COVID-19 Vaccination Programs Research Articles

The Effect of Public Tolerance towards Corruptive Behaviour on Healthcare Efficiency and Equity – The Case of the UK’s COVID-19 Vaccination Programme

Over the past four years, the COVID-19 pandemic has caused significant uncertainty, suffering, and economic disruption worldwide. Consequently, governments have faced pressure to ensure fair vaccine access while achieving vaccination targets quickly. Such challenging circumstances can create opportunities for nepotism and bribery, increasing attention to corruption risks associated with the pandemic response. This study investigates the relationship between public attitudes towards corruptive behaviour and the efficiency and equity of the UK's COVID-19 vaccination programme. It combines primary data on public tolerance towards corruptive behaviour with secondary data on the efficiency of the vaccination program at the local authority level in England and Scottland. We employ a survival analysis approach, estimating Cox Proportional Hazards Models, which examine the time taken to reach vaccination targets. Our findings suggest moderate tolerance towards nepotism/favouritism and bribery among the British public, with 28% of survey participants considering monetary bribery and 34% considering nepotism/favouritism as acceptable means to secure early vaccination access. Moreover, while public tolerance towards corruptive behaviour generally had a negative impact on the efficiency of the vaccination programme, it appears to have expedited the vaccination rollout in politically aligned local authorities governed by the Conservative and Unionist Party. However, this positive effect on efficiency appears to have come at the expense of reduced equity in vaccine distribution. These findings underscore the trade-off between efficiency and equity in vaccine distribution during public health crises, emphasising the need for health policies that balance efficiency with equity to ensure fair and effective distribution of vaccines in the future.

Cohort study of cardiovascular safety of different COVID-19 vaccination doses among 46 million adults in England

The first dose of COVID-19 vaccines led to an overall reduction in cardiovascular events, and in rare cases, cardiovascular complications. There is less information about the effect of second and booster doses on cardiovascular diseases. Using longitudinal health records from 45.7 million adults in England between December 2020 and January 2022, our study compared the incidence of thrombotic and cardiovascular complications up to 26 weeks after first, second and booster doses of brands and combinations of COVID-19 vaccines used during the UK vaccination program with the incidence before or without the corresponding vaccination. The incidence of common arterial thrombotic events (mainly acute myocardial infarction and ischaemic stroke) was generally lower after each vaccine dose, brand and combination. Similarly, the incidence of common venous thrombotic events, (mainly pulmonary embolism and lower limb deep venous thrombosis) was lower after vaccination. There was a higher incidence of previously reported rare harms after vaccination: vaccine-induced thrombotic thrombocytopenia after first ChAdOx1 vaccination, and myocarditis and pericarditis after first, second and transiently after booster mRNA vaccination (BNT-162b2 and mRNA-1273). These findings support the wide uptake of future COVID-19 vaccination programs.

Costs of the COVID-19 vaccination programme: estimates from the West Rand district of South Africa, 2021/2022

BackgroundThe COVID-19 vaccination programme in South Africa was rolled out in February 2021 via five delivery channels- hospitals, primary healthcare (PHC), fixed, temporary, and mobile outreach channels. In this study, we estimated the financial and economic costs of the COVID-19 vaccination programme in the first year of roll out from February 2021 to January 2022 and one month prior, in one district of South Africa, the West Rand district.MethodsFinancial and economic costs were estimated from a public payer’s perspective using top-down and ingredient-based costing approaches. Data were collected on costs incurred at the national level and from the West Rand district. Total cost and cost per COVID-19 vaccine dose were estimated for each of the five delivery channels implemented in the district. In addition, we estimated vaccine delivery costs which we defined as total cost exclusive of vaccine procurement costs.ResultsTotal financial and economic costs were estimated at US$8.5 million and US$12 million, respectively; with a corresponding cost per dose of US$15.31 (financial) and US$21.85 (economic). The two biggest total cost drivers were vaccine procurement which contributed 73% and 51% to total financial and economic costs respectively, and staff time which contributed 10% and 36% to total financial and economic costs, respectively. Total vaccine delivery costs were estimated at US$2.1 million (financial) and US$5.7 million (economic); and the corresponding cost per dose at US$3.84 (financial) and US$10.38 (economic). Vaccine delivery cost per dose (financial/economic) was estimated at US$2.93/12.84 and US$2.45/5.99 in hospitals and PHCs, respectively, and at US$7.34/20.29, US$3.96/11.89 and US$24.81/28.76 in fixed, temporary and mobile outreach sites, respectively. Staff time was the biggest economic cost driver for vaccine delivery in PHCs and hospitals while per diems and staff time were the biggest economic cost drivers for vaccine delivery in the three outreach delivery channels.ConclusionThis study offers insights for budgeting and planning of COVID-19 vaccine delivery in South Africa’s public healthcare system. It also provides input for cost-effectiveness analyses to guide future strategies for maximizing vaccination coverage in the country.

Description of COVID-19 Vaccination Behavior in Rural and Urban Communities in Serang District

Public health status in Indonesia can be influenced by the implementation of healthy behavior in the community. There are differences in behavior between people in rural and urban areas and factors that can cause vaccine delays that have the potential to affect COVID-19 vaccination coverage in Indonesia. This study aims to determine the behavior of COVID-19 vaccination in rural and urban communities in Serang Regency. This study used a descriptive research design with a quantitative approach which was conducted in October−November 2021 with a sample of 334 people aged 18−59 years. The results showed that the vaccination status of the respondents was complete dose (rural 65.3% and urban 70.3%), waiting for dose 2 (rural 22.4% and urban 18.6%), and dose 1 had been received but the dosing schedule 2 had passed (rural 12.3% and urban 11.1%). Three perceptions that are still low in percentage are perceptions of vulnerability, perceptions of obstacles, and cues to act. Some of the reasons for stopping the termination of COVID-19 in the community are not yet feeling that they will have severe symptoms if exposed to COVID-19, feeling confused about information related to COVID-19, not being able to carry out COVID-19 vaccinations because the schedule for COVID-19 vaccination program coincides with other activities, did not receive an invitation from the local government to vaccinate against COVID-19, vaccinate because people in their environment had vaccinated against COVID-19, did not receive support from cadres or religious leaders for the COVID-19 vaccination. Improved policy behavior can be improved by changing perceptions of vulnerability to COVID-19, reducing barriers, and also providing cues according to education through social media with the key message of spending the full dose of vaccine.

Physicians’ perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

ObjectivesParents’ decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians’ perspectives on COVID-19 vaccinations for...

The cost of adding rapid screening for diabetes, hypertension, and COVID-19 to COVID-19 vaccination queues in Johannesburg, South Africa

BackgroundNon-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventions. However, there is limited knowledge of the associated costs and resources required. We evaluated the cost of integrating NCD screening and COVID-19 antigen rapid diagnostic testing (Ag-RDT) into a COVID-19 vaccination program.MethodsWe conducted a prospective cost analysis at three public sector primary healthcare clinics and one academic hospital in Johannesburg, South Africa, conducting vaccinations. Participants were assessed for eligibility and recruited during May-Dec 2022. Costs were estimated from the provider perspective using a bottom-up micro-costing approach and reported in 2022 USD.ResultsOf the 1,376 enrolled participants, 240 opted in to undergo a COVID-19 Ag-RDT, and none tested positive for COVID-19. 138 (10.1%) had elevated blood pressure, with 96 (70%) having no prior HTN diagnosis. 22 (1.6%) were screen-positive for DM, with 12 (55%) having no prior diagnosis. The median cost per person screened for NCDs was $1.70 (IQR: $1.38-$2.49), respectively. The average provider cost per person found to have elevated blood glucose levels and blood pressure was $157.99 and $25.19, respectively. Finding a potentially new case of DM and HTN was $289.65 and $36.21, respectively. For DM and DM + HTN screen-positive participants, diagnostic tests were the main cost driver, while staff costs were the main cost driver for DM- and HTN screen-negative and HTN screen-positive participants. The median cost per Ag-RDT was $5.95 (IQR: $5.55-$6.25), with costs driven mainly by test kit costs.ConclusionsWe show the cost of finding potentially new cases of DM and HTN in a vaccine queue, which is an essential first step in understanding the feasibility and resource requirements for such initiatives. However, there is a need for comparative economic analyses that include linkage to care and retention data to fully understand this cost and determine whether opportunistic screening should be added to general mass health activities.

Patient-Reported Outcomes in COVID-19 Treatment with Monoclonal Antibodies Reveal Benefits in Return to Usual Activities.

This study aimed to assess the effects of a monoclonal antibody (mAb) combination on symptoms, daily function, and overall health-related quality of life. We analyzed patient-reported outcomes data from symptomatic outpatients in a phase1/2/3 trial. Patients with confirmed SARS-CoV-2 infection and ≥ 1 risk factor for severe COVID-19 received mAb treatment (casirivimab plus imdevimab 1200mg) or placebo. Prespecified exploratory assessments included time to sustained symptoms resolution, usual health, and return to usual activities (assessed daily for 29days). The trial was conducted from September 2020 to February 2021, prior to widespread COVID-19 vaccination programs and Omicron-lineage variants against which casirivimab + imdevimab is not active. In this analysis 736 outpatients received mAb and 1341 received placebo. Median time to sustained symptoms resolution was consistently shorter with mAb versus placebo (≥ 2consecutive days: 14 vs 17days, [nominal p = 0.0017]; ≥ 3 consecutive days: 17vs 21days, [nominal p = 0.0046]). Median time to sustained return to usual health and usual activities were both consistently shorter with mAb versus placebo (≥ 2 consecutive days: 12vs 15days [nominal p = 0.0001] and 9 vs 11days [nominal p = 0.0001], respectively; ≥ 3 consecutive days: 14 vs 18days [nominal p = 0.0003] and 10 vs 13days [nominal p = 0.0041], respectively). mAb treatment against susceptible SARS-CoV-2 strains improved how patients feel and function, as evidenced by shortened time to sustained symptoms resolution and return to usual health and activities. Future studies are warranted to assess the patient experience with next generation mAbs. GOV: Registration number, NCT04425629; Submission date June 11, 2020.

Public Perception of the COVID-19 Vaccine: Literature Review

Introduction: Community perceptions of COVID-19 vaccines are responses or acceptance based on the information obtained regarding beliefs about the halal status of vaccines, willingness to be vaccinated, and the capacity of healthcare workers providing the COVID-19 vaccine. This is due to numerous issues affecting information about the COVID-19 vaccine. These facts have encouraged the government to enhance the COVID-19 vaccination program within the community. Objective: This study aims to explore and analyze the public perception of the COVID-19 vaccine. It seeks to identify key factors influencing attitudes towards the vaccine, including trust in health authorities, misinformation, demographic variables, and socio-political influences. The objective is to provide a comprehensive understanding of the drivers of vaccine acceptance and hesitancy to inform public health interventions. Method: This writing uses a literature review method. It involves searching for and filtering articles that meet predetermined criteria through inclusion criteria. In this writing, scientific articles were found using Google Scholar with search keywords "community perceptions," "knowledge," and "COVID-19 vaccine." Result: The study revealed a complex landscape of public perception regarding the COVID-19 vaccine. Trust in health authorities and exposure to misinformation emerged as significant factors impacting perceptions. There is a relationship between knowledge and community behavior, education level and vaccination history with knowledge, religion with community attitudes, and COVID-19 vaccination history. Conclusion: Knowledge influences community perceptions of the COVID-19 vaccine. Therefore, it is necessary to provide comprehensive and equitable information to all communities about the usefulness, safety of the COVID-19 vaccine, and all updated information regarding the COVID-19 vaccine.

The impact of the COVID-19 vaccination programme on symptomatic and severe SARS-CoV-2 infection during a period of Omicron variant dominance in Ireland, December 2021 to March 2023.

BackgroundAs Ireland prepared for an autumn 2023 COVID-19 vaccination booster campaign, there was concern that vaccine fatigue would affect uptake, which has been abating.AimThis study aimed to quantify the direct impact of the COVID-19 vaccination programme in Ireland on averted COVID-19-related outcomes including symptomatic presentations to primary care/community testing centres, emergency department (ED) presentations, hospitalisations, intensive care unit (ICU) admissions and deaths, in individuals aged ≥ 50 years, during Omicron dominance.MethodsWe conducted a retrospective observational COVID-19 vaccine impact study in December 2021-March 2023 in Ireland. We used national data on notified outcomes and vaccine coverage, as well as vaccine effectiveness (VE) estimates, sourced from the World Health Organization's live systematic review of VE, to estimate the count and prevented fraction of outcomes in ≥ 50-year-olds averted by the COVID-19 vaccination programme in this age group.ResultsThe COVID-19 vaccination programme averted 48,551 symptomatic COVID-19 presentations to primary care/community testing centres (36% of cases expected in the absence of vaccination), 9,517 ED presentations (53% of expected), 102,160 hospitalisations (81% of expected), 3,303 ICU admissions (89% of expected) and 15,985 deaths (87% of expected).ConclusionsWhen Omicron predominated, the COVID-19 vaccination programme averted symptomatic and severe COVID-19 cases, including deaths due to COVID-19. In line with other international vaccine impact studies, these findings emphasise the benefits of COVID-19 vaccination for population health and the healthcare system and are relevant for informing COVID-19 booster vaccination programmes, pandemic preparedness and communicating the reason for and importance of COVID-19 vaccination in Ireland and internationally.

Hubungan Pemberian Program Vaksinasi Dengan Tingkat Kecemasan Pada Masyarakat Saat Pandemic Covid-19 Di Daerah RT 02 Desa Bojong Baru Kabupaten Bogor Tahun 2021

The COVID-19 vaccination program is a new program initiated by the government to create herd immunity for COVID-19 with a target target of 70% of the population. Vaccination turns out to provide its own anxiety for the community. Anxiety occurs during the Covid-19 pandemic and is also felt when there is a vaccination program in the community. To find out the relationship between the vaccination program and the level of anxiety in the community during the Covid-19 pandemic in the Rt. 02 Bojong Baru Village, Bogor Regency in 2021. The type of research used is descriptive correlation research using a cross sectional study approach. Based on the results of the Spearman rank test, there is a correlation or relationship between the administration of the vaccination program and the level in the Rt.

Longitudinal Follow-Up Study on the Side Effects of COVID-19 Vaccines: A Telephonic Questionnaire Approach.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted urgent efforts to develop and deploy effective vaccines. Covishield and Covaxin are two prominent COVID-19 vaccines authorized for emergency use; however, concerns regarding their safety persist. This longitudinal follow-up study aimed to comprehensively assess and compare the demographic characteristics, frequencies, severities of reported side effects, and associations between vaccine type and demographic factors among individuals vaccinated with Covishield and Covaxin. A telephonic questionnaire was used to collect data from individuals who attended COVID-19 vaccination programs between January 1, 2021, and January 1, 2022. Logistic regression analysis was performed to investigate the associations between vaccine type, demographic factors, and likelihood of experiencing side effects. Covaxin recipients exhibited a lower incidence of mild flu-like illness (16 cases) and post-vaccination infection (55 cases) than Covishield recipients (110 and 98 cases, respectively). However, Covaxin recipients reported more cases of soreness at the injection site (139 cases) than did Covishield recipients (172 cases). Logistic regression analysis revealed significantly higher odds of experiencing side effects among Covaxin recipients than among Covishield recipients (OR = 1.687, p < 0.001). Age was inversely associated with the likelihood of experiencing side effects (OR = 0.982, p < 0.001), while sex and ethnicity also exhibited significant associations. This study provides valuable insights into the safety profiles of the Covishield and Covaxin COVID-19 vaccines. These findings underscore the importance of ongoing surveillance and evaluation of vaccine safety and tolerability to inform public health policies and vaccination strategies.

Lessons Learned from the COVID-19 Pandemic: Interpreting Vaccination Strategies in a Nationwide Demographic Study.

Brazil was strongly affected by the COVID-19 pandemic. Its continental dimension and socio-demographic characteristics pose challenges to distribution and accessibility, making vaccination programs challenging. The objectives of the study were to describe the clinical and demographic characteristics of the general population vaccinated against COVID-19 by October 2021 and analyze the strategies implemented during the vaccination program. A retrospective nationwide study that analyzed data from the OpenDataSUS platform of the Informatics Department of the Brazilian Ministry of Health (DataSUS), which contains information from all individuals in Brazil who have received at least one dose of any vaccine against COVID-19 approved by the National Health Agency (ANVISA) from 17 January to 3 October 2021. Until 3 October, a total of 146,254,578 persons (68.6 per 100 inhabitants) received at least one dose of a vaccine in Brazil. The north and northeast regions had the lowest vaccination rates compared with the remaining regions (North: 56.8, Northeast: 62.0, South: 74.4, and Southeast: 73.2 per 100 inhabitants). Elderly individuals had the highest vaccination rates, particularly those above 70 years old. Heterologous dosing regimens were administered to 1,063,079 individuals (0.7% of those receiving the first dose). The COVID-19 vaccination program reached more than two-thirds of the population in Brazil by 9 months after its start, but the vaccination coverage was heterogeneous, reflecting the country's geographic and socio-demographic characteristics. Establishing priority groups for vaccination was a main characteristic of the vaccination strategy. In addition, technology transfer agreements have played an important role in increasing vaccine accessibility.

Healthcare workers’ willingness to receive COVID-19 booster dose and associated factors in the Democratic Republic of the Congo

ABSTRACT The COVID-19 booster dose is considered an important adjunct for the control of the COVID-19 pandemic due to reports of reduced immunity in fully vaccinated individuals. The aims of this study were to assess healthcare workers’ intention to receive the booster dose of COVID-19 vaccine and to identify predictive factors among healthcare workers. A cross-sectional study was conducted among healthcare workers selected in two provinces, Kasai Oriental, and Haut-Lomami. Data were collected using a questionnaire administered through structured face-to-face interviews, with respondents using a pre-tested questionnaire set up on the Open Data Kit (ODK Collect). All data were analyzed using SPSS v26.0 (IBM Corporation, Armonk, NY, USA). Vaccination coverage for COVID-19, considering declarations by health workers, is around 85.9% for the province of Kasai Oriental and 85.8% for Haut-Lomami. A total of 975 responses were collected, 71.4% of health workers at Kasai Oriental and 66.4% from Haut-Lomami declared a definite willingness to receive a COVID-19 vaccine booster. The duration of protection was the main reason for accepting a booster COVID-19 dose for 64.6% of the respondents. Logistic regression analysis showed that having chronic diseases (aOR = 2.95 [1.65–5.28]), having already received one of the COVID-19 vaccines (aOR = 2.72 [1.43–5. 19]); the belief that only high-risk individuals, such as healthcare professionals and elderly people suffering from other illnesses, needed a booster dose (aOR = 1.75 [1.10–2.81]). Considering the burden of COVID-19, a high acceptance rate for booster doses could be essential to control the pandemic. Our results are novel and could help policymakers design and implement specific COVID-19 vaccination programs to reduce reluctance to seek booster vaccination.

COVID-19 vaccine fatigue in Scotland: how do the trends in attrition rates for the second and third doses differ by age, sex, and council area?

Abstract Vaccine fatigue is the propensity for individuals to start but not finish a vaccination program with several doses, which means they are less protected. Our study examines vaccine fatigue in the COVID-19 vaccination programme in Scotland. We model the attrition rates across multiple doses with a hierarchical binomial logistic regression model with correlated age- and area-specific random effects with conditional autoregressive priors, where inference uses integrated nested Laplace approximations. We find attrition rates smoothly decrease with increasing age, are much higher for the third dose than the second, and are generally higher for males than females.

The emotions for COVID-19 vaccine: Insights from Twitter analytics about hesitancy and willingness for vaccination

The declaration by the World Health Organization and government-initiated actions by different countries for the COVID-19 vaccine have led to the rapid evolution of sentiments on various social media platforms. Real-time data related to vaccination has grown the need to anticipate the changes in vaccine uptake. Using Twitter dataset, the study models different emotions and their associated word. The emotions are majorly classified into hesitancy and willingness for vaccination. The study categorizes the tweets into pre-launch, post-launch, and booster doses of the COVID-19 vaccine. Based on comparative analysis, most sentiments were related to hesitancy for vaccination during pre-launch. In post-launch, the majority of sentiments were oriented towards willingness for vaccination. However, during the booster dose, the sentiments were oriented toward happy, adequate, and free emotions. Over the time period, the willingness of the COVID-19 vaccine has improved. The practitioners and policymakers can obtain real-time sentiments based on this approach and strategize the long-term vaccination policy for COVID-19 and other vaccination programs.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model.

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

Operation CoVER Saint Louis (COVID-19 Vaccine in the Emergency Room): Impact of a Vaccination Program in the Emergency Department.

Coronavirus 2019 (COVID-19) inequitably impacted minority populations and regions with limited access to healthcare resources. The Barnes-Jewish Emergency Department in St. Louis, MO, serves such a population. The COVID-19 vaccine is an available defense to help achieve community immunity. The emergency department (ED) is a potential societal resource to provide access to a vaccination intervention. Our objective in this study was to describe and evaluate a novel ED COVID-19 vaccine program, including its impact on the local surrounding underserved community. This was a retrospective, post-protocol implementation review of an ED COVID-19 vaccination program. Over the initial six-month period, we compiled data on all vaccinated patients out of the ED to evaluate demographic data and the impact on underserved regional areas. We report a successful ED-based COVID-19 vaccine program (with over 1,000 vaccines administered). This program helped raise regional and state vaccination rates. Over 50% of the population that received the COVID-19 vaccine from the ED were from defined socially vulnerable patient populations. No adverse effects were documented. Operation CoVER (COVID-19 Vaccine in the Emergency Room) Saint Louis was able to successfully vaccinate a socially vulnerable patient population. This free, COVID-19 ED-based vaccine program with dedicated pharmacy support, was novel in emergency medicine practice. Similar ED-based vaccine programs could help with future vaccine distribution.

Provincial Intra-Action Review of the COVID-19 Vaccination Programme: Opportunities to Improve Vaccine Response in North Kivu, Democratic Republic of Congo.

Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response. The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level. Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation. The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19-22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response. This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.

COVID-19 Vaccination and Incidence of Pediatric SARS-CoV-2 Infection and Hospitalization

A SARS-CoV-2 vaccine was approved for adolescents aged 12 to 15 years on May 10, 2021, with approval for younger age groups following thereafter. The population level impact of the pediatric COVID-19 vaccination program has not yet been established. To identify whether California's pediatric COVID-19 immunization program was associated with changes in pediatric COVID-19 incidence and hospitalizations. A case series on COVID-19 vaccination including children aged 6 months to 15 years was conducted in California. Data were obtained on COVID-19 cases in California between April 1, 2020, and February 27, 2023. Postvaccination evaluation periods spanned 141 days (June 10 to October 29, 2021) for adolescents aged 12 to 15 years, 199 days (November 29, 2021, to June 17, 2022) for children aged 5 to 11 years, and 225 days (July 17, 2022, to February 27, 2023) for those aged 6 to 59 months. During these periods, statewide vaccine coverage reached 53.5% among adolescents aged 12 to 15 years, 34.8% among children aged 5 to 11 years, and 7.9% among those aged 6 to 59 months. Age-stepped implementation of COVID-19 vaccination was used to compare observed county-level incidence and hospitalization rates during periods when each age group became vaccine eligible to counterfactual rates predicted from observations among other age groups. COVID-19 case and hospitalization data were obtained from the California reportable disease surveillance system. Between April 1, 2020, and February 27, 2023, a total of 3 913 063 pediatric COVID-19 cases and 12 740 hospitalizations were reported in California. Reductions of 146 210 cases (95% prediction interval [PI], 136 056-158 948) were estimated among adolescents aged 12 to 15 years, corresponding to a 37.1% (35.5%-39.1%) reduction from counterfactual predictions. Reductions of 230 134 (200 170-265 149) cases were estimated among children aged 5 to 11 years, corresponding to a 23.7% (20.6%-27.3%) reduction from counterfactual predictions. No evidence of reductions in COVID-19 cases statewide were found among children aged 6 to 59 months (estimated averted cases, -259; 95% PI, -1938 to 1019), although low transmission during the evaluation period may have limited the ability to do so. An estimated 168 hospitalizations (95% PI, 42-324) were averted among children aged 6 to 59 months, corresponding to a 24.4% (95% PI, 6.1%-47.1%) reduction. In meta-analyses, county-level vaccination coverage was associated with averted cases for all age groups. Despite low vaccination coverage, pediatric COVID-19 immunization in California averted 376 085 (95% PI, 348 355-417 328) reported cases and 273 (95% PI, 77-605) hospitalizations among children aged 6 months to 15 years over approximately 4 to 7 months following vaccination availability. The findings of this case series analysis of 3 913 063 cases suggest reduced pediatric SARS-CoV-2 transmission following immunization. These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations.

Policies and cultural beliefs: Community perceptions about COVID-19 vaccine hesitancy in Indonesia.

Vaccine hesitancy is a global concern and a significant threat to COVID-19 vaccination programs. This study aimed to explore vaccine hesitancy from the perspective of the Indonesian community related to policies and cultural beliefs. A descriptive qualitative approach was utilized in this study. Twenty participants were recruited from various settings to ensure the representation of experiences in different contexts in Indonesia. Audio-recorded, semi-structured, individual, in-depth interviews were carried out. Content analysis was performed to identify the main key themes. Twenty participants were recruited from various regions of Java Island, Indonesia. The participants revealed hesitancy about the COVID-19 vaccine, including the themes of mistrust, controversy, and the culture and beliefs of the community. This study highlights COVID-19 vaccine hesitancy in Indonesia, which may have implications for the community's perceptions and beliefs regarding the uptake of the COVID-19 vaccine. The trust issue remains a major challenge to convincing the community to accept the vaccine at the grassroots level. Targeted education and communication strategies are essential in addressing trust issues surrounding COVID-19 vaccines among critical stakeholders and religious leaders in Indonesia. Public health nursing plays a crucial role in fostering community acceptance and ensuring the success of vaccination programs.