Transition to Endemic: Acceptance of Additional COVID-19 Vaccine Doses Among Canadian Adults in A National Cross-Sectional Survey

BackgroundAdditional 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. MethodsWe 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. ResultsOf 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. ConclusionsTo 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.

The emergence of SARS-CoV-2 variant(s) and its impact on the prevalence of COVID-19 cases in Nabatieh region, Lebanon

BackgroundAn outbreak of an unknown respiratory illness caused by a novel corona-virus, SARS-CoV-2, emerged in the city of Wuhan in Hubei province, China, in December 2019 and was referred to as coronavirus disease-2019 (COVID-19). Soon after, it was declared as a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 mainly infects the respiratory tract with different outcomes ranging from asymptomatic infection to severe critical illness leading to death. Different SARS-CoV-2 variants are emerging of which three have raised concerns worldwide due to their high transmissibility among populations. ObjectiveTo study the prevalence of COVID-19 in the region of Nabatieh - South Lebanon during the past year and assess the presence of SARS-CoV-2 variants and their effect on the spread of infection during times of lock-down. Methods: In our study, 37,474 nasopharyngeal swab samples were collected and analyzed for the detection of SARS-CoV-2 virus in suspected patients attending a tertiary health care center in South Lebanon during the period between March 16, 2020 and February 21, 2021. ResultsResults demonstrated a variation in the prevalence rates ranging from less than 1% during full lockdown of the country to 8.4% upon easing lockdown restrictions and reaching 27.5% after the holidays and 2021 New Year celebrations. Interestingly, a new variant(s) appeared starting January 2021 with a significant positive association between the prevalence of positive tests and the percentage of the variant(s). ConclusionOur results indicate that the lockdown implemented by the Lebanese officials presented an effective intervention to contain COVID-19 spread. Our study also showed that lifting lockdown measures during the holidays, which allowed indoor crowded gatherings to occur, caused a surge in COVID-19 cases and rise in the mortality rates nationwide. More importantly, we confirmed the presence of a highly transmissible SARS-CoV-2 variant(s) circulating in the Lebanese community, at least since January 2021 onwards.

Continuity of routine immunization programs in Canada during the COVID-19 pandemic

IntroductionIn Canada, the COVID-19 pandemic has interrupted many routine health services, placed additional strain on the health care system, and resulted in many Canadians being either unable or unwilling to attend routine immunization appointments. We sought to capture and synthesize information about changes to routine immunization programs in response to the pandemic and plans to catch-up any missed immunizations. MethodsProvincial/territorial (P/T) public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics: how routine immunization delivery was affected during and after initial lockdown periods, plans to catch-up missed doses, and major challenges and achievements in continuing routine immunization programs. Data were coded and categorized according to common responses and descriptive analysis was performed. ResultsInterviews occurred with participants from 11 of 13 P/Ts. School immunization programs were reported to be most negatively affected by the pandemic (n=9). In the early pandemic period, infant, preschool, and maternal/prenatal programs were prioritized, with most P/Ts continuing these services with adaptations for COVID-19. After the initial lockdown period, all routine programs were continuing with adaptations in most P/Ts. Infant, preschool, and school programs were most often targeted for catch-up through measures such as appointment rebooking and making additional clinics and/or providers available. Major challenges included resource limitations (e.g., staff shortages, PPE shortages, limited infrastructure) (n=11), public health restrictions (n=8), and public hesitancy to attend appointments (n=5). ConclusionsCanadian routine immunization programs faced some disruptions due to the COVID-19 pandemic, particularly the school, adult, and older adult programs. Further research is needed to determine the measurable impact of the pandemic on routine vaccine coverage levels.

Environmental scan of provincial and territorial planning for COVID-19 vaccination programs

BackgroundPublic health departments in Canada are currently facing the challenging task of planning and implementing COVID-19 vaccination programs. ObjectiveTo collect and synthesize information regarding COVID-19 vaccination programs in each of the provinces and territories (P/Ts). MethodsProvincial/territorial public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics, drawn from scientific literature and media: unique factors for COVID-19 vaccination, adoption of National Advisory Committee on Immunization (NACI) recommendations, priority groups for early vaccination, and vaccine safety and effectiveness monitoring. Data were grouped according to common responses and descriptive analysis was performed. ResultsEighteen interviews occurred with 25 participants from 11 of 13 P/Ts. Factors unique to COVID-19 vaccination included prioritizing groups for early vaccination (n=7), public perception of vaccines (n=6), and differing eligibility criteria (n=5). Almost all P/Ts (n=10) reported reliance on NACI recommendations. Long-term care residents (n=10) and health care workers (n=10) were most frequently prioritized for early vaccination, followed by people with chronic medical conditions (n=9) and seniors (n=8). Most P/Ts (n=9) are planning routine adverse event monitoring to assess vaccine safety. Evaluation of effectiveness was anticipated to occur within public health departments (n=3), by researchers (n=3), or based on national guidance (n=4). ConclusionPlans for COVID-19 vaccination programs in the P/Ts exhibit some similarities and are largely consistent with NACI guidelines, with some discrepancies. Further research is needed to evaluate the success of COVID-19 vaccination programs once implemented.