Future Pandemic Response Research Articles

Modeling Population Mobility Flows: A Hybrid Approach Integrating a Gravity Model and Machine Learning

Population mobility between cities significantly affects traffic congestion, disease spread, and societal well-being. As globalization and urbanization accelerate, understanding the dynamics of population mobility becomes increasingly important. Traditional population migration models reveal the factors influencing migration, while machine learning methods provide effective tools for creating data-driven models to handle the nonlinear relationships between origin and destination characteristics and migration. To deepen the understanding of population mobility issues, this study presents GraviGBM, an expandable population mobility simulation model that combines the gravity model with machine learning, significantly enhancing simulation accuracy. By employing SHAPs (SHapley Additive exPlanations), we interpret the modeling results and explore the relationship between urban characteristics and population migration. Additionally, this study includes a case analysis of COVID-19, extending the model’s application during public health emergencies and evaluating the contribution of model variables in this context. The results show that GraviGBM performs exceptionally well in simulating inter-city population migration, with an RMSE of 4.28, far lower than the RMSE of the gravity model (45.32). This research indicates that distance emerged as the primary factor affecting mobility before the pandemic, with economic factors and population also playing significant roles. During the pandemic, distance remained dominant, but the significance of short distances gained importance. Pandemic-related indicators became prominent, while economics, population density, and transportation substantially lost their influence. A city-to-city flow analysis shows that when population sizes are comparable, economic factors prevail, but when economic profiles match, living conditions dictate migration. During the pandemic, residents from hard-hit areas moved to more distant cities, seeking normalcy. This research offers a comprehensive perspective on population mobility, yielding valuable insights for future urban planning, pandemic response, and decision-making processes.

Awareness and preparedness of healthcare workers for the initial wave of COVID-19 in Aotearoa New Zealand.

The TMGH-Global COVID-19 Collaborative was a multinational, multicentre, cross-sectional survey assessing the awareness and preparedness of healthcare workers (HCWs) during the first wave of the pandemic across 57 countries. Here, we report the results from Aotearoa New Zealand. This cross-sectional survey was conducted at Christchurch Hospital between February and May 2020. Data were collected from a convenience sample of HCWs and analysed using descriptive and multivariate regression to determine awareness (out of 40) and preparedness (out of 15) scores and influencing factors. Of the 158 participants (response rate 20.8%), most were women (73%) and doctors (58%) with a median age of 38 years (interquartile range [IQR] 29-49). The median awareness and preparedness scores were 33.6 (IQR 31.1-35.1) and 8 (IQR 6-8), respectively. Mainstream media was the primary source of information on COVID-19 among HCWs. The awareness score was significantly affected by gender and profession, whereas the preparedness score was influenced by age, profession, clinical experience duration and COVID-19 training. Although frontline HCWs had high awareness levels, preparedness was low. Variables influenced awareness and preparedness differently. These findings identified gaps in pandemic readiness and factors that can be leveraged to enhance future pandemic preparedness and response in New Zealand.

Using survey experiment pretesting to support future pandemic response.

The world could witness another pandemic on the scale of COVID-19 in the future, prompting calls for research into how social and behavioral science can better contribute to pandemic response, especially regarding public engagement and communication. Here, we conduct a cost-effectiveness analysis of a familiar tool from social and behavioral science that could potentially increase the impact of public communication: survey experiments. Specifically, we analyze whether a public health campaign that pays for a survey experiment to pretest and choose between different messages for its public outreach has greater impact in expectation than an otherwise-identical campaign that does not. The main results of our analysis are 3-fold. First, we show that the benefit of such pretesting depends heavily on the values of several key parameters. Second, via simulations and an evidence review, we find that a campaign that allocates some of its budget to pretesting could plausibly increase its expected impact; that is, we estimate that pretesting is cost-effective. Third, we find pretesting has potentially powerful returns to scale; for well-resourced campaigns, we estimate pretesting is robustly cost-effective, a finding that emphasizes the benefit of public health campaigns sharing resources and findings. Our results suggest survey experiment pretesting could cost-effectively increase the impact of public health campaigns in a pandemic, have implications for practice, and establish a research agenda to advance knowledge in this space.

Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic.

During the COVID-19 pandemic, hypertensive patients had increased infection and healthcare disruption in many low- and middle-income countries (LMICs) with limited vaccine access. The objective of this report is to describe COVID-19 experiences and vaccination uptake among hypertensive patients in Colombia and Jamaica. A cross-sectional study of patients with hypertension was conducted in primary care clinics in both countries between 2021 and 2022. Trained interviewers used a telephone-administered questionnaire to assess COVID-19 experiences (infection, vaccination, and healthcare access). A total of 576 patients (68.5% female, mean age: 67.5 years) participated. Health service disruption affecting access to care was low (<10%). Compared to Jamaica, more participants from Colombia reported testing positive for COVID-19, having family members or friends testing positive, losing family members or friends due to COVID-19, and being vaccinated. In logistic regression models, adjusted for age, sex, education, and rural/urban clinic status, fear of COVID-19 (OR 2.7, 95% CI: 1.2-6.1) and residence in Colombia (OR 5.9, 95% CI: 2.4-14.6) were associated with higher vaccination uptake. Disparities in access to COVID-19 testing and diagnosis may have influenced these country differences including fear of COVID-19 and vaccine uptake. Other factors need to be better understood to prepare for future pandemic responses.

The adoption of international travel measures during the first year of the COVID-19 pandemic: a descriptive analysis

ObjectiveTo describe the adoption of international travel measures during the first year of the COVID-19 pandemic.MethodsTo comprehensively analyze the measures adopted, we constructed a dataset based on the WHO’s Public Health and Social Measures (PHSM) database, which covered 252 countries, territories, or other areas (CTAs), including all 194 WHO Member States, from December 31, 2019, to December 31, 2020. We examined the adoption of measures by type, over time, and by the implementing and targeted CTA, including their levels of income.FindingsWe identified 11,431 international travel measures implemented during the first year of the pandemic. The adoption of measures was rapid and widespread: over 60% of Member States had adopted a travel measure before the WHO declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020. Initially, health screening and travel restrictions were the most adopted measures; however, quarantine and testing became more widely adopted over time. Although only a small portion of the total measures adopted constituted full border closure, approximately half of all Member States implemented this measure. Many travel measures targeted all CTAs but were unlikely to have been adopted universally enough to provide public health benefits. Low-income countries relied more on more universal measures, including full border closure, and were slower in scaling up testing compared to higher-income countries.ConclusionThe adoption of international travel measures during the first year of the COVID-19 pandemic varied across jurisdictions and over time. Lower-income countries used a different mix and scaled-up measures slower than higher-income countries. Understanding what measures were used is crucial for assessing their effectiveness in controlling the spread of COVID-19, reviewing the usefulness of the International Health Regulations, and informing future pandemic preparedness and response activities.

Impact of COVID-19 on referrals to paediatric liaison psychiatry at Children's Health Ireland at Crumlin as the pandemic moved to endemic status.

Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions. To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions. All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions. Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles. Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.

Public-engagement strategies of the South Asian COVID-19 Task Force: The role of racialized healthcare workers in COVID-19 mitigation in Ontario.

The COVID-19 pandemic began in late 2019 and its uneven impact across different communities globally was quickly evident. In Canada, South Asian communities were disproportionately affected. In response, the South Asian COVID-19 Task Force (SACTF) emerged, seeking to address the unique challenges faced by the South Asian community. The embedded single case study design was employed to explore the role of SACTF in COVID-19 mitigation in Ontario. Informed by critical race theory and a public engagement conceptual framework published by the Canadian Health Services Research Foundation (2010), we analyzed how contexts guided the goals, processes, and outcomes of SACTF activities. We conducted one-on-one semi-structured interviews and focus group discussions with SACTF's Board of Directors and analyzed SACTF-produced knowledge dissemination materials and media coverage of SACTF spanning March 2020 to February 2022. SACTF's success in educating and advocating for South Asians offers important insights into the gaps in public health communication and the inequities in healthcare delivery. It emphasizes the importance of tailoring emergency responses to community-specific needs and the role of racialized healthcare workers in facilitating trust-building within minority communities. By incorporating insights of racialized healthcare workers in health system decision-making, both public engagement and community health outcomes can be improved. This study contributes to a nuanced understanding of community-centric pandemic responses and demonstrates the need for diverse representation in decision-making processes for long-term health system resilience. Both healthcare knowledge and lived experiences made SACTF alert to how pandemics unfold differently and have differential effects on racialized populations. SACTF's responses offer practical recommendations for future pandemic preparedness and emergency responses, emphasizing the role of advocacy groups in addressing public health gaps and serving as crucial allies for communities and governments.

Effects of COVID-19 on Irish general practice activity from 2019 to 2021: a retrospective analysis of 500,000 consultations using electronic medical record data.

General practice (GP) is crucial to primary care delivery in the Republic of Ireland and is almost fully computerised. General practice teams were the first point of contact for much COVID-19-related care and there were concerns routine healthcare activities could be disrupted due to COVID-19 and related restrictions. The study aimed to assess effects of the pandemic on GP activity through analysis of electronic medical record data from general practice clinics in the Irish Midwest. A retrospective, descriptive study of electronic medical record data relating to patient record updates, appointments and medications prescribed across 10 GP clinics over the period 2019-2021 inclusive. Data relating to 1.18 million record transactions for 32k patients were analysed. Over 500k appointments were examined, and demographic trends presented. Overall appointment and prescribing activity increased over the study period, while a dip was observed immediately after the pandemic's arrival in March 2020. Delivery of non-childhood immunisations increased sixfold as a result of COVID-19, childhood immunisation activity was maintained,while cervical smears decreased in 2020 as the screening programme was halted. A quarter of consultations in 2020 and 2021 were teleconsultations, and these were more commonplace for younger patients. General practice responded robustly to the pandemic by taking on additional activities while maintaining routine services where possible. The shift to teleconsulting was a significant change in workflow. Analysing routinely collected electronic medical record data can provide valuable insights for service planning, and access to these insights would be beneficial for future pandemic responses.

Excess Deaths in Korea During the COVID-19 Pandemic: 2020-2022.

Excess deaths, an indicator that compares total mortality rates before and during a pandemic, offer a comprehensive view of the pandemic's impact. However, discrepancies may arise from variations in estimating expected deaths. This study aims to compare excess deaths in Korea during the coronavirus disease 2019 pandemic using 3 methods and to analyze patterns using the most appropriate method. Expected deaths from 2020 to 2022 were estimated using mortality data from 2015-2019 as reference years. This estimation employed 3 approaches: (1) simple average, (2) age-adjusted average, and (3) age-adjusted linear regression. Excess deaths by age, gender, and cause of death were also presented. The number of excess deaths varied depending on the estimation method used, reaching its highest point with the simple average and its lowest with the age-adjusted average. Age-adjusted linear regression, which accounts for both the aging population and declining mortality rates, was considered most appropriate. Using this model, excess deaths were estimated at 0.3% for 2020, 4.0% for 2021, and 20.7% for 2022. Excess deaths surged among individuals in their 20s throughout the pandemic, largely attributed to a rise in self-harm and suicide. Additionally, the results indicated sharp increases in deaths associated with "endocrine, nutritional, and metabolic diseases" and "symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified." Substantial variations in excess deaths were evident based on estimation method, with a notable increase in 2022. The heightened excess deaths among young adults and specific causes underscore key considerations for future pandemic responses.

Compliance of the Jordanian Population with the Protective Measures during and after the COVID-19 Pandemic; A Nation-Wide Survey

Background: The COVID-19 pandemic has spread globally, with over 695 million confirmed cases and 6.9 million deaths as of September 2023. Compliance with protective measures is considered essential to combat the pandemic. Objectives: To assess the adherence of the Jordanian population to preventive measures during the COVID-19 pandemic. The survey specifically focused on the habits and practices of Jordanians during the pandemic, as mentioned in the introductory sentence of the Google Forms questionnaire. Methods: This cross-sectional study was conducted among the general population in Jordan aged 18 and above using an online questionnaire distributed from March to July 2022. The questionnaire was divided into two sections: demographic characteristics and practice-related questions. Data were collected using Google Forms and analyzed using R Statistical Software. Results: Most of the 409 participants were under 30 years old (65.5%), female (70%), and held a college diploma or higher degree (80%). Around 57% had been infected with COVID-19 at least once, while 60% had a relative, friend, or colleague who died due to COVID-19. More than half of the participants (54%) demonstrated favorable practices. The multivariate analysis revealed that a previous COVID-19 infection significantly increased the odds of having favorable practices (OR=2.44; CI[1.59-3.77]; p&lt;0.001). Conclusion: This study evaluated how Jordanians adhered to COVID-19 preventive measures during the pandemic. It was found that roughly half of the population effectively followed precautions such as using masks and hand sanitizers, although adherence to a balanced diet was less frequent. The likelihood of taking precautions increased after having had COVID-19. The study also reported high vaccine acceptance rates. These findings underscore the importance of public adherence to preventive measures, especially in areas like nutrition, and provide insights for future pandemic responses.

Perceptions of lived in experiences of healthcare workers during COVID-19 Pandemic in a tertiary Care hospital: A perspective from Pakistan.

This study aimed to explore the perceptions of frontline Healthcare Workers (HCWs) towards managing COVID-19 in Tertiary care hospital in Pakistan. This qualitative exploratory study was conducted from January to May 2021 at a Tertiary care hospital designated for COVID-19 patients in Rawalpindi Pakistan. Semi-structured in-depth interviews were conducted from twenty six HCWs. To acquire a sample that was diverse in terms of professional capacity, degree of experience and exposure, purposive sampling technique was used. After thematic analysis, themes were generated by identifying patterns among codes. Five themes emerged. All HCWs experienced significant amount of negative emotions including fear, uncertainty, imposing social distancing and workload. There were also positive experiences such as rewarding, call of duty and professional growth. HCWs experiences related to personal protective equipment (PPE) were communication issues, physical and dermatological issues, reuse and working confidently while wearing PPE. HCWs were buoyed by cooperation and facilitation, trainings and health education from administration. Coping mechanisms were used such as seeking team support, adjusting cognition to deal with reality and resorting to religion. Negative emotions predominated in the beginning and positive emotions emerged gradually. PPE and administrative support played significant role. HCWs' mental health was maintained in part by their self-coping styles. The findings of this study can be employed to inform and enhance future pandemic response initiatives.

Measuring the frequency and determinants of COVID-19 prevention behaviours: a cross-sectional assessment of large-scale programmes in seven countries, late 2020

ObjectivesThis multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The...

Youth mental health care use during the COVID-19 pandemic in Alberta, Canada: an interrupted time series, population-based study

BackgroundDuring the COVID-19 pandemic, youth had rising mental health needs and changes in service accessibility. Our study investigated changes in use of mental health care services for Canadian youth in Alberta before and during the COVID-19 pandemic. We also investigated how youth utilization patterns differed for subgroups based on social factors (i.e., age, gender, socioeconomic status, and geography) previously associated with health care access.MethodsWe used cross-sectional population-based data from Alberta, Canada to understand youth (15–24 year) mental health care use from 2018/19 to 2021/22. We performed interrupted time series design, segmented regression modeling on type of mental health care use (i.e., general physician, psychiatrist, emergency room, and hospitalization) and diagnosis-related use. We also investigated the characteristics of youth who utilized mental health care services and stratified diagnosis-related use patterns by youth subgroups.ResultsThe proportion of youth using mental health care significantly increased from 15.6% in 2018/19 to 18.8% in 2021/22. Mental health care use showed an immediate drop in April 2020 when the COVID-19 pandemic was declared and public health protections were instituted, followed by a steady rise during the next 2 years. An increase was significant for general physician and psychiatrist visits. Most individual diagnoses included in this study showed significant increasing trends during the pandemic (i.e., anxiety, adjustment, ADHD, schizophrenia, and self-harm), with substance use showing an overall decrease. Mortality rates greatly increased for youth being seen for mental health reasons from 71 per 100,000 youth in 2018/19 to 163 per 100,000 in 2021/22. In addition, there were clear shifts over time in the characteristics of youth using mental health care services. Specifically, there was increased utilization for women/girls compared to men/boys and for youth from wealthier neighborhoods. Increases over time in the utilization of services for self-harm were limited to younger youth (15–16 year).ConclusionsThe study provides evidence of shifts in mental health care use during the COVID-19 pandemic. Findings can be used to plan for ongoing mental health needs of youth, future pandemic responses, and other public health emergencies.

Motivators and Barriers to COVID-19 Vaccination Intentions Across U.S. County-Level Barriers in the COVID-19 Vaccine Coverage Index.

County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine. This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups. Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versushigh/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05). Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

Future support on evidence-informed priority setting and situational analysis of the potential role of Health Technology Assessment in Africa to support future pandemic preparedness and response: protocol for a scoping review

BackgroundThe COVID-19 pandemic has highlighted the importance of evidence-informed priority setting and situational analysis in pandemic preparedness and response. Health Technology Assessment (HTA) has been identified as an essential tool for evidence-informed decision-making in healthcare. However, the potential role of HTA in pandemic preparedness and response in Africa has yet to be explored. The objective of this scoping review is to ascertain the current understanding of the possible role of HTA in Africa to support future pandemic preparedness and response.MethodsWe will conduct a scoping review of literature published between 2010 and 2024. Electronic databases like Embase, PubMed, Scopus, Web of Science, and Google Scholar will be utilized to perform the search. We will also search grey literature sources such as websites of relevant organizations and government agencies. The search will only include studies that were conducted in the English language. Two reviewers will evaluate the titles and abstracts of the publications independently to determine their eligibility using Covidence. Full-text articles will be reviewed for eligibility and data extraction. The data will be extracted using a standardized form. The extracted data will include information on the study design, objectives, methods, findings, and conclusions. The thematic analysis approach will guide the data analysis. Themes and sub-themes will be identified and reported. The review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.DiscussionThis scoping review will identify the existing knowledge on the potential role of HTA in Africa to support future pandemic preparedness and response. The findings will aid in identifying deficiencies in knowledge and provide valuable insights for future study. Additionally, they will inform policy-makers and other stakeholders about the potential contribution of the Health Technology Assessment (HTA) in enhancing Africa’s readiness and response to pandemics.

Human mobility patterns in Brazil to inform sampling sites for early pathogen detection and routes of spread: a network modelling and validation study

Detecting and foreseeing pathogen dispersion is crucial in preventing widespread disease transmission. Human mobility is a fundamental issue in human transmission of infectious agents. Through a mobility data-driven approach, we aimed to identify municipalities in Brazil that could comprise an advanced sentinel network, allowing for early detection of circulating pathogens and their associated transmission routes. In this modelling and validation study, we compiled a comprehensive dataset on intercity mobility spanning air, road, and waterway transport from the Brazilian Institute of Geography and Statistics (2016 data), National Transport Confederation (2022), and National Civil Aviation Agency (2017-23). We constructed a graph-based representation of Brazil's mobility network. The Ford-Fulkerson algorithm was used to rank the 5570 Brazilian cities according to their suitability as sentinel locations, allowing us to predict the most suitable locations for early detection and to track the most likely trajectory of a newly emerged pathogen. We also obtained SARS-CoV-2 genetic data from Brazilian municipalities during the early stage (Feb 25-April 30, 2020) of the virus's introduction and the gamma (P.1) variant emergence in Manaus (Jan 6-March 1, 2021), for the purposes of model validation. We found that flights alone transported 79·9 million (95% CI 58·3-101·4 million) passengers annually within Brazil during 2017-22, with seasonal peaks occurring in late spring and summer, and road and river networks had a maximum capacity of 78·3 million passengers weekly in 2016. By analysing the 7 746 479 most probable paths originating from source nodes, we found that 3857 cities fully cover the mobility pattern of all 5570 cities in Brazil, 557 (10·0%) of which cover 6 313 380 (81·5%) of the mobility patterns in our study. By strategically incorporating mobility patterns into Brazil's existing influenza-like illness surveillance network (ie, by switching the location of 111 of 199 sentinel sites to different municipalities), our model predicted that mobility coverage would have a 33·6% improvement from 4 059 155 (52·4%) mobility patterns to 5 422 535 (70·0%) without expanding the number of sentinel sites. Our findings are validated with genomic data collected during the SARS-CoV-2 pandemic period. Our model accurately mapped 22 (51%) of 43 clade 1-affected cities and 28 (60%) of 47 clade 2-affected cities spread from São Paulo city, and 20 (49%) of 41 clade 1-affected cities and 28 (58%) of 48 clade 2-affected cities spread from Rio de Janeiro city, Feb 25-April 30, 2020. Additionally, 224 (73%) of the 307 suggested early-detection locations for pathogens emerging in Manaus corresponded with the first cities affected by the transmission of the gamma variant, Jan 6-16, 2021. By providing essential clues for effective pathogen surveillance, our results have the potential to inform public health policy and improve future pandemic response efforts. Our results unlock the potential of designing country-wide clinical sample collection networks with mobility data-informed approaches, an innovative practice that can improve current surveillance systems. Rockefeller Foundation.

Comprehensive Clustering Analysis and Profiling of COVID-19 Vaccine Hesitancy and Related Factors across U.S. Counties: Insights for Future Pandemic Responses.

This study employs comprehensive clustering analysis to examine COVID-19 vaccine hesitancy and related socio-demographic factors across U.S. counties, using the collected and curated data from Johns Hopkins University. Utilizing K-Means and hierarchical clustering, we identify five distinct clusters characterized by varying levels of vaccine hesitancy, MMR vaccination coverage, population demographics, and political affiliations. Principal Component Analysis (PCA) was conducted to reduce dimensionality, and key variables were selected based on their contribution to cumulative explained variance. Our analysis reveals significant geographic and demographic patterns in vaccine hesitancy, providing valuable insights for public health strategies and future pandemic responses. Geospatial analysis highlights the distribution of clusters across the United States, indicating areas with high and low vaccine hesitancy. In addition, multiple regression analyses within each cluster identify key predictors of vaccine hesitancy in corresponding U.S. county clusters, emphasizing the importance of socio-economic and demographic factors. The findings underscore the need for targeted public health interventions and tailored communication strategies to address vaccine hesitancy across the United States and, potentially, across the globe.

Using health belief model constructs to understand the role of perceived disease threat and resilience in responding to COVID-19 among people who use drugs: a cluster analysis.

The Health Belief Model (HBM) has been successfully applied to understanding adherence to COVID-19 prevention practices. It has not, however, been used to understand behavior in people who use drugs (PWUD). The aim of this study was to use the HBM to better understand COVID-19 perceptions among PWUD and understand how resiliency affects those perceptions. A cross-sectional survey was completed from September to December 2021 with PWUD (n = 75) who utilize services at a large harm reduction organization in Philadelphia. Segmentation analysis was done using a k-means clustering approach. Two clusters emerged based on perceived COVID-19 personal impact and resiliency (Less COVID impact/High resilience (NoCOV/HR) and High COVID impact/Low resilience (COV/LR). Differences in responses by cluster to perceptions of COVID-19 and individual pandemic response grouped by HBM constructs were assessed using Student's t-test and chi squares. Significant differences in HBM constructs were seen between clusters. Those in the COV/LR cluster were more likely to think they were susceptible to getting COVID-19 and less likely to believe they knew how to protect themselves. The NoCOV/HR cluster believed they were able to protect themselves from COVID-19 and that they were able to easily understand messages about protecting themselves. Understanding how PWUD conceptualize disease threat and using HBM can better inform interventions to improve future pandemic response. Findings suggest that resilience is key to protecting PWUD from future infectious disease outbreaks. Interventions aimed at increasing resiliency among PWUD may improve preventative behavior and decrease disease burden in this vulnerable population.

Severe outcomes among adults with TB during COVID-19.

The COVID-19 pandemic prompted strict public health measures to reduce SARS-CoV-2 transmission, potentially interrupting TB programmes in the Western Cape, South Africa. We conducted a retrospective cohort study, estimating changes in new TB case rates and risk of death during TB-specific admissions within 6 months of TB first evidence, during the pre-pandemic (1 January 2019-26 March 2020) and after the implementation of public health and social measures (PHSM) periods (26 March 2020-30 September 2021), based on PHSM strictness. We used interrupted time series and logistic regression models to adjust for key characteristics. We found an average 22% reduction (95% CI 19-25) in monthly TB cases during the entire PHSM implementation period. Additionally, the risk of death during TB-specific admissions increased, with the adjusted odds ratio ranging across PHSM levels from 1.36 (95% CI 1.17-1.57) on Level 1 to 1.44 (95% CI 1.16-1.79) on Level 2 compared with the pre-pandemic period. There was a decline in the number of diagnosed TB cases and an increased risk of severe outcomes from 26 March 2020 to 30 September 2021 in the Western Cape. TB programme recovery strategies must be prioritised, and TB management programmes must be integrated into future pandemic responses.

Validating the Delone and Mclean’s model in a developing country’s infectious disease pandemic context.

BackgroundThis study aimed at validating the updated DeLone and McLean’s information systems success model (D&MISS) in a developing country’s infectious disease pandemic preparedness and response context. The findings from this study are relevant to inform policies and actions for enhancing developing countries’ the Health Information System’s (HIS) performance, and specifically to improve their future pandemic readiness and response. The study sought to respond to a key research question: to what extent can the D&MISS model provide evidence to enhance the HIS’s infectious disease pandemic readiness and response in developing countries?MethodA cross-sectional study design that involved a multi-stage probability sampling approach to select eligible healthcare workers was applied. Conducted in Nigeria and Liberia, 576 primary healthcare workers, out of the proposed 600, participated, representing a response rate of 96%. The D&MISS model served as the theoretical underpinning for this study, and nine hypothesized relationships were stated before the study based on the interconnectedness of the model’s six dimensions. Structural Equation Modelling (SEM) data analysis using the Partial Least Square approach was used to determine if hypothesized relationships were supported.Results70% of the observed variance in the Net Benefit construct was explained by the predictive influence of the Use and User Satisfaction constructs. The Use construct had a slightly more substantial predictive influence than the User Satisfaction construct. Eight of the nine hypothesized relationships were supported, except for the relationship between Information Quality and Use. The relationships between System Quality and Use and User Satisfaction and Net Benefit had the highest beta coefficient, statistically significant at p < 0.05.Conclusion and relevanceThe D&MISS model demonstrated its relevance in providing evidence on the gaps of the HISs regarding future pandemic preparedness and response. However, from a future research opportunity, its enhancement and modifications with context-specific dimensions peculiar to developing countries will improve its ability to provide more context-specific evidence to improve pandemic preparedness and response for developing countries.