Covid-19 vaccine passports: access, equity, and ethics

Discretion in decision to receive COVID-19 vaccines and associated socio-economic inequalities in rates of uptake: a whole-of-population data linkage study from Australia

OBJECTIVE

In Australia, first and second compared to third dose of a COVID-19 vaccine were implemented under different policies and contexts, resulting in greater discretion in decisions to receive a third compared to first and second dose. We quantified socio-economic inequalities in first and third dose to understand how discretion is associated with differences in uptake.

STUDY DESIGN

Whole-of-population cohort study.

METHODS

Linked immunisation, census, death and migration data were used to estimate weekly proportions who received first and third doses of a COVID-19 vaccine until 31 August 2022 for those with low (no formal qualification) compared to high (university degree) education, stratified by 10-year age group (from 30 to 89 years). We estimated relative rates using Cox regression, including adjustment for sociodemographic factors.

RESULTS

Among 13.1 million people in our study population, 94% had received a first and 80% a third dose by 31 August 2022. Rates of uptake of first and third dose were around 50% lower for people with low compared to high education. Gaps were small in absolute terms for first dose, and at the end of the study period ranged from 1 to 11 percentage points across age groups. However, gaps were substantial for third dose, particularly at younger ages where the socio-economic gap was as wide as 32 percentage-points.

CONCLUSION

Education-related inequalities in uptake were larger where discretion in decisions was larger. Policies that limited discretion in decisions to receive vaccines may have contributed to achieving the dual aims of maximising uptake and minimising inequalities.

The Moral Foundations of Vaccine Passports

The debate around vaccine passports has been polarising and controversial. Although the measure allows businesses to resume in-person operations and enables transitioning out of lockdown due to the COVID-19 pandemic, some have expressed concerns about liberty violations and discrimination. Understanding the splintered viewpoints can aid businesses in communicating such measures to employees and consumers. We conceptualise the business implementation of vaccine passports as a moral decision rooted in individual values that influence reasoning and emotional reaction. We surveyed support for vaccine passports on a nationally representative sample in the United Kingdom in 2021: April (n = 349), May (n = 328), and July (n = 311). Drawing on the Moral Foundations Theory-binding (loyalty, authority, and sanctity), individualising (fairness and harm), and liberty values-we find that individualising values are a positive predictor and liberty values a negative predictor of support for passports, suggesting adoption hinges on addressing liberty concerns. Longitudinal analysis examining the trajectory of change in support over time finds that individualising foundations positively predict changes in utilitarian and deontological reasoning over time. In contrast, a fall in anger over time predicts increased support towards vaccine passports. Our study can inform business and policy communication strategies of existing vaccine passports, general vaccine mandates, and similar measures in future pandemics.

Digital vaccine passports and digital health diplomacy: an online model WHO simulation

In the wake of Coronavirus disease 2019 (COVID-19), several nations have sought to implement digital vaccine passports (DVPs) to enable the resumption of international travel. Comprising a minimum dataset for each unique individual, DVPs have the makings of a global electronic health record, broaching key issues involved in building a global digital health ecosystem. Debate simulations offer a safe, interactive space to foster participatory policy discussions for advancing digital health diplomacy. This study used an online simulation of a Model World Health Assembly to critically analyze the sociotechnical issues associated with the global implementation of DVPs, and to generate useful insights and questions about the role of diplomacy in global digital health. The debate arguments addressed and provided insights into the technological, scientific, ethical, legal, policy, and societal aspects of DVPs. Reflecting on the simulation, we discuss its opportunities and challenges for the digitalization, decolonization, decentralization, and democratization of participatory policymaking.

Predictors of SARS-CoV-2 Vaccine Uptake among Health Professionals: A Cross-Sectional Study in Ghana

COV-2 SARs has disproportionately affected low- and middle-income countries such as Ghana, where the healthcare system was not prepared enough to provide care, drugs, and equipment. This study was carried out to assess predictors of COVID-19 vaccine acceptance among health professionals in the Bono region of Ghana. A facility-based cross-sectional study was conducted among 424 health professionals recruited through simple random sampling. Univariate and multivariate logistic regression models were utilized to identify the predictors of COVID-19 vaccine acceptance presented as an odds ratio (OR) with a 95% confidence interval (CI). All respondents had heard about the COVID-19 vaccine. The most common source of information was the media (45.8%). The proportion of health professionals who accepted the COVID-19 vaccine was 73.6%. Among those who did not take the vaccine, 64.3% were willing to take it in the future. The key predictors of taking the COVID-19 vaccine included: age 25 to 45 years (AOR = 1.96, 95% CI: 1.14-3.35), age older than 45 years (AOR = 5.30, 95% CI: 2.59-10.87), males (AOR = 4.09, 95% CI: 2.34-7.15), Christians (AOR = 3.10, 95% CI: 1.44-7.72), and at least three years of experience (AOR = 1.74, 95% CI: 1.033-2.93). Reasons for not taking vaccines included: vaccines were rapidly developed and approved (41.0%), immediate side effects (39.2%), and unforeseen future effects (37.5%). This study showed that most participants had received their first dose of COVID-19 vaccination, and most of those hesitant about the vaccine were willing to receive it in the future. This is a positive finding for policy makers since it reflects that fewer resources will be needed for behavioural change initiatives. In addition, it would present a chance to focus on minority individuals who are unwilling to take the vaccine and offer targeted community mobilisation.

Cost benefit analysis of alternative testing and quarantine policies for travelers for infection control: A case study of Singapore during the COVID-19 pandemic

Background

Border control mitigates local infections but bears a heavy economic cost, especially for tourism-reliant countries. While studies have supported the efficacy of border control in suppressing cross-border transmission, the trade-off between costs from imported and secondary cases and from lost economic activities has not been studied. This case study of Singapore during the COVID-19 pandemic aims to understand the impacts of varying quarantine length and testing strategies on the economy and health system. Additionally, we explored the impact of permitting unvaccinated travelers to address emerging equity concerns. We assumed that community transmission is stable and vaccination rates are high enough that inbound travelers are not dissuaded from traveling.

Methods

The number of travelers was predicted considering that longer quarantine reduces willingness to travel. A micro-simulation model predicted the number of COVID-19 cases among travelers, the resultant secondary cases, and the probability of being symptomatic in each group. The incremental net monetary benefit (INB) of Singapore was quantified under each border-opening policy compared to pre-opening status, based on tourism receipts, cost/profit from testing and quarantine, and cost and health loss due to COVID-19 cases.

Results

Compared to polymerase chain reaction (PCR), rapid antigen test (ART) detects fewer imported cases but results in fewer secondary cases. Longer quarantine results in fewer cases but lower INB due to reduced tourism receipts. Assuming the proportion of unvaccinated travelers is small (8% locally and 24% globally), allowing unvaccinated travelers will accrue higher INB without exceeding the intensive care unit (ICU) capacity. The highest monthly INB from all travelers is $2,236.24 m, with 46.69 ICU cases per month, achieved with ARTs at pre-departure and on arrival without quarantine. The optimal policy in terms of highest INB is robust under changes to various model assumptions. Among all cost-benefit components, the top driver for INB is tourism receipts.

Conclusions

With high vaccination rates locally and globally alongside stable community transmission, opening borders to travelers regardless of vaccination status will increase economic growth in the destination country. The caseloads remain manageable without exceeding ICU capacity, and costs of cases are offset by the economic value generated from travelers.

"Any idea how fast 'It's just a mask!' can turn into 'It's just a vaccine!'": From mask mandates to vaccine mandates during the COVID-19 pandemic

Protests starting in the summer of 2020, notedly in the US and UK, have brought together two constituencies: pre-existing anti-vaccine groups and newly formed oppositional COVID-19 groups. The oppositional COVID-19 groups vary in composition and nature, but the central focus is a disagreement about the seriousness and threat of COVID-19 and with the public health measures to control COVID-19. What unites many disparate interests is an aversion to mandates. The compulsion to undertake particular public health activities such as mask-wearing and vaccination is a complex topic of public attitudes and beliefs alongside public health goals and messaging. We aim to analyse social media discussions about facemask wearing and the adoption of potential vaccines for COVID-19. Using media monitoring software Meltwater^TM, we analyse English-language tweets for one year from 1st June 2020 until 1st June 2021. We pay particular attention to connections in conversations between key topics of concern regarding masks and vaccines across social media networks. We track where ideas and activist behaviours towards both health interventions have originated, have similarities, and how they have changed over time. Our aim is to provide an overview of the key trends and themes of discussion concerning attitudes to and adoption of health measures in the control of COVID-19 and how publics react when confronted with mandatory policies. We draw on an already extensive literature about mandatory vaccination policies to inform our assessment, from psychology and behavioural science to ethics, political theory, sociology, and public policy.

The influencing factors of digital health passport adoption and acceptance during COVID-19 in Saudi Arabia

Background

The COVID-19 outbreak has left a destructive trail around the world in terms of deaths, travel restrictions, trade deficits, and an economy that is collapsing, including job losses, real estate, health benefit loss, and a decrease in the quality of access to care and services in almost all sectors, as well as generally in the overall quality of life. The successful development of COVID-19 vaccines may hasten the acceleration of global post-pandemic recovery by vaccinating residents, with a particular focus on important groups, in order to decrease secondary transmission. This will facilitate the easing of enforced restrictions on global and local travel, the tourism industry, education sectors, and other aspects of social life. Vaccinating residents may also help reduce the risk of secondary transmission. The efforts that Saudi Arabia made to control the epidemic were outstanding on all fronts and in all spheres, including the health, education, commerce, and tourism industries, among others.

Objective

The purpose of this research was to investigate the elements that influence a traveler's decision to acquire and use a digital health passport (DHP), which was introduced by the Tawakkalna application in Saudi Arabia at the COVID-19 conference.

Methods

The technology acceptance model (TAM) and the information system success model (ISSM) were the primary theoretical frameworks that guided this investigation. The terms "perceived ease of use" (PEOU), "perceived usefulness" (PU), "information quality" (IQ), "service quality" (SQ), and "net benefit" (NB) were applied in order to investigate the user's acceptance and use of the DHP, as well as how it contributes to the facilitation of traveling and public perception toward using the DHP.

Results

In order to assess the validity of the proposed model and its four assumptions, a survey was sent through social media platforms to get responses from nationals and residents of Saudi Arabia. The SPSS program was used to evaluate a total of 103 replies that were considered valid. Following the completion of the study, the findings revealed that PEOU, PU, IQ, SQ, and NB all had favorable impacts on the use of DHP.

Conclusion

PEOU, PU, IQ, and SQ have a significant relationship with NB that affects the public's acceptance and use of DHP. This study has established validity and reliability while testing the relationship between the variables suggested in the research model.

A systematic review of the impact of corruption in Latin America during the spread of the first wave of COVID-19

As the Covid-19 pandemic crisis raged in Latin America, numerous acts of corruption affected containment strategies and weakened institutional systems. A systematic review was conducted during the first wave of contagion in 2020 to analyse the relationship between corruption and Covid-19 in Latin American countries, highlighting its components and the institutions involved. Following the PRISMA guidelines, scientific databases and prepublications were searched using the terms (((SARS-CoV-2) OR (Covid-19)) AND ((Corruption [Mesh]) AND (Latin America))). Seventy-two studies were included in the initial search, 36 in MEDLINE/PubMed, 20 in Scielo, and 11 prepublications. Of the 25 eligible studies, none met the required standard for inclusion. Although corruption is endemic in Latin America, its levels and impact during the first wave of Covid-19 contagion have not been quantified.

Managing the risk of COVID-19 via vaccine passports: Modeling economic and policy implications

The increasing use of vaccine passports (VPs) to certify immunity from the prevailing coronavirus has created positive and negative aspects that have shaken the workings of markets. The VPs are, however, not universally used and not required by all businesses and governments at this point. Given the newness associated with VPs and the ongoing uncertainty of the pandemic, full implications of VPs have not been considered. This paper provides some formal insights into the implications of the use of VPs, borrowing from the established economic theory. Recommendations for public policy are provided.

How to boost the boosters? A survey-experiment on the effectiveness of different policies aimed at enhancing acceptance of a "Seasonal" vaccination against COVID-19

Background

Evidence suggests a gradual decrease in the effectiveness of the anti-COVID-19 vaccines, stressing the potential need for periodical booster shots. However, it is hard to tell whether previously applied policies for enhancing vaccine acceptance will be as effective for repeated periodical booster shots during a pandemic. Hence, this study aims to explore the effectiveness of different health policies on periodical vaccination acceptance amidst an ongoing pandemic.

Methods

A cross sectional online experiment was performed in a representative sample of 929 Israeli citizens. Participants were randomly allocated to 4 groups simulating different hypothetical periodical-vaccination-promoting policy scenarios: (1) Mandate (N = 229); (2) a negative monetary incentive (N = 244); (3) a positive monetary incentive (N = 228) and (4) information provision (N = 228). Compliance intentions and vaccine-acceptance-related variables were measured. Analysis included multivariate hierarchic logistic and linear regressions.

Results

Compliance intentions levels were medium (M = 3.13 on a 1–5 scale). Only 20.2% of the sample demonstrated strong acceptance of periodical vaccination, which is lower than the acceptance rate of the seasonal flu shot in the country in the year preceding the pandemic. Type of policy was related to the extent to which a respondent strongly agreed to be periodically vaccinated or not. Specifically, strong acceptance was more likely when positive or negative incentives were presented in comparison to the mandate or information provision conditions. However, when examining the extent of compliance among respondents who were less decisive, the type of policy did not predict the extent to which these respondents intended to comply. In addition, compliance intentions were related with the perceived benefits and barriers of the vaccine, the perceived efficacy of getting vaccinated and social norms. Hesitator’s intentions were additionally associated with anti-COVID-19 vaccination history, perceived severity of the disease and trust in government.

Conclusions

Pandemic-containing vaccines may be perceived as less effective and beneficial than pandemic-preventing vaccines. Individuals with different levels of motivation for periodical vaccination during a pandemic may be affected by different factors. While strongly opinionated individuals are affected by the type of vaccination-promoting policy, hesitators are affected by a larger number of factors, which provide policy makers with greater opportunities to enhance their vaccination intentions.

COVID-19 vaccine hesitancy and vaccine passports: a cross-sectional conjoint experiment in Japan

OBJECTIVES

While the development of vaccines against the Novel Coronavirus (COVID-19) brought hope of establishing herd immunity and ending the global pandemic, vaccine hesitancy can hinder the progress towards herd immunity. In this study, by analysing the data collected when citizens undergo public health restrictions due to the pandemic, we assess the determinants of vaccine hesitancy, reasons for hesitation and potential effectiveness of vaccine passports used to relax public health restrictions on mitigating vaccine hesitancy.

DESIGN

Cross-sectional study, longitudinal study and conjoint experimental design.

SETTING

An online survey conducted in Japan in July 2021.

PARTICIPANTS

A demographically representative sample of 5000 Japanese adults aged 20-74.

PRIMARY OUTCOME MEASURES

COVID-19 vaccination intention RESULTS: We found that about 30% of respondents did not intend to get vaccinated or had not yet decided, with major reasons for vaccine hesitancy relating to concerns about the safety and side effects of the vaccine. In line with previous findings, younger age, lower socioeconomic status, and psychological and behavioural factors such as weaker COVID-19 fear were associated with vaccine hesitancy. Easing of public health restrictions such as travel, wearing face masks and dining out at night was associated with an increase in vaccine acceptance by 4%-10%. Moreover, we found that more than 90% of respondents who intended to get vaccinated actually received it while smaller proportions among those undecided and unwilling to get vaccinated did so.

CONCLUSION

With a major concern about vaccine safety and side effects, interventions to mitigate against these may help to reduce vaccine hesitancy. Moreover, when citizens are imposed with restrictions, vaccine passports that increase their freedom may be helpful to increase vaccination rates.

Citizens’ Perception of COVID-19 Passport Usefulness: A Cross Sectional Study

This paper assesses the influence on people’s perception of the utility of the immunity passport (IP) program by sociodemographic factors, infectivity status, and the objective of its use. The material of this paper is a cross-sectional survey of 400 residents in Spain. The relation between utility perception and input variables is fitted with ordinary least squares (OLS) regression and linear quantile regression (LQR). The principal explanatory variable of usefulness perception is being vaccinated, especially when the objective of the IP is regulating mobility. The OLS estimate of the coefficient regression is (cr) = 0.415 (p = 0.001). We also found a positive and significant influence of that factor in all LQRs (cr = 0.652, p = 0.0026 at level (τ) = 0.75; cr = 0.482, p = 0.0047 at τ = 0.5 and cr = 0.201, p = 0.0385 at τ = 0.25). When the objective of the IP is regulating leisure, being vaccinated is relevant only to explain the central measures of usefulness perception. If the IP is used to regulate traveling, variables related to interviewees’ infectivity have greater relevance than sociodemographic factors. When its objective is ruling assembly, the more important variables than being vaccinated are gender and age. To create an effective implementation of the IP, it is advisable to have a general agreement among the population on its convenience. Therefore, the findings in this study have important implications for public health decision-makers.

Exploring vaccine hesitancy in care home employees in North West England: a qualitative study

OBJECTIVES

Care homes have experienced a high number of COVID-19 outbreaks, and it is therefore important for care home employees to receive the COVID-19 vaccine. However, there is high vaccine hesitancy among this group. We aimed to understand barriers and facilitators to getting the COVID-19 vaccine, as well as views on potential mandatory vaccination policies.

DESIGN

Semi-structured interviews.

SETTING

Care home employees in North West England. Interviews conducted in April 2021.

PARTICIPANTS

10 care home employees (aged 25-61 years) in the North West, who had been invited to have, but not received the COVID-19 vaccine.

RESULTS

We analysed the interviews using a framework analysis. Our analysis identified eight themes: perceived risk of COVID-19, effectiveness of the vaccine, concerns about the vaccine, mistrust in authorities, facilitators to getting the vaccine, views on mandatory vaccinations, negative experiences of care work during the COVID-19 pandemic, and communication challenges.

CONCLUSIONS

Making COVID-19 vaccination a condition of deployment may not result in increased willingness to get the COVID-19 vaccination, with most care home employees in this study favouring leaving their job rather than getting vaccinated. At a time when many care workers already had negative experiences during the pandemic due to perceived negative judgement from others and a perceived lack of support facing care home employees, policies that require vaccination as a condition of deployment were not positively received.

A comparative analysis of COVID-19 vaccination certificates in 12 countries/regions around the world: Rationalising health policies for international travel and domestic social activities during the pandemic

As the unprecedented pandemic of COVID-19 became a major barrier during the past two years, many countries were using the “COVID pass” or COVID-19 vaccination certificates in attempts to facilitate effective international travel and domestic social activities. The difficulty remained in how the “COVID pass” from different countries and regions could be mutually recognised. This study surveys the current practice of COVID-19 vaccination certificates in 12 representative countries/regions around the world and provides a comprehensive mapping of the vaccination certificates in these countries/regions. The study compares and contrasts the vaccination certificates in both format and content, including their primary purposes, international accreditation, naming conventions, recipients’ personal information, and the details on vaccines and vaccination. The findings are interpreted in light of implementation practices in each country/region and discussed in relation to their various functions, as well as legal, technical, and ethical considerations. Based on the analysis and discussion recommendations are made on the practice of vaccination certificates in attempts to facilitate effective international travel and domestic social activities.

Why 'one size fits all' is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey

OBJECTIVES

The present study explored public's willingness to use COVID-19 immunity certificates across six different domestic scenarios.

DESIGN

Cross-sectional online survey.

SETTING

UK representative survey conducted on 3 August 2021.

PARTICIPANTS

534 UK residents over 18 years old.

INTERVENTIONS

Participants replied to the same set of questions.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents' sociodemographic characteristics.

RESULTS

Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle.

CONCLUSIONS

The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.

COVID-19 in low-tolerance border quarantine systems: Impact of the Delta variant of SARS-CoV-2

In controlling transmission of coronavirus disease 2019 (COVID-19), the effectiveness of border quarantine strategies is a key concern for jurisdictions in which the local prevalence of disease and immunity is low. In settings like this such as China, Australia, and New Zealand, rare outbreak events can lead to escalating epidemics and trigger the imposition of large-scale lockdown policies. Here, we develop and apply an individual-based model of COVID-19 to simulate case importation from managed quarantine under various vaccination scenarios. We then use the output of the individual-based model as input to a branching process model to assess community transmission risk. For parameters corresponding to the Delta variant, our results demonstrate that vaccination effectively counteracts the pathogen's increased infectiousness. To prevent outbreaks, heightened vaccination in border quarantine systems must be combined with mass vaccination. The ultimate success of these programs will depend sensitively on the efficacy of vaccines against viral transmission.

Applications of blockchain for vaccine passport and challenges

Purpose

The purpose of this study is to investigate the applications of blockchain in vaccine passport solution. The world is facing an unprecedented situation because of the COVID-19 pandemic. Many countries have witnessed sporadic lockdown and travel restrictions and it has marred trade and tourism. As the mass vaccination has started the life is slowly and steadily returning to true normal. Various countries are issuing vaccination passports to manage the immunization information and validate it. To realize vaccine-passport’s true potential, security and privacy concerns should be being taken care of. There is a need for studies to evaluate the emerging technology for the vaccine passport.

Design/methodology/approach

This study uses a mix of qualitative and quantitative methods to achieve its objective. This study uses a systematic literature review to analyze the potential of blockchain for vaccine passports. The case study of three different types of organizations implementing blockchain for vaccine passports was analyzed and results were presented. Last but not least, focus group discussion and search of secondary literature was to done to identify scientific, ethical and legal challenges associated with the use of vaccine passports. The method used for calculating the importance score of these challenges was analytical hierarchy process.

Findings

This study concludes that blockchain-based solutions are very suitable for vaccine passports and addresses the concern related to interoperability, privacy and security. The case study approach was used to elaborate the use of blockchain in three different options available for the vaccine. Last but not least, this study identifies the challenges faced by vaccine passport programs and suggests measures to overcome them. This study concludes that the ethical challenges associated with vaccine passports are more important and should be preferentially treated.

Research limitations/implications

This study is timely and will be he lpful for policymakers in designing the vaccine passport programs. It gives valuable insight to decision-makers evaluating technologies for the development of vaccine passport programs. This study identifies nine challenges to be tackled to making a vaccine passport program successful.

Originality/value

To the best of the author’s knowledge, this study is not able to find out a review on the use of blockchain technology for vaccine passports, and this study attempts to fill this gap. This study further discusses the cases of organizations that have implemented blockchain technology for vaccine passport programs.

The Effects of Media Encouragements on Coronavirus Vaccination Decision and Public Interest in Traveling Abroad

A lack of knowledge exists about individuals’ vaccination decisions and their relation to their tourism behaviors. In this regard, this study examines the willingness of international travelers to take a COVID-19 vaccine prior to traveling. A quantitative research design with a survey method and the ordinary least square (OLS) multiple regression analysis was used to test the hypotheses. The media encouragement positively affected the travelers’ attitude toward the behavior and their injunctive social norm, whereas the travelers’ attitude toward the behavior and injunctive social norm positively affected their COVID-19 vaccination intention. The regression results also proved the mediating effect of both attitudes toward the behavior and injunctive social norm in the relationship between media encouragement and COVID-19 vaccination intention. This research successfully provided evidence regarding the role of media encouragement in travelers’ willingness to take the COVID-19 vaccination.

Ofeleein i mi Vlaptin-Volume II: Immunity Following Infection or mRNA Vaccination, Drug Therapies and Non-Pharmacological Management at Post-Two Years SARS-CoV-2 Pandemic

The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people's physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of "ofeleein i mi vlaptin", that is, to help or not to harm.

OUP accepted manuscript

In several countries, governments have implemented so-called ‘COVID passport’ schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.

The Israeli Experience with the "Green Pass" Policy Highlights Issues to Be Considered by Policymakers in Other Countries

In the first half of 2021, Israel had been ahead of other countries concerning the speed of its rollout and coverage of COVID-19 vaccinations. During that time, Israel had implemented a vaccine certificate policy, the "Green Pass Policy" (GPP), to reduce virus spread and to allow the safe relaxation of COVID-19 restrictions in a time of great uncertainty. Based on an analysis of GPP regulations and public statements compiled from the Israeli Ministry of Health website, we describe the design and implementation of the GPP. We also look back and discuss lessons learned for countries that are considering a GPP policy, given the current upsurge of the Delta variant as of summer 2021. To reduce equity concerns when introducing a GPP, all population groups should be eligible for the vaccine (contingent on approval from the manufacturer) and have access to it. Alternatively, health authorities can grant temporary certificates based on a negative test. We also highlight the fact that in practice, there will be gaps between the GPP regulations and implementation. While some places might require a GPP without legal need, others will not implement it despite a legal obligation. The GPP regulations should have standardised epidemiological criteria, be implemented gradually, remain flexible, and change according to the epidemiological risks.

COVID-19 transmission and the safety of air travel during the pandemic: a scoping review

PURPOSE OF REVIEW

To examine the literature assessing safety of air travel relating to coronavirus disease 2019 (COVID-19) transmission from January 2020 to May 2021. The COVID-19 pandemic has had an unprecedented impact on air travel and global mobility, and various efforts are being implemented to determine a safe way forward. As the pandemic evolves, so do the challenges that force various stakeholders, including the aviation industry, health authorities, and governments, to reassess and adapt their practices to ensure the safety of travellers.

RECENT FINDINGS

The literature was reviewed for multiple aspects of air travel safety during the COVID-19 pandemic. Recurring themes that surfaced included the pivotal role of commercial air travel in the geographic spread of COVID-19, the efficacy of travel restrictions and quarantines, inflight transmission risk and the role of preventive measures, the utility of pre and post flight testing, the development of effective vaccines and subsequent challenges of vaccine passports, and the ongoing threat of novel highly transmissible variants.

SUMMARY

Much uncertainty lies ahead within the domains of these findings, and ongoing research, discourse and review will be necessary to navigate and determine the future direction and safety of air travel. Recovery will be slow, necessitating innovative, multipronged and collaborative solutions.

Investigation of plasma exchange and hemoperfusion effects and complications for the treatment of patients with severe COVID-19 (SARS-CoV-2) disease: A systematic scoping review

Some previous studies suggested that the plasma exchange (PE) and hemoperfusion (HP) played a cardinal role in the treatment of severe coronavirus disease 2019 (COVID-19) cases by diminishing the cytokine storm. This study aimed to assess the effects of PE and HP on cytokine storms in patients with severe COVID-19 through a systematic scoping review. Four Electronic databases (Medline [accessed from PubMed], Scopus, Science Direct, and Cochrane library) were searched systematically on February 2, 2021, using MESH terms and related keywords in the English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, their findings were assessed and reported. A total of 755 articles were obtained within the first step of searching, and 518 remained after removing the duplications. Through the title and abstract screening, 438 were removed. Of the rest, 59 papers were excluded. Finally, after reading the full text of the remained articles, 21 were included in data extraction. Most of the previously reported evidence were case reports and case series. Findings were summarized in two categories. The first category encompassed nine studies regarding HP and continuous renal replacement therapy, and the second category included twelve studies about PE. The results revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID-19 patients. Highlights Some studies showed that plasma exchange (PE) and hemoperfusion (HP) played an important role in the treatment of patients with severe COVID-19 disease. The results of this systematic scoping review revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID-19 patients.

The potential impact of vaccine passports on inclination to accept COVID-19 vaccinations in the United Kingdom: Evidence from a large cross-sectional survey and modeling study

BACKGROUND

The UK Government is considering the introduction of vaccine passports for domestic use and to facilitate international travel for UK residents. Although vaccine incentivisation has been cited as a motivating factor for vaccine passports, it is unclear whether vaccine passports are likely to increase inclination to accept a COVID-19 vaccine.

METHODS

We conducted a large-scale national survey in the UK of 17,611 adults between 9 and 27 April 2021. Bayesian multilevel regression and poststratification is used to provide unbiased national-level estimates of the impact of the introduction of vaccine passports on inclination to accept COVID-19 vaccines and identify the differential impact of passports on uptake inclination across socio-demographic groups.

FINDINGS

We find that a large minority of respondents report that vaccination passports for domestic use (46·5%) or international travel (42·0%) would make them no more or less inclined to accept a COVID-19 vaccine and a sizeable minority of respondents also state that they would 'definitely' accept a COVID-19 vaccine and that vaccine passports would make them more inclined to vaccinate (48·8% for domestic use and 42·9% for international travel). However, we find that the introduction of vaccine passports will likely lower inclination to accept a COVID-19 vaccine once baseline vaccination intent has been adjusted for. This decrease is larger if passports were required for domestic use rather than for facilitating international travel. Being male (OR 0·87, 0·76 to 0·99) and having degree qualifications (OR 0·84, 0·72 to 0·94) is associated with a decreased inclination to vaccinate if passports were required for domestic use (while accounting for baseline vaccination intent), while Christians (OR 1·23, 1·08 to 1·41) have an increased inclination over atheists or agnostics. Change in inclination is strongly connected to stated vaccination intent and will therefore unlikely shift attitudes among Black or Black British respondents, younger age groups, and non-English speakers.

INTERPRETATION

Our findings should be interpreted in light of sub-national trends in uptake rates across the UK, as our results suggest that passports may be viewed less positively among socio-demographic groups that cluster in large urban areas. We call for further evidence on the impact of vaccine certification and the potential fallout for routine immunization programmes in both the UK and in wider global settings, especially those with low overall trust in vaccinations.

FUNDING

This survey was funded by the Merck Investigator Studies Program (MISP).

The Vaccination Process against the COVID-19: Opportunities, Problems and mHealth Support

The vaccination against the COVID-19, finally available, has the potential to represent an important defence against the pandemic. The identification of both obstacles and tools to combat them are, at this moment, of strategic importance. Previous experiences on vaccinations have shown solutions and paths to take, also based on the behavioural sciences. The objective of the opinion is to face how mobile technology can help us both to fight these problems and to optimize the vaccination process. The opinion has four polarities. The first polarity consists in having detected the problems hampering an effective vaccination process. These problems have been grouped into the following four: Electronic and Informatic divide, Escape, Exposure risk, and Equity. The second polarity consists in having verified how the mobile technology can be useful to face the identified problems. The third polarity highlights the usefulness and importance of using electronic surveys. These tools are based on mobile technology. They are useful problem sensors for the stakeholders. The fourth polarity faces how mobile technology and mHealth can be of aid to optimize the flow of the vaccination process, from the first call up to the certification. This polarity is supported by an example based on the Italian national App IO. The study highlights: (a) on one side, the potential of mobile technology; on the other side, the need for interventions to reduce the digital divide with the purpose to increase its use. (b) How the role of mobile technology can be complementary to other intervention methods.

Vaccine design and delivery approaches for COVID-19

COVID-19 is still a deadly disease that remains yet a major challenge for humans. In recent times, many large pharmaceutical and non-pharmaceutical companies have invested a lot of time and cost in fighting this disease. In this regard, today's scientific knowledge shows that designing and producing an effective vaccine is the best possible way to diminish the disease burden and dissemination or even eradicate the disease. Due to the urgent need, many vaccines are now available earlier than scheduled. New technologies have also helped to produce much more effective vaccines, although the potential side effects must be taken into account. Thus, in this review, the types of vaccines and vaccine designs made against COVID-19, the vaccination programs, as well as the delivery methods and molecules that have been used to deliver some vaccines that need a carrier will be described.

COVID-19 Vaccine Passport and International Traveling: The Combined Effect of Two Nudges on Americans' Support for the Pass

Immunity passports have the potential to allow large-scale international traveling to resume. However, they can only become an effective tool if they are widely supported by the general public. We carry out a double blind randomized online experiment with a sample of N=4000 Americans to study (i) whether two nudges can increase the level of support for a COVID pass for international traveling, (ii) the relationship between the effects of the nudges, and (iii) if these nudges have a negative spillover on the intention to get vaccinated. We find that both nudges increase the support for the COVID pass and that their impact is stronger when they are used together. Moreover, we find that the two nudges do not negatively affect intentions to get vaccinated. Our findings have important implications for policymakers and for the nascent literature on the interaction between multiple nudges.

"Vaccine Passports" May Backfire: Findings from a Cross-Sectional Study in the UK and Israel on Willingness to Get Vaccinated against COVID-19

Domestic “vaccine passports” are being implemented across the world as a way of increasing vaccinated people’s freedom of movement and to encourage vaccination. However, these vaccine passports may affect people’s vaccination decisions in unintended and undesirable ways. This cross-sectional study investigated whether people’s willingness and motivation to get vaccinated relate to their psychological needs (autonomy, competence and relatedness), and how vaccine passports might affect these needs. Across two countries and 1358 participants, we found that need frustration—particularly autonomy frustration—was associated with lower willingness to get vaccinated and with a shift from self-determined to external motivation. In Israel (a country with vaccine passports), people reported greater autonomy frustration than in the UK (a country without vaccine passports). Our findings suggest that control measures, such as domestic vaccine passports, may have detrimental effects on people’s autonomy, motivation, and willingness to get vaccinated. Policies should strive to achieve a highly vaccinated population by supporting individuals’ autonomous motivation to get vaccinated and using messages of autonomy and relatedness, rather than applying pressure and external controls.

COVID-19 vaccination passport: prospects, scientific feasibility, and ethical concerns

A vaccination passport (also known as "vaccination certificate," "immunization passport," or "digital health pass") is a document that provides proof of vaccination and certifies that the holder is protected from illness. It is a more reliable and practical substitute for immunity passports since COVID-19 vaccination is considered a better correlate of protection. Vaccination passport can be considered as a tool offering the holder the privilege of traveling freely within countries without any restrictions. The majority of the countries that are dependent on travel and tourism have exhibited a positive inclination toward implementing COVID-19 vaccination passports, while others have a mixed opinion. The successful implementation of vaccination passports will be a complex task for the policymakers as it requires addressing several ethical, legal, and data security concerns outlined in this article. However, vaccination passports can offer economic and health benefits that will allow the gradual recovery of the economy.

COVID-19 immunity (or vaccine) passports: a documentary overview and analysis of regimes of health verification within the coronavirus pandemic

Purpose

Introducing immunity or vaccine passports is one non-pharmaceutical intervention that governments are considering to exempt immune, vaccinated or otherwise risk-free individuals from lockdowns and other public health restrictions during the coronavirus pandemic. The primary objective of these documents would be to begin reopening societies, restarting economies and returning to a pre-pandemic normalcy. This article aims to present the start of a conceptual documentary analysis of (proposed and existing) COVID-19 immunity passports in order to more fully center their documentary status within research, considerations and conversations about their potential roles, impacts and implications.

Design/methodology/approach

Inspired by Paula A. Treichler's argument for the importance of theoretical thought for untangling the socio-cultural phenomena of epidemics, and drawing upon interdisciplinary theories of documentation, identity and public health, combined with recent news coverage of the coronavirus pandemic, this article provides a contemporary overview and conceptual analysis of emerging documentary regimes of COVID-19 immunity verification involving immunity or vaccine passports.

Findings

Three major interconnected objectives could be fulfilled by immunity passports. First, they would establish and materialize an official identity of COVID-19 immune for people possessing the formal document. Second, they would serve as material evidence establishing and verifying individuals' immunity, vaccination or risk-free status from the coronavirus that would, in term, determine and regulate their movements and other privileges. Third, they would create tangible links between individuals and governments' official or recognized identity category of COVID-19 immune. Immunity passports would, therefore, help enable and enforce governmental authority and power by situating individuals within documentary regimes of COVID-19 immunity verification.

Research limitations/implications

In the expanding interdisciplinary literature on COVID-19 immunity passports, sometimes also called certificates, licenses, or passes, there appears to be only minimal reference to their documentary instantiations, whether physical, digital, and/or hybrid documents. As yet, there is not any specific documentary approach to or analysis of immunity passports as kinds of documentation. A documentary approach helps to illuminate and emphasize the materiality of and ontological considerations concerning the coronavirus pandemic and its associated kinds of immunity or vaccination.

Social implications

By beginning an exploration of what makes immunity passports thinkable as a public health response to the coronavirus pandemic, this article illuminates these health and identity documents' material implications for, and effects on, individuals and societies. This article, therefore, helps shed light on what immunity passports reveal about the complicated and contested intersections of identity, documentation, public health and socio-political control and discipline.

Originality/value

This article contributes the start of a documentary analysis of (proposed and existing) COVID-19 immunity passports in order to more fully center their documentary status within research and conversations about them.

Decolonising human rights: how intellectual property laws result in unequal access to the COVID-19 vaccine

The recent rapid development of COVID-19 vaccines offers hope in addressing the worst pandemic in a hundred years. However, many countries in the Global South face great difficulties in accessing vaccines, partly because of restrictive intellectual property law. These laws exacerbate both global and domestic inequalities and prevent countries from fully realising the right to health for all their people. Commodification of essential medicines, such as vaccines, pushes poorer countries into extreme debt and reproduces national inequalities that discriminate against marginalised groups. This article explains how a decolonial framing of human rights and public health could contribute to addressing this systemic injustice. We envisage a human rights and global health law framework based on solidarity and international cooperation that focuses funding on long-term goals and frees access to medicines from the restrictions of intellectual property law. This would increase domestic vaccine production, acquisition and distribution capabilities in the Global South.

COVID-19 vaccine passport for safe resumption of travel

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues despite the implementation of effective restrictive public health measures, including strict travel restrictions. In light of safe and effective vaccines against COVID-19, ‘vaccine passports’, as a temporary recommendation will facilitate resumption of travel.

Mapping of the Covid-19 Vaccine Uptake Determinants From Mining Twitter Data

Opinion polls on vaccine uptake clearly show that Covid-19 vaccine hesitancy is increasing worldwide. Thus, reaching herd immunity not only depends on the efficacy of the vaccine itself, but also on overcoming this hesitancy of uptake in the population. In this study, we revealed the determinants regarding vaccination directly from people's opinions on Twitter, based on the framework of the 6As taxonomy. Covid-19 vaccine acceptance depends mostly on the characteristics of new vaccines (i.e. their safety, side effects, effectiveness, etc.), and the national vaccination strategy (i.e. immunization schedules, quantities of vaccination points and their localization, etc.), which should focus on increasing citizens' awareness, among various other factors. The results of this study point to areas for potentially improving mass campaigns of Covid-19 immunization to increase vaccine uptake and its coverage and also provide insight into possible directions of future research.