When mistrust in the government and scientists reinforce social inequalities in vaccination against Covid-19

ObjectiveTo assess whether mistrust in the government and scientists reinforces social and racial inequalities in vaccination practises DesignA follow-up of a random population-based cohort survey. SettingIn July 2021, in France. Participants80,971 participants aged 18 years and more. Main outcome measuresAdjusted odds ratios of Covid-19 vaccination status (received at least one dose/ intends to get vaccinated/ does not know whether to get vaccinated/refuses vaccination) were assessed using multinomial regressions to test associations with social and mistrust factors and to study how these two factors interacted with each other. ResultsIn all, 72.2% were vaccinated at the time of the survey. The population of unvaccinated people was younger, less educated, had lower incomes, and more often belonged to racialised minorities, as compared to vaccinated people. Mistrust of government and scientists to curb the spread of the epidemic were the factors most associated with refusing to be vaccinated: OR=8.86 (7.13 to 11.00) for the government and OR=9.07 (7.71 to 10.07) for scientists, compared to vaccinated people. Mistrust was more prevalent among the poorer which consequently reinforced social inequalities in vaccination. The 10% poorest who did not trust the government reached an OR of 16.2 (11.9 to 22) for refusing to be vaccinated compared to the 10% richest who did. ConclusionThere is a need to develop depoliticised outreach programmes targeted at the most socially disadvantaged groups, and to design vaccination strategies conceived with people from different social and racial backgrounds to enable them to make fully informed choices.

Trends in social exposure to SARS-Cov-2 in France. Evidence from the national socio-epidemiological cohort - EPICOV

BackgroundWe aimed to study whether social patterns of exposure to SARS-CoV-2 infection changed in France throughout the year 2020, in light to the easing of social contact restrictions. MethodsA population-based cohort of individuals aged 15 years or over was randomly selected from the national tax register to collect socio-economic data, migration history, and living conditions in May and November 2020. Home self-sampling on dried blood was proposed to a 10% random subsample in May and to all in November. A positive anti-SARS-CoV-2 ELISA IgG result against the virus spike protein (ELISA-S) was the primary outcome. The design, including sampling and post-stratification weights, was taken into account in univariate and multivariate analyses. ResultsOf the 134,391 participants in May, 107,759 completed the second questionnaire in November, and respectively 12,114 and 63,524 were tested. The national ELISA-S seroprevalence was 4.5% [95%CI: 4.0%-5.1%] in May and 6.2% [5.9%-6.6%] in November. It increased markedly in 18-24-year-old population from 4.8% to 10.0%, and among second-generation immigrants from outside Europe from 5.9% to 14.4%. This group remained strongly associated with seropositivity in November, after controlling for any contextual or individual variables, with an adjusted OR of 2.1 [1.7-2.7], compared to the majority population. In both periods, seroprevalence remained higher in healthcare professions than in other occupations. ConclusionThe risk of Covid-19 infection increased among young people and second-generation migrants between the first and second epidemic waves, in a context of less strict social restrictions, which seems to have reinforced territorialized socialization among peers.

Social inequalities in hostility toward vaccination against Covid-19

In recent decades, France has appeared as a country particularly hostile to vaccination in general. When asked in November 2020 about the intention to take the Covid-19 vaccine, the French public showed, once again, reluctance. Therefore, France appeared as an ideal case study to analyze whether the hostility toward the Covid-19 vaccine has its own reasons or whether it is related to the reluctance to the principle of vaccination itself. Our objective was to determine the specificity of the social determinants of the intention to get the Covid-19 vaccine. Thanks to the use of a large random sample of the general population in France (86,000 individuals), the reluctant to Covid-19 vaccine could be clearly distinguished from the hesitant and the convinced, and thereby thoroughly analyzed. Our analysis highlighted a gendered reluctance toward vaccination in general but even more so regarding vaccination against Covid-19. It might refer to women being more concerned about the possible effects of an injection in their body, especially at the age of maternity and a differentiated socialization making them more sensitive than men to long-term risks and more apprehensive toward rapid technological change. We also found that people at the bottom of the social hierarchy, in terms of level of education, financial resources, and immigration status, were more likely to refuse the Covid-19 vaccine. Nevertheless, this reluctance was less prominent than for vaccination in general, reflecting the actual spread of the epidemic in various social milieux. Finally, our analysis showed that trust in the governments actions was significantly associated with reluctance toward the Covid-19 vaccine, even more than toward vaccination in general. Specific campaigns should be thought beforehand to reach women and people at the bottom of the social hierarchy to avoid furthering social inequalities in terms of morbidity and mortality.

A national mixed-mode seroprevalence random population-based cohort on SARS-CoV-2 epidemic in France: the socio-epidemiological EpiCov study

Backgroundthe EpiCov study, initiated at the end of the first national lockdown in France, aimed to provide national and regional estimates of the seroprevalence of SARS-CoV-2 infection, and to analyze relations between living conditions and the dynamics of the epidemic. We present and discuss here the survey methodology, and describe the first-round fieldwork. Method371,000 individuals aged 15 years or more were randomly selected from the national tax register, stratified by departments, including three overseas departments, and by poverty level with over-representation of people living below the poverty line. Health, socio-economics, migration history, and living conditions were collected through self-computed-assisted web interviews or via computer-assisted telephone interviews. The first-round survey was conducted in May. A random subsample was eligible to receive material for home blood self-sample on dried blood spot (DBS), in order to detect IgG antibodies against the spike protein (Euroimmun ELISA-S), and neutralizing antibodies for non-negative ELISA-S. For the second-round conducted in November, all respondents were eligible for the antibodies detection from home DBS sample, as well as the other household members aged 6 years or more for 20% of them. Participation and adjustment for nonresponse134,391 respondents completed the first-round questionnaire from May 2 to June 1, 2020, including 16,970 (12.6%) respondents under the poverty line. Multimodal web/tel interviews was randomly assigned to 20% of the sample. The other were assigned to exclusive CAWI. Overall 17,441 respondents were eligible for home blood sample, among them 12,114 returned the DBS (interquartile date: May 25-June 5). The response probability was first estimated from logit models adjusted on a wide range of auxiliary demographic and socio-economic variables available from the sampling frame, and final weights calibrated to the margins of the population census permitted to correct for a large part of the non-response bias. ConclusionThe Epicov study is one of the largest national random population-based seroprevalence cohort, with both an epidemiological and sociological approaches to evaluate the spread of the COVID-19 epidemic, and the impact on health and living conditions. One of the major interests of this study is the broad coverage of the socio-economic and territorial diversity of the population.

When lockdown policies amplify social inequalities in COVID-19 infections. Evidence from a cross-sectional population-based survey in France.

ObjectivesTo assess social inequalities in the trends in COVID-19 infections following lockdown DesignA cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Participants10 401 participants aged 18-64, from a national cohort who lived in the three metropolitan French regions most affected by the first wave of COVID-19. Main outcomeThe main outcome was occurrence of possible COVID-19 symptoms, defined as the occurrence of sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than three days in the 15 days before the survey. We used multinomial regression models to identify social and health factors related to possible COVID-19 before and during the lockdown. ResultsIn all, 1,304 (13.0%; 95% CI: 12.0%-14.0%) reported cases of possible COVID-19. The effect of lockdown on the occurrence of possible COVID-19 was different across social hierarchies. The most privileged class individuals saw a significant decline in possible COVID-19 infections between the period prior to lockdown and during the lockdown (from 8.8% to 4.3%, P=0.0001) while the decline was less pronounced among working class individuals (6.9% before lockdown and 5.5% during lockdown, P=0.03). This differential effect of lockdown remained significant after adjusting for other factors including history of chronic disease. The odds of being contaminated during lockdown as opposed to the prior period increased by 57% among working class individuals (OR=1.57; 95% CI: 1.0-2.48). The same was true for those engaged in in-person professional activities during lockdown (OR=1.53; 95% CI: 1.03-2.29). InterpretationLockdown was associated with social inequalities in the decline in COVID-19 infections, calling for the adoption of preventive policies to account for living and working conditions. Such adoptions are critical to reduce social inequalities related to COVID-19, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities. Section 1: What is already known on this topicSignificant differences in COVID-19 incidence by gender, class and race/ethnicity are recorded in many countries in the world. Lockdown measures implemented throughout the globe have been effective in reducing transmission risks. Section 2: What this study addsOur study shows that lockdowns impact was socially differentiated and has benefited the working classes the least. Such results underline the need to design COVID-19 preventive policies that take into account living and working conditions, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.

Seroprevalence of SARS-CoV-2 among adults in three regions of France following the lockdown and associated risk factors: a multicohort study.

Aim To estimate the seroprevalence of SARS-CoV-2 infection in May-June 2020 after the lockdown in adults living in three regions in France and to identify the associated risk factors. Methods Participants in a survey on COVID-19 from an existing consortium of three general adult population cohorts living in the Ile-de-France (IDF) or Grand Est (GE), two regions with high rate of COVID-19, or in the Nouvelle-Aquitaine (NA), with a low rate, were asked to take a dried-blood spot (DBS) for anti-SARS-CoV-2 antibodies assessment. The primary outcome was a positive anti-SARS-CoV-2 ELISA IgG result against the spike protein of the virus (ELISA-S). The secondary outcomes were a positive ELISA IgG against the nucleocapsid protein (ELISA-NP), anti-SARS-CoV-2 neutralizing antibodies titers >=40 (SN), and predicted positivity obtained from a multiple imputation model (MI). Prevalence estimates were adjusted using sampling weights and post-stratification methods. Findings Between May 4, 2020 and June 23, 2020, 16,000 participants were asked to provide DBS, and 14,628 were included in the analysis, 983 with a positive ELISA-S, 511 with a positive ELISA-NP, 424 with SN>=40 and 941 (Standard Deviation=31) with a positive MI. Adjusted estimates of seroprevalence (positive ELISA-S) were 10.0% (95%CI 9.1%;10.9%) in IDF, 9.0% (95%CI 7.7%; 10.2%) in GE and 3.1% (95%CI 2.4%; 3.7%), in NA. The adjusted prevalence of positive ELISA-NP, SN and MI were 5.7%, 5.0% and 10.0% in IDF, 6.0%, 4.3% and 8.6% in GE, and 0.6%, 1.3% and 2.5% in NA, respectively. A higher seroprevalence was observed in younger participants and when at least one child or adolescent lived in the same household. A lower seroprevalence was observed in smokers compared to non-smokers. Interpretation At the end of the lockdown the prevalence of anti-SARS-CoV-2 IgG or neutralizing antibodies remained low in the French adult population, even in regions with high reported rates of COVID-19.