Supply,then demand? Health expenditure,political leanings,cost obstacles to care,and vaccine hesitancy predict state-level COVID-19 vaccination rates

ObjectivesTo examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021.MethodsUsing publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout.ResultsWe identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications.ConclusionsBoth supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time.Policy ImplicationsInvesting in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages.     

What accounts for the variation in COVID-19 vaccine hesitancy in Eastern,Southern and Western Europe?

In the wake of mass COVID-19 vaccination campaigns in 2021, significant differences in vaccine skepticism emerged across Europe, with Eastern European countries in particular facing very high levels of vaccine hesitancy and refusal. This study investigates the determinants of COVID-19 vaccine hesitancy and refusal, with a focus on these differences across Eastern, Southern and Western Europe. The statistical analyses are based on individual-level survey data comprising quota-based representative samples from 27 European countries from May 2021. The study finds that demographic variables have complex associations with vaccine hesitancy and refusal. The relationships with age and education are non-linear. Trust in different sources of health-related information has significant associations as well, with people who trust the Internet, social networks and ‘people around’ in particular being much more likely to express vaccine skepticism. Beliefs in the safety and effectiveness of vaccines have large predictive power. Importantly, this study shows that the associations of demographic, belief-related and other individual-level factors with vaccine hesitancy and refusal are context-specific. Yet, explanations of the differences in vaccine hesitancy across Eastern, Southern and Eastern Europe need to focus on why levels of trust and vaccine-relevant beliefs differ across regions, because the effects of these variables appear to be similar. It is the much higher prevalence of factors such as distrust of national governments and medical processionals as sources of relevant medical information in Eastern Europe that are relevant for explaining the higher levels of vaccine skepticism observed in that region.     

“I won’t be a guinea pig”: Rethinking public health communication and vaccine hesitancy in the context of COVID-19

At the beginning of 2021, when Canada started distribution of COVID-19 vaccines, the unprecedented scope and severity of the pandemic led to very high levels of public awareness and attention, with Canadians actively seeking information. We argue that while there was continuous public health communication about COVID-19 and the newly available vaccines, these messages did not address the specific anxieties elicited by the novel vaccines, even as vaccination guidelines changed. Instead, public health messages about COVID-19 vaccines resembled those aimed at reducing vaccine hesitancy for routine immunization and did not sufficiently address the constant changes to COVID-19 vaccine recommendations. In a context of heightened public concern and significant public attention, it is crucial for communicators to acknowledge that hesitancy is vaccine-specific, and that novel diseases and new vaccines produce specific concerns. Long-term strategies should address the novelty of the technology and of the risk, thoroughly explain the reasons for shifting vaccination guidelines, and leverage trusted sources, such as community leaders. Further, as COVID-19 vaccines become less effective against some of the more recent variants of the virus, vaccine messaging needs to be tailored to evolve with shifting realities to not lose productive gains in the COVID-19 vaccination campaign to date.     

COVID-19 vaccine and boosted immunity: Nothing ad interim to do?

Today, Coronavirus Disease 2019 (COVID-19) is a global public health emergency and vaccination measures to counter its diffusion are deemed necessary. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the etiological agent of the disease, unleashes a T-helper 2 immune response in those patients requiring intensive care. Here, we illustrate the immunological mechanism to train the immune system towards a more effective and less symptomatic T-helper 1 immune response, to be exploited against SARS-CoV-2.     

The public’s role in COVID-19 vaccination: Human-centered recommendations to enhance pandemic vaccine awareness,access, and acceptance in the United States

Given the social and economic upheavals caused by the COVID-19 pandemic, political leaders, health officials, and members of the public are eager for solutions. One of the most promising, if they can be successfully developed, is vaccines. While the technological development of such countermeasures is currently underway, a key social gap remains. Past experience in routine and crisis contexts demonstrates that uptake of vaccines is more complicated than simply making the technology available. Vaccine uptake, and especially the widespread acceptance of vaccines, is a social endeavor that requires consideration of human factors. To provide a starting place for this critical component of a future COVID-19 vaccination campaign in the United States, the 23-person Working Group on Readying Populations for COVID-19 Vaccines was formed. One outcome of this group is a synthesis of the major challenges and opportunities associated with a future COVID-19 vaccination campaign and empirically-informed recommendations to advance public understanding of, access to, and acceptance of vaccines that protect against SARS-CoV-2. While not inclusive of all possible steps than could or should be done to facilitate COVID-19 vaccination, the working group believes that the recommendations provided are essential for a successful vaccination program.     

No significant increase in Guillain-Barré syndrome after COVID-19 vaccination in adults: A vaccine adverse event reporting system study

ObjectiveTo investigate the association between Guillain-Barré syndrome (GBS) and COVID-19 vaccination.BackgroundOn July 13, 2021, the US Food and Drug Administration (FDA) released a new warning that Johnson & Johnson COVID-19 vaccine could increase the risk of developing GBS.MethodsThe reporting rate of adult GBS after COVID-19 vaccination, ascertained with Brighton criteria, was compared with the reporting rate after other vaccinations during the same time period, and also compared with the reporting rate during control periods. Statistical methods such as proportion tests, and Pearson’s chi-squared test were utilized to identify significant relationships. Self-controlled and case centered analyses were conducted. A machine learning model was utilized to identify the factors associated with a worse outcome defined as emergency room (ER) or doctor visits, hospitalizations, and deaths.ResultsThe reporting rate of GBS after COVID-19 vaccination was significantly higher than after influenza and other vaccinations (49.7, 0.19, 0.16 per 10 million, p < 0.0001). However, the reporting rate was within the incidence range of GBS in the general population. Using self-controlled and case centered analyses, there was a significant difference in the reporting rate of GBS after COVID-19 vaccination between the risk period and control period (p < 0.0001). There was an estimated 0.7–1.7 per million excess reports of GBS within 6 weeks of COVID-19 vaccination. Machine learning model demonstrated that female gender and age between 18 and 44 are associated with worse outcome. No association was found between the onset interval of GBS and its prognosis.ConclusionsAlthough the reporting rate of GBS after COVID-19 vaccination was not statistically different than that of the general population, the increased reporting of GBS within the first 6 weeks after COVID-19 vaccination, more so than with other vaccinations, suggests that some cases of GBS are temporally associated with COVID-19 vaccination. However, there is a reduction in the reporting rate of GBS after other vaccines, compared to reporting rates pre-COVID-19, highlighting limitations inherent in any passive surveillance system. These findings warrant continuous analysis of GBS after COVID-19 vaccination. Further improvement of the machine learning model is needed for clinical use.     

Measuring “Fearonomic Effects” in Valuing Therapies: An Application to COVID-19 in China

ObjectivesTo develop a checklist that helps quantify the economic impact associated with fear of contagion and to illustrate how one might use the checklist by presenting a case study featuring China during the coronavirus disease 2019 (COVID-19) outbreak.MethodsBased on “fearonomic effects,” a qualitative framework that conceptualizes the direct and indirect economic effects caused by the fear of contagion, we created a checklist to facilitate empirical estimation. As a case study, we first identified relevant sectors affected by China’s lockdown policies implemented just before the Lunar New Year (LNY) week. To quantify the immediate impact, we then estimated the projected spending levels in 2020 in the absence of COVID-19 and compared these projections with actual spending during the LNY week. Data sources used include Chinese and global websites. To characterize uncertainty, we reported upper and lower bound estimates and calculated midpoints for each range.ResultsThe COVID-19 epidemic is estimated to cost China’s economy $283 billion ($196-369 billion), that is, ¥2.0 trillion renminbi (¥1.4-¥2.6 trillion), during the LNY week. Reduced restaurant and movie theater business ($106 [$103-$109] billion, 37.5% [36.4%-38.5%]) and reduced public transportation utilization ($96 [$13-$179] billion dollars, 33.9% [4.6%-63.3%]) explain most of this loss, followed by travel restrictions and the resulting loss of hotel business and tourism ($80.36 billion, 28.4%).ConclusionOur checklist can help quantify the immediate and near-term impact of COVID-19 on a country’s economy. It can also help researchers and policy makers consider the broader economic and social consequences when valuing future vaccines and treatments.     

Jabbing together? The complementarity between social capital,formal public health rules,and COVID-19 vaccine rates in the United States

COVID-19 vaccine rates provide a unique opportunity to explore vaccine hesitancy and potential interactions between social capital and individual, normative values, namely for public health and/or personal freedom. While economists and public health scholars realize the independent effects social capital and stringent public health rules have on prevalence and mortality rates, few recognize how these factors influence vaccination rates. We advance this literature with a novel framework to analyze these interactions. With county-level data on COVID-19 vaccinations, social capital, and measures of the values people have for personal freedom and public health, we find that vaccination rates depend on individual values, the level of social capital, and the interaction between the two. Social capital mediates the values people hold dear, which can influence vaccination rates in positive and negative ways. Our results are robust to the inclusion of relevant controls and under multiple specifications. These results suggest that individuals and the communities people enter into and exit out of play an important role in decisions to vaccinate, which are independent of formal, governmental public health measures.     

Seropositivity to Nucleoprotein to detect mild and asymptomatic SARS-CoV-2 infections: A complementary tool to detect breakthrough infections after COVID-19 vaccination?

BackgroundWith COVID-19 vaccine roll-out ongoing in many countries globally, monitoring of breakthrough infections is of great importance. Antibodies persist in the blood after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Since COVID-19 vaccines induce immune response to the Spike protein of the virus, which is the main serosurveillance target to date, alternative targets should be explored to distinguish infection from vaccination.MethodsMultiplex immunoassay data from 1,513 SARS-CoV-2 RT-qPCR-tested individuals (352 positive and 1,161 negative) without COVID-19 vaccination history were used to determine the accuracy of Nucleoprotein-specific immunoglobulin G (IgG) in detecting past SARS-CoV-2 infection. We also described Spike S1 and Nucleoprotein-specific IgG responses in 230 COVID-19 vaccinated individuals (Pfizer/BioNTech).ResultsThe sensitivity of Nucleoprotein seropositivity was 85% (95% confidence interval: 80–90%) for mild COVID-19 in the first two months following symptom onset. Sensitivity was lower in asymptomatic individuals (67%, 50–81%). Participants who had experienced a SARS-CoV-2 infection up to 11 months preceding vaccination, as assessed by Spike S1 seropositivity or RT-qPCR, produced 2.7-fold higher median levels of IgG to Spike S1 ≥ 14 days after the first dose as compared to those unexposed to SARS-CoV-2 at ≥ 7 days after the second dose (p = 0.011). Nucleoprotein-specific IgG concentrations were not affected by vaccination in infection-naïve participants.ConclusionsSerological responses to Nucleoprotein may prove helpful in identifying SARS-CoV-2 infections after vaccination. Furthermore, it can help interpret IgG to Spike S1 after COVID-19 vaccination as particularly high responses shortly after vaccination could be explained by prior exposure history.     

COVID-19 vaccination rates among adolescents (12–17 years) by immigrant background and sociodemographic factors: A nationwide registry study in Norway

PurposeLower COVID-19 vaccination rates have been observed among some adult immigrant populations in Norway, and there appears to be an association with sociodemographic factors. However, knowledge is lacking on the distribution of vaccination rates and role of sociodemographic factors among adolescents. This study aims to describe COVID-19 vaccination rates among adolescents according to immigrant background, household income, and parental education.MethodsIn this nationwide registry study, we analyzed individual-level data on adolescents (12–17 years) from the Norwegian Emergency preparedness register for COVID-19 until September 15th, 2022. We estimated incidence rate ratios (IRR) for receiving at least one COVID-19 vaccine dose by country background, household income and parental education, using Poisson regression, adjusting for age, sex, and county.ResultsThe sample comprised 384,815 adolescents. Foreign-born and Norwegian-born with foreign-born parents, had lower vaccination rates (57 % and 58 %) compared to adolescents with at least one Norwegian-born parent (84 %). Vaccination rates by country background varied from 88 % (Vietnam) to 31 % (Russia). Variation and associations by country background, household income, and parental education were greater among 12–15-year-olds than 16–17-year-olds. Household income and parental education were positively associated with vaccination. Compared to the lowest income and education category, IRRs for household income ranged from 1.07 (95 % CI 1.06–1.09) to 1.31 (95 % CI 1.29–1.33) among 12–15-year-olds, and 1.06 (95 % CI 1.04–1.07) to 1.17 (95 % CI 1.15–1.18) among 16–17-year-olds. For parental education, from IRR 1.08 (95 % CI 1.06–1.09) to 1.18 (95 % CI 1.17–1.20) among 12–15-year-olds, and 1.05 (95 % CI 1.04–1.07) to 1.09 (95 % CI 1.07–1.10) among 16–17-year-olds.ConclusionCOVID-19 vaccination rates varied by immigrant background and age group, with lower rates especially among adolescents with background from Eastern Europe and among younger adolescents. Household income and parental education were positively associated with vaccination rates. Our results may help target measures to increase vaccination rates among adolescents.     

A “step too far” or “perfect sense”? A qualitative study of British adults’ views on mandating COVID-19 vaccination and vaccine passports

BackgroundDebate is ongoing about mandating COVID-19 vaccination to maximise uptake. Policymakers must consider whether to mandate, for how long, and in which contexts, taking into account not only legal and ethical questions but also public opinion. Implementing mandates among populations who oppose them could be counterproductive.MethodsQualitative telephone interviews (Feb-May 2021) with British adults explored views on vaccine passports and mandatory vaccination. Participants (n = 50) were purposively selected from respondents to a probability-based national survey of attitudes to COVID-19 vaccination, to include those expressing vaccine-hesitancy. Data were analysed thematically.FindingsSix themes were identified in participants’ narratives concerning mandates: (i) mandates are a necessary and proportionate response for some occupations to protect the vulnerable and facilitate the resumption of free movement; (ii) mandates undermine autonomy and choice; (iii) mandates represent an over-reach of state power; (iv) mandates could potentially create ‘vaccine apartheid’; (v) the importance of context and framing; and (vi) mandates present considerable feasibility challenges. Those refusing vaccination tended to argue strongly against mandates. However, those in favour of vaccination also expressed concerns about freedom of choice, state coercion and social divisiveness.DiscussionTo our knowledge, this is the first in-depth UK study of public views on COVID-19 vaccine mandates. It does not assess support for different mandates but explores emotions, principles and reasoning underpinning views. Our data suggest that debate around mandates can arouse strong concerns and could entrench scepticism. Policymakers should proceed with caution. While surveys can provide snapshots of opinion on mandates, views are complex and further consultation is needed regarding specific scenarios.     

“Together in a pressure cooker”: Parenting children with disabilities during the COVID-19 lockdown

BackgroundCOVID-19 has had a disproportionate and unprecedented impact on children with disabilities, their parents and families. This impact has been particularly evident during periods of lockdowns and severe restrictions.ObjectiveThis study employed the social model of disability to illuminate negative and positive experiences of Israeli parents of children with disabilities during the first COVID-19 lockdown, as well as the way social environments, particularly educational and welfare services, shape that experience.MethodsThe study draws upon thematic analysis of written responses of 80 Israeli parents to open-ended questions.ResultsThree main themes were found: (1) lack of responsiveness of both informal and formal supports to family needs, mainly in the educational and welfare systems; (2) juggling multiple roles and tasks along with the parents' routinely intensive caregiving role; and (3) the impact on the family's wellbeing and relationships.ConclusionThese results are discussed in light of the social model of disability, showing how social restrictions and barriers affect both negative and positive experiences of these families. Also discussed are practical implications for future crises.     

Cross-regional analysis of the association between human mobility and COVID-19 infection in Southeast Asia during the transitional period of “living with COVID-19”

BackgroundIn response to COVID-19, Southeast Asian (SEA) countries had imposed stringent lockdowns and restrictions to mitigate the pandemic ever since 2019. Because of a gradually boosting vaccination rate along with a strong demand for economic recovery, many governments have shifted the intervention strategy from restrictions to “Living with COVID-19” where people gradually resumed their normal activities since the second half of the year 2021. Noticeably, timelines for enacting the loosened strategy varied across Southeast Asian countries, which resulted in different patterns of human mobility across space and time. This thus presents an opportunity to study the relationship between mobility and the number of infection cases across regions, which could provide support for ongoing interventions in terms of effectiveness.ObjectiveThis study aimed to investigate the association between human mobility and COVID-19 infections across space and time during the transition period of shifting strategies from restrictions to normal living in Southeast Asia. Our research results have significant implications for evidence-based policymaking at the present of the COVID-19 pandemic and other public health issues.MethodsWe aggregated weekly average human mobility data derived from the Facebook origin and destination Movement dataset. and weekly average new cases of COVID-19 at the district level from 01-Jun-2021 to 26-Dec-2021 (a total of 30 weeks). We mapped the spatiotemporal dynamics of human mobility and COVID-19 cases across countries in SEA. We further adopted the Geographically and Temporally Weighted Regression model to identify the spatiotemporal variations of the association between human mobility and COVID-19 infections over 30 weeks. Our model also controls for socioeconomic status, vaccination, and stringency of intervention to better identify the impact of human mobility on COVID-19 spread.ResultsThe percentage of districts that presented a statistically significant association between human mobility and COVID-19 infections generally decreased from 96.15% in week 1 to 90.38% in week 30, indicating a gradual disconnection between human mobility and COVID-19 spread. Over the study period, the average coefficients in 7 SEA countries increased, decreased, and finally kept stable. The association between human mobility and COVID-19 spread also presents spatial heterogeneity where higher coefficients were mainly concentrated in districts of Indonesia from week 1 to week 10 (ranging from 0.336 to 0.826), while lower coefficients were mainly located in districts of Vietnam (ranging from 0.044 to 0.130). From week 10 to week 25, higher coefficients were mainly observed in Singapore, Malaysia, Brunei, north Indonesia, and several districts of the Philippines. Despite the association showing a general weakening trend over time, significant positive coefficients were observed in Singapore, Malaysia, western Indonesia, and the Philippines, with the relatively highest coefficients observed in the Philippines in week 30 (ranging from 0.101 to 0.139).ConclusionsThe loosening interventions in response to COVID-19 in SEA countries during the second half of 2021 led to diverse changes in human mobility over time, which may result in the COVID-19 infection dynamics. This study investigated the association between mobility and infections at the regional level during the special transitional period. Our study has important implications for public policy interventions, especially at the later stage of a public health crisis.