Vaccination Policy Research Articles

Seroprevalence of anti-diphtheria toxoid antibody and implications for vaccination policy in Vietnam’s South-central coast: a cross-sectional study

BackgroundDiphtheria is a re-emerging infectious disease and public health concern worldwide and in Vietnam with increasing cases in recent years. This study aimed to assess the anti-diphtheria toxoid antibodies status in Khanh Hoa Province and identify factors contributing to the vaccination policy in the south-central coast of Vietnam.MethodsThis was a cross-sectional study to evaluate the seroprevalence of anti-diphtheria toxoid antibodies among 1,195 participants, aged 5 – 40 years in Khanh Hoa Province, Vietnam. Immunoglobulin G antibody levels against diphtheria were detected using a commercial anti-diphtheria toxoid enzyme-linked immunosorbent assay (SERION ELISA classic Diphtheria Immunoglobulin G) and were categorized following the World Health Organization guidelines.ResultsThe mean anti-diphtheria toxoid antibody levels were 0.07 IU/ml (95% Confidence Interval: 0.07–0.08). Anti-diphtheria toxoid antibody levels were found to be associated with age and history of diphtheria vaccination. The 5–15 years age group had the highest levels (0.09 IU/ml), while the older age group had the lowest antibody level (p < 0.001). Individuals who received three doses (adjusted Odds ratio: 2.34, 95%CI: 1.35 – 4.07) or 4+ doses (adjusted Odds ratio: 2.45, 95%CI: 1.29 – 4.64) had a higher antibody level compared to those who received only one dose regardless of age.ConclusionIt is crucial to promote routine vaccination coverage to over 95% for children under one year of age with three primary doses of the diphtheria-containing vaccine, including additional doses at 18 months and 7 years of age. Booster doses should be promoted and administered to adolescents and adults every 10 years.

EU digital public diplomacy in Southeast Asia during the COVID19 pandemic

ABSTRACT This article explores whether and how the EU projected a digital form of public diplomacy in Southeast Asia during the COVID19 pandemic through its vaccine policy. Using Twitter (now X) data from the EU delegations and ambassadors in Malaysia, Indonesia and Vietnam, and applying a post-Foucauldian epistemology, the article argues that a vaccine-focused EU digital public diplomacy sustained the central role of the EU and the projection of a normatively positive EU identity in the region.

Political Partisanship, Confucian Collectivism, and Public Attitudes toward the Vaccination Policy in Taiwan.

Conventional wisdom suggests that people with a collectivist tradition tend to comply more with the government's regulatory and even coercive disease-prevention policies. Besides this socio-cultural element, political partisanship is also an important aspect relating to people's willingness to cooperate with the government. This study aims to examine the relationships between these two factors and three dimensions of vaccination policy attitudes: common responsibility to take the vaccine, the government's vaccine mandate, and indignation over anti-vaxxers. Using the data from a nationally representative cross-sectional survey conducted in 2022 in Taiwan, this study applies multiple linear OLS regression to examine the relationships between vaccination policy attitudes and Confucian collectivism and political partisanship. Confucian collectivism and political partisanship aligning with the ruling party are associated with supportive vaccination policy attitudes. For those who do not align with the ruling party, the negative attitudes toward the vaccination policy appear in different dimensions according to the party they lean to. Confucian collectivism is prevalent in Taiwan and is related to public attitudes toward vaccination policy. This association is independent of political partisanship. Public health authorities should consider the socio-cultural context and political atmosphere for the effectiveness of disease-prevention measures.

Impact of the COVID-19 pandemic on self-paid vaccination intentions for children: a cross-sectional study in China

ObjectivesWhile it is widely accepted that COVID-19 has disrupted routine vaccination globally, the long-term impact of COVID-19 on parental vaccination intentions is uncertain. This study aims to estimate whether COVID-19...

Increasing Influenza Vaccination Rates among Patients with Type 2 Diabetes Mellitus in Chongqing, China: A Cross-Sectional Analysis Using Behavioral and Social Drivers Tools.

Influenza vaccination is essential for type 2 diabetes mellitus (T2DM) patients due to their higher risks of severe complications and mortality from influenza. This study investigated the willingness of T2DM patients in Chongqing, China, to receive the influenza vaccination during the 2023/2024 season, using behavioral and social drivers (BeSD) tools to improve vaccination uptake in this high-risk group. A multi-stage sampling method was used to select participants, and face-to-face surveys were conducted in community health centers between March 1 and May 1, 2023. Binary logistic regression was used to analyze the factors influencing vaccination willingness, and standardized scores identified barriers and drivers. Among 1672 T2DM patients, 11.7% had been vaccinated during the 2022/2023 season, and 59.6% were willing to receive the vaccination in the 2023/2024 season. Higher willingness was associated with ethnic minorities (odds ratio [OR], 3.18, 95% confidence interval [CI]: 1.58-6.39), being unemployed individuals (OR 2.69, 95% CI: 1.60-4.52), higher monthly household income per capita (OR 2.72, 95% CI: 1.65-4.50), having diabetes complications (OR 1.76, 95% CI: 1.23-2.51), sufficient vaccine knowledge (OR 1.87, 95% CI: 1.48-2.37), and previous vaccination (OR 7.75, 95% CI: 4.83-12.44). Concerning BeSDs, fear of infecting friends or family members and trust in vaccine efficacy were the predominant drivers, while high vaccine costs were the greatest barrier. Future strategies should focus on improving vaccine knowledge, supporting healthcare workers and peer recommendations, and enhancing vaccination policies. Key interventions such as health education among high-risk groups, such as unemployed individuals, advocacy campaigns, pay-it-forward strategies, and policies for free vaccination could improve coverage in Chongqing.

Epidemiology and Impact of Anti-Pneumococcal Vaccination and COVID-19 on Resistance of Streptococcus pneumoniae Causing Invasive Disease in Piedmont, Italy.

The international surveillance of antimicrobial resistance (AMR) reports S. pneumoniae as one of leading causes of death associated with AMR. Against invasive disease, several vaccinations are available and a reduction in AMR in S. pneumoniae has been observed. Here, we evaluated the impact of anti-pneumococcal vaccination policy and the SARS-CoV2 outbreak on AMR in S. pneumoniae causing invasive disease. We collected all strains of S. pneumoniae causing invasive disease from 2008 in the Piedmont region (Italy). Each strain was typed in order to identify the serogroup and data about AMR were collected. The population under surveillance was classified as infants, children, adults, and the old population. We collected n = 2076 S. pneumoniae strains, with 21.9% and 40.3% being resistant to penicillin G and erythromycin, respectively. We reported an increased risk of infection with penicillin-resistant S. pneumoniae among all populations and evaluated whether the infection was caused by a serotype included in the vaccine formulation. A similar increase was observed after the SARS-CoV2 outbreak. In the Piedmont region, subsequently to the introduction of anti-pneumococcal vaccination, a significant increase in the risk of penicillin G-resistant invasive pneumococcal disease among infants and old population was reported. No significant impact was found for the SARS-CoV2 outbreak.

Prevalence and genotype distribution of human papillomavirus infection among 66000 women from 2014 to 2023 in the plateau region of Southwest China

BackgroundPersistent infection with high-risk human papillomavirus (HR-HPV) plays a key role in the onset of cervical cancer. This study was designed to examine the epidemiological trends and genotype distribution of HPV from 2014 to 2023 in the plateau region of Southwest China.MethodsThe findings could offer valuable insights for clinical screening of cervical cancer and the formulation of HPV vaccination policies. This retrospective study analyzed 66,000 women who received HPV-DNA testing at the First People’s Hospital of Qujing, Yunnan, China, between 2014 and 2023. The cohort consisted of 33,512 outpatients, 3,816 inpatients, and 28,672 individuals undergoing health examinations. Cervical cells were collected for DNA extraction, and PCR amplification along with Luminex xMAP technology were used to detect 27 HPV genotypes. The data analysis was conducted using GraphPad Prism and IBM SPSS Statistics 27 software.ResultsThe overall HPV infection rate at the First People’s Hospital of Qujing declined from 24.92% in 2014 to 16.29% in 2023, averaging 16.02%. Specific infection rates were 18.50% among outpatients, 12.97% among inpatients, and 13.53% for health examination attendees. The predominant high-risk HPV genotypes identified were HPV52 (2.61%), HPV16 (2.06%), HPV58 (1.81%), HPV53 (1.55%), and HPV39 (1.09%). Meanwhile, the most frequent low-risk HPV genotypes were HPV6 (1.30%), HPV61 (1.21%), and HPV11 (0.85%). In HPV-positive cases, the distribution of single, double, triple, and quadruple or more infections were 79.90%, 15.17%, 3.59%, and 1.33%, respectively. The proportions of pure LR-HPV, pure HR-HPV, and mixed infections were 22.16%, 67.82%, and 10.02%, respectively. Age-specific analysis revealed a bimodal distribution of HPV infection, with the infection rate rapidly decreasing from 44.02% in the ≤ 19 age group to 19.55% in the 20–29 age group and 13.84% in the 30–39 age group, followed by a gradual increase to 14.64% in the 40–49 age group, 16.65% in the 50–59 age group, and 22.98% in the ≥ 60 age group. The coverage rates of the three available vaccines are all below 50%. The results of this study indicated a declining trend in HPV prevalence in the plateau region of Southwest China over the period from 2014 to 2023, especially in the reduction of genotypes targeted by vaccines.ConclusionThere were significant variations in the genotypes prevalent among different age groups, years, and patient sources within the same region. The underwhelming vaccination rates emphasize the critical need for developing either a multivalent vaccine or a personalized vaccine that targets the HPV genotypes common in the Chinese population. Furthermore, vaccinating adolescents to curb HPV infection and ensuring regular cervical cancer screenings for postmenopausal women are crucial steps.

The Role of Vaccination, Testing, and Public Restriction Policies in COVID-19 Mortality and Incidence: Insights from Global Burden of Disease Regions

IntroductionThis study aimed to examine the impacts of vaccination, testing, and government policies on COVID-19 mortality and incidence rates and compare these strategies' effectiveness by seven super regions of the Global Burden of Disease (GBD).Material and methodsThis study used data from January 3, 2020, to March 29, 2023. The incidence and mortality indices were calculated using “daily cases” and “daily deaths” and selected as dependent variables. Vaccination, COVID-19 tests, strictness of a government's policy were explored using corresponding metrics.ResultsDaily cases were four times higher in the high-income region (371.1) than those in the Latin America and the Caribbean region (98.3), but the mortality rate was similar (1.5). The number of vaccinated people did not consistently reduce the mortality across all GBD regions. However, full vaccination was associated with decreased mortality in all regions except Central, Eastern, and Southeastern Europe and Central Asia (CEEECA). Regarding daily testing, a favorable correlation was observed between daily deaths on a global scale, excluding Southeast Asia, East Asia, and Oceania. Overall, vaccination coverage and government policies were effective in reducing the COVID-19 mortality and incidence rates. However, only the high-income region showed a negative association between the stringency index to COVID-19 and incidence and mortality rates.ConclusionsFull vaccination significantly reduced COVID-19 mortality globally, except in the CEEECA region. HI regions showed lower incidence and mortality rates with stricter government measures. Effective vaccination programs and policies are crucial, emphasizing the need for strengthened international cooperation in future pandemics.

Achilles’ heel: elderly COVID-19 vaccination policy in China

BackgroundDespite high overall COVID-19 vaccine coverage, the continuously low elderly vaccination rate in mainland China remains a dangerous threat as the country shifts away from its zero-Covid policy. This retrospective study uses the Multiple Streams Framework to examine how macro-level factors may explain poor elderly vaccination outcomes.MethodsWe performed a thematic analysis of qualitative data obtained from 95 official press conferences from October 20, 2020, to February 27, 2023, vaccination-related policy documents, and media coverage, using both inductive and deductive coding approaches.ResultsOur findings suggest that in the problem stream, elderly vaccination was not a “focusing event” during the initial vaccine rollout, resulting in delayed outreach to this population. Additionally, ideologically driven complacency and discrepancies in top-down implementation undermined elderly vaccination in the political stream. In the policy stream, precautious and ambiguous statements, inconsistent policy content, radical shifting media messages, and less age-friendly digital technologies also affected elderly vaccination.ConclusionsThe poor convergence of the three streams led the elderly to be the Achilles’ heel of China’s COVID-19 containment strategy. Future studies should focus on priority identification, adoption of enforcement measures, and timely and effective policy dissemination. The empirical lessons from China can inform and optimize elderly vaccination policy design and implementation in the post-pandemic era.

Assessing the Intention to Use a First-Generation Vaccine against COVID-19 Using Quantile Regression: A Cross-Sectional Study in Spain

Understanding the factors that influence the intention to use vaccines is crucial for implementing effective public health policies. This study examined the impact of various cognitive, affective, normative, and sociodemographic variables on the intention to be vaccinated against COVID-19 with the first-generation AstraZeneca vaccine. A survey of 600 residents of Spain was used to assess the influence and hierarchy of the drivers of the intention to vaccinate via least-squares and quantile regressions. The most significant factors were the perceptions of efficacy and social influence, both of which had positive impacts (p &lt; 0.0001). The positive influence of fear of COVID-19 and the negative influence of fear of the vaccine were also significant in shaping the central tendency toward vaccination. However, these fear-related variables, particularly the fear of COVID-19, lost importance in quantile adjustments outside the central tendency. Among the sociodemographic variables, only the negative impact of income was statistically significant. These results are valuable for the development of vaccination policies because they measure the sensitivity of attitudes toward vaccination to exogenous variables not only in the central values, as is common in similar studies, but also across the entire range of responses regarding the intention to vaccinate. This additional analysis, which is not commonly performed in studies on vaccine acceptance, allows us to distinguish between variables which are consistently related to the intention to vaccinate and those that influence only expected responses.

COVID-19 Vaccination and Public Health: Addressing Global, Regional, and Within-Country Inequalities.

The COVID-19 pandemic, with over 775 million cases and 7 million deaths by May 2024, has drastically impacted global public health and exacerbated existing healthcare inequalities. The swift development and distribution of COVID-19 vaccines have been critical in combating the virus, yet disparities in access to and administration of the vaccine have highlighted deep-seated inequities at global, regional, and national levels. Wealthier nations have benefited from early access to vaccines, while low- and middle-income countries (LMICs) have faced persistent shortages. Initiatives such as COVAX aimed to address these disparities, but challenges persist. Socioeconomic factors, education, ethnic identity, and the healthcare infrastructure play crucial roles in vaccine equity. For example, lower-income individuals often face barriers such as poor access to healthcare, misinformation, and logistical challenges, particularly in rural areas. Addressing these inequities requires a multifaceted approach, integrating national policies with local strategies to enhance vaccines' accessibility, counter misinformation, and ensure equitable distribution. Collaborative efforts at all levels are essential to promote vaccine equity and effectively control the pandemic, ensuring that all populations have fair access to life-saving vaccines. This review explores these complex issues, offering insights into the barriers and facilitators of vaccine equity and providing recommendations to promote more equitable and effective vaccination programs. With a focus on the different levels at which vaccination policies are planned and implemented, the text provides guidelines to steer vaccination strategies, emphasizing the role of international cooperation and local policy frameworks as keys to achieving equitable vaccination coverage.

How did New Zealanders decide to get vaccinated against COVID-19? Developing a novel comprehensive model of vaccination intention

ABSTRACT This research introduces and validates the Comprehensive Model of Vaccination Intention (CMVI) to offer a holistic understanding of COVID-19 vaccination uptake in New Zealand. The CMVI excels by presenting a highly explanatory model, incorporating trust in the government's vaccination policy along with and a spectrum of social, cognitive, contextual, and affective variables from theories of Interpersonal Behavior, Planned Behavior, and Health Belief Model. A nationally representative sample of 993 participants was analyzed using confirmatory factor analysis and structural equation modeling. The findings underscore the positive impact of subjective norms and societal perceptions of vaccination, attitude toward vaccination, trust in government, and vaccination habits on COVID-19 vaccination intention. This study highlights the importance of normalizing vaccination to boost intention and shows how emotions shape attitudes. It also finds that better vaccine accessibility and trust in the government lower perceived costs and raise perceived benefits, improving overall attitude and strengthening vaccination intention.

Lessons for Future Vaccination Policies: COVID-19 Vaccination Intention in People With and Without Chronic Diseases

PurposeThis study compared COVID-19 vaccination intentions in those with and without chronic diseases (CDs and non-CDs) in South Korea. We hypothesized that the factors associated with COVID-19 vaccination intentions would differ between CDs and non-CDs in South Korea. MethodUsing survey data collected through a Korean online panel in June 2021, we conducted a cross-sectional secondary data analysis. Of the 2,292 participants, 411 had at least one chronic disease. To construct a comparable dataset, we selected non-CDs via a 1:1 case-control matching for age and gender. We then utilized a multivariable binary logistic regression model to explore the factors contributing to COVID-19 vaccination intentions in CDs and non-CDs. ResultsAll told, 75% of participants in both groups indicated that they intended to vaccinate against COVID-19. In both groups, those who mistrusted general vaccine benefits reported significantly lower COVID-19 vaccination intentions. Regarding factors associated with vaccination intentions, CDs identified anxiety regarding coronavirus and exposure to COVID-19 vaccination promotions at the community level, while non-CDs highlighted hesitancy regarding vaccines and confidence in government/health services. ConclusionImproving vaccination acceptance will require the development and implementation of tailored approaches for CDs and non-CDs and efforts to minimize general vaccine mistrust.

Unveiling the dynamics of respiratory infections revealed by multiplex PCR testing during the COVID-19 pandemic in Taiwan, 2020–2023

BackgroundThe emergence of SARS-CoV-2 in late 2019 sparked the global COVID-19 pandemic, leading to varied vaccine policies worldwide. The evolving patterns of respiratory pathogens, aside from SARS-CoV-2, during the pandemic have had a significant impact on the development of vaccine strategies. MethodsThis study explores the landscape of respiratory pathogens, encompassing SARS-CoV-2, respiratory syncytial virus (RSV), and influenza viruses, through a retrospective analysis of data obtained from the BioFire Respiratory Panel 2.1 (RP 2.1) at China Medical University Hospital (Taichung, Taiwan) spanning from January 2020 to November 2023. ResultsAmong the 7950 respiratory samples studied, pediatric cases exhibited higher positivity (64.9%, 2488/3835) and mixed detection rates (43.8%, 1090/2488) than adults. Annual mixed detection rates increased (27.9–48%). Prevalence analysis revealed diverse patterns across age groups, with higher rates in pediatrics. Notably, human rhinovirus/enterovirus predominated (48.1%). Mixed detection illustrated viral co-detections, notably with parainfluenza viruses and adenovirus. Government policies and pandemic dynamics influenced infection patterns, with RSV resurgence after May 2022. Age-specific RSV detection demonstrated a shift, influencing vaccine considerations. Amid global vaccine initiatives, RSV's increasing trend in adults warrants attention. ConclusionsThis comprehensive analysis emphasizes the importance of multiplex PCR testing in shaping targeted vaccination strategies during evolving respiratory pathogen landscapes.

Measuring vaccination coverage and concerns of vaccine holdouts from web search logs

To design effective vaccine policies, policymakers need detailed data about who has been vaccinated, who is holding out, and why. However, existing data in the US are insufficient: reported vaccination rates are often delayed or not granular enough, and surveys of vaccine hesitancy are limited by high-level questions and self-report biases. Here we show how search engine logs and machine learning can help to fill these gaps, using anonymized Bing data from February to August 2021. First, we develop a vaccine intent classifier that accurately detects when a user is seeking the COVID-19 vaccine on Bing. Our classifier demonstrates strong agreement with CDC vaccination rates, while preceding CDC reporting by 1–2 weeks, and estimates more granular ZIP-level rates, revealing local heterogeneity in vaccine seeking. To study vaccine hesitancy, we use our classifier to identify two groups, vaccine early adopters and vaccine holdouts. We find that holdouts, compared to early adopters matched on covariates, are 67% likelier to click on untrusted news sites, and are much more concerned about vaccine requirements, development, and vaccine myths. Even within holdouts, clusters emerge with different concerns and openness to the vaccine. Finally, we explore the temporal dynamics of vaccine concerns and vaccine seeking, and find that key indicators predict when individuals convert from holding out to seeking the vaccine.

Addressing the issue of coercive vaccination policies

Addressing the issue of coercive vaccination policies

The role of online crisis actors in teachers’ work and lives

ABSTRACT It is not surprising that various sources have recently described the teaching profession in Australia as ‘in crisis’. The consequences of pandemic policy have provided opportunities for groups to exploit the cascading crises facing teachers. We argue the online political ecosystem recognises teachers as a trope useful for retaining or gaining power. Astroturfing is the process by which political actors seek to present policy platforms emerging in an organic way from ‘the people’. We detail how teachers were targeted as political leverage, within political frames that centred vaccinated teachers. We examine theTeachers’ Professional Association of Australia (TPAA), an example of an astroturfed member group. Using a qualitative approach to digital sociology we analysed the strategies used by the TPAA to manufacture a crisis associated with teacher vaccinations and answer this research question: in what ways was digital astroturfing present in the TPAA campaign against mandatory vaccinations? We find sufficient evidence to indicate that astroturfing did occur, and was employed by the TPAA in an effort to weaken traditional union movements in Australia producing a form of union uberfication. Such a development poses an existential risk to existing teacher associations and trade unions and more broadly to the health of democracies.

Prevalence of tuberculosis, Paratuberculosis and brucellosis in organized livestock farms of Tamil Nadu

Tuberculosis, paratuberculosis and brucellosis are most important diseases affecting livestock and causing severe socioeconomic losses in India. The present study is aimed to determine the prevalence of brucellosis, tuberculosis in cattle, buffaloes, goats and sheep in organized livestock farms of Tamil Nadu, India. Our screening results showed that brucellosis was found 3.13 % positivity in cattle and buffaloes and 100% negativity in sheep and goats. Tuberculosis was found 0.11%, 8.1%and 0.16% positivity in cattle and buffaloes, horses, sheep and goat, respectively. In case of Paratuberculosis, 1.76 % and 2.89% and positivity were recorded in cattle, buffaloes and sheep and goat, respectively in organized livestock farms of Tamil Nadu, India. Since brucellosis, tuberculosis and paratuberculosis are considered under emerging and remerging disease list so continuous periodical screening of livestock needed to prevent spread of those infections and implementation of vaccination policy in high prevalence area.

Clinical-Epidemiological Profile of COVID-19 Patients Admitted during Three Waves of the Pandemic in a Tertiary Care Center, in Belém, Pará, Amazon Region of Brazil.

Coronavirus disease 2019 (COVID-19) is a disease with a broad clinical spectrum, which may result in hospitalization in healthcare units, intensive care, and progression to death. This study aimed to describe and compare the clinical and epidemiological profile of COVID-19 during the three waves of the disease, in patients admitted to a public hospital in the city of Belém, Pará, in the Amazon region of Brazil. This descriptive, observational, and cross-sectional study was population-based on individuals who were hospitalized with a diagnosis of COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR), and who were interviewed and monitored at the public hospital, from February 2020 to April 2022. The prevalence was male patients, older than 60 years. The most frequent symptoms were dyspnea, cough, and fever. Systemic arterial hypertension was the most prevalent comorbidity followed by diabetes mellitus. Less than 15% of patients were vaccinated. The nasal oxygen cannula was the most used oxygen therapy interface followed by the non-rebreathing reservoir mask. Invasive mechanical ventilation predominated and the median time of invasive mechanical ventilation ranged from 2 to 6 days among waves. As for the hospital outcome, transfers prevailed, followed by deaths and discharges. The presence of comorbidities, advanced age, and male sex were important factors in the severity and need for hospitalization of these patients, and the implementation of the vaccination policy was an essential factor in reducing the number of hospital admissions.

Trust in institutions affects vaccination campaign outcomes.

Trust is an important driver of various outcomes, but little is known about whether trust in institutions affects actual vaccination campaign outcomes rather than only beliefs and intentions. We used nationally representative, individual-level data for 114 countries and combined them with data on vaccination policies and rates. We measured the speed of the vaccination campaign for each country using the estimated growth rate of a Gompertz curve. We then performed country-level regressions in the global sample and explored heterogeneity across World Bank development groups. Globally, higher trust in institutions significantly increased vaccination rates (p<0.01) and vaccination speed (p<0.01). The effect was strong in low- and middle-income countries but statistically not significant in high-income countries. Our findings have implications for the design of vaccination campaigns for national governments and international organizations. The findings highlight the importance of trust in institutions when designing communication strategies around vaccination campaigns in low- and middle-income countries.