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Wong IOL, Wong C, Mak N, Dai A, Xiao J, Wu P, Ni MY, Liao Q, Cowling BJ. Assessment of the impact of the vaccine pass policy on COVID-19 vaccine hesitancy and uptake among Chinese adults in Hong Kong. Vaccine 2024; 42:3346-3354. [PMID: 38627146 DOI: 10.1016/j.vaccine.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Recognising the importance of attaining high vaccine coverage to mitigate the COVID-19 impact, a Vaccine Pass scheme was implemented during and after the first large Omicron wave with high mortality in older ages in Hong Kong in early 2022 requiring three doses by June 2022. We did not identify any studies evaluating the policy impact of vaccination mandates with vaccine uptake over whole policy period of time in a Chinese population. We aim to evaluate the impact of the Vaccine Pass policy on COVID-19 vaccine uptake in adults in a Chinese population in Hong Kong. METHODS We analysed patterns in vaccine uptake and hesitancy using local data from population vaccine registry and 32 cross-sectional telephone surveys conducted from October 2021 to December 2022. The association of Vaccine Pass phases with vaccine uptake was examined using logistic regression analyses, taking into account covariates including self-risk perception, perceived self-efficacy in preventing COVID-19 and trust in government in pandemic control as well as physical distancing measures and demographics. RESULTS The uptake of primary series and third doses was positively significantly associated with the successive stages of Vaccine Pass implementation (adjusted odds ratios ranged from 2.41 to 7.81). Other statistically significant drivers of uptake included age group, chronic condition, higher perceived personal susceptibility to COVID-19, higher trust in government, and higher educational attainment. CONCLUSION Vaccine uptake in older adults was observed to have increased by a greater extent after the policy annoucement and implementation, under the contextual changes during and after a large Omicron wave with high mortality in Hong Kong in early 2022. Since the policy withdrawal the uptake of further booster doses has been very low in all ages. We suggest that improving voluntary booster uptake in older adults should be prioritized.
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Affiliation(s)
- Irene O L Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cherry Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Nelly Mak
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Alan Dai
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jingyi Xiao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong, China
| | - Michael Y Ni
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Urban Systems Institute, The University of Hong Kong, Hong Kong, China
| | - Qiuyan Liao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong, China.
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Lederman Z, Corcos S. The duty of care and the right to be cared for: is there a duty to treat the unvaccinated? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:81-91. [PMID: 38180693 PMCID: PMC10904556 DOI: 10.1007/s11019-023-10186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
Vaccine hesitancy or refusal has been one of the major obstacles to herd immunity against Covid-19 in high-income countries and one of the causes for the emergence of variants. The refusal of people who are eligible for vaccination to receive vaccination creates an ethical dilemma between the duty of healthcare professionals (HCPs) to care for patients and their right to be taken care of. This paper argues for an extended social contract between patients and society wherein vaccination against Covid-19 is conceived as essential for the protection of the right of healthcare providers to be taken care of. Thus, a duty of care is only valid when those who can receive vaccination actually receive it. Whenever that is not the case, the continuing functioning of HCPs can only be perceived as supererogatory and not obligatory.
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Affiliation(s)
- Zohar Lederman
- Department of Emergency Medicine, LKS Medical Faculty, University of Hong Kong, Hong Kong, Hong Kong.
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Towett G, Snead RS, Grigoryan K, Marczika J. Geographical and practical challenges in the implementation of digital health passports for cross-border COVID-19 pandemic management: a narrative review and framework for solutions. Global Health 2023; 19:98. [PMID: 38066568 PMCID: PMC10709942 DOI: 10.1186/s12992-023-00998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rapid global spread of infectious diseases, epitomized by the recent COVID-19 pandemic, has highlighted the critical need for effective cross-border pandemic management strategies. Digital health passports (DHPs), which securely store and facilitate the sharing of critical health information, including vaccination records and test results, have emerged as a promising solution to enable safe travel and access to essential services and economic activities during pandemics. However, the implementation of DHPs faces several significant challenges, both related to geographical disparities and practical considerations, necessitating a comprehensive approach for successful global adoption. In this narrative review article, we identify and elaborate on the critical geographical and practical barriers that hinder global adoption and the effective utilization of DHPs. Geographical barriers are complex, encompassing disparities in vaccine access, regulatory inconsistencies, differences across countries in data security and users' privacy policies, challenges related to interoperability and standardization, and inadequacies in technological infrastructure and limited access to digital technologies. Practical challenges include the possibility of vaccine contraindications and breakthrough infections, uncertainties surrounding natural immunity, and limitations of standard tests in assessing infection risk. To address geographical disparities and enhance the functionality and interoperability of DHPs, we propose a framework that emphasizes international collaboration to achieve equitable access to vaccines and testing resources. Furthermore, we recommend international cooperation to establish unified vaccine regulatory frameworks, adopting globally accepted standards for data privacy and protection, implementing interoperability protocols, and taking steps to bridge the digital divide. Addressing practical challenges requires a meticulous approach to assessing individual risk and augmenting DHP implementation with rigorous health screenings and personal infection prevention measures. Collectively, these initiatives contribute to the development of robust and inclusive cross-border pandemic management strategies, ultimately promoting a safer and more interconnected global community in the face of current and future pandemics.
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van Enk B, van Houtum H, van Uden AM. The political autoimmunity of the COVID-19 response: how national borders and patents undermine a sustainable and equitable global health. BMJ Glob Health 2023; 8:bmjgh-2023-012293. [PMID: 37247872 DOI: 10.1136/bmjgh-2023-012293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Ben van Enk
- Human Geography, Planning and International Development, University of Amsterdam, Amsterdam, The Netherlands
- Nijmegen Centre for Border Research, Radboud University, Nijmegen, The Netherlands
| | - Henk van Houtum
- Nijmegen Centre for Border Research, Radboud University, Nijmegen, The Netherlands
- Copernicus Institute of Sustainable Development, Faculty of Geosciences, University Utrecht, Utrecht, Netherlands
| | - Annelies Marleen van Uden
- Copernicus Institute of Sustainable Development, Faculty of Geosciences, University Utrecht, Utrecht, Netherlands
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Jung SO, Son YH. Public Perception Before and After COVID-19 Vaccine Pass for the Unvaccinated to Eat Alone: Social Media Data Analytics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231169407. [PMID: 37096812 PMCID: PMC10130937 DOI: 10.1177/00469580231169407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
This study was conducted to compare the trends of public perception in South Korea about the vaccine pass requiring the unvaccinated to eat alone during the COVID-19 crisis. Data were collected via Text mining; frequency, association, and sentiment analysis using the social big data analysis service, (known as "Some-Trend"), 2 months before and after December 16, 2021, when the vaccine pass was announced. The total number of search results was 4899 occurrences of the keywords using "eating alone" and "Hon-bab" (Korean abbreviation for eating alone). During the week of December 16, the frequency was the highest (770 occurrences). Compared to the weeks before the announcement sentiment analysis shows that words including "Reject," "Discrimination," and "Uncomfortable," among others, either newly appeared or increased in frequency. And also, the percentage of positive words decreased from 54.5% to 34% and that of negative words increased from 30.2% to 43.3%. The introduction of the vaccine pass has raised negative public interest, particularly regarding the policy of unvaccinated people forcefully restricted to eat alone. Accordingly, this study showed that the vaccine policy had not gain positive perception of the public.
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Affiliation(s)
- Sun Ok Jung
- Ewha Womans University, Seoul, Republic of Korea
| | - Yoon Hee Son
- Ewha Womans University, Seoul, Republic of Korea
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John SD. How low can you go? Justified hesitancy and the ethics of childhood vaccination against COVID-19. JOURNAL OF MEDICAL ETHICS 2022; 48:1006-1009. [PMID: 35217530 PMCID: PMC8914403 DOI: 10.1136/medethics-2021-108097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
This paper explores some of the ethical issues around offering COVID-19 vaccines to children. My main conclusion is rather paradoxical: the younger we go, the stronger the grounds for justified parental hesitancy and, as such, the stronger the arguments for enforcing vaccination. I suggest that this is not the reductio ad absurdum it appears, but does point to difficult questions about the nature of parental authority in vaccination cases. The first section sketches the disagreement over vaccinating teenagers, arguing that the UK policy was permissible. The second section outlines a problem for this policy, that it faces justified vaccine hesitancy. The third section discusses three strategies for responding to this problem, arguing that there may be no simple way of overcoming parents' reasons to resist vaccinations.
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Affiliation(s)
- Stephen David John
- History and Philosophy of Science, University of Cambridge, Cambridge, UK
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Medicine and health of 21st Century: Not just a high biotech-driven solution. NPJ Genom Med 2022; 7:67. [DOI: 10.1038/s41525-022-00336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
AbstractMany biotechnological innovations have shaped the contemporary healthcare system (CHS) with significant progress to treat or cure several acute conditions and diseases of known causes (particularly infectious, trauma). Some have been successful while others have created additional health care challenges. For example, a reliance on drugs has not been a panacea to meet the challenges related to multifactorial noncommunicable diseases (NCDs)—the main health burden of the 21st century. In contrast, the advent of omics-based and big data technologies has raised global hope to predict, treat, and/or cure NCDs, effectively fight even the current COVID-19 pandemic, and improve overall healthcare outcomes. Although this digital revolution has introduced extensive changes on all aspects of contemporary society, economy, firms, job market, and healthcare management, it is facing and will face several intrinsic and extrinsic challenges, impacting precision medicine implementation, costs, possible outcomes, and managing expectations. With all of biotechnology’s exciting promises, biological systems’ complexity, unfortunately, continues to be underestimated since it cannot readily be compartmentalized as an independent and segregated set of problems, and therefore is, in a number of situations, not readily mimicable by the current algorithm-building proficiency tools. Although the potential of biotechnology is motivating, we should not lose sight of approaches that may not seem as glamorous but can have large impacts on the healthcare of many and across disparate population groups. A balanced approach of “omics and big data” solution in CHS along with a large scale, simpler, and suitable strategies should be defined with expectations properly managed.
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Arakpogun EO, Rodrigo P, Olan F. "You Shall Not Pass" without a Jab: An Institutional Theory Perspective to COVID-19 Vaccine Passport Policies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14105. [PMID: 36360982 PMCID: PMC9654031 DOI: 10.3390/ijerph192114105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
The recent health crises (e.g., COVID-19, Ebola and Monkeypox) have pointed out huge disparities in vaccine accessibility across the world. Nonetheless, certain governments have instituted vaccine passport policies (VPPs) to manage public health, raising mixed concerns from the public. Focusing on COVID-19 outbreak as an example, this review and commentary article utilises an institutional theory perspective to uncover the factors contributing to the global vaccine divide. We also explore the wider impact of VPPs to determine whether such tools promote freedom or social exclusion. Our insights shed light on a controversial and increasingly divisive policy with an international dimension and institutional implications. For instance, while some argue that VPPs may be relatively better than the blunt instrument of lockdowns, VPPs also implicate access and discrimination concerns. Given the various reasons for global vaccine disparities, a hybrid policy that combines vaccine passports with other public health practices (e.g., rapid lateral flow/affordable polymerase chain reaction (PCR) tests and good hygiene) may be more viable. Furthermore, while VPPs may not be desirable and acceptable domestically, they may be inevitable for international travel.
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Goel RK, Jones JR. Managing the risk of COVID-19 via vaccine passports: Modeling economic and policy implications. MANAGERIAL AND DECISION ECONOMICS : MDE 2022; 43:2578-2586. [PMID: 35465149 PMCID: PMC9015226 DOI: 10.1002/mde.3546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Rajeev K. Goel
- Department of EconomicsIllinois State UniversityNormalIllinoisUSA
- Innovation and International CompetitionKiel Institute for the World EconomyKielGermany
| | - James R. Jones
- Katie School of InsuranceIllinois State UniversityNormalIllinoisUSA
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Larson HJ, Lin L, Goble R. Vaccines and the social amplification of risk. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:1409-1422. [PMID: 35568963 PMCID: PMC9347756 DOI: 10.1111/risa.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/20/2022] [Accepted: 03/06/2022] [Indexed: 05/13/2023]
Abstract
In 2019, the World Health Organization (WHO) named "Vaccine Hesitancy" one of the top 10 threats to global health. Shortly afterward, the COVID-19 pandemic emerged as the world's predominant health concern. COVID-19 vaccines of several types have been developed, tested, and partially deployed with remarkable speed; vaccines are now the primary control measure and hope for a return to normalcy. However, hesitancy concerning these vaccines, along with resistance to masking and other control measures, remains a substantial obstacle. The previous waves of vaccine hesitancy that led to the WHO threat designation, together with recent COVID-19 experience, provide a window for viewing new forms of social amplification of risk (SAR). Not surprisingly, vaccines provide fertile ground for questions, anxieties, concerns, and rumors. These appear in new globalized hyperconnected communications landscapes and in the context of complex human (social, economic, and political) systems that exhibit evolving concerns about vaccines and authorities. We look at drivers, impacts, and implications for vaccine initiatives in several recent historical examples and in the current efforts with COVID-19 vaccination. Findings and insights were drawn from the Vaccine Confidence Project's decade long monitoring of media and social media and its related research efforts. The trends in vaccine confidence and resistance have implications for updating the social amplification of risk framework (SARF); in turn, SARF has practical implications for guiding efforts to alleviate vaccine hesitancy and to mitigate harms from intentional and unintentional vaccine scares.
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Affiliation(s)
- Heidi J. Larson
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
- Deparment of Health Metrics SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Leesa Lin
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
- Laboratory of Data Discovery for Health Limited (D24H)Hong Kong Science Park, Hong Kong Special Administrative Region, China
- School of Public HealthThe University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rob Goble
- George Perkins Marsh InstituteClark UniversityWorcesterMassachusettsUSA
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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. Health Policy 2022; 126:755-762. [PMID: 35680529 PMCID: PMC9148623 DOI: 10.1016/j.healthpol.2022.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/14/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Abstract
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.
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13
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Abstract
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.
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Affiliation(s)
- Kristin Voigt
- Corresponding author: Kristin Voigt, Institute for Health and Social Policy and Department of Philosophy, McGill University, 855 Sherbrooke Street West, Montreal, QC H3A 2T7, Canada;
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