to the tagted girls born in the fiscal year (FY) 2003. The cumulative vaccination rate of them reached 10.07% (14/139), which was significantly higher than that (0.00%) for girls born in FY 2002 who did not receive such a leaflet (p < 0.001). We sincerely ask the national government to change their stance towards the HPV vaccine. We also strongly suggest that, in the meantime, local governments immediately begin to provide an appropriate information of cervical cancer and HPV vaccine to the targeted girls and their parents in a way similar to what Isumi City has now shown to be effective.

Policy Views and Negative Beliefs About Vaccines in the United States, 2019.

Objectives. To determine whether holding vaccine misconceptions, in the form of negative beliefs about vaccines, correlates with opposing governmental action at all levels designed to increase vaccination (e.g., removing personal belief and religious vaccine exemptions).Methods. Drawing on data from a nationally representative survey of 1938 US adults, we assessed the relation between negative beliefs about vaccines and provaccination policies.Results. Beyond sociodemographic and policy-relevant variables, such as gender and partisan affiliation, questionable negative beliefs about vaccines are the strongest predictor of opposition to policies designed to increase vaccination.Conclusions. Negative beliefs about vaccines in the general population may thwart the passage or implementation of policies designed to increase vaccination. Implementing strategies that reduce these negative beliefs should be a priority of educators and public health officials.

Talk to Patients About: What's Wrong With Vaccine Exemptions?

In 2003, the Texas Legislature allowed parents to opt their children out of getting mandatory public school vaccines. Since then, exemptions have jumped more than 3,000%, to 72,743 statewide, according to the Texas Department of State Health Services. That number of exemptions threatens "herd" or "community" immunity for vaccine-preventable diseases.

On the influenza vaccination policy through mathematical modeling.

OBJECTIVES: Aimed at mitigating influenza transmission, this study assessed the timing of the vaccination program and took vaccine capacity, strain mismatch and priority group into consideration. METHODS: An age-structured dynamic transmission model was fitted to the laboratory data of the national influenza surveillance system to reconstruct a baseline scenario with which the vaccination scenarios of interest could be compared. Outcome measures were defined as the impacts on the seasonal epidemic: decompression of the epidemic peak, reduction of the epidemic burden and change of the epidemic peak time. RESULTS: It was found that vaccine capacity building, although indispensable, could not guarantee substantial impact on the seasonal influenza epidemic. Vaccine mismatch might greatly offset vaccine capacity building. Notably, advance vaccine distribution could compensate for some vaccine underperformance. In the case of a well-matched vaccine, advance vaccine distribution could even exploit its utility. CONCLUSIONS: This study indicated that timely vaccine distribution should be put high on the agenda of seasonal influenza control policies. It provided a tangible platform for the policymakers to evaluate health policy impacts and to enhance risk communication with the public through mathematical modeling.