Vaccination Policy Research Articles

Need and Rationale of the Adult Immunisation in India: A Review

Abstract A comprehensive literature review of published articles (till October 2023) was done through PubMed, Embase and Google Scholar search engines to delineate the need for adult immunisation, recommended adult vaccines, barriers to adult immunisation, future research areas and way forward in the Indian context. A total of 29,894 articles were screened from PubMed, Embase and Google Scholar. Of these, a full-text review of 53 articles was done. The findings emphasised the need for adult immunisation in India because of the growing vulnerable elderly population with comorbidities, immunosenescence, waning immunity, rising incidence of VPDs leading to higher morbidity and mortality amongst them, rising cost of hospitalisation and the emergence of antimicrobial resistance. The recommended adult vaccines include human papilloma virus vaccine, pneumococcal vaccine, influenza and typhoid vaccine for healthy adults and special population groups, respectively. Challenges include less prioritisation in the National Vaccination Policy, insufficient awareness amongst healthcare providers and vaccine hesitancy.

Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis.

With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8% (95% CI 1.4%-16.1%) to 71.8% (95% CI 63%-80.7%) and from 33.6% (95% CI 23.6%-43.6%) to 98.6% (95% CI 97.6%-99.7%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50% and 100% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration.

Economic burden of cardiorespiratory hospitalizations associated with respiratory syncytial virus among United States adults in 2017–2019

ABSTRACT Morbidity and mortality caused by respiratory syncytial virus (RSV) in older adults and those with underlying health conditions can be potentially alleviated through vaccination. To assist vaccine policy decision-makers and payers, we estimated the annual economic burden of RSV-associated cardiorespiratory hospitalizations among insured US adults aged ≥18 y in the Merative MarketScan claims database from September through August of 2017–2018 and 2018–2019. Negative binomial regression models were used to estimate the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. This number was multiplied by mean cardiorespiratory hospitalization costs to estimate total costs for RSV-associated cardiorespiratory hospitalizations. Number and cost for International Classification of Diseases (ICD)-coded RSV hospitalizations were quantified from MarketScan. In 2017–2018 and 2018–2019, respectively, 18,515,878 and 16,462,120 adults with commercial or Medicare supplemental benefits were assessed. In 2017–2018, 301,248 cardiorespiratory hospitalizations were observed; 0.32% had RSV-specific ICD codes, costing $44,916,324, and 5.52% were RSV-associated cardiorespiratory hospitalizations, costing $734,078,602 (95% CI: $460,826,580–$1,103,358,799). In 2018–2019, 215,525 cardiorespiratory hospitalizations were observed; 0.34% had RSV-specific ICD codes, costing $33,053,105, and 3.14% were RSV-associated cardiorespiratory hospitalizations, costing $287,549,472 (95% CI: $173,377,778–$421,884,259). RSV contributes to substantial economic burden of cardiorespiratory hospitalizations among US adults. Modeling excess risk using viral positivity data provides a comprehensive estimation of RSV hospitalization burden and associated costs, compared with relying on ICD diagnosis codes alone.

Analyzing the 7C psychological antecedents of vaccine acceptance throughout the COVID-19 pandemic among healthcare sector workers in France: A repeated cross-sectional study (CappVac-Cov)

BackgroundAcross various stages of the COVID-19 pandemic and related vaccine recommendations in France, we assessed the association of the 7C-psychological antecedents with vaccine uptake/intention for booster vaccination among healthcare-sector workers (HCSWs). We also assessed whether 7C-antecedent profiles changed over time. MethodologyThe Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES) conducted three repeated web-surveys which were disseminated by email chain-referral among HCSWs throughout France. The questionnaires waves took place: July-November 2021, February-March 2022 and January-March 2023 (P2, P3 and P4). We also reanalysed data from a prior similar study conducted late 2020-early 2021 (Moirangthem et al. (2022)) (P1). To evaluate the association of 7C-items with vaccine uptake-intention for future vaccination, we estimated adjusted prevalence ratios (aPR) using robust variance Poisson regression. We report the 7C-item population attributable loss in vaccine intention. ResultsThe four surveys (P1-P4) encompassed 5234, 339, 351 and 437 participants. At earlier stages of the vaccine campaign, the principal antecedents of vaccine intention were favorable perception of vaccination benefit-risk-balance (BRB) (vs. unfavorable, aPR: 2.32), reactance to employer encouragement for vaccination (motivates vs. dissuades-me, aPR:2.23), vaccine confidence (vs. not-being-confident, aPR: 1.71) and social conformism towards vaccination (favorable vs. skeptical opinion in private environment, aPR: 1.33). Under a vaccine mandate for HCSWs, only perceiving vaccination as a collective action was associated with current vaccine status (agree vs. disagree, aPR: 2.19). At later stages of the epidemic, hypothetical booster vaccine intentions were strongly associated with BRB perception (favorable vs. unfavorable, aPR: 2.07) and perceiving vaccination as a collective action (agree vs. disagree, aPR: 1.69). Fearing a severe side effect from vaccination decreased population vaccine intention by 26.2 %. ConclusionOur results suggest that both 7C-antecedents and their association with vaccine behaviour can change over time, and underscore the importance of assuring confidence in vaccine safety.

Optimal vaccination strategies for imperfect vaccines and variable host susceptibility

I present a method to allocate a given number of vaccines to members of a population who differ in their susceptibility to the disease so that the final size of the epidemic is minimised. I consider an arbitrary distribution of protection that the vaccine confers, including the extreme cases of leaky and all-or-none vaccines. The optimal vaccination policy depends on the distribution of protection. While for low values of the basic reproduction number R0 the optimal policy prioritises the most susceptible hosts, I show that for almost any distribution the order of priority reverses and the least susceptible hosts should be vaccinated when R0 is high. The exception where this does not happen is the all-or-none vaccine. However, even a small deviation from the ideal all-or-none distribution can imply that the limited number of vaccines should be given to less susceptible hosts already at realistic values of R0.

Development and Bayesian validation of a competitive inhibition ELISA for detection of antibodies against Brucella abortus in cattle

Bovine brucellosis is a zoonotic disease caused by Brucella abortus, responsible for abortions in cows. It is endemic in low- and middle-income countries, where the brucellosis control and eradication programs are based on compulsory vaccination, detection of infected cattle through serologic assays, and culling of infected animals at slaughterhouses. The development of high sensitivity and specificity, and low-cost serologic assays guarantee their implementation in countries where the disease is endemic. The aim of the present study was to develop and validate a competitive inhibition enzyme-linked immune assay (ciELISA) to detect anti-B. abortus antibodies in sera from cattle. The developed ciELISA was validated using 2833 serum samples from dairy and beef cattle. From these, 1515 sera were from uninfected cows that belonged to free of brucellosis herds and 1318 were from infected cows that belonged positive to brucellosis herds. Sera were analyzed with the developed ciELISA, the buffer plate antigen (BPA) test, and the complement fixation test (CFT). The brucellosis status of the herds was officially established according to the country legislation and consistent for at least 5 years and was defined for each cow using the CFT as gold standard. The cutoff for the ciELISA was calculated using a ROC curve and its sensitivity and specificity were analyzed using the Bayesian Latent Class Model (BLCM) approach. The agreement among tests was calculated using the kappa (κ) value. In addition, 15 calves were vaccinated with 3 × 1010 viable cells of B. abortus Strain 19 vaccine, and the dynamics of antibodies were measured by CFT, buffered plate antigen (BPA) test, and the developed ciELISA. The obtained cutoff for ciELISA was ≥ 47 percentage of inhibition (% I), at the BLCM approach the sensitivity was 99.01 % (95 % CI: 97.55–100) and the specificity 98.74 % (95 % CI: 97.68–99.8). The κ between the ciELISA and BPA was κ = 0.88 and between the ciELISA and CFT κ = 0.95. Antibodies against B. abortus were detected in all the vaccinated calves 7 days after vaccination (AV) by the three assays, at day 135 AV all the calves were negative to CFT (15/15), 93.3 % (14/15) to ciELISA and 73.3 % (11/15) to BPA, and at day 190 AV all the calves were negative to the three assays. The developed ciELISA showed a very good performance, could detect the majority of vaccinated animals as negative after 135 days and could be used for the detection of anti-B. abortus antibodies in serum samples for the brucellosis control and eradication program.

US State Restrictions and Excess COVID-19 Pandemic Deaths

Despite considerable prior research, it remains unclear whether and by how much state COVID-19-related restrictions affected the number of pandemic deaths in the US. To determine how state restrictions were associated with excess COVID-19 deaths over a 2-year analysis period. This was a cross-sectional study using state-level mortality and population data from the US Centers for Disease Control and Prevention for 2020 to 2022 compared with baseline data for 2017 to 2019. Data included the total US population, with separate estimates for younger than 45 years, 45 to 64 years, 65 to 84 years, and 85 years or older used to construct age-standardized measures. Age-standardized excess mortality rates and ratios for July 2020 to June 2022 were calculated and compared with prepandemic baseline rates. Excess death rates and ratios were then regressed on single or multiple restrictions, while controlling for excess death rates or ratios, from March 2020 to June 2020. Estimated values of the dependent variables were calculated for packages of weak vs strong state restrictions. Behavioral changes were investigated as a potential mechanism for the overall effects. Data analyses were performed from October 1, 2023, to June 13, 2024. Age and cause of death. Excess deaths, age-standardized excess death rates per 100 000, and excess death ratios. Mask requirements and vaccine mandates were negatively associated with excess deaths, prohibitions on vaccine or mask mandates were positively associated with death rates, and activity limitations were mostly not associated with death rates. If all states had imposed restrictions similar to those used in the 10 most restrictive states, excess deaths would have been an estimated 10% to 21% lower than the 1.18 million that actually occurred during the 2-year analysis period; conversely, the estimates suggest counterfactual increases of 13% to 17% if all states had restrictions similar to those in the 10 least-restrictive states. The estimated strong vs weak state restriction difference was 271 000 to 447 000 deaths, with behavior changes associated with 49% to 79% of the overall disparity. This cross-sectional study indicates that stringent COVID-19 restrictions, as a group, were associated with substantial decreases in pandemic mortality, with behavior changes plausibly serving as an important explanatory mechanism. These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.

Socioeconomic determinants and reasons for non-acceptance to vaccination recommendations during the 3rd - 5th waves of the COVID-19 pandemic in Hungary

BackgroundIn Hungary, although six types of vaccines were widely available, the percentage of people receiving the primary series of COVID-19 vaccination remained below the EU average. This paper investigates the reasons for Hungary’s lower vaccination coverage by exploring changing attitudes towards vaccination, socio-demographic determinants, and individual reasons for non-acceptance during the 3rd - 5th pandemic waves of COVID-19.MethodsThe study’s empirical analysis is based on representative surveys conducted in Hungary between February 19, 2021, and June 30, 2022. The study used a total of 17 surveys, each with a sample size of at least 1000 respondents. Binomial logistic regression models were used to investigate which socio-demographic characteristics are most likely to influence vaccine hesitancy in Hungary. The study analysed 2506 open-ended responses to identify reasons for vaccine non-acceptance. The responses were categorised into four main categories and 13 sub-categories.ResultsBetween the third and fifth wave of the pandemic, attitudes towards COVID-19 vaccination have significantly changed. Although the proportion of vaccinated individuals has increased steadily, the percentage of individuals who reported not accepting the vaccine has remained almost unchanged. Socio-demographic characteristics were an important determinant of the observed vaccine hesitancy, although they remained relatively stable over time. Individuals in younger age groups and those with lower socioeconomic status were more likely to decline vaccination, while those living in the capital city were the least likely. A significant reason behind vaccine refusal can undoubtedly be identified as lack of trust (specifically distrust in science), facing an information barrier and the perception of low personal risk.ConclusionAlthough compulsory childhood vaccination coverage is particularly high in Hungary, voluntary adult vaccines, such as the influenza and COVID-19 vaccines, are less well accepted. Vaccine acceptance is heavily affected by the social-demographic characteristics of people. Mistrust and hesitancy about COVID-19 vaccines, if not well managed, can easily affect people’s opinion and acceptance of other vaccines as well. Identifying and understanding the complexity of how vaccine hesitancy evolved during the pandemic can help to understand and halt the decline in both COVID-19 and general vaccine confidence by developing targeted public health programs to address these issues.

The power of the family in times of pandemic: Cross-country evidence from 93 countries

The majority of the hospitalizations and deaths associated with COVID-19 occurred in people over the age of 65. In addition, previous studies have shown that intergenerational contacts played a key role in COVID-19-related infection and fatality. This paper utilized two large-scale multinational surveys to uncover the important role of family ties in infection prevention across 93 countries. Using the World Values Survey, we measured country-level family ties emphasizing respondents’ view of their parents. We elicited individual willingness to uptake infection prevention measures from a panel study conducted each month in the early phase of the COVID-19 pandemic between March 2020 and July 2021. We find that in countries with stronger family ties, people show more support for non-pharmaceutical interventions and higher vaccine acceptance; moreover, young people are more supportive of mandatory vaccination. The association between strength of family ties and compliance with infection prevention measures was salient before COVID-19 vaccines became available and was persistent before the global vaccination coverage reached 25%.

The impact of the COVID-19 pandemic and the free vaccination policy on seasonal influenza vaccination uptake among older adults in Ningbo, Eastern China

ABSTRACT In 2020–21, during the COVID-19 pandemic, a free influenza vaccination program was initiated among the elderly residents in Ningbo, China. The impact of the COVID-19 pandemic and free vaccination policy on influenza vaccine uptake needs to be evaluated. The influenza vaccine uptake among individuals born before 31 December, 1962 from 2017–18 to 2022–23 season in Ningbo was analyzed. Multivariate logistic regressions were used to estimate the impact of the COVID-19 pandemic and free vaccination policy. Our analysis included an average of 1,856,565 individuals each year. Influenza vaccination coverage increased from 1.14% in 2017–18 to 33.41% in 2022–23. The vaccination coverage among the free policy target population was 50.03% in 2022–23. Multivariate analysis showed that free vaccination policy increased influenza vaccine uptake most (OR = 11.99, 95%CI: 11.87–12.11). The initial phase of the pandemic was associated with a positive effect on influenza vaccination (OR = 2.09, 95%CI: 2.07–2.12), but followed by a negative effect in the subsequent two seasons(2021–22: OR = 0.75, 95%CI: 0.73–0.76; 2022–23: OR = 0.40, 95%CI: 0.39–0.40). COVID-19 vaccination in the current season was a positive predictor of influenza vaccine uptake while not completing booster COVID-19 vaccination before was negative predictor in 2022–23. Having influenza vaccine history and having ILI medical history during the last season were also positive predictors of influenza vaccine uptake. Free vaccination policies have enhanced influenza vaccination coverage among elderly population. The COVID-19 pandemic plays different roles in different seasons. Our study highlights the need for how to implement free vaccination policies targeting vulnerable groups with low vaccination coverage.

Understanding Kenyan policymakers' perspectives about the introduction of new maternal vaccines.

New vaccine policy adoption is a complex process, especially in low-and-middle-income countries (LMICs), requiring country policymakers to navigate challenges such as competing priorities, human and financial resource constraints, and limited logistical capacity. Since the Expanded Programme on Immunization's (EPI) beginning, most new vaccine introductions under this structure have not been aimed at adult populations. The majority of adult vaccines offered under the EPI are not typically tested among and tailored for pregnant persons, except those that are specifically recommended for pregnancy. Given that new maternal vaccines, including RSV and GBS vaccines, are on the horizon, it is important to understand what barriers may arise during the policy development and vaccine introduction process. In this study, we sought to understand information needs among maternal immunization policymakers and decision-makers in Kenya for new vaccine maternal policy adoption through in-depth interviews with 20 participants in Nakuru and Mombasa counties in Kenya. Results were mapped to an adapted version of an established framework by Levine et al., (2010) focused on new vaccine introduction in LMICs. Participants reported that the policy process for new maternal vaccine introduction requires substantial evidence as well as coordination among diverse stakeholders. Importantly, our findings suggest that the process for new maternal vaccines does not end with the adoption of a new policy, as intended recipients and various actors can determine the success of a vaccine program. Previous shortcomings, in Kenya, and globally during HPV vaccine introduction show the need to allocate adequate resources in education of communities given the sensitive target group. With maternal vaccines targeting a sensitive group - pregnant persons- in the pipeline, we are at an opportune time to understand how to ensure successful vaccine introduction with optimal acceptance and uptake, while also addressing vaccine hesitancy to increase population benefit.

Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing Homes.

Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020-23. The lessons learned from this experience point to the need for more fundamental and nuanced changes to avoid similar outcomes from a future pandemic: greater integration of long-term care into public health planning, and ultimately a shift in the physical structure of nursing homes. More incremental measures such as vaccination mandates, higher staffing, and balancing infection control with resident quality of life will avoid some adverse outcomes, but without more systemic change, nursing home residents and staff will remain at substantial risk for repetition of the poor outcomes from the COVID-19 pandemic.

Exploring perspectives on vaccinations delivered in complementary nonclinical settings and by nonphysician health professionals: A qualitative interview study

BackgroundAlthough vaccines are an effective solution for preventing infectious disease, some vaccination rates remain below national targets, creating a need to increase vaccination access and uptake. A potential solution to improve vaccination rates is the implementation of policies that allow for more convenient vaccination access, such as the expansion of vaccination delivery by nonphysician healthcare providers (NPHPs) outside of traditional clinical settings. ObjectiveTo understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by NPHPs, and the barriers surrounding administration. MethodsWe performed interviews with healthcare providers and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy. ResultsThirty-eight participants completed interviews. Participants reported that U.S. individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites. ConclusionNPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the United States.

Optimal design of vaccination policies: A case study for Newfoundland and Labrador

This paper proposes pandemic mitigation vaccination policies for Newfoundland and Labrador (NL) based on two compact mixed integer programming (MIP) models of the distance-based critical node detection problem (DCNDP). Our main focus is on two variants of the DCNDP that seek to minimize the number of connections with lengths of at most one (1-DCNDP) and two (2-DCNDP). A polyhedral study for the 1-DCNDP is conducted, and new aggregated inequalities are provided for the 2-DCNDP. The computational experiments show that the 2-DCNDP with aggregated inequalities outperforms the one with disaggregated inequalities for graphs with a density of at least 0.5%. We also study the strategic vaccine allocation problem as a real-world application of the DCNDP and conduct a set of computational experiments on a simulated contact network of NL. Our computational results demonstrate that the DCNDP-based strategies can have a better performance in comparison with the real-world strategies implemented during COVID-19.

Vaccine Politics.

A vaccine law and policy expert reflects on the dangers of the influence of politics on public health decision making.

HESITANGES ABOUT COVID-19 VACCINATION AMONG STUDENTS, TEACHERS AND PARENTS

Vaccination is a leading strategy for the prevention and control of individual and public health in the fight against the COVID-19 pandemic. Purpose: This study aims to investigate and analyze the attitudes toward vaccination and the factors conditioning hesitancy about the vaccine´s prevention of COVID-19 among three target groups: students, parents and teachers. Materials and methods: An online anonymous survey was conducted among 228 participants - students in 11th and 12th grade at two language high schools in the city of Plovdiv (n=114), teachers (n=44) and parents (n=70) in November 2021 Results: Vaccination attitudes were fairly heterogenous, ranging from complete agreement to categorical disagreement in the answers of all three studied groups. The prevailing opinion among parents is that vaccination has no absolute protective effect regarding the risk of infection with COVID-19. Both parents and teachers, as well as students, strongly object to mandatory vaccination against COVID-19. An important factor influencing the hesitancy of vaccine prevention is the concern of whether the new vaccines are harmless and effective. Negative expectations of possible adverse reactions to the administered vaccines are shared among half of the students and a significant part of the studied group of parents and teachers. Conclusions: Established factors influencing vaccine hesitancy should be considered when conducting future vaccination trial campaigns for immunoprophylaxis among adolescents.

Dynamic evolution of COVID-19 vaccine hesitancy over 2021-2023 among Chinese population: Repeated nationwide cross-sectional study.

Globally, the rollout of COVID-19 vaccine had been faced with a significant barrier in the form of vaccine hesitancy. This study adopts a multi-stage perspective to explore the prevalence and determinants of COVID-19 vaccine hesitancy, focusing on their dynamic evolutionary features. Guided by the integrated framework of the 3Cs model (complacency, confidence, and convenience) and the EAH model (environmental, agent, and host), this study conducted three repeated national cross-sectional surveys. These surveys carried out from July 2021 to February 2023 across mainland China, targeted individuals aged 18 and older. They were strategically timed to coincide with three critical vaccination phases: universal coverage (stage 1), partial coverage (stage 2), and key population coverage (stage 3). From 2021 to 2023, the surveys examined sample sizes of 29 925, 6659, and 5407, respectively. The COVID-19 vaccine hesitation rates increased from 8.39% in 2021 to 29.72% in 2023. Urban residency, chronic condition, and low trust in vaccine developer contributed to significant COVID-19 vaccine hesitancy across the pandemic. Negative correlations between the intensity of vaccination policies and vaccine hesitancy, and positive correlations between vaccine hesitancy and long COVID, were confirmed. This study provides insights for designing future effective vaccination programs for emerging vaccine-preventable infectious X diseases.

Assessing the modification impact of vaccination on the relationship of the Discomfort Index with hand, foot, and mouth disease in Guizhou: A multicounty study.

Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and humidity are well-documented predictors. However, evidence on the combined effect of temperature and humidity is still limited. It also remains unclear whether such an effect could be modified by the enterovirus 71 (EV71) vaccination. Based on 320,042 reported HFMD cases during the summer months between 2012 and 2019, we conducted a study utilizing Distributed Lag Non-Linear Models (DLNM) and time-varying DLNM to examine how China's HFMD EV71 vaccine strategy would affect the correlation between meteorological conditions and HFMD risk. The incidence of HFMD changed with the Discomfort Index in an arm-shaped form. The 14-day cumulative risk of HFMD exhibited a statistically significant increase during the period of 2017-2019 (following the implementation of the EV71 vaccine policy) compared to 2012-2016 (prior to the vaccine implementation). For the total population, the range of relative risk (RR) values for HFMD at the 75th, 90th, and 99th percentiles increased from 1.082-1.303 in 2012-2016 to 1.836-2.022 in 2017-2019. In the stratified analyses, Han Chinese areas show stronger relative growth, with RR values at the 75th, 90th, and 99th percentiles increased by 14.3%, 39.1%, and 134.4% post-vaccination, compared to increases of 22.7%, 41.6%, and 38.8% in minority areas. Similarly, boys showed greater increases (24.4%, 47.7%, 121.5%) compared to girls (8.1%, 28.1%, 58.3%). Additionally, the central Guizhou urban agglomeration displayed a tendency for stronger relative growth compared to other counties. Although the EV71 vaccine policy has been implemented, it hasn't effectively controlled the overall risk of HFMD. There's been a shift in the main viral subtypes, potentially altering population susceptibility and influencing HFMD occurrences. The modulating effects of vaccine intervention may also be influenced by factors such as race, sex, and economic level.

Social Exclusion of People Who Abstain from Mandatory COVID-19 Vaccination for Medical Reasons: A Contemporary Ethical Conflict

The measures of obligatory vaccination against COVID-19 disease in Greece, have failed to cater to people, who for serious medical reasons, were prohibited by their private doctors to be vaccinated. This fact, however, leads to their unwilling social seclusion, since they cannot obtain the vaccination certificate that ensures access to all social activities. They are, therefore, faced with the dilemma of consenting to vaccination, disregarding possible health or even fatal consequences, or social exclusion and isolation. This research study aims to discuss this ethical conflict, between what is considered ethical for society in contrast to restriction of personal will and health. It wishes to rediscover the very essence of the commitment to protecting human rights-health and social well-being. This dilemma will be viewed and examined under the scope of core ethical values and principles met in Hippocrates’ oath and the fundamental ethical theory of Utilitarianism. The study will try, drawing from these ethical theories and definitions, to test these questions and conclude on what the indicative ethical choice is. The study wishes to propose suggestions of measures that can be taken to ensure equal operations for all citizens, based on medical ethics and self-disposition principles. It will also propose actions that should be put in the equation, sensitive groups. We feel that a balanced ethical approach that does not accentuate disparities within and among different groups, could ensure health equality, better social resilience, and commitment to effective prospective preparedness.

Vaccination Policy, Delayed Care and Health Expenditures

Abstract This paper evaluates the effect of COVID-19 vaccination on the individual propensity to delay or skip medical care. Our research design exploits the arguably exogenous variation in age-specific vaccine eligibility rollout across states and over time as an instrument for individual vaccination status. We find that receiving a COVID-19 vaccine reduces the likelihood of delaying care for any medical condition by 37%. Furthermore, our analysis reveals that children are significantly less likely to delay or skip healthcare as a result of their parents becoming vaccine eligible, indicating the presence of a positive health spillover within households that extends beyond protection against infection. Our analysis also shows that vaccination reduces concerns about contracting or spreading COVID-19, leading to increased mobility and potentially reducing delays or avoidance in seeking healthcare. Additionally, we find that vaccination notably increased access to elective care and surgeries, but had no significant impact on emergency department admissions, mental health cases or other medical conditions. Our results highlight the important role that vaccines play in, not only protecting against coronavirus, but also safeguarding against the worsening of health due to delayed or foregone medical care. The decline in delayed or foregone care caused by vaccination is particularly strong among minorities and those with a low socioeconomic background, revealing an important role that vaccination efforts can play in narrowing inequities in health and healthcare. In supplementary analysis, we use novel data on debit and credit card spending to demonstrate that increased vaccine uptake has a positive, albeit statistically insignificant, effect on consumer healthcare spending in the short run. Taken together, our findings imply that advancements in vaccine development coupled with a regulatory process that accelerates the availability of vaccines to the public in a safe manner can have the additional benefit of tackling unmet healthcare needs during a public health crisis.