Vaccination remains one of the most effective public health interventions; however, recent global trends indicate a reversal in routine immunisation coverage alongside resurgent outbreaks of vaccine-preventable diseases. This review synthesises current evidence on declining immunisation coverage, the re-emergence of diseases such as measles and poliomyelitis, and the growing influence of vaccine hesitancy and misinformation on vaccine uptake. A systematic search of PubMed, Scopus, and WHO/UNICEF databases was conducted using terms including 'vaccine hesitancy', 'immunisation coverage', 'vaccine-preventable diseases', 'misinformation', and 'vaccine policy', covering literature published between 2000 and 2024. We examine how pandemic-related disruptions, structural inequities, and evolving information ecosystems have collectively weakened immunisation system resilience across diverse settings. Beyond epidemiological consequences, declining coverage reflects broader challenges related to trust, governance, and equity in vaccine delivery. The review highlights the limitations of reactive, outbreak-driven approaches and emphasises the central role of strong routine immunisation systems embedded within primary healthcare. We discuss policy implications for integrating behavioural and social science insights, strengthening risk communication, and advancing equity-oriented immunisation governance. We conclude that sustaining and extending global immunisation gains will depend on aligning scientific innovation with public trust and system resilience. Addressing vaccine confidence as a core component of immunisation performance is essential to safeguarding global health security in the coming decade.

Political interference in vaccination policy and transnational implications for Latin America and the Caribbean.

This case study explores how faith-informed educational leaders navigate tensions on contested issues when organizational and stakeholder expectations conflict with their moral convictions. Drawing on a progressive Catholic principal managing policy conflict with the conservative school board over LGBTQ+ inclusion, and a scientifically minded Catholic superintendent facing stakeholder backlash during COVID-19 vaccine mandate, the study applies Kant’s categorical imperative to examine decision-making under pressure. The categorical imperative provides the ethical framework, for reflecting on authentic leadeship action when conviction and compliance collide. The case invites students and practitioners to apply philosophical reasoning to real world leadership dilemmas.

Vaccine mandates were widely implemented against COVID-19, and a large and multidisciplinary literature has emerged as a result, covering fields such as epidemiology, economics, ethics, and law. We compiled an openly available repository of this literature, including 503 studies on COVID-19 vaccine mandates. We identified them through a manual multi-database search and performed the data extraction using a large language model. The dataset stores information, for each study, on the scope and sanctions of the relevant mandate(s), the study design, target population, outcomes, and themes, allowing users to quickly navigate this complex literature. We use the dataset to present key statistical facts and insights about this literature, and we leave to other scholars the opportunity of interrogating it further. As a worked example, we conduct a narrative review of quasi-experimental studies on COVID-19 vaccine mandates. These consistently show short-run increases in first-dose uptake following mandate announcements, with limited evidence on long-run uptake and downstream social, health, and economic outcomes. We provide all data and code to support secondary analyses and future evidence syntheses.

Introduction: Placental malaria increases the risk of adverse birth outcomes. Current preventive measures are undermined by poor coverage, growing resistance to chemo-preventive and therapeutic drugs, and vector eliminating insecticides. Candidate placental malaria (PM) vaccines (PAMVAC and PRIMVAC) have shown safety and immunogenicity in Phase I trials, but empirical evidence on their potential population-level value is lacking. This study modelled the expected cost-effectiveness of a PM vaccine administered before pregnancy. Methods: A decision-analytic model compared two strategies from the provider’s perspective: vaccinating women of childbearing age versus no vaccination. The model incorporated gravidity-specific risks of PM, neonatal mortality and the malaria attributable fractions from the literature. Since the efficacy of a PM vaccine for malaria prevention is unknown, we assumed a 40% efficacy and varied this estimate widely in sensitivity analyses. Primary outcomes were incremental cost-effectiveness ratios (ICERs) per perinatal disability adjusted life years (DALYs) averted. Baseline, best-case, and worst-case scenarios were analysed. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Cost-effectiveness was defined as an ICER below half of sub- Saharan Africa’s 2025 GDP per capita ($1556). Results: The vaccine was most cost-effective among primigravidae. Under baseline assumptions (40% efficacy; 30% uptake; $5 dose price), the ICER was $321 per perinatal DALY averted for primigravidae versus $4444 for multigravidae. Best-case assumptions further improved cost-effectiveness ($225 vs. $3148). Sensitivity analyses showed robust cost-effectiveness for primigravidae across all plausible parameter ranges, while ICERs in multigravidae were highly sensitive to programme costs and vaccine efficacy. Cost-effectiveness acceptability curves demonstrated that vaccination becomes favourable for primigravidae at relatively low willingness-to-pay thresholds. Conclusions: A placental malaria vaccine delivered before pregnancy has high potential to be cost-effective in endemic areas when targeted to protect primigravidae. These findings support prioritised deployment strategies and highlight the value of early economic modelling to inform vaccine development and policy planning.

ABSTRACT: The meat industry is responsible for about 5.7% of Brazil's GDP, employing 639,000 workers directly, who are exposed to diverse labor risks during their work day. This research objective is to understand the set of infectious diseases that can affect these workers, based on exposure to biological risk in their work environment, creating a single list of microorganisms that cause such diseases. Method: We performed an integrative bibliographic review with pre-defined descriptors, from a search in 11 databases (COCHRANE Library; EMBASE; LILACS; PubMed/MEDLINE; SciELO; Web of Science; Scopus; ProQuest Dissertations & Theses Global - PQDT Global ; Banco de Theses da CAPES; Biblioteca Digital Brasileira de Dissertações - BDTD), with the initial selection of 714 scientific publications for analysis of titles and abstracts and, among these, 111 articles for detailed analysis. Results: with the integrated analysis of the selected publications, it was possible to compile a list of most of the microorganisms that can infect workers in the meat industry, during the exercise of their work. We suggest that creating this list is the initial step towards advancing in the better understanding of this topic, with positive impacts on health and safety at work, as well as for public health in general. Conclusions: we suggest some proposals for applying the knowledge systematized in this study: a) qualify the health surveillance system for workers in meat processing plants; b) establish a mandatory vaccination program for workers in this sector; c) creation of a new annex in NR 36, where Brazilian government publicizes the set of biological agents found in these establishments, as in Annex II of NR 32; d) changes related to the classification of unhealthiness in Annex 14 (biological risks) of NR 15; e) changes in the framework for counting special activity time (special retirement) for this group of workers.

Abstract Intervention Uptake of the HPV vaccine in Alberta, Canada, remains below the 90% immunization targets. Under Alberta’s expanded HPV vaccine policy, adults aged 18–26 are eligible for no-cost HPV immunization. This study describes a 2023 HPV vaccine intervention targeting seven post-secondary institutions in the province. Research question How do tailored HPV vaccine-promoting messages, informed by the Extended Theory of Planned Behaviour and delivered using a social influencer approach, influence 18–26-year-old Albertan’s HPV vaccine-related intentions and uptake? Methods Collaborating with Alberta post-secondary institutions and a not-for-profit mobile vaccine clinic, two clusters of HPV vaccine clinics were offered for up to 4 days, preceded by up to 2 weeks of a targeted HPV vaccine promotion campaign. Campaign messages were developed using the Extended Theory of Planned Behaviour and disseminated through socially influential approaches: post-secondary institutional social media platforms and on-campus initiatives. Data were collected from views and interactions with messages. Each message contained links to information about the HPV vaccine and immunization appointment bookings for eligible 18–26-year-olds. Results The campaign received 21,405 social media views, 270 interactions via likes, saves, and shares. A total of 279 individuals booked an HPV vaccine appointment and 195 were immunized during the intervention; 69 individuals sought an HPV vaccine but were deemed ineligible due to policy-related age restrictions. Post-secondary institutions most disseminated campaign messages that focused on perceived risk and HPV-related attitudes. Conclusion Targeted HPV vaccine messaging, as well as no-cost convenient HPV vaccine access may improve HPV vaccine uptake among post-secondary students.

ABSTRACT RN employment rebounded unevenly across the states of the U.S. after the acute phase of COVID‐19. We examine how 2021 state COVID‐19 policy mixes across six domains were associated with registered nurse (RN) employment recovery in 2022: telehealth expansion, early prescription refill flexibility, cost relief (cost‐sharing + vaccine cost relief), paid sick leave, mask mandates, and vaccine mandates. Using 51 jurisdictions (50 states plus the District of Columbia), we apply Qualitative Comparative Analysis (QCA) in a mixed‐set design, coding policy domains as crisp‐set membership indicators (0/1) based on documented adoption in 2021 and calibrating the outcome as a set‐membership score from the percent change in RN employment from 2021 to 2022 (p25/median/p75 anchors). At a consistency cutoff of 0.70, we identify multiple configurations sufficient for high recovery (solution consistency = 0.809; total coverage = 0.444), consistent with equifinality. Access‐oriented tools (telehealth expansion and refill flexibility) recur across several high‐recovery configurations, while mandates and paid sick leave vary across pathways. The empirical results are robust to stricter specifications, including a higher consistency cutoff (0.75), a higher frequency threshold (Freq ≥ 2), and alternative calibration anchors (20/50/80). In contrast, low recovery (1‐Y) is characterized by different sufficient configurations (solution consistency = 0.965; total coverage = 0.416), underscoring causal asymmetry. We interpret these results as configuration‐level associations rather than causal estimates and highlight how feasible access policies interact with mandates and workforce protections within broader state policy mixes linked to RN employment recovery.

Mongolia continues to experience the world's highest incidence of hepatocellular carcinoma (HCC), driven by chronic hepatitis B (HBV) and hepatitis C (HCV) infections. In response, the Mongolian Government has implemented comprehensive public health interventions, including the national 'Healthy Liver Programme,' to reduce viral hepatitis transmission and liver-related morbidity. This narrative review aims to evaluate national strategies, progress, and ongoing challenges in HBV and HCV control. Policy documents from government agencies, WHO, and NGOs were reviewed, along with scientific publications retrieved from PubMed, and Embase using terms such as 'HBV,' 'HCV,' and 'treatment access.' Grey literature was also analysed. The review focused on (i) national strategies and action plans; (ii) programmatic interventions, vaccination, screening, and treatment scale-up; and (iii) reported trends in coverage, treatment uptake, and progress towards WHO 2030 elimination targets. Findings were synthesised by comparing policy commitments with implementation outcomes and triangulating evidence across multiple sources. Forty-four peer-reviewed articles and 12 policy documents were included. Mongolia has achieved >95% infant HBV vaccination and 93.9% hepatitis A coverage, reducing HBsAg prevalence among children under five to 0.3% by 2023. Among adults, HBsAg prevalence declined from 6.9% in 2015 to 5.5% in 2023, while HCV prevalence decreased from 6.7% to 3.7%. More than 120,000 HCV infections have been diagnosed, with over half treated through national initiatives; by 2023, 4,700 HBV and 66,959 HCV patients had initiated therapy. Liver cancer incidence decreased from 39.1% in 2016 to 32.7% in 2021, and annual HCC cases fell from 857 in 2015 to 567 in 2022. Mongolia aims to reduce viral hepatitis prevalence by 90% and liver-related mortality by 85% in the coming decade. While substantial progress has been made, strengthened health system capacity and improved monitoring mechanisms are essential to close remaining gaps and accelerate progress towards hepatitis elimination. Policy implementation: Mongolia implemented several key policies, including the Targeted Prevention and Control Program to Eradicate Viral Hepatitis (1988-2000), mandatory HBV vaccination, and the Healthy Liver programmes (2016-2020 and 2022-2025).Vaccination programmes: Mongolia was among the first to introduce hepatitis B vaccination for newborns in 1991 and added a pentavalent vaccine in 2005. The HAV vaccine was introduced in 2012, with high coverage rates for children under one year.Healthy liver programme: This programme improved access to diagnostic and treatment options for viral hepatitis, including introducing antiviral medicines and reimbursement for antiviral therapy costs through national health insurance.Success achieved: The incidence of total viral hepatitis was reduced to 0.7 per 10,000 population by 2022, surpassing the goal of 10 per 10,000. HBsAg prevalence in children under five met WHO's regional goal, and HCV prevalence among adults significantly decreased.Treatment access: Patients in Mongolia have access to treatments for HBV, HCV, and HCC with significant reimbursement from the Health Insurance Fund. The affordability of these treatments has improved, making them accessible to a larger population.

Across mid-February to mid-March 2026, the vaccine landscape was marked by significant regulatory activity, major industry restructuring, and continued clinical progress across multiple platforms. The European Medicines Agency issued a positive recommendation for the world's first combination influenza and COVID-19 mRNA vaccine, while the US FDA's vaccine regulatory environment remained unsettled, with the resignation of the Center for Biologics Evaluation and Research director, ongoing legal challenges to childhood vaccine policy changes, and the launch of a new unified adverse event reporting platform. In clinical development, first-in-human and first-in-world trials advanced for a pan-influenza universal vaccine candidate and a personalised paediatric mRNA cancer vaccine, respectively. Market activity was headlined by Moderna's $2.25B settlement with Genevant Sciences and Arbutus Biopharma resolving long-running lipid nanoparticle patent litigation, and the announcement that BioNTech's co-founders will establish an independent mRNA-focused company.

BACKGROUND Vaccination is one of the most effective tools available to protect against infectious diseases. In Italy, Law no. 119/2017 expanded the list of mandatory vaccinations to 10: against poliomyelitis, diphtheria, tetanus, hepatitis B, pertussis, Haemophilus influenzae type b (hexavalent vaccine), measles-mumps-rubella (MMR), and varicella (chickenpox). The present study focuses exclusively on 3 of them: MMR, hexavalent, and varicella. The emergence of the COVID-19 pandemic led to a significant reorganization of the healthcare organization. The aim of this study was to assess the potential effect of the COVID-19 pandemic on mandatory vaccination coverage. MATERIAL AND METHODS A retrospective analysis was conducted on official vaccination data from the local health authority of Salerno. Coverage rates were compared across pre-pandemic and pandemic years and were contextualized within regional and national trends. RESULTS Hexavalent coverage remained consistently high (>94%) throughout the period, with only minor declines during the pandemic. The MMR vaccine showed a progressive increase from 87.75% in 2016 to over 93% in 2021, with a slight decrease in 2022. The largest increase was observed for varicella, which went from 67.26% to over 91% in 2021-2022. The results highlight an overall stable or growing trend, without persistent declines due to the pandemic. Overall, the resilience of vaccination services has allowed coverage to remain close to regional and national objectives. CONCLUSIONS Pediatric vaccination coverage remained high even during the pandemic, showing the resilience of the local vaccination system. The effective organization allows for maintaining high levels of immunization even in crisis conditions.

Global implications of recent changes in U.S. vaccine policy: ethical and trust challenges for immunization programs.

Given the stronger immunological effects of vaccines pre-transplant, the question of whether pre-transplant COVID-19 vaccination should be mandatory has been raised. The objective of this study was to gather transplant patients' perspectives on ethical issues related to mandatory vaccination and access to transplantation in Canada. We conducted semi-structured interviews with 45 transplant recipients and five transplant candidates from a Québec transplant program. The interviews were digitally recorded and transcribed. Thematic and content analysis was conducted. Most participants were in favor of pre-transplant vaccine mandates given that vaccination is part of pre-transplant assessment, transplant patients have moral responsibilities and/or vaccine mandates are legitimate especially in a public health emergency. Restrictions on patient autonomy, the ethical duty to ensure access to life-saving transplantation and unequal access to vaccines were concerns raised by participants about vaccination mandates and access to transplantation. Many participants did not support excluding unvaccinated patients from transplant lists. Most, however, agreed with prioritizing vaccinated candidates in organ allocation. This study indicates broad support for the promotion of pre-transplant vaccination. However, preventing access to life-saving organ because an individual is missing specific vaccinations raised concerns among participants. The results of this study could inform vaccination policies in transplantation in future public health emergencies.

ABSTRACT Background Varicella is a common vaccine-preventable disease in China, with frequent outbreaks in schools and communities. In late 2018, Wuxi implemented a free two-dose varicella vaccination policy. This study evaluated its epidemiological impact. Research design and methods We analyzed outbreak data from Wuxi during 2014–2024. Main outcomes included outbreaks, cases, and outbreak duration. Interrupted time series and ARIMA models were used to evaluate temporal trends. Fixed-effects regression examined the association between vaccination coverage and outbreak indicators. Spatial analysis identified clustering patterns before and after policy. Results After policy implementation (2019–2024), outbreaks decreased by about 56% and cases decreased by about 60%. Annual percent change shifted from strongly positive before the policy (APC > 140%, p < 0.05) to negative after the policy (APC < −30%, p < 0.05). Each 1% increase in two-dose coverage was associated with reductions of 0.82 outbreaks (p < 0.001), 21.67 cases (p < 0.001), and 2.55 days in duration (p < 0.05). Spatial clustering weakened over time. Conclusion The free two-dose vaccination policy was associated with substantial reductions in varicella outbreaks in Wuxi. Sustaining high two-dose coverage remains important. Interpretation should consider the ecological design, lack of individual-level vaccination data, and potential COVID-19-related confounding.

The assumption that the justifiability of scientific belief depends exclusively on the relevant facts is a widely accepted orthodoxy both inside and outside of the scientific establishment. Drawing on the pragmatic and moral encroachment thesis in epistemology, this article challenges that assumption by showing that practical and moral considerations affect the justifiability of our beliefs regarding the safety of COVID-19 vaccines. In particular, I show that a proper consideration of the practical and moral costs of committing to the belief that COVID-19 vaccines are safe enough for a general vaccine mandate requires COVID-19 vaccines to meet a higher-than-current evidentiary standard of safety. Furthermore, I show that a reassessment of existing COVID-19 vaccines against a higher evidentiary standard of safety would entail a wider scope of medical exemptions and remedial duties. Beyond the case of COVID-19 vaccines, this argument has important general implications for how scientific beliefs should be assessed.

Maternal immunization against group B Streptococcus: Immune correlates, microbiome trade-offs, and global implementation challenges.

Alongside the development of antibiotics, vaccination is the medical innovation with arguably the greatest impact on human health. Testament to its success is the eradication of infectious diseases, such as smallpox, that devastated human populations for almost 4000 years. Live-attenuated vaccines (LAV), which retain the capacity for infection and replication, were the first to be developed and remain highly efficacious, underpinning successful human vaccination campaigns (e.g. polio virus, measles virus, yellow fever virus). The cost of this success is the capacity of LAVs to cause disease in a small proportion of recipients, typically owing to overt or previously unappreciated immunodeficiency. From the careful investigation of such rare events, major clinical and scientific lessons about human antiviral immunity have been drawn. Here, we review features of pathogenic LAV dissemination, which continue to inform our understanding of critical steps in the immune control of LAVs. We discuss recent data on specific variants identified in geographically isolated populations and reflect on more common phenocopies of these monogenic defects, with potential implications for vaccine practice and policy. Collectively, these insights may inform approaches to the growing population of individuals rendered more vulnerable to LAVs by aging, multimorbidity or medical intervention. They also serve to highlight the clinical need for therapeutic strategies to combat pathogenic LAV dissemination.

Low uptake rotavirus vaccine: A study of vaccine effectiveness against rotavirus-related hospitalization based on electronic health records, Slovenia, 2019-2023.

Effectiveness of JN.1-adapted COVID-19 vaccine against medically attended SARS-CoV-2 infection and COVID-19 hospitalization in adults in Japan, from October 2024 to April 2025: VERSUS.

Civic evaluation can be defined as action-research conducted by citizens, through the use of established tools. When citizens, despite their alleged lack of expertise in the public sphere, organise themselves and act together on public policies, they are able to produce and use information from experts and other sources, as well as from their direct experience with the issue being addressed. The case study ‘Civic monitoring of vaccination services’ - promoted in Italy by the NGO Cittadinanzattiva - is a concrete example of the role of citizens in supporting vaccination policies. Particularly at the European level, it is crucial to recognise and strengthen the involvement of civil society in vaccination, also for a swift implementation of the Council Conclusions on vaccination of December 2022, focusing on two areas of action: tackling vaccination hesitancy and preparing for the next challenges through EU cooperation.