Shifting gender barriers in immunisation in the COVID-19 pandemic response and beyond

Effectiveness of Lianhua Qingwen Granule and Jingyin Gubiao Prescription in Omicron BA.2 Infection and Hospitalization: A Real-World Study of 56,244 Cases in Shanghai, China

OBJECTIVE

To examine the effectiveness of Chinese medicine (CM) Lianhua Qingwen Granule (LHQW) and Jingyin Gubiao Prescription (JYGB) in asymptomatic or mild patients with Omicron infection in the shelter hospital.

METHODS

This single-center retrospective cohort study was conducted in the largest shelter hospital in Shanghai, China, from April 10, 2022 to May 30, 2022. A total of 56,244 asymptomatic and mild Omicron cases were included and divided into 4 groups, i.e., non-administration group (23,702 cases), LHQW group (11,576 cases), JYGB group (12,112 cases), and dual combination of LHQW and JYGB group (8,854 cases). The length of stay (LOS) in the hospital was used to assess the effectiveness of LHQW and JYGB treatment on Omicron infection.

RESULTS

Patients aged 41-60 years, with nadir threshold cycle (CT) value of N gene <25, or those fully vaccinated preferred to receive CM therapy. Before or after propensity score matching (PSM), the multiple linear regression showed that LHQW and JYGB treatment were independent influence factors of LOS (both P<0.001). After PSM, there were significant differences in LOS between the LHQW/JYGB combination and the other groups (P<0.01). The results of factorial design ANOVA proved that the LHQW/JYGB combination therapy synergistically shortened LOS (P=0.032).

CONCLUSIONS

Patients with a nadir CT value <25 were more likely to accept CM. The LHQW/JYGB combination therapy could shorten the LOS of Omicron-infected individuals in an isolated environment.

Exploring the Big Data Paradox for various estimands using vaccination data from the global COVID-19 Trends and Impact Survey (CTIS)

Selection bias poses a substantial challenge to valid statistical inference in nonprobability samples. This study compared estimates of the first-dose COVID-19 vaccination rates among Indian adults in 2021 from a large nonprobability sample, the COVID-19 Trends and Impact Survey (CTIS), and a small probability survey, the Center for Voting Options and Trends in Election Research (CVoter), against national benchmark data from the COVID Vaccine Intelligence Network. Notably, CTIS exhibits a larger estimation error on average (0.37) compared to CVoter (0.14). Additionally, we explored the accuracy (regarding mean squared error) of CTIS in estimating successive differences (over time) and subgroup differences (for females versus males) in mean vaccine uptakes. Compared to the overall vaccination rates, targeting these alternative estimands comparing differences or relative differences in two means increased the effective sample size. These results suggest that the Big Data Paradox can manifest in countries beyond the United States and may not apply equally to every estimand of interest.

Identifying factors that can be used to assess a country's readiness to deploy a new vaccine or improve uptake of an underutilised vaccine: a scoping review

OBJECTIVES

Identifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping review aims to identify common themes that emerge across articles, which include tools or guidance that can be used to establish whether a country is ready to deploy a new vaccine or increase uptake of an underutilised vaccine.

DESIGN

Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.

DATA SOURCES

Embase, CINAHL, Cochrane Library, Google Scholar, MEDLINE, PsycINFO and Web of Science were searched for articles published until 9 September 2023. Relevant articles were also identified through expert opinion.

ELIGIBILITY CRITERIA

Articles published in any year or language that included tools or guidance to identify factors that influence a country's readiness to deploy a new or underutilised vaccine.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened records and performed data extraction. Findings were synthesised by conducting a thematic analysis.

RESULTS

38 articles met our inclusion criteria; these documents were created using methodologies including expert review panels and Delphi surveys and varied in terms of content and context-of-use. 12 common themes were identified relevant to a country's readiness to deploy a new or underutilised vaccine. These themes were as follows: (1) legal, political and professional consensus; (2) sociocultural factors and communication; (3) policy, guidelines and regulations; (4) financing; (5) vaccine characteristics and supply logistics; (6) programme planning; (7) programme monitoring and evaluation; (8) sustainable and integrated healthcare provision; (9) safety surveillance and reporting; (10) disease burden and characteristics; (11) vaccination equity and (12) human resources and training of professionals.

CONCLUSIONS

This information has the potential to form the basis of a globally applicable evidence-based vaccine readiness assessment tool that can inform policy and immunisation programme decision-makers.

Income disparities in COVID-19 vaccine and booster uptake in the United States: An analysis of cross-sectional data from the Medical Expenditure Panel Survey

COVID-19 vaccination has significantly decreased morbidity, hospitalizations, and death during the pandemic. However, disparities in vaccination uptake threatens to stymie the progress made in safeguarding the health of Americans. Using a nationally representative adult (≥18 years old) sample from the 2021 Medical Expenditure Panel Survey (MEPS), we aimed to explore disparities in COVID-19 vaccine and booster uptake by income levels. To reflect the nature of the survey, a weighted logistic regression analysis was used to explore factors associated with COVID-19 vaccine and booster uptake. A total of 241,645,704 (unweighted n = 21,554) adults were included in the analysis. Average (SD) age of the population was 49 (18) years old, and 51% were female. There were disparities in COVID-19 vaccine and booster uptake by income groups. All other income groups were less likely to receive COVID-19 vaccines and booster shot than those in the high-income group. Those in the poor income group had 55% lower odds of being vaccinated for COVID-19 (aOR = 0.45, p<0.01). Considering the female population only, women with lower incomes may have greater disparities in access to COVID-19 vaccines than do males with lower incomes. Disparities in COVID-19 vaccination by income may have even greater implications as the updated vaccines are rolled out in the US without the government covering the cost as before.

Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030

Vaccine-preventable diseases pose a significant threat to children under five globally, creating disparities in immunization coverage. Despite its cost-effectiveness and life-saving potential, immunization faces challenges in achieving equitable coverage. Gender inequalities deeply influence access to healthcare, affecting immunization rates. This study examines the action plans submitted by participants of the World Health Organization's (WHO) IA2030 Scholar Level 1 certification course in 2021. A qualitative analysis was conducted on a subset of 111 action plans that scored above 75%, employing narrative thematic analysis to categorize and explore gender incorporation and identified barriers based on the IA2030 Gender Guide. Among the 111 analyzed action plans, gender considerations were present in almost all plans, underscoring the effectiveness of integrating gender perspectives in the course curriculum. The most frequently cited barriers included low education and health literacy, issues related to accessing quality immunization services, gendered dynamics in decision-making within households, and limited access to resources and mobility, predominantly impacting women. The findings confirm that gender inequalities significantly contribute to suboptimal immunization coverage. An intersectional approach, recognizing diverse social markers impacting immunization, is vital to address disparities effectively. Moreover, the need for gender-sensitive data and deeper understanding of intersectional dynamics was emphasized. The study highlights the importance of gender-transformative interventions, including community engagement and efforts targeting both men and women to enhance immunization coverage. While acknowledging limitations, such as potential biases in peer evaluations and the need for wider inclusivity in gender perspectives, this analysis underscores the significance of mainstreaming gender in immunization capacity-building programs. The integration of gender considerations not only raises awareness but also equips professionals to create more gender-responsive immunization programs. Continuous efforts to incorporate gender perspectives can lead to more effective, equitable, and gender-transformative immunization initiatives at various levels.

Evolution of Public Attitudes and Opinions Regarding COVID-19 Vaccination During the Vaccine Campaign in China: Year-Long Infodemiology Study of Weibo Posts

BACKGROUND

Monitoring people's perspectives on the COVID-19 vaccine is crucial for understanding public vaccination hesitancy and developing effective, targeted vaccine promotion strategies. Although this is widely recognized, studies on the evolution of public opinion over the course of an actual vaccination campaign are rare.

OBJECTIVE

We aimed to track the evolution of public opinion and sentiment toward COVID-19 vaccines in online discussions over an entire vaccination campaign. Moreover, we aimed to reveal the pattern of gender differences in attitudes and perceptions toward vaccination.

METHODS

We collected COVID-19 vaccine-related posts by the general public that appeared on Sina Weibo from January 1, 2021, to December 31, 2021; this period covered the entire vaccination process in China. We identified popular discussion topics using latent Dirichlet allocation. We further examined changes in public sentiment and topics during the 3 stages of the vaccination timeline. Gender differences in perceptions toward vaccination were also investigated.

RESULTS

Of 495,229 crawled posts, 96,145 original posts from individual accounts were included. Most posts presented positive sentiments (positive: 65,981/96,145, 68.63%; negative: 23,184/96,145, 24.11%; neutral: 6980/96,145, 7.26%). The average sentiment scores were 0.75 (SD 0.35) for men and 0.67 (SD 0.37) for women. The overall trends in sentiment scores showed a mixed response to the number of new cases and significant events related to vaccine development and important holidays. The sentiment scores showed a weak correlation with new case numbers (R=0.296; P=.03). Significant sentiment score differences were observed between men and women (P<.001). Common and distinguishing characteristics were found among frequently discussed topics during the different stages, with significant differences in topic distribution between men and women (January 1, 2021, to March 31, 2021: χ²₃=3030.9; April 1, 2021, to September 30, 2021: χ²₄=8893.8; October 1, 2021, to December 31, 2021: χ²₅=3019.5; P<.001). Women were more concerned with side effects and vaccine effectiveness. In contrast, men reported broader concerns around the global pandemic, the progress of vaccine development, and economics affected by the pandemic.

CONCLUSIONS

Understanding public concerns regarding vaccination is essential for reaching vaccine-induced herd immunity. This study tracked the year-long evolution of attitudes and opinions on COVID-19 vaccines according to the different stages of vaccination in China. These findings provide timely information that will enable the government to understand the reasons for low vaccine uptake and promote COVID-19 vaccination nationwide.