Vaccination Policy Research Articles

A Different Perspective on the COVID-19 Pandemic: Origin of the Outbreak (Part 1).

In December 2019, an outbreak caused by novel coronavirus 2019 (COVID-19) started in Wuhan, China. After extensive speculation about a causative agent, a novel betacoronavirus, in the same family as SARS-CoV and MERS-CoV, was identified via next-generation sequencing from samples received from several pneumonia patients. Ribonucleic acid extracted from the patient's bronchoalveolar lavage fluid was used as a template to clone and sequence the genome of SARS-CoV-2. Shortly after, the World Health Organization announced a worldwide pandemic. However, later reports revealed that the COVID-19 pathogen has a genetic footprint that had never been observed in natural coronavirus, suggesting a "gain of function virus" that might have been engineered in a laboratory. Clear conclusions about the outbreak's origins are still lacking. Theories regarding most probable wildlife animal reservoir for the SARS-CoV-2 have been scientifically shaky. Exactly how the virus jumped from wild animals to humans remains a mystery. Onging debate coalesces around 2 competing theories: laboratory accidental versus intentional escape scenario of a genetically engineered virus versus zoonotic emergence. Within a year after the declaration of the COVID-19 pandemic, Pfizer-BioNTech and Moderna published their 2-month duration follow-up mRNA vaccine trial results. Later reports revealed a rapidly declining vaccineinduced immunity, questionable effectiveness of these vaccines against the new variants despite boosting, inability to stop viral transmission, and, most importantly, the onset of serious adverse events. In the 2 context of all these uncertainties, controversies, and the remaining many unanswered questions, this first review presents a different perspective on the origin of the COVID-19 pandemic. A later analysis will address the subsequent events that followed in terms of diagnosis, protective measures, vaccines roll-out and vaccine mandate.

Possible counter-intuitive impact of local vaccine mandates for vaccine-preventable infectious diseases.

We modeled the impact of local vaccine mandates on the spread of vaccine-preventable infectious diseases, which in the absence of vaccines will mainly affect children. Examples of such diseases are measles, rubella, mumps, and pertussis. To model the spread of the pathogen, we used a stochastic SIR (susceptible, infectious, recovered) model with two levels of mixing in a closed population, often referred to as the household model. In this model, individuals make local contacts within a specific small subgroup of the population (e.g., within a household or a school class), while they also make global contacts with random people in the population at a much lower rate than the rate of local contacts. We considered what would happen if schools were given freedom to impose vaccine mandates on all of their pupils, except for the pupils that were exempt from vaccination because of medical reasons. We investigated first how such a mandate affected the probability of an outbreak of a disease. Furthermore, we focused on the probability that a pupil that was medically exempt from vaccination, would get infected during an outbreak. We showed that if the population vaccine coverage was close to the herd-immunity level, then both probabilities may increase if local vaccine mandates were implemented. This was caused by unvaccinated pupils possibly being moved to schools without mandates.

Human Papilloma Virus Infection and Gene Subtypes Analysis in Women Undergoing Physical Examinations: A 2015-2020 Study in Wenzhou, China.

Persistent infection with high-risk human papillomavirus (HPV) is closely related to cervical cancer. The epidemiologic characteristics of cervical HPV have regional differences. Therefore, it is necessary to develop the most favorable policies according to the actual situation of each region to prevent and reduce the prevalence of cervical cancer. This retrospective cross-sectional study investigated the prevalence, gene subtypes, and temporal trends of HPV in women undergoing physical examination in Wenzhou, to provide a decision-making basis for further prevention and control of HPV. A total of 31131 cervical exfoliated cell specimens obtained from physical examinations in Wenzhou, a coastal city of China, from 2015 to 2020 were collected. The age distribution was analyzed using the chi-squared test, and the time change trend was analyzed using the Mann-Kendall trend test. On this basis, the distribution characteristics of the HPV subtypes were analyzed. The total prevalence rate was 9.55%, and the prevalence rate in different age groups ranged from 7.77% to 14.16%. The prevalence rate in different years was 8.84%-11.83%. The prevalence rate was bimodal; it was highest in the group 25years old, followed by the group >61years old. The top five high-risk gene subtypes were HPV52, HPV58, HPV53, HPV16, and HPV39, whereas the low-risk subtypes were HPV61, HPV81, HPV44, HPV43, and HPV55. Of all the positive samples, 76.03% were infected with a high-risk subtype. Most female HPV patients in Wenzhou are infected with high-risk gene subtypes. Therefore, physical examination and screening for HPV should be further strengthened, and the corresponding vaccination policy should focus on high-risk gene subtypes.

Epidemiology of Coronavirus Disease 2019 during the Second and Third Wave in Chennai, India: An Analysis of the Coronavirus Disease 2019 Surveillance System, February 2021-February 2022.

Analysis of the coronavirus disease 2019 (COVID-19) surveillance system in the first wave indicated that the data-driven approach helped in resource allocation and public health interventions. We described the epidemiology of COVID-19 cases in Chennai, Tamil Nadu, India, from February 2021 to February 2022. We analyzed the COVID-19 surveillance data from Chennai City, Tamil Nadu, India's Greater Chennai Corporation. We described the deidentified line list of COVID-19 cases and deaths by months, zones, age, and gender. We estimated the incidence of COVID-19 cases per million population, test positivity rate (TPR), and case fatality ratio (CFR). Of the 434,040 cases reported in Chennai from February 1, 2021, to February 28, 2022, 53% were male. The incidence per million peaked in May 2021 (19,210) and January 2022 (15,881). Age groups more than 60 years reported maximum incidence. Southern region zones reported higher incidence. Overall TPR was 5.8%, peaked in May 2021 (17.5%) and January 2022 (15.1%). Over half of the 4929 reported deaths were in May 2021 (56%). Almost half of the deaths were 61-80 years (52%), followed by 41-60 years (26%). Overall CFR was 1%, which peaked in June 2021 (4%). We conclude that Chennai city experienced a surge in COVID-19 due to delta and omicron variants. Understanding descriptive epidemiology is vital for planning the public health response, resource allocation, vaccination policies, and risk communication to the community.

Did Partial Lockdown Policy Effectively Reduce the First Wave of COVID-19 in Indonesia? A Regression Discontinuity Approach

One of the crucial issues in determining pandemic mitigation is deciding the optimal lockdown policy, whether a complete or partial lockdown could effectively reduce the spreading of COVID-19 without a vaccination policy, which could avoid global economic recession. The conventional pandemic model has limitations in predicting these linkages. The latest Causal Inference method that has been powerful in economic and health policy evaluation, such as Regressions Discontinuity Design (RDD), can contribute to this analysis. In contrast, RDD analysis in existing references is underused. This paper's objective is how the partial lockdown policy in Indonesia effects on spreading COVID-19 virus using RDD analysis. The results indicate that the partial lockdown policy reduced new cases of COVID-19 compared with having no partial lockdown policy. The results close to complete lockdown. This study uses panel data from official health, Waze, and other social variables. The pandemic model was developed from theoretical and empirical estimation. The spillover analysis was estimated using a Bayesian panel fixed-effect with Markov Chain Monte Carlo to relax the SUTVA problem. The DKI Jakarta has effectively reduced the spread of confirmed COVID-19 cases by about 10% to 22% from the baseline. The impact was less in West Java, at about 5%–18.5% from baseline. The government can control mobility during weekend periods and at the beginning of Ramadan. Policy enacted at the level of government (subdistrict level) most proximal to households had more influence on spillover effect reduction than those enacted at higher levels of government. The RDD analysis offers new implications to existing references for incorporating economic and pandemic variables for further research. Collaborating across the government level against the pandemic is paramount to controlling human mobility close to households.

Twenty Years of Progress and the Way Forward: Immunization Registry Information System in Korea.

The National Immunization Program in The Republic of Korea offers mandatory and free vaccinations to children under 12, regulated by the Infectious Disease Prevention and Control Act. Tracking vaccination coverage is crucial for population protection and public health strategies. Since 2002, the Immunization Registry Information System (IRIS) has been used nationwide to capture vaccination data. This study reviewed documents related to IRIS's establishment and development. The Republic of Korea legally supports IRIS's construction and data collection, integrating vaccination data with the Ministry of the Interior and Safety's resident registration to minimize errors. This collaboration also facilitates cost reimbursement and digital registration, promoting wider vaccination coverage. IRIS manages expense claims once vaccination details are logged, and authorized medical institutions can access these records in real-time. Since 2015, the Korea Disease Control and Prevention Agency has been compiling annual data on national vaccination coverage. IRIS also sends automated reminders in 12 languages, reports adverse effects, and issues vaccination certificates. However, IRIS lacks integration between vaccine and disease registries, unlike countries such as England, Denmark, and the Netherlands. Improving integration capabilities could enhance IRIS's support for public health through an integrated information system.

Recent State Legislative Attempts to Restructure Public Health Authority: The Good, The Bad, and The Way Forward.

The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health - a partnership of public health law organizations - has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.

The Impact of COVID-Related Restrictions on the Mental Health of Students.

The first stage of the COVID pandemic in spring and early summer of 2020 was shaped by restrictions due to the so-called flattening-the-curve approach. Students globally were impacted when public and private colleges and universities were forced to either shut down temporarily or transition to remote learning. Studies from around the world found increased levels of stress, anxiety, depression, and suicidal ideation. Female students often reported being more affected than male students. Suicide rates, however, did not increase. The second stage, starting in late summer 2020, saw the highest case numbers but also a slow and mostly partial return to normal life enabled by vaccination efforts and policy decisions. The mental health of students in most countries recovered well, even when they had to go through repeated or continued lockdowns or restrictions. Although it cannot be predicted what portion of students will be affected by mental health issues in ten or twenty years, it is certain that there will be long-term mental health consequences for many. It is also uncertain which approach, "living with COVID" or "zero COVID," will show less impact on the mental health of students' long term.

Intellectual property rights and fair vaccine distribution: A new perspective on the TRIPS Agreement

The COVID-19 pandemic has highlighted inequities concerning global vaccine distribution, as well as issues surrounding patents and intellectual property rights for these vaccines. This paper addresses the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) regarding vaccines. Adhered to by all state members of the World Trade Organization (WTO), the agreement sets minimum regulatory standards for governments on intellectual property, including vaccines. Our contribution is a new analysis of TRIPS Art. 31 Bis concerning flexibilities in its terms of use on global vaccine distribution. We consider existing solutions for fairer vaccine distribution, such as governments enforcing a compulsory vaccine licence, and governmental/individual charitable efforts. We then focus on issues with know-how distribution and access to knowledge in the TRIPS context. We conclude that the enhanced provisions of TRIPS are ill-suited to global pandemics. To ensure fairer global vaccine distribution, we argue that patent pools and further TRIPS amendments are needed to endow less and least-developed countries with the ability to implement government-use compulsory licenses and to negotiate compensation terms later under judicial review. Further, to enable countries lacking the technical manufacturing capabilities to produce vaccines under license, TRIPS needs to be amended to permit technology and know-how transfer (Holder, 2023).

The Impact of Mandatory Vaccination Policies on Covid-19 Immunization Rates: An Analysis of Law Efficiency

The Impact of Mandatory Vaccination Policies on Covid-19 Immunization Rates: An Analysis of Law Efficiency

COVID-19 and Japanese Encephalitis Vaccination: Occurrence of Disease in Area with and without Mandatory Vaccination Policies

COVID-19 and Japanese Encephalitis Vaccination: Occurrence of Disease in Area with and without Mandatory Vaccination Policies

A Different Perspective of COVID-19 Pandemic: Efficacy and Safety of mRNA Vaccines in Immunocompetent and Immunocompromised Individuals (Part 3).

Shortly after the declaration of the pandemic, several anti-SARS-CoV-2 vaccines entered phase 3 clinical trials. One year later, Pfizer-BioNTech and Moderna published their initial trial results, encompassing a 2-month follow-up. The studies were only designed to test whether the vaccines were effective and safe on the short-term.The vaccine's efficacy in the 2 trials was defined as relative risk reduction instead of absolute risk reduction, a more accurate determinant of vaccine effectiveness in the real world. These studies were not designed to assess viraltransmission, disease severity, and death as primary outcomes.Vulnerable subgroups of individuals were excluded from the studies. No correlate of immunity against the SARS-CoV2 was identified.Vaccine-induced immunity declined shortly after vaccination and was not protective against new variants. Vaccination and boosting effectiveness were suboptimal in immunocompromised patients. In contrast, in recovered COVID-19 patients, natural immunity was shown to be protective, lasting longer and being more effective against new variants. Findings from subsequent scientific reports questioned the effectiveness of these vaccines in providing protective immunity despite boosting in infection-naïve and infection-experienced individuals. Reports also raised concerns on their safety in relation to cardiovascular pathology, sudden death, and acquired autoimmunity mainly in the low-risk young population. With the doubtful accuracy of the polymerase chain reaction testing in relation to case definition and diagnosis, the inability of the vaccines to stop viral transmission, the uncertain effectiveness of these vaccines, and serious adverse events of these vaccines lead us to question the validity ofthe vaccine mandate in public and private domains.

Military Vaccine Mandates: Thirty-Five Navy SEALs Believe Fighting for Religious Exemptions is A Shot Worth Taking

Abstract Americans take great pride in their constitutional freedoms, especially the renowned First Amendment, which states that “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” (U.S. Const. amend. I) The free exercise of religion is safeguarded by the First Amendment’s Free Exercise Clause; yet, in the face of a public health crisis – how far does this protection extend? Moreover, does the Free Exercise Clause cover all Americans equally? In 2020, the Corona virus (COVID-19) pandemic began testing the limits of the First Amendment. President Joseph Biden and Secretary of Defense Lloyd Austin mandated that all active and reserve military members take the newly developed COVID-19 vaccinations. Failing to comply would leave service members with no other option than to be dishonorably discharged from military service. This paper seeks to analyze the current case of thirty-five Navy SEALs who were denied religious exemptions from the COVID-19 vaccines, and examines the implications this has on First Amendment protections for military servicemembers.

The Worrying Phenomenon of COVID-19 Vaccine Hesitancy and Its Negative Impact on Pandemic Control Efforts: Common Themes that Emerged in the Middle East and North Africa (MENA) Region.

Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, intensive measures were taken to mitigate its negative health, psychological, social, and economic impact. COVID-19 continues to pose serious threats globally, with vaccination as the central safe strategy to control the pandemic. However, COVID-19 vaccine hesitancy is a major concern, especially in the Middle East and North Africa (MENA). Concerns regarding vaccine safety, efficacy, and misinformation contribute to vaccine hesitancy. Addressing these concerns and providing accurate information is crucial for increasing COVID-19 vaccine acceptance and uptake in this region, where the coverage is low. Variable rates of COVID-19 vaccine hesitancy were found in the numerous studies conducted in the region. Complex factors contributed to vaccination hesitancy in the region including concerns about COVID-19 vaccine safety and efficacy, low trust in healthcare systems, complacency toward the risks of COVID-19, constraints hindering access to COVID-19 vaccination services, as well as the circulation of misinformation and conspiracy beliefs about COVID-19 and its vaccination. Effective approaches to address COVID-19 vaccine hesitancy in the MENA region rely on developing evidence-based communication strategies that are recommended to build trust in vaccination, highlight the disease risks, and counter COVID-19 vaccine-related misinformation. Ensuring COVID-19 vaccine affordability is also necessary besides the cautious consideration of implementing COVID-19 vaccine mandates. Based on the preceding discussion, this chapter aims to identify the common themes of COVID-19 vaccine hesitancy in the MENA region. In addition, the chapter highlights the importance of understanding the root causes of COVID-19 vaccination hesitancy and its associated determinants to develop effective strategies for promoting COVID-19 vaccine acceptance and uptake in the MENA region. To build community trust, promote community education and awareness, and counter misinformation for better COVID-19 vaccine coverage in the region, it is recommended to involve healthcare professionals and policymakers.

Monitoring and evaluation of provincial classical swine fever immunization implementation with an E2 subunit vaccine in Jeju Island, South Korea.

Accidental vaccination with a live attenuated low-virulence strain of Miyagi (LOM) vaccine led to the reemergence of classical swine fever virus (CSFV) in Jeju province, South Korea in 2014. To control the continual outbreaks of LOM-derived CSFV, the provincial government launched a provincial mass vaccination project using a CSF-E2 subunit vaccine. We conducted this study to assess the herd immunity level and outcomes of E2 vaccine-based immunization in breeding and growing herds on Jeju Island during 2020-2021. A large-scale vaccination trial using the Bayovac CSF-E2 vaccine investigated its efficacy in breeding and growing herds under farm application conditions (10 CSFV-affected and three CSFV-naïve swine farms). The level of herd immunity in each farm was classified into three (S1-S3) and six (G1-G6) profiles in breeding and growing herds, respectively. Immunity monitoring revealed a remarkable improvement in the herd immunity status in all farms. The majority (10/13) of farms, including CSFV-free farms, showed the S1G1 immunity profile in 2021, indicating the appropriate implementation of the advised vaccination regime. Moreover, there were significant decreases in Erns seropositivity from 100% to 50% and 25.9% to 4.3% at farm and pig levels, respectively. In particular, all farms were confirmed as CSFV free in the growing-finishing herds. Our large-scale trial demonstrated the effectiveness of the E2 subunit vaccine in establishing herd immunity stabilization and eliminating CSFV circulation in the affected farms and highlighted the need for a provincial vaccination policy to regain the CSF-free status on Jeju Island.

The Sooner, the Better? Optimal Vaccination Policy with Limited Vaccine Supply

The Sooner, the Better? Optimal Vaccination Policy with Limited Vaccine Supply

Advancing Behavioral Dynamics in Health Policy Decision-Making: Integrating Insights for Effective Vaccination Policy and Addressing AMR

Advancing Behavioral Dynamics in Health Policy Decision-Making: Integrating Insights for Effective Vaccination Policy and Addressing AMR

Advancing Behavioral Dynamics in Health Policy Decision-Making: Integrating Insights for Effective Vaccination Policy and Addressing AMR

Advancing Behavioral Dynamics in Health Policy Decision-Making: Integrating Insights for Effective Vaccination Policy and Addressing AMR

Enhancing Lifelong Vaccination: Insights from Spain, France and Italy

Vaccinations are not limited to children and teenagers, as recently reiterated in the Council Conclusions on Vaccination. With the European Union's population continuing to age, there is a growing need to prioritize adult vaccination alongside pediatric vaccinations. In April 2023, the Italian NGO Cittadinanzattiva, through its European branch Active Citizenship Network, launched a new project called 'Civil Society promoting vaccination across the life-course' during the European Immunization Week. The goal was to enhance collaboration and dialogue with all relevant health stakeholders, engaging citizens' and patients' associations across Europe to better understand and implement vaccination policies. This article presents the outcomes of three national focus groups held in the second half of 2023 across Spain, France and Italy. The methodology involved discussions in native languages to gain qualitative insights into life-course immunization, barriers, and strategies. Engaging leaders from civic and patients' associations, healthcare professionals, and policymakers, the collaborative effort explored lessons learned and identified pathways for improving vaccination rates. Positive shifts in stakeholders' perspectives underscore the pivotal role of preventive measures, prompting increased policymakers' awareness. However, challenges arise, including a polarized approach to vaccination and issues in communication causing confusion and distrust, amplified by media influence. Presently, there is an overall stagnation in vaccination rates, with a slight decline, particularly in influenza vaccinations, signaling vaccination “fatigue”. Common suggestions include advocating for effective and personalized communication, leveraging digital tools, endorsing patient and civic organizations as strong vaccine advocates, and recognizing the increased role of different healthcare professionals (pharmacists, nurses, etc.) as invaluable support resources. Additionally, the importance of vaccination campaign evaluation is emphasized.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.