Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies

Emerging blood biomarkers in Alzheimer's disease: a proteomic perspective

Early detection of Alzheimer's disease (AD) remains a formidable clinical challenge, but emerging blood-based assays show promise for identifying at-risk individuals long before cognitive symptoms arise. This is the first comprehensive synthesis comparing mass-spectrometry and immunoassay platforms across multiple blood-based AD biomarkers and the first to integrate these findings into a unified roadmap for clinical implementation. In this review, we compare high-throughput mass spectrometry and ultrasensitive immunoassays for quantifying circulating amyloid-β isoforms, phosphorylated tau species (p-tau181, p-tau217), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), YKL-40 and selected inflammatory markers. Individual biomarkers demonstrate diagnostic accuracies (AUC) up to 0.90, and integrating these protein signatures with APOE ε4 genotype, brief cognitive assessments and neuroimaging via machine-learning models boosts discrimination of preclinical AD from normal aging to over 80% accuracy. We trace the path from initial discovery through analytical validation to clinical implementation, emphasizing critical hurdles such as variability in sample collection, limited cohort diversity and regulatory requirements. Future work must standardize preanalytical protocols, extend validation across populations, refine ultrasensitive detection techniques, and combine proteomic data with genomics and other "omics" layers to move toward routine blood-based screening. These coordinated efforts provide a clear roadmap for transforming early AD diagnosis and enabling timely, personalized interventions.

Understanding occupational and attitudinal factors influencing UK healthcare worker decisions for COVID-19 and influenza vaccination: A cross-sectional survey within SIREN

BACKGROUND

Seasonal vaccination of healthcare workers (HCWs) against COVID-19 and influenza has been recommended to protect patients and the workforce against Winter pressures. We aimed to investigate demographic, occupational, accessibility and tolerability factors associated with COVID-19 and influenza vaccination among HCWs within the SIREN study cohort in 2023/24.

METHODS

We conducted a cross-sectional survey between 29 February-22 March 2024 within SIREN, a prospective HCW cohort across the UK. Adjusted odds ratios (aOR) and 95 % confidence intervals (CI) from a multivariable regression analysis were used to identify factors associated with vaccination. Proportions were calculated to describe the rationale for receiving/not receiving seasonal vaccines.

RESULTS

A total of 5357/33,007 (16.2 %) SIREN participants completed the survey. 66.7 % (3572/5357) received both vaccines, 2.4 % (129/5357) COVID-19 only, 12.4 % (662/5357) influenza only, and 18.3 % (979/5357) neither. Participants were more likely to receive any vaccine if they were over 65 years (aOR 2.73, 95 % CI: 1.64-4.55), a doctor (aOR 2.28, 95 % CI: 1.70-3.05) or had a chronic respiratory condition (aOR 1.52, 95 % CI: 1.20-1.92). Participants of Black ethnicity were less likely to be vaccinated (aOR 0.42, 95 % CI: 0.27-0.66). The top reason for vaccination was to protect oneself (81.6 %). Concern about long-term side effects was the main reason for not getting vaccinated among those who did not receive the COVID-19 vaccine (30.1 %).

DISCUSSION

We observed differences in uptake and attitudes towards seasonal vaccines among UK HCWs within the SIREN cohort. Differences in demographic characteristics, occupation and attitudes varied by vaccine type and this should be considered when planning seasonal vaccination programmes to protect the health workforce.

Factors influencing adolescents' decision-making about COVID-19 vaccination: a systematic review with qualitative synthesis

Introduction

Attitudes towards vaccination are influenced by a broad range of factors, yet little is known about the drivers shaping adolescents' vaccination beliefs. The aim of this study was to qualitatively explore the factors influencing adolescents' individual decision-making towards COVID-19 vaccination.

Methods

A systematic review was conducted using Medline, Web of Science, Sociological Abstracts, and Publicly Available Content Database. Studies on attitudes, beliefs, and perceptions of adolescents regarding COVID-19 vaccines were included. The JBI Critical Appraisal Checklist was used for quality assessment, followed by thematic synthesis of the included studies.

Results

In total, 13 studies were included, revealing 5 key themes: (1) Limited vaccine literacy influences adolescents' attitudes towards COVID-19 vaccines; (2) Family, peers, and community strongly influence adolescents' COVID-19 vaccine decision-making; (3) Different levels of trust in vaccine providers and governments influence adolescents' attitudes towards COVID-19 vaccines; (4) Desire to go back to normality influences adolescents' COVID-19 vaccine attitudes towards vaccine acceptancy; (5) Autonomy influences adolescents' COVID-19 vaccine decision-making.

Discussion

The review findings suggest that vaccine acceptance among adolescents could be improved through tailored and accessible vaccine literacy messaging, addressing structural mistrust, and empowering adolescents to make autonomous health decisions that take into account diverse contexts and populations.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512197, identifier CRD42024512197.

Mapping Vaccination Mindsets among UK Residents of Black Ethnicities with HIV: Lessons from COVID-19

Vaccine hesitancy is a leading threat to public health, but little is known about the beliefs and mindsets that drive vaccine hesitancy, especially among people of Black ethnicities. This study aimed to understand vaccine related beliefs and their relationship with SARS-CoV-2 vaccine uptake in UK residents of Black ethnicities living with HIV. Adults of self-reported Black ethnicities with HIV were recruited at 12 clinics in England. Participants completed questionnaires in clinic, including an adapted version of the Beliefs about Medicines Questionnaire (BMQ) to assess Necessity and Concerns beliefs about the SARS-CoV-2 vaccine. SARS-CoV-2 vaccination status was ascertained through self-report and shared care records. A total of 863 participants were enrolled between June 2021 and October 2022, most of whom (92%) had received at least one dose of the SARS CoV-2 vaccine. After adjusting for age and region of birth, higher perceived need for the vaccine (OR = 2.39, 95% CI = 1.51-3.81), fewer concerns about the vaccine (OR = 0.16, 95% CI = 0.08-0.30), and weaker endorsement of COVID-19 Conspiracy Beliefs (OR = 0.31, 95% CI = 0.19-0.50) were associated with vaccination uptake. Being born outside sub-Saharan Africa was associated with reduced odds of being vaccinated. This study shows the importance of specific beliefs driving vaccine hesitancy and uptake. Further studies should explore the role of these beliefs and mindsets in influencing uptake of other vaccinations, and to work with key stakeholders to explore how to address vaccine hesitancy and improve vaccine uptake in these and other populations.

COVID-19 vaccine decision-making and the role of institutions across the pandemic in UK Black African and Black Caribbean communities

INTRODUCTION

In the UK, individuals from Black African and Black Caribbean backgrounds show particularly low rates of COVID-19 vaccination uptake. Initial research highlighted institutional mistrust as a prevalent influencing factor in COVID-19 vaccine decision-making, but most data were obtained from un-differentiated minority ethnic samples. This study explored the role of institutional mistrust across the entire COVID-19 vaccination rollout period, focusing on Black African and Black Caribbean communities.

METHODS

Purposive sampling resulted in 13 participants (7 = male, 6 = female; M = 52 years), who expressed uncertainty about one or more of the menu of COVID-19 vaccinations. An in-person focus group and online semi-structured interviews were conducted to explore COVID-19 vaccination views and institutional influences. Data were analysed thematically.

RESULTS

Three overarching themes were identified, each with constituent sub-themes, mapping onto the chronological sequence of the vaccination rollout: (1) 'mistrust during initial vaccine decision-making' (e.g., highlighting historical racial inequities and biased news exposure), (2) 'negative experiences of institutions during the pandemic' (e.g., highlighting systemic pressures to vaccination and perceptions of deception), and (3) 'vaccination attitudes post-pandemic' (e.g., highlighting varied views and concerns about booster vaccinations).

CONCLUSIONS

Findings emphasize the enduring influence of institutions on COVID-19 vaccination attitudes of UK individuals from Black African and Black Caribbean backgrounds. Initial vaccination adherence through perceived coercive governmental strategies appeared counterproductive for ongoing willingness to vaccinate. Instead, co-producing campaigns and providing opportunities to discuss concerns with trusted healthcare professionals in the community are recommended. These findings can be applied to future vaccination campaigns against COVID-19 and other similar health threats.

"If that would have lessened my symptoms, that would have been great...": a qualitative study about the acceptability of tecovirimat as treatment for mpox

BACKGROUND

Tecovirimat, an antiviral treatment for smallpox, was approved as a treatment for mpox by the European Medicines Agency in January 2022. Approval was granted under "exceptional circumstances" based on effectiveness found in pre-clinical challenge studies in animals and safety studies in humans showing minimal side effects. As clinical efficacy studies are still ongoing, there is currently limited information with regard to the acceptability of tecovirimat to treat mpox. The aim of this study is to understand prospective acceptability of use of tecovirimat as treatment for mpox.

METHODS

A co-produced, qualitative, focus group study design was conducted with a theoretically informed sample of people from communities at higher risk and with experience of mpox illness. Thirteen participants took part: all self-identified as cisgender male, 1 self-identified as Black British, 1 as British Asian, 5 as White, 3 as White British, 3 as White Other. Inclusion criteria were as follows: experience of mpox illness; age 18 and over; living in the United Kingdom (UK); living in the UK during 2022 mpox outbreak. Focus groups were recorded, transcribed and thematically analysed using a combination inductive and deductive coding informed by the Treatment Acceptability Framework.

RESULTS

Very few participants were aware of tecovirimat as a treatment option and none were offered it during their mpox illness. Key factors influencing acceptability found in this study were as follows: levels of trust in medicine; level of information; provider communication approach; quality of experience of mpox care. Marginalised communities at highest risk of mpox may have prior experience of structural discrimination which can greatly influence treatment acceptability.

CONCLUSIONS

This exploratory study suggest that offering tecovirimat (or comparable emergency-licensed treatments) to people with mpox is acceptable, although uptake will depend on knowledge of mpox treatment options, trust in medicine and medical professionals and provision of relevant information and choice. To increase acceptability of such treatments, clinicians should ensure patients are aware of mpox symptom management options, including pain relief; acknowledge and address patient concerns upfront and within the context of non-stigmatising care; and communicate offers in a consistent and supportive manner in line with locally approved eligibility criteria and protocols at the time.

Tracking Immunity: An Increased Number of COVID-19 Boosters Increases the Longevity of Anti-RBD and Anti-RBD-Neutralizing Antibodies

BACKGROUND/OBJECTIVES

Since the World Health Organization declared COVID-19 a pandemic in March 2020, the virus has caused multiple waves of infection globally. Arizona State University (ASU), the largest four-year university in the United States, offers a uniquely diverse setting for assessing immunity within a large community. This study aimed to test our hypothesis that an increased number of exposures to SARS-CoV-2 RBD through vaccination/boosters/infection will increase SARS-CoV-2 antibody seroprevalence by increasing the longevity of anti-RBD and anti-RBD-neutralizing antibodies.

METHODS

A serosurvey was conducted at ASU from 30 January to 3 February 2023. Participants completed questionnaires about demographics, respiratory infection history, symptoms, and COVID-19 vaccination status. Blood samples were analyzed for anti-receptor binding domain (RBD) IgG and anti-nucleocapsid (NC) antibodies, offering a comprehensive view of immunity from both natural infection and vaccination.

RESULTS

The seroprevalence of anti-RBD IgG antibodies was 96.2% (95% CI: 94.8-97.2%), and 64.9% (95% CI: 61.9-67.8%) of participants had anti-NC antibodies. Anti-RBD IgG levels correlated strongly with neutralizing antibody levels, and participants who received more vaccine doses showed higher levels of both anti-RBD IgG and neutralizing antibodies. Increasing the number of exposures through vaccination and/or infection resulted in higher and long-lasting antibodies.

CONCLUSIONS

The high levels of anti-RBD antibodies observed reflect substantial vaccine uptake within this population. Ongoing vaccination efforts, especially as new variants emerge, are essential to maintaining protective antibody levels. These findings underscore the importance of sustained public health initiatives to support broad-based immunity and protection.

Vaccination uptake is influenced by many cues during health information seeking online

BACKGROUND

Much government response to improving vaccination uptake during the COVID-19 pandemic has focused on the problems of misinformation and disinformation. There may, however, be other signals within online health information that influence uptake of vaccination.

OBJECTIVE

This study identified the influence of various health information signals within online information communities on the intention of receiving the vaccine.

METHOD

A deductive approach was used to derive constructs from signalling theory. Constructs were validated by a convenience sample using a questionnaire. Structural equation modelling (SEM) was used to evaluate the measurement model, the structural model and the multigroup analysis.

RESULTS

The analysis showed a significant impact of signals derived from past experience, information asymmetry and source credibility constructs on the perceived quality of the vaccine service. The perceived quality also had a significant impact on the intention to receive the vaccine.

DISCUSSION

Signalling theory was able to explain the importance of health information signals perceived from online platforms on the intention of individuals to receive the vaccine.

CONCLUSION

Information asymmetry between information provider and receiver, perceived credibility of sources and perceived quality of the vaccination service may influence decisions about vaccination.

Parental decisions regarding the vaccination of children and adolescents against SARS-CoV-2 from 2020 to 2023: A descriptive longitudinal study of parents and children in Montreal, Canada

BACKGROUND

Given the growing evidence on the benefits of hybrid immunity, continued monitoring of vaccine uptake is warranted, particularly of socio-demographic subgroups with early vaccine hesitancy. Racial/ethnic and lower income groups experienced a high infection incidence, but few studies account for the child's history of SARS-CoV-2 infection on the parent's decision to vaccinate their child.

METHODS

EnCORE is a SARS-CoV-2 pediatric cohort study comprising five rounds of data collection from 2020 to 2023, with parental questionnaires at each round. Parent's responses on their intention to vaccinate their child and their reasons were summarized descriptively. Vaccine uptake was estimated through time and in relation to participant characteristics, using multivariable regression to adjust for covariates including a history of PCR/serology-confirmed SARS-CoV-2 infection prior to vaccine eligibility. At study end, we estimated the average time lapsed from last vaccine dose.

RESULTS

The samples for vaccine uptake and intention to vaccinate analyses were 631 and 1137 participants, respectively. At study end, uptake was 88 % but approximately 49 % of 2-to-4-year-olds remained unvaccinated (95 % CI 39.0, 58.1) and for vaccinated participants the median time since last vaccination was 353 days. In regression analyses, after adjusting for infection prior to vaccine eligibility and other covariates, we found approximately a two-fold increase in unvaccinated status associated with the parent's identification as a racial/ethnic minority and with household income in the lowest sample tercile (minority: adjusted relative risk [aRR] 2.45, 95 % CI 1.56, 3.86; income: aRR 1.76, 95 % CI 1.17, 2.66).

CONCLUSION

By mid-2023, most participants were not protected by vaccine-induced antibodies, because they were unvaccinated or several months had lapsed from their last dose. A COVID-19 infection prior to vaccine eligibility was associated with a greater risk of remaining unvaccinated but did not fully account for low uptake in ethnic/racial minorities and lower income groups.

'It was just the given thing to do': exploring enablers for high childhood vaccination uptake in East London's Bangladeshi community-a qualitative study

Background

Despite being an underserved ethnic minority group, characteristics which have been associated with low vaccine uptake, the Bangladeshi community in the UK exhibits high childhood vaccination uptake for several vaccines, including measles, mumps and rubella compared with several ethnic groups. This study explored key enablers for early childhood vaccination uptake among the Bangladeshi community in East London, UK.

Methods

A qualitative study using semi-structured interviews was conducted with 23 Bangladeshi parents 11 primary healthcare professionals (HCPs) and 5 community service providers (CSPs) involved in delivering childhood vaccination services, predominantly in the East London borough of Tower Hamlets. Parents were recruited purposively from the community while HCPs and CSPs were recruited from relevant organisations. The Social Ecological Model (SEM) was used as a theoretical framework for data collection and analysis. Data were analysed thematically.

Results

Multilevel vaccination enablers identified by parents, HCPs and CSPs across the different levels of the SEM included: parental trust in the immunisation programme and HCPs; a rigorous call and recall service; the normalisation of receiving childhood vaccinations within the Bangladeshi community and the availability of culturally tailored and accessible vaccination services.

Conclusions

This study highlights how multi-level trust in a vaccination programme can propel positive vaccine uptake in an underserved, ethnic minority population. Our findings suggest culturally sensitive, person-centred delivery of vaccination services, alongside leveraging community dynamics and trusted social networks, are imperative to meeting the informational, linguistic and cultural needs that facilitate vaccine uptake within the Bangaldeshi community. We recommend using existing trusted community networks to disseminate tailored vaccine information and actively reminding parents about due vaccinations to promote uptake amongst other underserved, ethnic minority communities with low uptake in high-income settings. Further research involving non-immunising parents is recommended to gain more comprehensive insight into vaccine decision-making within this community.

How has co-design been used to address vaccine hesitancy globally? A systematic review

Improving vaccine confidence is a topic of major public health importance. Reasons for vaccine hesitancy are multifactorial, making it challenging to find strategies to address them. This systematic review aimed to synthesize the literature on how co-design has been used to reduce vaccine hesitancy. We searched six databases in March and October 2024. Eligible studies described the co-design process used to develop interventions for addressing vaccine hesitancy and increasing vaccine confidence. We assessed the quality of included studies, extracted and descriptively summarized the key data. Twenty-seven articles were included, 20 of which were based in a high-income setting. Most studies centered on the COVID-19 (n = 9) and HPV (n = 9) vaccines. Co-design yielded diverse interventions, with videos being the most common intervention format (n = 11). We observed substantial variations in the reporting style and terminology used within the studies and limited attempts to assess intervention effectiveness.

Adherence to COVID-19 vaccination recommendations and vaccine hesitancy in US blood donors

BACKGROUND

General vaccination rates have been falling globally despite unequivocal health benefits. Noncompliance can result from access barriers and/or hesitant attitudes. Few studies have investigated the prevalence and determinants of noncompliance with COVID-19 vaccination in blood donors.

METHODS

We surveyed blood donors on COVID-19 infection and vaccination history, barriers and motivations for COVID-19 vaccination, and comorbidities. We estimate the prevalence of noncompliance, the prevalence of hesitancy toward COVID-19 vaccines, and investigate associated factors using multivariable models.

RESULTS

From December 2021 to December 2022, 33,610 survey respondents were included. Of these, 24% had not been vaccinated for COVID-19 or had missing vaccination information, and 99% of those who reported reasons for being unvaccinated declared at least one of three hesitant attitudes presented in the survey (safety concerns; personal/cultural/religious beliefs; being young and not worrying about being vaccinated). Among noncompliant donors, <2% reported access barriers. In the multivariable model addressing factors associated with vaccine noncompliance, younger age, male gender, White/Caucasian race, absence of comorbidities, residency in a State with less restrictive COVID-19 policies, and living in micropolitan or rural areas were identified as significant predictors. Younger age and White/Caucasian race were independently associated with vaccine hesitancy among noncompliant donors.

CONCLUSIONS

We found high rates of noncompliance with COVID-19 vaccination in blood donors, mostly driven by vaccine hesitancy. Understanding vaccine adherence among blood donors-a relatively highly educated and healthy population, with good healthcare access and usually motivated by altruism-could provide key information on determinants of vaccine noncompliance that may be harder to overcome.

Discrimination backfires? Minority ethnic disparities in vaccine hesitancy

A number of minority ethnic groups (MEGs) exhibited persistent reluctance to receive the COVID-19 vaccine. This paper attempts to empirically identify and validate some of the contentious behavioral determinants for vaccine hesitancy (VH) that remain unexplained including the role of risk perceptions, trust in government institutions, and prior experiences of racism and trauma. We draw on unique longitudinal data from a minority-boosted sample that was collected in the United Kingdon (UK). We document robust evidence of MEG disparities in VH, which declined between November 2020 and March 2021. While VH is associated to both historical and current distrust in government, risk beliefs, exposure to racism, and an individuals socio-economic background, these factors do not fully explain MEG disparities. Furthermore, similar patterns of inequality are observed when we examine MEG disparities in healthcare use, suggesting that disparities in VH reflect broader unobservable structural barriers to healthcare access.

Recognizing Social Injustice and Epistemic Mistrust in Helping Adolescents with Multiple Needs: The AMBIT (Adaptive Mentalization-Based Integrative Treatment) Approach

Epistemic trust-trust in the relevance and utility of social learning-is central to helping processes between clients and workers in helping services. Yet, due to their experiences, clients may adaptively develop predispositions toward stances of epistemic mistrust or epistemic credulity. From an AMBIT (adaptive mentalization-based integrative treatment) perspective, this article argues that epistemic mistrust and credulity are both caused by social injustice and generate further social injustice. Helping services commonly respond in ways that fail to acknowledge this social injustice and, perversely, deliver further injustice still. Our primary focus is how these issues relate to work with clients, but we argue that they are present in work within AMBIT's other foci, too: in teams, multiagency networks, and learning. We conclude that workers and helping services have a moral duty to recognize and attend to the multiple social injustices associated with epistemic mistrust and credulity.

A Qualitative Study of the Views of Ethnic Minority Healthcare Workers Towards COVID-19 Vaccine Education (CoVE) to Support Vaccine Promotion and Uptake

Ethnic minority healthcare workers (EMHCW) are at high risk of COVID-19 infection and adverse health outcomes, but vaccine uptake is low among ethnic minority communities, including EMHCW. We explored the views of EMHCW towards COVID-19 Vaccine Education (CoVE), a digital training resource to improve knowledge and confidence for promoting the COVID-19 vaccine. Thirty EMHCW completed CoVE, then participated in a semi-structured qualitative interview. Principles of framework analysis were used to deductively analyse data using concepts from the Kirkpatrick New World Model of training evaluation. CoVE was viewed to be engaging, accessible and relevant to EMHCW. This training increased EMHCW perceived knowledge and confidence to provide evidence-based information to others, dispel myths, and reduce vaccine hesitancy. Participants reported changes in vaccine promotion behaviours and vaccine uptake. CoVE could be used to help improve vaccine literacy among EMHCW, enhance health communications about vaccines, and ultimately help facilitate uptake of occupational vaccination programs.

A Public Health Ethics Framework for Populations with Limited English Proficiency

25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP.

Understanding the barriers and enablers to participation in vaccine trials in a pregnant population from diverse ethnic background in an inner-city UK hospital

BACKGROUND

Vaccination during pregnancy is an important healthcare intervention for safeguarding the health of the mother and their infants. Ethnic disparities in recruitment to vaccine research studies during pregnancy potentially contribute to health inequalities. The aim of the current study was to explore the barriers and enablers influencing the willingness of pregnant women from ethnic minority backgrounds to participate in vaccine research studies.

METHODS AND FINDINGS

Semi-structured qualitative online interviews were conducted with 23 pregnant women from diverse ethnic backgrounds in the UK. Interviews were transcribed verbatim, and thematically analysed. Our findings suggest that participants perceived vaccines and vaccine research, in principle, to be beneficial to the individual and to society, and understood the value of vaccination in mitigating severity of disease and protecting the health of mothers and their infants. Apprehension over the safety of vaccination in pregnancy was common and reduced willingness to participate. For those that decided to participate in vaccine trials in pregnancy, this was seen as an act of solidarity, a way to contribute to a collective responsibility for the public health of the community. Personal and community connections and representation-seeing people from their own communities represented in in the recruitment process shapped decisions about vaccine trial participating. Trust and mistrust in health systems, shaped by past experiences of interacting with healthcare professionals were likely to inform whether they would consider participating. Practical considerations such as excessive time commitments related to study procedures, travel and organising childcare were barrier to participation. The level of invasiveness of trial procedures were also a concern, although increased monitoring during the trial was seen as a potential benefit, mitigating some safety concerns.

CONCLUSIONS

Our study reinforcing previously identified barriers to vaccine participation among pregnant women from diverse ethnic communities. This study underlines the need to develop tailored interventions that focus on fostering trust with the aid of community engagement to understand cultural contexts, establishing authentic representation, and address practical considerations, to contribute to enhancing vaccine trial participation in pregnancy in those from diverse ethnic communities.

Socioeconomic status as a risk factor for SARS-CoV-2 infection in pregnant women

OBJECTIVES

Due to the association between COVID-19 and adverse pregnancy outcomes, pregnant women are considered to be a vulnerable patient group. Studies have shown that low socioeconomic status (SES) is a risk factor for SARS-CoV-2 infection. COVID-19 and low SES are likely to have a synergistic adverse effect. This study aimed to evaluate the socioeconomic background, indicated by self-reported SES, educational level, and financial situation, in pregnant women who were positive for SARS-CoV-2.

METHODS

A case-control study was conducted, including all pregnant women with positive SARS-CoV-2 PCR tests at Kepler University Hospital Linz between May 2020 and August 2021 (n=150) and a control group matched 1:1 relative to gestational age at birth (n=150). Data were collected using written questionnaires and medical records from the hospital information system.

RESULTS

Lower self-reported socioeconomic status (p=0.029) and lower education level (p=0.003) were detected in the COVID group. Mothers in the COVID group were significantly younger (p=0.024). However, after adjustment for educational attainment, younger age was not confirmed as a risk factor for SARS-CoV-2 infection during pregnancy (p=0.326). The social gradient was not explained by the assumed mediators and confounders.

CONCLUSIONS

These findings confirm an association between lower socioeconomic status and the risk of SARS-CoV-2 infection during pregnancy. Since both socioeconomic factors and COVID-19 impose negative effects on pregnancy outcomes, health inequalities should be taken into consideration when implementing SARS-CoV-2 prevention measures and when providing health care for pregnant women from disadvantaged communities.

Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic

During the COVID-19 pandemic, hypertensive patients had increased infection and healthcare disruption in many low- and middle-income countries (LMICs) with limited vaccine access. The objective of this report is to describe COVID-19 experiences and vaccination uptake among hypertensive patients in Colombia and Jamaica. A cross-sectional study of patients with hypertension was conducted in primary care clinics in both countries between 2021 and 2022. Trained interviewers used a telephone-administered questionnaire to assess COVID-19 experiences (infection, vaccination, and healthcare access). A total of 576 patients (68.5% female, mean age: 67.5 years) participated. Health service disruption affecting access to care was low (<10%). Compared to Jamaica, more participants from Colombia reported testing positive for COVID-19, having family members or friends testing positive, losing family members or friends due to COVID-19, and being vaccinated. In logistic regression models, adjusted for age, sex, education, and rural/urban clinic status, fear of COVID-19 (OR 2.7, 95% CI: 1.2-6.1) and residence in Colombia (OR 5.9, 95% CI: 2.4-14.6) were associated with higher vaccination uptake. Disparities in access to COVID-19 testing and diagnosis may have influenced these country differences including fear of COVID-19 and vaccine uptake. Other factors need to be better understood to prepare for future pandemic responses.

Incremental net benefit of extending human papillomavirus vaccine to boys in oropharyngeal cancer burden: Meta-analysis of cost-effectiveness studies

Background/purpose

The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) is increasing worldwide. HPV vaccines have shown efficacy in preventing diseases in both males and females. Therefore, there is a need to develop cost-effective strategies for HPV vaccines to prevent HPV-related OPC. This meta-analysis aimed to evaluate cost-effectiveness using the global mean of incremental cost-effectiveness ratios compared to the willingness-to-pay threshold and incremental net benefits (INBs) of HPV vaccination strategies between boys' extension vaccine and girls only. These recommendations will be useful for countries that have not implemented universal HPV vaccines in national programs, such as Taiwan.

Materials and methods

Studies evaluating the cost-effectiveness of HPV vaccination strategies in the prevention of OPC that included both sexes versus girls only were identified through the Cochrane Library, EMBASE, PubMed, ScienceDirect, and Web of Science databases on February 05, 2024, and a meta-analysis of pooled INBs was performed using a random-effects model. The outcome was an effective measurement of the OPC burden. The results are represented in USD (2024).

Results

Fifteen model analyses were included. All the studies were conducted in high-income countries. The global mean of incremental cost-effectiveness ratio was $39,553 (95% CI, $27,008-66,641) per quality-adjusted life years gained, which was below the global mean of the willingness-to-pay threshold of $65,473 (95% CI, $52,138-83,755). Pooled INBs of $9370 (95% CI, $5046-13,695; P < 0.001) favored the extended HPV in boys.

Conclusion

HPV vaccination strategies that include boys are cost-effective compared to those with girls only in preventing OPC burden. By implementing a universal HPV vaccination program, countries can receive $9370 in additional monetary benefits per patient. Given its relevance to high-income countries, this study offers key insights that can aid policymakers in Taiwan.

COVID-19 Vaccine decision-making: trust among the transgender and disability communities in India

BACKGROUND

Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India.

METHODS

Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model.

RESULTS

Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional.

CONCLUSION

These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.

Association between beliefs in medical conspiracy theories and health behaviors among medical and healthcare students. Implications for professional practice

BACKGROUND

While conspiracy theories cover many different themes, medical conspiracy theories (MCTs) have become particularly prevalent in modern societies. As beliefs in MCTs can become a source of "infodemics", influence individual health behaviors and cause distrust in medical institutions and personnel, healthcare workers must find ways to overturn patients' conspiracy thinking. However, as the medical world is not free of these beliefs, in this study, we investigated beliefs in MCTs among medical and health science students and their association with reported health behaviors.

METHODS

Our sample was derived from a self-administered, anonymized, computer-assisted web survey conducted among 1,175 medical and health science students enrolled at the Poznan University of Medical Sciences, Poland.

RESULTS

From a set of twenty different MCTs, one-third of students rejected all of them, 18% believed in one, 15% in two, 10% in three, and 24% supported four or more conspiracy theories. In addition, many students were hesitant or unsure about MCTs. We also found that nursing and midwifery students were the most likely to believe in MCTs, while medical and dental students were the least supportive. Support for MCTs was higher among students in the early years of their studies and who declared themselves religious and conservative. This study also highlights the association between students' support for MCTs and their reported health behaviors, including avoiding vaccinations, using alternative medicine, taking vitamin C, or using social media as an essential source of health information.

CONCLUSIONS

As medical and health science students are prone to conspiratorial thinking, they should be trained to act as a trusted and reliable source of medical information, to mitigate conspiratorial beliefs, and to act as role models for their patients and society, effectively shaping health behaviors in the population.

Developing films to support vaccine-hesitant, ethnically diverse parents' decision-making about the human papillomavirus (HPV) vaccine: a codesign study

OBJECTIVE

To illustrate an evidence-, theory- and person-based approach to codesign the COMMUNICATE films that support parental decision-making about the human papillomavirus (HPV) vaccine for their teenagers.

DESIGN

Codesign study.

SETTING

Localities covered by two immunisation teams in London and the south-west of England.

METHODS

The intervention planning phase involved combining evidence from a literature review with qualitative interview data to identify barriers and facilitators to HPV vaccine uptake, as well as design features that should be incorporated within the COMMUNICATE films. The intervention development phase involved identifying guiding principles for the COMMUNICATE films, mapping behaviour change techniques onto the behaviour change wheel and codesigning the COMMUNICATE films. Feedback from users informed modifications to maximise acceptability and feasibility and to support behaviour change.

RESULTS

The primary and secondary evidence highlighted important content to include within the COMMUNICATE films: emphasise the benefits of the HPV vaccine, provide transparent information about the safety profile and side effects and emphasise the universality and commonality of HPV infection. A series of scripts were used to guide 4 film shoots to create the content in multiple community languages with 16 participants, including vaccine-hesitant, ethnically diverse parents and professionals. Overall, participants were positive about the films. Potential messengers and ways the films could be distributed, identified by parents, include local social media networks or text messages from general practices. The need for information about the HPV vaccine to be shared by schools ahead of consent being sought was also raised.

CONCLUSIONS

By using an integrated approach to intervention development, this study has begun to address the need for an intervention to support vaccine-hesitant, ethnically diverse parents' decision-making about the HPV vaccination programme. A future study to codesign, implement and evaluate a communication strategy for the COMMUNICATE films is planned.

Training health workers and community influencers to be Vaccine Champions: a mixed-methods RE-AIM evaluation

INTRODUCTION

Increasing trust and confidence in vaccines is a global priority, as countries have grappled with delivering COVID-19 vaccines, maintaining routine childhood vaccination rates and introducing new vaccines. Community-based vaccine promotion interventions are commonly implemented, but effectiveness evidence is limited. In 2022, supported by the Australian Government and in partnership with Fiji's Ministry of Health and UNICEF, we codesigned, delivered and comprehensively evaluated a vaccine education and communication training programme for health workers and community influencers to promote COVID-19 and routine immunisation.

METHODS

The Vaccine Champions programme included three phases: (1) codesign with Fiji stakeholders; (2) vaccine education and communication training for Vaccine Champions and (3) support for Champions to deliver community vaccine discussion sessions over 6 months.The RE-AIM framework evaluation measured programme reach, effectiveness, adoption, implementation and maintenance. Mixed-methods data were collected through interviews, surveys and field notes, integrating qualitative and quantitative data to triangulate findings. Primary outcomes included Champions' knowledge, communication self-efficacy, trust in COVID-19 vaccines, programme satisfaction and community members' intention to vaccinate.

RESULTS

We trained 35 Champions (27/35 female), including health workers, faith and community influencers. Half had a health background (17/35). Champions conducted 54 discussion sessions, reaching 1717 community members. Most Champions (22/35) conducted at least 1 session, with 16 running 3 or more. Champions who did not run sessions reported barriers like lack of confidence and competing duties. Training increased Champions' communication self-efficacy and trust in COVID-19 vaccines. Community member intention to vaccinate increased from 41% (394/960) to 83% (822/991) before and after a session. The programme was well received with interest in continued engagement.

CONCLUSION

Training health workers and community Vaccine Champions can promote vaccine confidence. Programmes require government support and engagement for sustainability. Robust evaluation frameworks are needed to build the evidence base.

Ethnic inequities in 6-8 week baby check coverage in England 2006- 2021: a cohort study using the Clinical Practice Research Datalink

BACKGROUND

Inequities in the coverage of 6-8-week maternal checks, health visitor reviews, and infant vaccinations have been reported in England. Ethnic inequities in 6-8-week baby checks have not been studied nationally.

AIM

To examine the effect of maternal ethnicity on 6-8 week baby check coverage in England 2006-2021.

DESIGN AND SETTING

This cohort study used electronic health records from primary care in England.

METHOD

Baby check coverage was calculated in 16 ethnic groups, by year and region. Risk ratios were estimated using modified Poisson regression. Coverage and timing of baby checks in relation to maternal checks and infant vaccinations by ethnic group were calculated.

RESULTS

Ethnic inequities in 6-8 week baby check coverage in England varied by year and region. Coverage increased 2006-2007 to 2015-2016, then stabilised to 80-90% for most groups. Coverage was lowest for Bangladeshi and Pakistani groups 2006-2007 to 2011-2012. In the West Midlands, coverage was lowest at approximately 60% for four groups: Bangladeshi, Caribbean, African, and Any other Black, African or Caribbean background. In the North West, coverage was lowest for Bangladeshi (65.3%) and Pakistani (69.2%) groups. These patterns remained after adjusting for other factors and persisted over time. Coverage was highest in those whose mothers received a maternal check and those who received at least one dose of 8-week infant vaccinations.

CONCLUSION

Coordinated action at the level of integrated commissioning boards, primary care networks, and GP practices is required to better understand the reasons behind these inequities and redress the persistent disparities in 6-8 week baby check coverage.

"Why would we?" A qualitative study on COVID-19 vaccination decision making among Ukrainian economic female migrants in Poland

Background

Ukraine has one of the lowest COVID-19 vaccination rates in Europe. This may pose a significant epidemiological risk in the context of the refugee crisis and the fact that, since 2020, SARS-CoV-2 has been spreading and changing globally.

Objective

To evaluate determinants of vaccination decision making among Ukrainian female migrants (UFMs).

Methods

A qualitative study with 45 UFMs was conducted between December 2021 and January 2022. UFMs, from 2 Polish provinces, differing in age, education and length of stay were invited with the use of the snowball technique. Using a semi-structured topic guide, eight focus groups were conducted in person, recorded and transcribed. Thematic, qualitative analysis was made; key themes which emerged from the data (with the help of the Working Group Determinants of Vaccine Hesitancy Matrix), were related to contextual, individual/group and contextual vaccine/vaccination-specific influences.

Results

Mothers were found to be playing a crucial role in children and adolescent COVID-19 vaccine decision-making process. Universal trust in the Polish healthcare system and vaccination procedures, employer requirements and willingness to preserve jobs, desire to get back to normal and social influences were paramount prerequisites to let UFMs make a decision to get vaccinated. However, COVID-19 vaccines also faced backlash among UFMs. Negative experiences with vaccines provided in Ukraine, doubts about the rapid vaccine development, combined with lack of confidence in vaccine safety, specifically regarding child vaccination, might have a bearing on UFMs' decision about declining COVID-19 vaccine while on migration. Discrimination through HCWs during vaccination visits was also reported. Corrupted Ukrainian healthcare system, which facilitates proof forgery regarding vaccination certificates, could act as a negative influencer of UFMs' vaccine decision-making.

Conclusion

The results provide the novel information, expressed in economic UFMs' own words. Findings show that influencers of the decision-making process regarding the COVID-19 vaccination are complex and polarized; elements of hesitancy may persist after migration. Any continuation of UFMs' vaccination with COVID-19 vaccine should be subject to designing accessible information to address modifiable demotivators of the vaccine decision-making process identified in this study.

The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England

BACKGROUND

Outreach clinics were part of efforts to maximise uptake in COVID-19 vaccination.

METHODS

We used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed.

RESULTS

50% of 288,473 exposed citizens were white British, and 71% were aged 0-49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was - 0.12% (95% CI: -0.90%, 0.66%); by age group it was - 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%).

CONCLUSIONS

Living within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.

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.

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.

Barriers and drivers to COVID-19 vaccination among the migrant and non-migrant population in Germany, 2021

BACKGROUND

During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake.

METHODS

We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake.

RESULTS

The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57-1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated.

CONCLUSION

Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions.

Interventions to increase vaccination in vulnerable groups: rapid overview of reviews

OBJECTIVE

Groups which are marginalised, disadvantaged or otherwise vulnerable have lower uptake of vaccinations. This differential has been amplified in COVID-19 vaccination compared to (e.g.) influenza vaccination. This overview assessed the effectiveness of interventions to increase vaccination in underserved, minority or vulnerable groups.

METHODS

In November 2022 we searched four databases for systematic reviews that included RCTs evaluating any intervention to increase vaccination in underserved, minority or vulnerable groups; our primary outcome was vaccination. We used rapid review methods to screen, extract data and assess risk of bias in identified reviews. We undertook narrative synthesis using an approach modified from SWiM guidance. We categorised interventions as being high, medium or low intensity, and as targeting vaccine demand, access, or providers.

RESULTS

We included 23 systematic reviews, including studies in high and low or middle income countries, focused on children, adolescents and adults. Groups were vulnerable based on socioeconomic status, minority ethnicity, migrant/refugee status, age, location or LGBTQ identity. Pregnancy/maternity sometimes intersected with vulnerabilities. Evidence supported interventions including: home visits to communicate/educate and to vaccinate, and facilitator visits to practices (high intensity); telephone calls to communicate/educate, remind/book appointments (medium intensity); letters, postcards or text messages to communicate/educate, remind/book appointments and reminder/recall interventions for practices (low intensity). Many studies used multiple interventions or components.

CONCLUSION

There was considerable evidence supporting the effectiveness of communication in person, by phone or in writing to increase vaccination. Both high and low intensity interventions targeting providers showed effectiveness. Limited evidence assessed additional clinics or targeted services for increasing access; only home visits had higher confidence evidence showing effectiveness. There was no evidence for interventions for some communities, such as religious minorities which may intersect with gaps in evidence for additional services. None of the evidence related to COVID-19 vaccination where inequalities of outcome are exacerbated.

PROSPERO REGISTRATION

CRD42021293355.

Ethico-racial positioning in campaigns for COVID-19 research and vaccination featuring public figures

This article analyses a set of videos which featured public figures encouraging racially minoritised people in the UK to take the COVID-19 vaccine or get involved in related research. As racially targeted health communication has both potentially beneficial and problematic consequences, it is important to examine this uniquely high-profile case. Using a purposive sample of 10 videos, our thematic content analysis aimed to reveal how racially minoritised people were represented and the types of concerns about the vaccine that were expressed. We found representations of racialised difference that centred on 'community' and invoked shared social experiences. The expressed concerns centred on whether ethnic difference was accounted for in the vaccine's design and development, plus the overarching issue of trust. Our analysis adopts and develops the concept of 'racialisation'; we explore how 'mutuality' underpinned normative calls to action ('ethico-racial imperatives') and how the videos 'responsibilised' racially minoritised people. We discuss two points of tension in this case: the limitations for addressing the causes of mistrust and the risks of reductivism that accompanied the ambiguous notion of community. Our analysis develops scholarship on racialisation in health contexts and provides public health practitioners with insights into the socio-political considerations of racially targeted communications.

The role of religion and COVID-19 vaccine uptake in England

BACKGROUND

While many countries have successfully deployed COVID-19 vaccination programmes, there are disparities in their uptake. One factor influencing vaccine coverage is religion. Existing research has found a link between religious beliefs and vaccine hesitancy. This study looks at religion in England to examine its relationship with public health.

METHODS

This analysis used data from a survey of over 12,000 respondents in England, conducted through the YouGov Online Panel. Respondents were asked whether they identified with a religion, and if so which, and the number of COVID-19 vaccinations they had received. We employed logistic regressions to analyse the data, accounting for age, gender, education, generalised trust, trust in government, and political ideology.

RESULTS

We find that respondents who identify as part of the Church of England have had significantly more COVID-19 vaccinations. Conversely, adherents to the Pentecostal Evangelical and Islamic faiths have had significantly fewer COVID-19 vaccinations. These relationships hold even when adjusting for age, education, level of trust, and political affiliation.

CONCLUSION

This research indicates a potential influence of religious affiliation on vaccine uptake, highlighting the need for more carefully-tailored public health programmes. Recognizing the diverse associations of different religious affiliations on health behaviour is important for shaping future vaccination campaigns and policy interventions. Engaging with religious communities and leaders may be one method through which to deal with vaccine hesitancy and improve public health.

Women's experiences of maternity care in the United Kingdom during the COVID-19 pandemic: A follow-up systematic review and qualitative evidence synthesis

BACKGROUND

Maternity care services in the United Kingdom have undergone drastic changes due to pandemic-related restrictions. Prior research has shown maternity care during the pandemic was negatively experienced by women and led to poor physical and mental health outcomes in pregnancy. A synthesis is required of published research on women's experiences of maternity care during the latter half of the COVID-19 pandemic.

AIM

To update a previous systematic review of maternity care experiences during the pandemic to June 2021, exploring experiences of maternity care specifically within the United Kingdom and how they may have changed, in order to inform future maternity services.

METHODS

A systematic review of qualitative literature was conducted using comprehensive searches of five electronic databases and the Cochrane COVID Study Register, published between 1 June 2021 and 13 October 2022, and further updated to 30 September 2023. Thematic Synthesis was utilised for data synthesis.

FINDINGS

Of 21,860 records identified, 27 studies were identified for inclusion. Findings included 14 descriptive themes across the five core concepts: (1)Care-seeking and experience; (2)Virtual care; (3)Self-monitoring; (4)COVID-19 vaccination; (5)Ethical future of maternity care.

DISCUSSION

Our findings in the UK are consistent with those globally, and extend those of the previous systematic review, particularly about women's perceptions of the COVID-19 vaccine during pregnancy.

CONCLUSION

Our findings suggest the following are important to women for future maternity care: personalisation and inclusiveness; clear and evidence-based communication to facilitate informed decision-making; and achieving balance between social commitments and time spent settling into motherhood.

COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review

OBJECTIVE

To compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries.

DESIGN

A realist review.

DATA SOURCES

Embase, PubMed, Dimensions ai and Google Scholar.

SETTING

High-income countries.

DEFINITIONS

We defined vaccination willingness as the proportion of participants willing or intending to receive vaccines prior to availability. We defined vaccine uptake as the real proportion of the population with complete vaccination as reported by each country until November 2021.

RESULTS

We included data from 62 studies and 18 high-income countries. For studies conducted among general populations, the proportion of vaccination willingness was 67% (95% CI 62% to 72%). In real-world settings, the overall proportion of vaccine uptake among those countries was 73% (95% CI 69% to 76%). 17 studies reported pre-rollout willingness for under-resourced communities. The summary proportion of vaccination willingness from studies reporting results among people from under-resourced communities was 52% (95% CI 0.46% to 0.57%). Real-world evidence about vaccine uptake after rollout among under-resourced communities was limited.

CONCLUSION

Our review emphasises the importance of realist reviews for assessing vaccine acceptance. Limited real-world evidence about vaccine uptake among under-resourced communities in high-income countries is a call to context-specific actions and reporting.

The PHERCC Matrix. An Ethical Framework for Planning, Governing, and Evaluating Risk and Crisis Communication in the Context of Public Health Emergencies

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix.

Socio-demographic determinants of COVID-19 vaccine uptake in Ontario: Exploring differences across the Health Region model

The COVID-19 pandemic continues to be a worldwide public health concern. Although vaccines against this disease were rapidly developed, vaccination uptake has not been equal across all the segments of the population, particularly in the case of underrepresented groups. However, there are also differences in vaccination across geographical areas, which might be important to consider in the development of future public health vaccination policies. In this study, we examined the relationship between vaccination status (having received the first dose of a COVID-19 vaccine), socio-economic strata, and the Health Regions for individuals in Ontario, Canada. Our results show that between October of 2021 and January of 2022, individuals from underrepresented communities were three times less likely to be vaccinated than White/Caucasian individuals across the province of Ontario, and that in some cases, within these groups, individuals in low-income brackets had significantly higher odds of vaccination when compared to their peers in high income brackets. Finally, we identified significantly lower odds of vaccination in the Central, East and West Health Regions of Ontario within certain underrepresented groups. This study shows that there is an ongoing need to better understand and address differences in vaccination uptake across diverse segments of the population of Ontario that the pandemic has largely impacted.

"It's no use saying it in English": A qualitative study exploring community leaders' perceptions of the challenges and opportunities with translating and interpreting COVID-19 related public health messaging to reach ethnic minorities in Australia

BACKGROUND

The Australian Government implemented a range of public health response strategies and communication approaches to reduce the spread of COVID-19; however, concerns have been raised around a failure to sufficiently consider culturally and linguistically diverse (CaLD) communities in these processes. This research aimed to understand the factors that have impacted COVID-19 communication and engagement efforts during the pandemic from the perspective of key CaLD community and faith-based leaders. A further aim was to understand the processes that could be adopted to support future communication strategies, including promoting pandemic-related vaccines.

APPROACH

This study included 29 key informant interviews with community and faith-based leaders in New South Wales, Australia.

RESULTS

The overwhelming message from community leaders was a sense of shared responsibility between their organisations and governments in communicating pertinent and accurate COVID-19 related information to CaLD communities. They expressed a sense of duty to keep their community members safe. However, community leaders and others shouldered significant costs related to resources and time that need to be acknowledged by governments in preparing for future disease outbreaks. They felt that governments should consider: 1) improving communication between governments and CaLD organisations; 2) responding to the specific CaLD needs with greater agility; 3) foregrounding social media in their communication strategy; 4) reinvesting in local public health units to know their population; 5) developing a health ambassadors model program; 6) preparing a hybrid model of translators/interpreters to fill the gap; and, 7) reimagining vaccine information campaigns to target CaLD communities better.

CONCLUSION

Given the technical details about the COVID-19 virus conveyed in government information campaigns and the media, ensuring the most vulnerable populations, including people from CaLD backgrounds, access clear, concise and timely public health messaging from governments and community organisations requires further attention.

Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: an umbrella review and findings from healthcare, education and criminal justice

OBJECTIVES

To assess the evidence for anti-racist interventions which aim to reduce ethnic disparities in healthcare, with a focus on implementation in the UK healthcare system.

DESIGN

Umbrella review.

DATA SOURCES

Embase, Medline, Social Policy and Practice, Social Care Online and Web of Science were searched for publications from the year 2000 up to November 2023.

ELIGIBILITY CRITERIA

Only systematic and scoping reviews of anti-racist interventions reported in English were included. Reviews were excluded if no interventions were reported, no comparator interventions were reported or the study was primarily descriptive.

DATA EXTRACTION AND SYNTHESIS

A narrative synthesis approach was used to integrate and categorise the evidence on anti-racist interventions for healthcare. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool.

RESULTS

A total of 29 reviews are included in the final review. 26 are from the healthcare sector and three are from education and criminal justice. The most promising interventions targeting individuals include group-based health education and providing culturally tailored interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority communities may provide an effective approach to reducing ethnic health disparities. Interventions to improve quality of care for conditions with disproportionately worse outcomes in ethnic minority communities show promise. At a policy level, structural interventions including minimum wage policies and integrating non-medical interventions such as housing support in clinical care has some evidence for improving outcomes in ethnic minority communities.

CONCLUSIONS

Many of the included studies were low or critically low quality due to methodological or reporting limitations. For programme delivery, different types of pathway integration, and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on individual behaviour change and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multilevel approach.

Disproportionate infection, hospitalisation and death from COVID-19 in ethnic minority groups and Indigenous Peoples: an application of the Priority Public Health Conditions analytical framework

The COVID-19 pandemic has resulted in disproportionate consequences for ethnic minority groups and Indigenous Peoples. We present an application of the Priority Public Health Conditions (PPHC) framework from the World Health Organisation (WHO), to explicitly address COVID-19 and other respiratory viruses of pandemic potential. This application is supported by evidence that ethnic minority groups were more likely to be infected, implying differential exposure (PPHC level two), be more vulnerable to severe disease once infected (PPHC level three) and have poorer health outcomes following infection (PPHC level four). These inequities are driven by various interconnected dimensions of racism, that compounds with socioeconomic context and position (PPHC level one). We show that, for respiratory viruses, it is important to stratify levels of the PPHC framework by infection status and by societal, community, and individual factors to develop optimal interventions to reduce inequity from COVID-19 and future infectious diseases outbreaks.

Exploring COVID-19 Vaccination Willingness in Italy: A Focus on Resident Foreigners and Italians Using Data from PASSI and PASSI d'Argento Surveillance Systems

(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d'Argento, in the period of August 2020-December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.

A. Pienaah C, Luginaah I. Child malaria vaccine uptake in Ghana: Factors influencing parents' willingness to allow vaccination of their children under five (5) years

BACKGROUND

Malaria is a substantial health burden in Ghana, particularly among children. Despite the availability of malaria vaccines, uptake remains low. Notwithstanding, there is a paucity of nationally representative studies on the factors driving hesitance towards the new malaria vaccine. In response, this study, guided by the Theory of Planned Behaviors (TPB), seeks to understand the determinants of child malaria vaccine uptake in Ghana to inform strategies for improving coverage.

MATERIALS AND METHODS

We employed multiple regression model to examine the association between maternal awareness, socioeconomic status, ethnicity, geographical location, and vaccine uptake using data from the 2019 Ghana Malaria Indicator Survey (MIS).

RESULTS

Maternal awareness of vaccine (OR = 2.200; P<0.01) significantly predicted higher likelihood of vaccine uptake. Household wealth was associated with child vaccination as parents in middle-income households (OR = 9.342; P<0.01), and those in poorest households (OR = 9.409; P<0.05) recorded higher likelihood of allowing their children to be vaccinated. With regards to ethnicity, parents from the Mande ethnic group (OR = 0.106; P<0.05) were less likely to allow their children to be vaccinated when compared to parents from the Akan ethnic group. Knowing that malaria is covered by National Health Insurance (OR = 2.407; P<0.05) was associated with higher likelihood of allowing child vaccination compared to not knowing. More so, geographical variations were observed as parents who lived in rural areas (OR = 0.254; P<0.05) were significantly less likely to allow vaccination of their children compared to those in urban areas.

CONCLUSIONS

Enhancing awareness through education campaigns can improve child malaria vaccine coverage. Observing socioeconomic disparities in uptake and ensuring equitable access to vaccines are vital. Tailored strategies considering ethnic background and geographical location, can as well enhance acceptance of the vaccine. This study provides valuable insights for developing effective strategies to reduce the burden of malaria in children and improve coverage of uptake. This study underscores the need to improve parental awareness and the relevance of the vaccine in preventing child mortality.

Access to SARS-CoV-2 vaccination in immigrants in Italy, by geographical area of origin

OBJECTIVE

Immigrants are commonly considered disadvantaged and at high risk of not receiving appropriate care, including vaccination. This study aimed to evaluate the access to SARS-CoV-2 vaccination in immigrants, by geographical area of origin, compared with Italian citizens. We also evaluated sex differences in vaccine's coverage by geographical area of origin.

METHODS

We performed a retrospective observational study in four Italian regions, including all resident subjects aged 5-69 years, and undergoing first dose SARS-CoV-2 vaccination in the period 28th December 2020- 3rd April 2022. We estimated cumulative coverage percentages, by age class and geographical area. To compare first-dose vaccine coverage by geographical area of origin, we estimated, through a Poisson analysis, Vaccine Coverage Ratios (VCR) with 95 % confidence intervals (95 %CI), adjusting for age and sex.

RESULTS

We included 16,294,785 Italian citizens and 2,534,351 immigrants aged 5-69 years and resident in the four regions considered. Regarding the geographical area of origin, 40.7 % of immigrants came from Eastern Europe, 13.5 % from North Africa and 13.1 % from Western Asia. A great variability in the first dose vaccine coverage emerged. We documented substantial heterogeneity in the first-dose vaccine coverage within immigrant's population, expressed with Italy as a reference, ranging from 0,768 (95 %CI: 0,766-0,769) in Eastern Europe countries to 1,013 (95 %CI: 1,009 - 1,018) in Eastern Asia. The chance of being vaccinated was found higher in males compared with females for African countries (VCR 1.07, 95 %CI 1.06-1.08) and Western Asian countries (VCR 1.08, 95 %CI 1.07-1.09).

CONCLUSION

We observed substantial heterogeneity in first-dose SARS-CoV-2 vaccination coverage in immigrants, suggesting a different propensity to vaccines according to the geographical area of origin. These data can help define appropriate and tailored strategies in order to improve vaccine coverage in some specific immigrant groups at the local health district level.

SARS-CoV-2 vaccination uptake in six ethnic groups living in Amsterdam, the Netherlands: A registry-based study within the HELIUS cohort

OBJECTIVE

Ethnic minority groups have experienced a disproportionate burden of COVID-19, and should therefore be especially encouraged to receive SARS-CoV-2 vaccination. This study compared first-dose uptake of the primary SARS-CoV-2 vaccination series across six ethnic groups in Amsterdam, the Netherlands in 2021.

METHODS

We analyzed data from participants of the population-based HELIUS cohort. We linked their data to the SARS-CoV-2 vaccination registry data of the Public Health Service of Amsterdam. We included registry data from January 6, 2021 (the start of the Dutch vaccination campaign) until September 6, 2021 (a date by which all adults in the Netherlands could have received one or two vaccine doses). SARS-CoV-2 vaccination uptake was defined as having received at least one vaccine dose of the primary vaccination series. We examined the association between ethnicity and vaccination uptake using multivariable logistic regression, while accounting for the age and sex distribution of ethnic groups in Amsterdam.

RESULTS

We included 19,006 participants (median age 53 years [interquartile range 41-62], 57% female). SARS-CoV-2 vaccination uptake was highest in the South-Asian Surinamese group (60.3%, 95%CI = 58.2-62.3%), followed by the Dutch (59.6%, 95%CI = 58.0-61.1%), Ghanaian (54.1%, 95%CI = 51.7-56.5%), Turkish (47.7%, 95%CI = 45.9-49.6%), African Surinamese (43.0%, 95%CI = 41.2-44.7%), and Moroccan (35.8%, 95%CI = 34.1-37.5%) groups. After adjusting for age, sex, perceived social support, and presence of relevant comorbidities, participants of African Surinamese, Ghanaian, Turkish and Moroccan origin were significantly less likely to be vaccinated than those of Dutch origin.

CONCLUSIONS

Prevention strategies should continue tailoring to specific ethnic groups to encourage vaccination uptake and reduce barriers to vaccination.

Improving Pathways to Care for Ethnic Minority Communities

It is well established that the COVID-19 pandemic has had a substantial impact on ethnic minority communities and has worsened existing health inequalities experienced by these populations globally. Individuals from ethnic minority backgrounds have not only been more likely to become infected with COVID-19 throughout the pandemic, but they have also higher risk of adverse symptoms and death following infection. Factors responsible for these discrepancies are wide reaching and encompass all aspects of the social determinants of health (SDoH). Although always an area of concern among healthcare professionals, barriers to health care experienced by ethnic minority populations became a more pertinent issue during the COVID-19 pandemic when all individuals required sufficient and sustained access to a healthcare system (whether this be for COVID-19 testing, vaccination or treatment). These healthcare barriers exacerbated the increased COVID-19 burden experienced by minority populations and will continue to detrimentally impact the health of these populations during future COVID-19 waves or indeed, future novel pandemics. This chapter aims to summarise the major healthcare barriers experienced by minority populations throughout the COVID-19 pandemic, including COVID-19 prevention, vaccine rollout, care during hospitalisation and post-COVID care for long COVID patients. To end, this chapter will summarise lessons learned and future directions that need to be taken to improve health disparities and healthcare access for minority populations in relation to the COVID pandemic and beyond.

Exploring the reasons behind low COVID-19 vaccination coverage in ethnic minorities-A qualitative study among Arabic-speaking public in Denmark

AIMS

In Denmark, COVID-19 infection rates have been higher, and vaccination coverage has been lower in areas with many residents from ethnic minority backgrounds. This study aimed to explore COVID-19 vaccination perceptions among Arabic-speaking minorities in Denmark.

MATERIALS AND METHODS

A total of 16 individuals, varying in age, gender, education, employment, health, vaccination status, and the Arabic-speaking country of origin, were recruited and interviewed in Arabic. The interviews were transcribed verbatim, translated into English, and analyzed using directed thematic analysis.

RESULTS

Most interviewees had some knowledge about how vaccines work to prevent infections; however, a wide spectrum of opinions about the effectiveness and safety of COVID-19 vaccines and vaccination policies in Denmark emerged. COVID-19 vaccination issues were extensively discussed in Arabic-speaking communities, but consensus was rarely reached. Many participants felt confused and only took vaccines for practical considerations, such as travel. Due to language barriers, some participants experienced difficulties in understanding vaccination-related information in electronic invitations from the health authorities and at vaccination centers, with family members often stepping in to provide translations.

CONCLUSIONS

Systematic efforts to actively disseminate translated COVID-19 vaccination information are needed to support ethnic minority individuals in making informed decisions.

Dimensions of equality in uptake of COVID-19 vaccination in Wales, UK: A multivariable linked data population analysis

Vaccination has proven to be effective at preventing severe outcomes of COVID-19 infection, and uptake in the population has been high in Wales. However, there is a risk that high-level vaccination coverage statistics may mask hidden inequalities in under-served populations, many of whom may be at increased risk of severe outcomes of COVID-19 infection. The study population included 1,436,229 individuals aged 18 years and over, alive and residence in Wales as at 31st July 2022, and excluded immunosuppressed or care home residents. We compared people who had received one or more vaccinations to those with no vaccination using linked data from nine datasets within the Secure Anonymised Information Linkage (SAIL) databank. Multivariable analysis was undertaken to determine the impact of a range of sociodemographic characteristics on vaccination uptake, including ethnicity, country of birth, severe mental illness, homelessness and substance use. We found that overall uptake of first dose of COVID-19 vaccination was high in Wales (92.1 %), with the highest among those aged 80 years and over and females. Those aged under 40 years, household composition (aOR 0.38 95 %CI 0.35-0.41 for 10+ size household compared to two adult household) and being born outside the UK (aOR 0.44 95 %CI 0.43-0.46) had the strongest negative associations with vaccination uptake. This was followed by a history of substance misuse (aOR 0.45 95 %CI 0.44-0.46). Despite high-level population coverage in Wales, significant inequalities remain across several underserved groups. Factors associated with vaccination uptake should not be considered in isolation, to avoid drawing incorrect conclusions. Ensuring equitable access to vaccination is essential to protecting under-served groups from COVID-19 and further work needs to be done to address these gaps in coverage, with focus on tailored vaccination pathways and advocacy, using trusted partners and communities.

"Who is Anders Tegnell?" Unanswered questions hamper COVID-19 vaccine uptake: A qualitative study among ethnic minorities in Sweden

BACKGROUND

Despite high COVID-19 vaccination coverage in many European countries, vaccination uptake has been lower among ethnic minorities, including in Sweden. This is in spite of the increased risk of contracting the virus and targeted efforts to vaccinate among first and second generation migrants. The aim of this study was to understand this dilemma by investigating ethnic minorities' perceptions and their experience of accessing the COVID-19 vaccine.

METHODS

This is a qualitative study drawing on 18 semi-structured interviews with health volunteers working in ethnic minority communities and with participants from the two largest ethnic minorities in Sweden (Syria and Somalia). Deductive qualitative analysis was completed using the 3C model by WHO (Complacency, Confidence and Convenience).

RESULTS

Complacency does not appear to be a barrier to intention to vaccinate. Participants are well aware of COVID-19 risk and the benefits of the vaccine. However, confidence in vaccine poses a barrier to uptake and there are a lot of questions and concerns about vaccine side effects, efficacy and related rumors. Confidence in health providers, particularly doctors is high but there was a sense of conflicting information. Accessing individually tailored health information and health providers is not convenient and a major reason for delaying vaccination or not vaccinating at all. Trust in peers, schools and faith-leaders is high and constitute pathways for effective health information sharing.

CONCLUSION

Ethnic minorities in Sweden are willing to get vaccinated against COVID-19. However, to increase vaccination uptake, access to individually tailored and face to face health information to answer questions about vaccine safety, efficacy, conflicting information and rumors is urgently required.