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

Closing the gap on vaccine uptake in developing countries: Is there a role for cash incentives?

Vaccination saves lives, yet vaccine uptake remains insufficient particularly in developing countries. While various approaches have been used to improve vaccine uptake, this review focuses on the potential of cash incentives to address this issue in developing countries. We examine the role and criticism of cash incentives and offer suggestions for reducing health disparities through targeting. We also explore potential bottleneck for scaling up the incentive program. The review concludes with recommendations for future steps.

Determinants of COVID-19 vaccination coverage in European and Organisation for Economic Co-operation and Development (OECD) countries

Introduction

In relatively wealthy countries, substantial between-country variability in COVID-19 vaccination coverage occurred. We aimed to identify influential national-level determinants of COVID-19 vaccine uptake at different COVID-19 pandemic stages in such countries.

Methods

We considered over 50 macro-level demographic, healthcare resource, disease burden, political, socio-economic, labor, cultural, life-style indicators as explanatory factors and coverage with at least one dose by June 2021, completed initial vaccination protocols by December 2021, and booster doses by June 2022 as outcomes. Overall, we included 61 European or Organisation for Economic Co-operation and Development (OECD) countries. We performed 100 multiple imputations correcting for missing data and partial least squares regression for each imputed dataset. Regression estimates for the original covariates were pooled over the 100 results obtained for each outcome. Specific analyses focusing only on European Union (EU) or OECD countries were also conducted.

Results

Higher stringency of countermeasures, and proportionately more older adults, female and urban area residents, were each strongly and consistently associated with higher vaccination rates. Surprisingly, socio-economic indicators such as gross domestic product (GDP), democracy, and education had limited explanatory power. Overall and in the OECD, greater perceived corruption related strongly to lower vaccine uptake. In the OECD, social media played a noticeable positive role. In the EU, right-wing government ideology exhibited a consistently negative association, while cultural differences had strong overall influence.

Conclusion

Relationships between country-level factors and COVID-19 vaccination uptake depended on immunization stage and country reference group. Important determinants include stringency, population age, gender and urbanization, corruption, government ideology and cultural context.

Cost-based COVID-19 vaccination and willingness to pay: A post-pandemic review

The primary objective of this paper is to serve as a valuable resource for policymakers who are confronted with the evolving landscape of the coronavirus disease 2019 (COVID-19), considering both free and cost-based vaccination approaches. The potential consequences of shifting from free to cost-based vaccination are explored, encompassing its impact on global vaccine equity and prioritization, economic well-being, healthcare systems and delivery, public health policies, and vaccine distribution strategies. Examining past studies on willingness to pay for the initial COVID-19 vaccine dose and booster shots provides insights into how individuals value COVID-19 vaccinations and underscores the significance of addressing issues related to affordability. If COVID-19 vaccinations incur expenses, using effective communication strategies that emphasize the importance of vaccination and personal health benefits can increase willingness to pay. Making COVID-19 vaccines accessible through public health programs or health insurance can help alleviate financial barriers and increase vaccination rates.

Can redistribution of vaccine improve global welfare? Lessons from COVID-19

The disparity in the distribution of COVID-19 vaccine has been recorded with more than 70% vaccination rate for high-income countries as compared to less than 40% for low-income countries. The low affordability of vaccines for the majority of low-income group invites the need for redistribution of vaccines. The disproportionate donation of vaccines across the globe motivates us to explore the incentive for the high-income group to redistribute. An exploratory analysis of cross-country COVID-19 vaccination distribution data shows that the countries which have received vaccines as donation has also contributed to vaccine wastage. This paper intends to provide a theoretical background for this counterintuitive observation using welfare analysis. We find that the market mechanism leads to a negative impact on global welfare due to redistribution. Only an invention with a defined redistribution mechanism may ensure an increase in global welfare. It is found that a critical value of redistribution mechanism reinforced by a minimum threshold level of income is essential to enhance welfare. The reduced form from the theoretical predictions is empirically validated with cross-country data on COVID-19 vaccination for all countries. As identified in theory, the internal support variables like political stability, government effectiveness, and health expenditure at the country level will impact global welfare. Therefore, when global cooperation is essential during a health crisis like COVID-19, improved internal coordination and intentions cannot be ignored.

Analysis of causal relations between vaccine hesitancy for COVID-19 vaccines and ideological orientations in Brazil

This article presents a causal inference analysis of vaccine hesitancy for Coronavirus disease 2019 (COVID-19) vaccines based on socio-demographic data obtained via questionnaires applied to a sample of the Brazilian population. This data includes the respondents' political preferences, age group, education, salary range, country region, sex, believing fake news, vaccine confidence, and intention to get the COVID-19 vaccine. The research created a causal graph using these variables, seeking to answer questions about the probability of people getting vaccinated. The results of this research corroborate findings observed in the literature, also presenting unique findings: (i) The perception that the vaccine is safe is positively affected by age group and negatively by religion; (ii) The older the person, the greater the probability of considering the vaccine safe and, consequently, of getting vaccinated; (iii) The religion variable showed great importance in the model since it has a simultaneous causal effect on political preferences and the perception of vaccine safety; (iv) The data reveal that the probability of a person accepting the vaccination against COVID-19 is reduced given the fact that they believe fake news related to the vaccine. The methodology applied in this research can be replicated for populations from other countries so that it is possible to generate customized models. General causal models can be helpful for agencies dealing with vaccine hesitancy to decide which variables should be addressed to reduce this phenomenon.

Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial Healthcare Worker Exposure Response and Outcomes of Hydroxychloroquine (HERO-HCQ)

OBJECTIVES

To determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCWs).

METHODS

In a 1: 1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial at 34 US clinical centers, 1360 HCWs at risk for COVID-19 infection were enrolled between April and November 2020. Participants were randomized to HCQ or matched placebo. The HCQ dosing included a loading dose of HCQ 600 mg twice on day 1, followed by 400 mg daily for 29 days. The primary outcome was a composite of confirmed or suspected COVID-19 clinical infection by day 30, defined as new-onset fever, cough, or dyspnea and either a positive SARS-CoV-2 polymerase chain reaction test (confirmed) or a lack of confirmatory testing due to local restrictions (suspected).

RESULTS

Study enrollment closed before full accrual due to recruitment challenges. The primary end point occurred in 41 (6.0%) participants receiving HCQ and 53 (7.8%) participants receiving placebo. No difference in the proportion of participants experiencing clinical infection (estimated difference of -1.8%, 95% confidence interval -4.6-0.9%, P = 0.20) was identified nor any significant safety issues.

CONCLUSION

Oral HCQ taken as prescribed appeared safe among HCWs. No significant clinical benefits were observed. The study was not powered to detect a small but potentially important reduction in infection.

TRIAL REGISTRATION

NCT04334148.