Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future?

Vaccine hesitancy, which embodies the unwillingness to receive vaccines when vaccination services are available and accessible, is one of the greatest threats to global health. Although vaccine hesitancy has existed among a small percentage of people for centuries, its harmful effects are likely to be more pronounced during the COVID-19 pandemic than ever before. COVID-19 vaccine hesitancy will pose substantial risks for both people who delay or refuse to be vaccinated and the wider community. It will make communities unable to reach thresholds of coverage necessary for herd immunity against COVID-19, thus unnecessarily perpetuating the pandemic and resulting in untold suffering and deaths. Vaccine hesitancy is pervasive, misinformed, contagious, and is not limited to COVID-19 vaccination. Our work shows that vaccine hesitancy is a complex and dynamic social process that reflects multiple webs of influence, meaning, and logic. People's vaccination views and practices usually comprise an ongoing engagement that is contingent on unfolding personal and social circumstances, which can potentially change over time. Therefore, as COVID-19 vaccination rolls out globally, scientists and decision-makers need to investigate the scale and determinants of vaccine hesitancy in each setting; so that tailored and targeted strategies can be developed to address it.

Interventions for vaccine hesitancy.

Despite overwhelming evidence of the effectiveness and safety of vaccinations, a growing number of people are reluctant to receive recommended vaccinations or refuse them altogether. Vaccination currently prevents 2-3 million deaths a year and a further 1.5 million deaths could be avoided if global coverage of vaccinations improved. However, recently vaccine hesitancy has led to a resurgence of preventable diseases. There is heterogeneity in vaccine hesitant individuals and a diversity of situations in which vaccine hesitancy can arise, thus requiring that interventions to address vaccine hesitancy be context-specific and problem-specific.

Cochrane corner: effectiveness of quarantine in reducing the spread of COVID-19.

INTRODUCTION: there is no effective vaccine against coronavirus disease 2019 (COVID-19) at present, so non-pharmacological interventions like quarantine are advocated to control its spread. Quarantine refers to the restriction of the movement of asymptomatic healthy people who have had contact with cases of a communicable disease. We highlight a Cochrane rapid review, published in April 2020, on the effectiveness of quarantine in limiting the spread of COVID-19. METHODS: the authors of the Cochrane rapid review searched multiple electronic databases for studies of any design, which assessed the effects of quarantine compared to no intervention. Eligible participants for the review included contacts of confirmed or suspected cases and people returning from countries with a declared outbreak of COVID-19, severe acute respiratory syndrome (SARS), or Middle East respiratory syndrome (MERS). The authors used the evidence from SARS and MERS studies to provide indirect evidence on COVID-19. RESULTS: the authors included 29 observational and mathematical modelling studies and found that quarantine may lead to substantial reductions in new COVID-19 cases and deaths. The review also shows that combining school closures, travel bans and social distancing to quarantine may lead to larger reductions in cases and deaths. CONCLUSION: the review suggests that quarantine should be part of the COVID-19 combination prevention tool kit for Africa. Therefore, in addition to other public health measures, African countries should roll out COVID-19 testing to identify, isolate and treat infected people and quarantine their contacts.

Setting up and relaxation of public health social and physical distancing measures for COVID-19: a rapid review.

INTRODUCTION: Physical and social distancing refer to purposeful reduction of close contact between people, such as school closures and workplace closures. These measures are useful in containing coronavirus disease 2019 (COVID-19) but have negative effects on social structures and the economy. There is thus a need for optimal timing on when to setup and relax them. We examined the evidence regarding the initiation and lifting of these public health measures. METHODS: We searched for eligible studies in PubMed, Scopus, and Google Scholar in April 2020, and conducted a qualitative synthesis of the study findings. RESULTS: We searched for eligible studies in PubMed, Scopus, and Google Scholar in April 2020, and conducted a qualitative synthesis of the study findings. The electronic searches yielded 2503 records, from which we included 10 observational and mathematical modeling studies. These studies used data from one or multiple countries on COVID-19 (nine studies) or another viral epidemic such as Zika (one study). Most of the studies show the importance of using physical and social distancing at the start of the epidemic and utilising a staggered approach when easing the restrictions, while scaling up testing. The lifting of lockdown measures should be accompanied by continued use of personal protective equipment, the limiting of workdays, and wide-scale testing. CONCLUSION: This review highlights the importance of timeous action when faced with an epidemic, let alone a pandemic. The setting up and relaxation of public measures are time sensitive and data-driven actions. In the absence of a safe and effective vaccine, these findings are relevant for the sustainable containment of COVID-19 in African countries.

A scoping review on research agendas to enhance prevention of epidemics and pandemics in Africa.

INTRODUCTION: research is not only needed to prioritise the best possible response during an epidemic and pandemic, it is also understood to be a core pillar of outbreak response. However, few African countries are equipped to perform the needed surveillance and research activities during an outbreak. Therefore, we mapped out research agendas aimed at increased research preparedness towards epidemics or pandemics in Africa. METHODS: eligible studies were searched for in in PubMed, Scopus, and Google Scholar. Additionally, grey literature was sought in Google, citation searches, as well as targeted sites such as the World Health Organization (WHO), Africa Centres for Disease Control and Prevention, African Union, and the Wellcome Trust. Searches were done in March 2020. RESULTS: the electronic searches yielded 7344 records, of which 34 articles were included in the study. The studies identified around 18 factors highlighted through various research agendas. Majority of the research agendas spoke to general epidemic preparedness and focused largely on understanding virus transmission such as its characteristics and dynamics, and the infrastructure needed to carry out vital research activities. CONCLUSION: the review highlights the research needs in order to carry out vital research work but to also bridge knowledge gaps and harmonize outbreak response from key stakeholders. However, Africa needs to create its own health research agendas and capacitate itself to conduct and lead these studies. African health research decisions must center on Africa, with African researchers taking the lead not only on the science produced but ensuring inclusive and equitable involvement from fellow researchers, and in engaging national health ministries as well as the communities.

Family-Centred Interventions for Elder Abuse: a Narrative Review.

Information about elder abuse has not only been sparse due to factors such as underreporting or lack of standardized research, but also in defining elder abuse. However elder abuse is commonly understood to be a single/repeated act, or lack of appropriate action, occurring within any relationship which embodies an expectation of trust, which causes harm or distress to elderly individual. In elder abuse, the relationship of trust usually entails the family, as it family members who are noted to be the most likely perpetrators of elder abuse With the increased prevalence of elder abuse in developed countries and a proclivity towards individualized interventions, this narrative review sought to explore family-centered interventions used to address elder abuse by using a RE-AIM framework.