The History Of Vaccines And Immunization: Familiar Patterns, New Challenges

Spike protein-related proteinopathies: A focus on the neurological side of spikeopathies

BACKGROUND

The spike protein (SP) is an outward-projecting transmembrane glycoprotein on viral surfaces. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), responsible for COVID-19 (Coronavirus Disease 2019), uses SP to infect cells that express angiotensin converting enzyme 2 (ACE2) on their membrane. Remarkably, SP has the ability to cross the blood-brain barrier (BBB) into the brain and cause cerebral damage through various pathomechanisms. To combat the COVID-19 pandemic, novel gene-based products have been used worldwide to induce human body cells to produce SP to stimulate the immune system. This artificial SP also has a harmful effect on the human nervous system.

STUDY DESIGN

Narrative review.

OBJECTIVE

This narrative review presents the crucial role of SP in neurological complaints after SARS-CoV-2 infection, but also of SP derived from novel gene-based anti-SARS-CoV-2 products (ASP).

METHODS

Literature searches using broad terms such as "SARS-CoV-2", "spike protein", "COVID-19", "COVID-19 pandemic", "vaccines", "COVID-19 vaccines", "post-vaccination syndrome", "post-COVID-19 vaccination syndrome" and "proteinopathy" were performed using PubMed. Google Scholar was used to search for topic-specific full-text keywords.

CONCLUSIONS

The toxic properties of SP presented in this review provide a good explanation for many of the neurological symptoms following SARS-CoV-2 infection and after injection of SP-producing ASP. Both SP entities (from infection and injection) interfere, among others, with ACE2 and act on different cells, tissues and organs. Both SPs are able to cross the BBB and can trigger acute and chronic neurological complaints. Such SP-associated pathologies (spikeopathies) are further neurological proteinopathies with thrombogenic, neurotoxic, neuroinflammatory and neurodegenerative potential for the human nervous system, particularly the central nervous system. The potential neurotoxicity of SP from ASP needs to be critically examined, as ASPs have been administered to millions of people worldwide.

Polymeric microneedle advancements in macromolecule drug delivery: current trends, challenges, and future perspectives

Microneedles (MNs) offer a transformative solution for delivering macromolecules, including proteins, RNA, and peptides. These are critical in treating complex diseases but face significant challenges such as immunogenicity, poor stability, high molecular weight, and delivery efficiency. Unlike conventional methods, MNs efficiently bypass biological barriers like the stratum corneum, enabling precise and minimally invasive transdermal drug delivery. This review explores various MN types such as solid, coated, hollow, hydrogel-forming, and dissolving and their therapeutic applications in cancer immunotherapy, diabetes management, and osteoporosis treatment. For instance, dissolving MNs have been employed for transdermal insulin delivery, enhancing patient compliance and therapeutic outcomes. Similarly, hydrogel MNs have shown promise in sustained drug release for immunotherapy applications. By addressing cost and scalability issues, polymeric MNs demonstrate significant potential for clinical translation, paving the way for innovations in macromolecule delivery, diagnostics, and personalised medicine. This review underscores the pivotal role of MNs in redefining drug delivery systems, offering improved efficacy, patient comfort, and accessibility.

Global vaccine research and application hotspots and trends: a systematic bibliometric analysis based on SCIE highly cited papers

OBJECTIVES

COVID-19, a public health emergency affecting the world in 2019, not only greatly promoted the development and application of vaccines but also effectively shortened the publishing time of scientific papers. In view of these facts, the current situation, status, problems and development trends of vaccine research and application were explored through bibliometric analysis of highly cited papers in the vaccine field within the time frame of 2014-2024, and the countries, institutions, authors, funding agencies and other relevant information that contributed most to vaccine research and application were summarised.

DESIGN

Bibliometric analysis through data analysis and visual mapping.

DATA SOURCES

Scientific articles.

DATA EXTRACTION AND SYNTHESIS

'Vaccine' and 'vaccines' were used in the WoS database to retrieve the publications and to adequately collect the data; Microsoft Excel was used for data analysis; and VOSviewer was used for visual description of data. Overall publication trends, countries, institutions and funding agencies, authors and articles, journals and languages, and research areas and co-occurrence keywords were analysed by bibliometrics.

RESULTS

A total of 3258 highly cited papers were published in the field of vaccines in the past decade, from 735 different journals. With the COVID-19 pandemic in 2019, the number of highly cited papers in the field of vaccine research increased significantly from 2020 to 2024, accounting for 76.12%. The number of highly cited papers for vaccines peaked in 2021 and 2022, followed by a rapid decline. Highly cited papers came from 7133 institutions in 153 countries, and the most influential country in the field of vaccines was the USA, which published 1733 highly cited papers, accounting for 53.19% of the highly cited papers. The top 15 institutions with the largest influence were all from the USA or UK with 2567 published papers in total, accounting for 78.79% of highly cited papers. 4787 funding agencies were recognised in funding 2368 highly cited papers. A total of 30 926 authors in 90 research areas contributed significantly to global vaccine research. The most highly cited paper was 'Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine' from the New England Journal of Medicine, which was cited 9435 times in total. Among the 9848 co-occurrence keywords, COVID-19 (including SARS-CoV-2, 2019-COVID and SARS2) was the most frequently co-occurrence keyword. It appeared in 1720 articles, accounting for 52.79%, indicating that COVID-19 was the most popular study in the last decade.

CONCLUSIONS

This study visualised the research and application of vaccines in the world from the perspective of papers output, drew the knowledge map and identified the important research hotspots and development trends in the vaccine field in the recent 10 years (2014-2024), which is helpful for Centres for Disease Control and Prevention, clinicians, researchers and health policymakers to better understand the research status and problems in vaccine research and application and predict its future development direction.

Past, present, and future of Phase 3 vaccine trial design: rethinking statistics for the 21st century

Vaccines are crucial for protecting health globally; however, their widespread use relies on rigorous clinical development programmes. This includes Phase 3 randomized controlled trials (RCTs) to confirm their safety, immunogenicity, and efficacy. Traditionally, such trials used fixed designs with predetermined assumptions, lacking the flexibility to change during the trial or stop early due to overwhelming evidence of either efficacy or futility. Modern vaccine trials benefit from innovative approaches like adaptive designs, allowing for planned trial adaptations based on accumulating data. Here, we provide an overview of the evolution of Phase 3 vaccine trial design and statistical analysis methods from traditional to more innovative contemporary methods. This includes adaptive trial designs, which offer ethical advantages and enable early termination if indicated; Bayesian methods, which combine prior knowledge and observed trial data to increase efficiency and enhance result interpretation; modern statistical analysis methods, which enable more accurate and precise inferences; the estimand framework, which ensures the primary question of interest is addressed in a trial; novel approaches using machine learning methods to assess heterogeneity of treatment effects; and statistical advances in safety analysis to evaluate reactogenicity and clinical adverse events. We conclude with insights into the future direction of vaccine trials, aiming to inform clinicians and researchers about conventional and novel RCT design and analysis approaches to facilitate the conduct of efficient, timely trials.

Validation of the Arabic translation of the vaccination attitudes examination (VAX) scale

BACKGROUND AND AIM

The availability of concise and valid instruments for measuring vaccination attitudes across different countries or populations is limited. The 12-item four-subscale Vaccination Attitudes Examination (VAX) scale designed to assess vaccination hesitancy has been validated in more than 15 languages. This study aimed to validate the Arabic translation of VAX.

METHODS

VAX was translated from Danish to Arabic following the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcome Measures. The translated VAX was distributed to the citizens of Saudi Arabia in March 2023 through an online survey system and the authors' networks. Internal consistency reliability was assessed with Cronbach's α. Factorial structure was examined using confirmatory factor analysis (CFA). Known-group validity was assessed based on COVID-19 vaccination status.

RESULTS

Responses from 164 participants who fully answered the questionnaire were analyzed. The mean age was 40 years, 77 % were females, and 90 % were fully vaccinated against COVID-19, with one-third receiving booster doses. CFA confirmed a well-fit four-factor structure. All items loaded well with their factors: standardized regression weight values ranged from 0.69 to 0.96. Correlations between the four factors ranged from 0.47 to 0.79. Cronbach α ranged from 0.874 to 0.930. As expected, the mean scores of all subscales were higher in those unvaccinated compared to those who were fully vaccinated as well as those fully vaccinated with a booster dose (p < 0.05).

CONCLUSION

The Arabic translation of the VAX exhibited a well-defined factorial structure with good internal consistency reliability and known-group validity. It is a valuable tool for measuring vaccination hesitancy in Arabic-speaking countries or populations, enabling the comparison of vaccine hesitancy across different countries and cultures.

Establishing the Vaccine Safety Health Link: A large, linked data resource for the investigation of vaccine safety concerns

OBJECTIVE

Post-licensure vaccine safety surveillance of adverse events following immunisation is critical to ensure public safety and confidence in vaccines. This paper aims to describe the governance structure and data linkage methodology behind the establishment of the largest linked vaccine safety surveillance data resource in Australia - The Vaccine Safety Health Link (VSHL).

METHODS

The Vaccine Safety Health Link contains linked records from the Australian Immunisation Register with records from hospital, perinatal, mortality, and notifiable disease datasets in near real-time. Linkage is done by the Centre for Victorian Data Linkage who receive the datasets in an identifiable format which then undergo standardisation, enrichment, linkage, quality assurance and de-identification, prior to being supplied for analysis.

RESULTS

The VSHL data resource allows sensitive and rapid analysis of a broad spectrum of suspected adverse events to ensure the safety of all vaccines administered. It is also used to refute spurious concerns where no associations are found, upholding trust, and maintaining vaccine confidence.

CONCLUSIONS

The Vaccine Safety Health Link's surveillance design complements existing vaccine safety surveillance methods. Challenges encountered and lessons learnt using Vaccine Safety Health Link would benefit linkage projects globally.

IMPLICATIONS FOR PUBLIC HEALTH

In its first two years, The Vaccine Safety Health Link has been used for 14 vaccine safety investigations. Studies into these conditions would not have otherwise been possible. The Vaccine Safety Health Link also partners with the Global Vaccine Data Network™ for approved collaborative studies with a combined population of over 300 million people.

Exploring recent progress of molecular farming for therapeutic and recombinant molecules in plant systems

An excellent technique for producing pharmaceuticals called "molecular farming" enables the industrial mass production of useful recombinant proteins in genetically modified organisms. Protein-based pharmaceuticals are rising in significance because of a variety of factors, including their bioreactivity, precision, safety, and efficacy rate. Heterologous expression methods for the manufacturing of pharmaceutical products have been previously employed using yeast, bacteria, and animal cells. However, the high cost of mammalian cell system, and production, the chance for product complexity, and contamination, and the hurdles of scaling up to commercial production are the limitations of these traditional expression methods. Plants have been raised as a hopeful replacement system for the expression of biopharmaceutical products due to their potential benefits, which include low production costs, simplicity in scaling up to commercial manufacturing levels, and a lower threat of mammalian toxin contaminations and virus infections. Since plants are widely utilized as a source of therapeutic chemicals, molecular farming offers a unique way to produce molecular medicines such as recombinant antibodies, enzymes, growth factors, plasma proteins, and vaccines whose molecular basis for use in therapy is well established. Biopharming provides more economical and extensive pharmaceutical drug supplies, including vaccines for contagious diseases and pharmaceutical proteins for the treatment of conditions like heart disease and cancer. To assess its technical viability and the efficacy resulting from the adoption of molecular farming products, the following review explores the various methods and methodologies that are currently employed to create commercially valuable molecules in plant systems.

Navigating Pakistan's immunization landscape: Progress and pitfalls

Objectives

This study aims to assess the impact of the 2022 floods in Pakistan on the incidence of vaccine-preventable diseases (VPDs) in flood-affected regions, specifically focusing on areas with traditionally low vaccination coverage.

Design

Weekly incidence data of VPDs from September to November 2021 and 2022 were collected and analyzed for the provinces of Sindh, Khyber Pakhtunkhwa, and Baluchistan. The study compared year-on-year changes in disease incidence to evaluate the effect of the floods on disease burden.

Results

The analysis revealed significant increases in the incidence of various VPDs in the flood-affected regions compared to the previous year. Diseases such as pertussis showed a 171% increase, while mumps exhibited nearly a 1000% increase in reported cases. Other diseases including polio, diphtheria, neonatal tetanus, measles, chickenpox, and rubella also experienced substantial rises in case numbers. Concurrently, cases of lower respiratory tract illnesses and diarrheal diseases in children under five years old surged notably.

Conclusions

The findings underscored the failure of relief and healthcare efforts in managing vaccine-preventable diseases in flood-affected areas of Pakistan. The study highlights an urgent need for targeted intervention strategies, including enhanced immunization drives and healthcare infrastructure improvements in vulnerable regions. The post-flood scenario presents a critical opportunity to address existing challenges in vaccination coverage and to mitigate future disease outbreaks through comprehensive public health initiatives.

The mark of success: The role of vaccine-induced skin scar formation for BCG and smallpox vaccine-associated clinical benefits

Skin scar formation following Bacille Calmette-Guérin (BCG) or smallpox (Vaccinia) vaccination is an established marker of successful vaccination and 'vaccine take'. Potent pathogen-specific (tuberculosis; smallpox) and pathogen-agnostic (protection from diseases unrelated to the intentionally targeted pathogen) effects of BCG and smallpox vaccines hold significant translational potential. Yet despite their use for centuries, how scar formation occurs and how local skin-based events relate to systemic effects that allow these two vaccines to deliver powerful health promoting effects has not yet been determined. We review here what is known about the events occurring in the skin and place this knowledge in the context of the overall impact of these two vaccines on human health with a particular focus on maternal-child health.

Revolutionizing cancer treatment: comprehensive insights into immunotherapeutic strategies

Cancer, characterized by the uncontrolled proliferation of aberrant cells, underscores the imperative for innovative therapeutic approaches. Immunotherapy has emerged as a pivotal constituent in cancer treatment, offering improved prognostic outcomes for a substantial patient cohort. Noteworthy for its precision, immunotherapy encompasses strategies such as adoptive cell therapy and checkpoint inhibitors, orchestrating the immune system to recognize and selectively target malignant cells. Exploiting the specificity of the immune response renders immunotherapy efficacious, as it selectively targets the body's immune milieu. Diverse mechanisms underlie cancer immunotherapies, leading to distinct toxicity profiles compared to conventional treatments. A remarkable clinical stride in the anticancer resources is immunotherapy. Remarkably, certain recalcitrant cancers like skin malignancies exhibit resistance to radiation or chemotherapy, yet respond favorably to immunotherapeutic interventions. Notably, combination therapies involving chemotherapy and immunotherapy have exhibited synergistic effects, enhancing overall therapeutic efficacy. Understanding the pivotal role of immunotherapy elucidates its complementary value, bolstering the therapeutic landscape. In this review, we elucidate the taxonomy of cancer immunotherapy, encompassing adoptive cell therapy and checkpoint inhibitors, while scrutinizing their distinct adverse event profiles. Furthermore, we expound on the unprecedented potential of immunogenic vaccines to bolster the anticancer immune response. This comprehensive analysis underscores the significance of immunotherapy in modern oncology, unveiling novel prospects for tailored therapeutic regimens.

MA, Tovar-Rosero YY, Oñate AA, O'Ryan M. Two centuries of vaccination: historical and conceptual approach and future perspectives

Over the past two centuries, vaccines have been critical for the prevention of infectious diseases and are considered milestones in the medical and public health history. The World Health Organization estimates that vaccination currently prevents approximately 3.5-5 million deaths annually, attributed to diseases such as diphtheria, tetanus, pertussis, influenza, and measles. Vaccination has been instrumental in eradicating important pathogens, including the smallpox virus and wild poliovirus types 2 and 3. This narrative review offers a detailed journey through the history and advancements in vaccinology, tailored for healthcare workers. It traces pivotal milestones, beginning with the variolation practices in the early 17th century, the development of the first smallpox vaccine, and the continuous evolution and innovation in vaccine development up to the present day. We also briefly review immunological principles underlying vaccination, as well as the main vaccine types, with a special mention of the recently introduced mRNA vaccine technology. Additionally, we discuss the broad benefits of vaccines, including their role in reducing morbidity and mortality, and in fostering socioeconomic development in communities. Finally, we address the issue of vaccine hesitancy and discuss effective strategies to promote vaccine acceptance. Research, collaboration, and the widespread acceptance and use of vaccines are imperative for the continued success of vaccination programs in controlling and ultimately eradicating infectious diseases.

COVID-19 vaccination acceptance, safety and side-effects in European patients with severe asthma

Background

Vaccination is vital for achieving population immunity to severe acute respiratory syndrome coronavirus 2, but vaccination hesitancy presents a threat to achieving widespread immunity. Vaccine acceptance in chronic potentially immunosuppressed patients is largely unclear, especially in patients with asthma. The aim of this study was to investigate the vaccination experience in people with severe asthma.

Methods

Questionnaires about vaccination beliefs (including the Vaccination Attitudes Examination (VAX) scale, a measure of vaccination hesitancy-related beliefs), vaccination side-effects, asthma control and overall safety perceptions following coronavirus disease 2019 (COVID-19) vaccination were sent to patients with severe asthma in 12 European countries between May and June 2021.

Results

660 participants returned completed questionnaires (87.4% response rate). Of these, 88% stated that they had been, or intended to be, vaccinated, 9.5% were undecided/hesitant and 3% had refused vaccination. Patients who hesitated or refused vaccination had more negative beliefs towards vaccination. Most patients reported mild (48.2%) or no side-effects (43.8%). Patients reporting severe side-effects (5.7%) had more negative beliefs. Most patients (88.8%) reported no change in asthma symptoms after vaccination, while 2.4% reported an improvement, 5.3% a slight deterioration and 1.2% a considerable deterioration. Almost all vaccinated (98%) patients would recommend vaccination to other severe asthma patients.

Conclusions

Uptake of vaccination in patients with severe asthma in Europe was high, with a small minority refusing vaccination. Beliefs predicted vaccination behaviour and side-effects. Vaccination had little impact on asthma control. Our findings in people with severe asthma support the broad message that COVID-19 vaccination is safe and well tolerated.

Analysis of Parents' Attitudes and Knowledge toward Immunization and How These Factors Influence Their Decisions to Vaccinate Their Children against Human Papilloma Virus (HPV)

Background and objectives: Vaccination hesitancy is a growing problem associated with decreasing chances for the elimination of vaccine-preventable diseases through immunization. This research was conducted to learn about parents' attitudes toward vaccination, particularly against HPV, in the context of their beliefs and fears regarding immunization and the impact of these views on their children's vaccination decisions. An additional goal was to determine what views or convictions most often lead to the phenomenon of delaying or refusing vaccinations, especially HPV vaccines, in the surveyed community. Materials and Methods: An online questionnaire was conducted in which parents marked how they vaccinated their children with mandatory vaccinations and whether they took the opportunity to protect their children with additional vaccinations, including HPV and COVID-19. Respondents also marked the extent to which they agreed with the statements, regarding the safety of vaccinations, doubts about them, as well as popular anti-vaccine myths. Results: A total of 250 questionnaires were collected with data on the immunization of 425 children. Associations between specific beliefs and vaccine abstention were established. The most motivating factor for vaccination against HPV was the parent's awareness that the virus HP is the cause of cancer. The most inhibiting factor was respondent's compliance with the opinion that HPV vaccines can affect the child's sexual activity. Conclusions: The results indicate that information campaigns are needed, especially focusing on vaccine safety and the regularity and transparency of monitoring adverse effects. The obtained results will be used to create educational interventions against vaccination hesitancy more adapted to local conditions.

Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization

Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.

Application of Traditional Vaccine Development Strategies to SARS-CoV-2

Over the past 150 years, vaccines have revolutionized the relationship between people and disease. During the COVID-19 pandemic, technologies such as mRNA vaccines have received attention due to their novelty and successes. However, more traditional vaccine development platforms have also yielded important tools in the worldwide fight against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A variety of approaches have been used to develop COVID-19 vaccines that are now authorized for use in countries around the world. In this review, we highlight strategies that focus on the viral capsid and outwards, rather than on the nucleic acids inside. These approaches fall into two broad categories: whole-virus vaccines and subunit vaccines. Whole-virus vaccines use the virus itself, in either an inactivated or an attenuated state. Subunit vaccines contain instead an isolated, immunogenic component of the virus. Here, we highlight vaccine candidates that apply these approaches against SARS-CoV-2 in different ways. In a companion article (H. M. Rando, R. Lordan, L. Kolla, E. Sell, et al., mSystems 8:e00928-22, 2023, https://doi.org/10.1128/mSystems.00928-22), we review the more recent and novel development of nucleic acid-based vaccine technologies. We further consider the role that these COVID-19 vaccine development programs have played in prophylaxis at the global scale. Well-established vaccine technologies have proved especially important to making vaccines accessible in low- and middle-income countries. Vaccine development programs that use established platforms have been undertaken in a much wider range of countries than those using nucleic acid-based technologies, which have been led by wealthy Western countries. Therefore, these vaccine platforms, though less novel from a biotechnological standpoint, have proven to be extremely important to the management of SARS-CoV-2. IMPORTANCE The development, production, and distribution of vaccines is imperative to saving lives, preventing illness, and reducing the economic and social burdens caused by the COVID-19 pandemic. Vaccines that use cutting-edge biotechnology have played an important role in mitigating the effects of SARS-CoV-2. However, more traditional methods of vaccine development that were refined throughout the 20th century have been especially critical to increasing vaccine access worldwide. Effective deployment is necessary to reducing the susceptibility of the world's population, which is especially important in light of emerging variants. In this review, we discuss the safety, immunogenicity, and distribution of vaccines developed using established technologies. In a separate review, we describe the vaccines developed using nucleic acid-based vaccine platforms. From the current literature, it is clear that the well-established vaccine technologies are also highly effective against SARS-CoV-2 and are being used to address the challenges of COVID-19 globally, including in low- and middle-income countries. This worldwide approach is critical for reducing the devastating impact of SARS-CoV-2.

Visual policy narrative messaging improves COVID-19 vaccine uptake

In the face of vaccine hesitancy, public health officials are seeking more effective risk communication approaches to increase vaccination rates. We test the influence of visual policy narratives on COVID-19 vaccination behavior through a panel survey experiment conducted in early 2021 (n = 3,900) and then 8 weeks later (n = 2,268). We examine the effects of three visual policy narrative messages that test the narrative mechanism of character selection (yourself, your circle, and your community) and a nonnarrative control on COVID-19 vaccine behavior. Visual risk messages that use narratives positively influence COVID-19 vaccination through serial mediation of affective response to the messages and motivation to get the COVID-19 vaccination. Additionally, character selection matters, as messages focusing on protecting others (i.e. your circle and your community) perform stronger than those of yourself. Political ideology moderated some of the effects, with conservative respondents in the nonnarrative control condition having a higher probability of vaccination in comparison to the protect yourself condition. Taken together, these results suggest that public health officials should use narrative-based visual communication messages that emphasize communal benefits of vaccinations.

A comparison between online social media discussions and vaccination rates: A tale of four vaccines

The recent COVID-19 pandemic has brought the debate around vaccinations to the forefront of public discussion. In this discussion, various social media platforms have a key role. While this has long been recognized, the way by which the public assigns attention to such topics remains largely unknown. Furthermore, the question of whether there is a discrepancy between people's opinions as expressed online and their actual decision to vaccinate remains open. To shed light on this issue, in this paper we examine the dynamics of online debates among four prominent vaccines (i.e., COVID-19, Influenza, MMR, and HPV) through the lens of public attention as captured on Twitter in the United States from 2015 to 2021. We then compare this to actual vaccination rates from governmental reports, which we argue serve as a proxy for real-world vaccination behaviors. Our results demonstrate that since the outbreak of COVID-19, it has come to dominate the vaccination discussion, which has led to a redistribution of attention from the other three vaccination themes. The results also show an apparent discrepancy between the online debates and the actual vaccination rates. These findings are in line with existing theories, that of agenda-setting and zero-sum theory. Furthermore, our approach could be extended to assess the public's attention toward other health-related issues, and provide a basis for quantifying the effectiveness of health promotion policies.

Application of Traditional Vaccine Development Strategies to SARS-CoV-2

Over the past 150 years, vaccines have revolutionized the relationship between people and disease. During the COVID-19 pandemic, technologies such as mRNA vaccines have received attention due to their novelty and successes. However, more traditional vaccine development platforms have also yielded important tools in the worldwide fight against the SARS-CoV-2 virus. A variety of approaches have been used to develop COVID-19 vaccines that are now authorized for use in countries around the world. In this review, we highlight strategies that focus on the viral capsid and outwards, rather than on the nucleic acids inside. These approaches fall into two broad categories: whole-virus vaccines and subunit vaccines. Whole-virus vaccines use the virus itself, either in an inactivated or attenuated state. Subunit vaccines contain instead an isolated, immunogenic component of the virus. Here, we highlight vaccine candidates that apply these approaches against SARS-CoV-2 in different ways. In a companion manuscript, we review the more recent and novel development of nucleic-acid based vaccine technologies. We further consider the role that these COVID-19 vaccine development programs have played in prophylaxis at the global scale. Well-established vaccine technologies have proved especially important to making vaccines accessible in low- and middle-income countries. Vaccine development programs that use established platforms have been undertaken in a much wider range of countries than those using nucleic-acid-based technologies, which have been led by wealthy Western countries. Therefore, these vaccine platforms, though less novel from a biotechnological standpoint, have proven to be extremely important to the management of SARS-CoV-2.

Protective vaccinations in the control and prevention of infectious diseases—knowledge of adult Poles in this field. Preliminary results

Background

Protective vaccinations are one of the basic means of infectious disease prevention. The aim of the study was to assess the implementation of compulsory and additional protective vaccinations among adult Poles, their knowledge about the purpose of introducing a vaccination schedule and adverse events following immunization. Opinions about and support for anti-vaccination movements were also examined.

Materials and methods

A total of 700 (100%) people aged 18 to 80 (x̅  = 32,16 ± 16,46) took part in the study, conducted using the proprietary questionnaire. All the participants selected randomly from patients of the Department of Cardiology, their visitors, doctors, nurses, paramedics, medical students, and authors’ acquaintances gave their informed consent to participate in the study.

Results

About 10% of the respondents did not complete the compulsory vaccination schedule. Almost 80% of respondents believed that the main reason for vaccinations schedule occurrence was the desire to completely exclude certain diseases and their complications from the population. More than half of the respondents have never had any additional vaccination. A statistically significant correlation was found between intake of at least one additional vaccination and age (χ²=22.262, p = 0.002) and education level (χ²= 11.074, p = 0.004). Among the respondents, there was a group that classified autism as one of the adverse events following immunization. About 95% of respondents never experienced any adverse events following immunizationand as many as 30 respondents declared their support for anti-vaccination movements.

Conclusion

The degree of the implementation of compulsory protective vaccinations in the study group was high, while additional vaccinations were insufficient. The purposefulness of introducing a vaccination schedule was correctly identified by the majority of the respondents, but the knowledge about adverse events following immunisation and their types was incomplete. Among participants were individuals who declared their support for anti-vaccination movements, so society should be constantly educated about vaccinations benefits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14821-2.

Computational design of vaccine immunogens

Computational protein engineering has enabled the rational design of customized proteins, which has propelled both sequence-based and structure-based immunogen engineering and delivery. By discerning antigenic determinants of viral pathogens, computational methods have been implemented to successfully engineer representative viral strains able to elicit broadly neutralizing responses or present antigenic sites of viruses for focused immune responses. Combined with improvements in customizable nanoparticle design, immunogens are multivalently displayed to enhance immune responses. These rationally designed immunogens offer unique and powerful approaches to engineer vaccines for pathogens, which have eluded traditional approaches.

Smallpox vaccination and vaccine hesitancy in the Kingdom of the Two Sicilies (1801) and the great modernity of Ferdinand IV of Bourbon: a glimpse of the past in the era of the SARS-COV-2 (COVID-19) pandemic

OBJECTIVE

The current health emergency caused by COVID-19 disease shows several correspondences with well-known epidemics of the past. The knowledge of their management and overcoming could give us useful tools to face the present COVID-19 pandemic and future epidemics.

STUDY DESIGN

On 1 March 1801, the first smallpox vaccinations were carried out in Palermo, and a few weeks later, the vaccine was also administered in Naples and the various provinces of the Kingdom. We aim to study the mass vaccination programme initiated by the Bourbon king Ferdinand IV that was the first large-scale campaign to be conducted in Italy and one of the first in Europe.

METHODS

The authors searched and examined historical testimony and different aspects linked to the public health issues on vaccination. It is a topical topic in the current period with the COVID pandemic.

RESULTS

Albeit with the due differences determined by the passage of time and by the scientific and cultural advances of modern society, this testimony from the past can provide us with food for thought regarding how to face the present COVID-19 pandemic and to prepare for the future. Indeed, it shows us how the terrible smallpox epidemic was handled and finally overcome, thanks to vaccination.

Systems Vaccinology in HIV Vaccine Development

Themes of discussions in the Special Issue of T Cell Immunity and HIV-1 Pathogenicity are outlined here [...]

COVID-19 Vaccination Policies: Ethical Issues and Responsibility

The World Health Organization (WHO) declared coronavirus 2 (SARS-CoV-2, COVID-19) a global pandemic on 11 March 2020. The emergence of the reliability of vaccines, the fear of possible vaccination-related side effects, and mass-media information created situations in which families and even health professionals developed hesitations regarding the need for vaccines, with a consequent decrease in vaccination coverage. This study discusses ethical issues and responsibility for the possible side effects of SARS-CoV-2 vaccination raised by vaccination policies.

Antibodies to combat viral infections: development strategies and progress

Monoclonal antibodies (mAbs) are appealing as potential therapeutics and prophylactics for viral infections owing to characteristics such as their high specificity and their ability to enhance immune responses. Furthermore, antibody engineering can be used to strengthen effector function and prolong mAb half-life, and advances in structural biology have enabled the selection and optimization of potent neutralizing mAbs through identification of vulnerable regions in viral proteins, which can also be relevant for vaccine design. The COVID-19 pandemic has stimulated extensive efforts to develop neutralizing mAbs against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with several mAbs now having received authorization for emergency use, providing not just an important component of strategies to combat COVID-19 but also a boost to efforts to harness mAbs in therapeutic and preventive settings for other infectious diseases. Here, we describe advances in antibody discovery and engineering that have led to the development of mAbs for use against infections caused by viruses including SARS-CoV-2, respiratory syncytial virus (RSV), Ebola virus (EBOV), human cytomegalovirus (HCMV) and influenza. We also discuss the rationale for moving from empirical to structure-guided strategies in vaccine development, based on identifying optimal candidate antigens and vulnerable regions within them that can be targeted by antibodies to result in a strong protective immune response.

Vaccine literacy: A concept analysis

The 2019 Coronavirus Disease (COVID-19) is dubbed as one of the deadliest and worst global pandemics. Many pandemic policies and programs were implemented in different countries across the globe, including the creation of vaccines that would enhance human immunity against the symptoms caused by the virus. Since then, debates on vaccines have emerged, citing vaccine hesitancy often associated with certain factors like socioeconomic status, beliefs, and vaccine awareness. This birthed to an intensive call for vaccine literacy as an effective means of encouraging people to get vaccinated against viruses. This paper uses the Walker and Avant's (2019, Strategies for theory construction in nursing, 6th edn. New York, NY: Pearson) approach of concept analysis with the help of its eight systematic stages. Results showed that vaccine literacy was adopted after the concept of health literacy. It is defined as a process of providing vaccine information, building communication, and increasing people's engagement about vaccines. The identified defining attributes of vaccine literacy include 'health literacy', 'disease prevention', 'education', and 'immunization'. Vaccine literacy is considered relevant in the nursing practice as knowledge on vaccine literacy easily advances nurses' practice roles through vaccination education, creating developmental policies about vaccines, and prescribing immunization to patients.

Multiple evanescent white dot syndrome following BNT162b2 mRNA COVID-19 vaccination

Purpose

To report a case with multiple evanescent white dot syndrome (MEWDS) following BNT162b2 mRNA COVID-19 vaccination.

Observations

Case: A 67-year-old Japanese female presented with central visual field loss and photopsia in the right eye (OD) for 5 days. She was complaining blurred vision with bright spots in vision in OD, but denied any ocular symptoms in left eye (OS). She had received the second dose of BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) one day before the onset of visual symptoms; flu-like symptoms such as mild fever and general fatigue also developed along with ocular symptoms such as decreased vision and hypersensitivity to light in OD following the second COVID-19 vaccine. The first dose of vaccine was administrated followed three weeks later by the second dose and was not associated with any ocular or systemic symptoms besides mild pain at the injection site. She had not been followed by any ophthalmologist before the initial visit. At the initial visit, best corrected visual acuity (BCVA) in decimal points was 0.2 in OD and 1.0 in OS. Ophthalmic examination showed multifocal white dots in the posterior retina with moderate vitritis (1+ haze and 2+ cells) in OD. Multimodal imaging in OD showed diffuse disruption of ellipsoid zone with variable punctate hyperreflective lesions at macula on optical coherence tomography, punctate hyperfluorescence in a wreath-like pattern and late staining on fluorescein angiography, and multiple hypofluorescent spots of various sizes in the late phases on indocyanine green angiography. Both multiple hypofluorescent spots and scattered hyperfluorescent spots corresponding to white dots in OD were also seen on fundus autofluorescence. Her laboratory and systemic evaluations were negative for syphilis, tuberculosis, or toxoplasma, and selected autoimmune diseases like sarcoidosis, Behcet's disease, rheumatoid arthritis, and systemic lupus erythematosus. No active intraocular inflammation or abnormality were seen in OS. One week later, the multifocal white dots disappeared in OD, and were almost invisible on fundus photography. At that time, multifocal electroretinogram showed decreased response with low amplitude density across the entire field in OD. The BCVA in OD spontaneously improved to 0.8 without any treatment. Collectively, these clinical course and findings were suggestive of a diagnosis of MEWDS after mRNA COVID-19 vaccination.

Conclusions and importance

In this present case, BNT162b2 mRNA COVID-19 vaccination might have been associated with MEWDS-like entity with vision loss. It is important for physicians to monitor the ocular status carefully in patients with visual disturbance after COVID-19 vaccination.

Analyzing the vaccination debate in social media data Pre- and Post-COVID-19 pandemic

The COVID-19 virus has caused and continues to cause unprecedented impacts on the life trajectories of millions of people globally. Recently, to combat the transmission of the virus, vaccination campaigns around the world have become prevalent. However, while many see such campaigns as positive (e.g., protecting lives), others see them as negative (e.g., the side effects that are not fully understood scientifically), resulting in diverse sentiments towards vaccination campaigns. In addition, the diverse sentiments have seldom been systematically quantified let alone their dynamic changes over space and time. To shed light on this issue, we propose an approach to analyze vaccine sentiments in space and time by using supervised machine learning combined with word embedding techniques. Taking the United States as a test case, we utilize a Twitter dataset (approximately 11.7 million tweets) from January 2015 to July 2021 and measure and map vaccine sentiments (Pro-vaccine, Anti-vaccine, and Neutral) across the nation. In doing so, we can capture the heterogeneous public opinions within social media discussions regarding vaccination among states. Results show how positive sentiment in social media has a strong correlation with the actual vaccinated population. Furthermore, we introduce a simple ratio between Anti and Pro-vaccine as a proxy to quantify vaccine hesitancy and show how our results align with other traditional survey approaches. The proposed approach illustrates the potential to monitor the dynamics of vaccine opinion distribution online, which we hope, can be helpful to explain vaccination rates for the ongoing COVID-19 pandemic.

Emerging trends of edible vaccine therapy for combating human diseases especially COVID ‐19: Pros, cons, and future challenges

The researchers are still doing efforts to develop an effective, reliable, and easily accessible vaccine candidate to protect against COVID‐19. As of the August 2020, nearly 30 conventional vaccines have been emerged in clinical trials, and more than 200 vaccines are in various development stages. Nowadays, plants are also considered as a potential source for the production of monoclonal antibodies, vaccines, drugs, immunomodulatory proteins, as well as used as bioreactors or factories for their bulk production. The scientific evidences enlighten that plants are the rich source of oral vaccines, which can be given either by eating the edible parts of plants and/or by oral administration of highly refined proteins. The use of plant‐based edible vaccines is an emerging trend as it possesses minimum or no side effects compared with synthetic vaccines. This review article gives insights into different types of vaccines, the use of edible vaccines, advantages of edible vaccines over conventional vaccines, and mechanism of action of edible vaccines. This review article also focuses on the applications of edible vaccines in wide‐range of human diseases especially against COVID‐19 with emphasis on future perspectives of the use of edible vaccines.

Vaccine Hesitancy

Purpose of Review

Recent Findings

Summary

Social media use and vaccine hesitancy in the European Union

Vaccine hesitancy can hinder the successful roll-out of vaccines. This paper examines COVID-19 vaccine hesitancy in the European Union, drawing from a large-scale cross-national survey covering all 27 EU Member States, carried out between February and March 2021 (n = 29,755). We study the determinants of vaccine hesitancy, focusing on the role of social media use. In multivariate regression models, we find statistically significant (p < 0.05) impacts on vaccine hesitancy of heavy use of social media and using social media as a main source of news. However, the effect of social media and the drivers of vaccine hesitancy vary depending on the reason for hesitancy. Most notably, hesitancy due to health concerns is mainly driven by physical health status and less by social media use, while views that COVID-19 risks are exaggerated (or that COVID-19 does not exist) are more common among men, people in good health, and those using social media as their main source of news.

Vaccine Efficacy Denial: A Growing Concern Affecting Modern Science, and Impacting Public Health

BACKGROUND

The discovery of the vaccination technique has been revealed by Edward Jenner in 1796: undoubtedly, it represents the first scientific attempt to control an infectious disease by vaccines, followed by other important studies carried out by Pasteur and Koch, and Sabin, who developed the first technique to attenuate the virus. In recent decades, numerous scholars have begun to create dangerous theories against the effectiveness of vaccines through scientifically invalid or fraudulent studies.

AIM

This critical review of the literature aims to analyse the main factors that have undermined the credibility of vaccines in the general population, to disprove false information and, on the other hand, emphasize the benefits of vaccines over the last 200 years.

DISCUSSIONS

Unfortunately, several studies have been carried out without the proper scientific rigour. The most impacting example is the study published by Andrew Wakefield in the Lancet journal that tried to correlate vaccines with the development of autism: this publication was withdrawn from the journal a few years after its publication, but the impact of incorrect scientific studies, fake news, and ambiguous healthcare policies has led to an adverse general opinion about the effectiveness of vaccines.

CONCLUSION

The excess of uncontrolled information is a serious concerning in the Coronavirus pandemic. The modern science must tackle this problem with a better willingness to communicate even the clinical studies to those people not able to understand the medical information autonomously. Nevertheless, a reliable science must also limit the dissemination of studies that do not meet the basic criteria of a methodological rigor and certainty of results, in order not to feed confusion in the scientific community.

Parents' and Guardians' Intentions to Vaccinate Children against COVID-19

A cross-sectional survey design was used to assess Arkansas parents'/guardians' intentions to vaccinate their child against COVID-19. Parents/guardians whose oldest child was age 0-11 years (n = 171) or 12-17 years (n = 198) were recruited between 12 July and 30 July 2021 through random digit dialing. Among parents/guardians with an age-eligible child, age 12-17, 19% reported their child had been vaccinated, and 34% reported they would have their child vaccinated right away. Among parents/guardians with a child aged 0-11, 33% of parents/guardians reported they would have their child vaccinated right away. Twenty-eight percent (28%) of parents/guardians whose oldest child was 12-17 and 26% of parents/guardians whose oldest child was 0-11 reported they would only have their child vaccinated if their school required it; otherwise, they would definitely not vaccinate them. For both groups, parents'/guardians' education, COVID-19 vaccination status, and COVID-19 vaccine hesitancy were significantly associated with intentions to vaccinate their child. More than a third of parents/guardians whose child was eligible for vaccination at the time of the survey reported they intended to have them vaccinated right away; however, they had not vaccinated their child more than two months after approval. This finding raises questions about the remaining barriers constraining some parents/guardians from vaccinating their child.

Trust and willingness towards COVID-19 vaccine uptake: a mixed-method study in Ghana, 2021

Background

On the account of limited doses of COVID-19 available to the country, the Government of Ghana created a priority list of persons to target for its vaccination agenda. In this paper, we look at trust and how it informs willingness to take the COVID-19 vaccine among persons targeted for the first phase of COVID-19 vaccination program in Ghana.

Methods

A sequential mixed-method investigation was conducted among the priority population - persons 60 years and above, frontline government functionaries, health workers, persons with underlying health conditions and, religious leaders and teachers. We sampled 415 respondents from the target population for a survey and 15 religious and traditional leaders from three cities; Accra, Cape Coast and Tamale for follow-up in-depth interviews based on the results of the survey data. Quantitative data is presented with descriptive proportions and multinomial logistic regression and thematic approach is applied to the interview data.

Results

Trust and willingness to take the vaccine are high in this priority population. Trust in the effectiveness and safety of the vaccine, rather than socioeconomic characteristics of respondents better predicted acceptance. From interview narratives, mistrust in political actors - both local and foreign, believe in superior protection of God and seeming misunderstanding of vaccine development processes countermand acceptance. On the other hand, the professional influence of people in one’s social networks, and past triumphs of vaccination programmes against concerning childhood diseases embed trust and acceptance.

Conclusions

Attention ought to be given to trust enhancing triggers while strategic communication approaches are used to remove triggers of mistrust.

To vax or not to vax: Predictors of anti-vax attitudes and COVID-19 vaccine hesitancy prior to widespread vaccine availability

The novel coronavirus (COVID-19) is a highly contagious disease responsible for millions of deaths worldwide. Effective vaccines against COVID-19 are now available, however, an extreme form of vaccine hesitancy known as anti-vax attitudes challenge vaccine acceptance and distribution efforts. To understand these anti-vax attitudes and their associated psychological characteristics, we examined several predictors of vaccine hesitancy for COVID-19 and anti-vax attitudes generally. We surveyed 1004 adults (M = 47.0 years, SD = 17.1 years, range 18-98 years) in September-October 2020 across the United States (51% female, 49% male; 76.5% White, 23.5% non-White), prior to widespread availability of the COVID-19 vaccines. Attitudes toward vaccinations were influenced by a variety of factors, especially political attitudes. We should therefore anticipate and attempt to mitigate these challenges to achieving widespread vaccination to reduce the spread of COVID-19 and other communicable diseases.

Current Prospects in Peptide-Based Subunit Nanovaccines

Vaccination renders protection against pathogens via stimulation of the body's natural immune responses. Classical vaccines that utilize whole organisms or proteins have several disadvantages, such as induction of undesired immune responses, poor stability, and manufacturing difficulties. The use of minimal immunogenic pathogen components as vaccine antigens, i.e., peptides, can greatly reduce these shortcomings. However, subunit antigens require a specific delivery system and immune adjuvant to increase their efficacy. Recently, nanotechnology has been extensively utilized to address this issue. Nanotechnology-based formulation of peptide vaccines can boost immunogenicity and efficiently induce cellular and humoral immune responses. This chapter outlines the recent developments and advances of nano-sized delivery platforms for peptide antigens, including nanoparticles composed of polymers, peptides, lipids, and inorganic materials.

Innovative vaccine platforms against infectious diseases: Under the scope of the COVID-19 pandemic

While classic vaccines have proved greatly efficacious in eliminating serious infectious diseases, innovative vaccine platforms open a new pathway to overcome dangerous pandemics via the development of safe and effective formulations. Such platforms play a key role either as antigen delivery systems or as immune-stimulators that induce both innate and adaptive immune responses. Liposomes or lipid nanoparticles, virus-like particles, nanoemulsions, polymeric or inorganic nanoparticles, as well as viral vectors, all belong to the nanoscale and are the main categories of innovative vaccines that are currently on the market or in clinical and preclinical phases. In this paper, we review the above formulations used in vaccinology and we discuss their connection with the development of safe and effective prophylactic vaccines against SARS-CoV-2.

Vaccinia Virus: From Crude Smallpox Vaccines to Elaborate Viral Vector Vaccine Design

Various vaccinia virus (VACV) strains were applied during the smallpox vaccination campaign to eradicate the variola virus worldwide. After the eradication of smallpox, VACV gained popularity as a viral vector thanks to increasing innovations in genetic engineering and vaccine technology. Some VACV strains have been extensively used to develop vaccine candidates against various diseases. Modified vaccinia virus Ankara (MVA) is a VACV vaccine strain that offers several advantages for the development of recombinant vaccine candidates. In addition to various host-restriction genes, MVA lacks several immunomodulatory genes of which some have proven to be quite efficient in skewing the immune response in an unfavorable way to control infection in the host. Studies to manipulate these genes aim to optimize the immunogenicity and safety of MVA-based viral vector vaccine candidates. Here we summarize the history and further work with VACV as a vaccine and present in detail the genetic manipulations within the MVA genome to improve its immunogenicity and safety as a viral vector vaccine.

The Politics of Learning from Rare Events

Actors engaged in learning from rare events must trade off between two different criteria for effective learning: validity—the extent to which learning can be used for understanding, prediction, and control—and reliability—the extent to which understandings of experience are public, stable, and shared. Existing models of learning from rare events have elided conflict and politics by assuming that individuals and organizations always seek new valid knowledge that then becomes public, stable, and shared across actors. Here we examine the politics of learning in a historical analysis of population-level learning by four different actors following the 1994 sinking of the ferry Estonia. We show how politics shaped the trade-off between reliability and validity and, in turn, shaped the nature of the learning. Whereas the new knowledge was sometimes both valid and reliable, the more common outcome was knowledge that was only partly valid and reliable. Rather than treat these outcomes as substandard, we show how they are important to the dynamics of learning, as different population-level actors take into account different aspects of experience. The result is a model that makes conflict and contestation—and hence politics—essential to effective learning.

Factors influencing COVID-19 vaccine hesitancy and acceptance among the Pakistani population

This study examined the factors associated with acceptance of the COVID-19 vaccine compared to hesitance in the Pakistani population and specifically focusing on the perceived beliefs, knowledge, concerns, risk, and safety perception relating to the COVID-19 vaccine. A total of 423 subjects were recruited from the Pakistan Institute of Medical Sciences, Islamabad, Pakistan. A 27-item valid and reliable questionnaire was used to assess socio-demographic characteristics, acceptance, and hesitance toward COVID-19 vaccine, perceived beliefs, knowledge, perceived concerns, risk, and safety of COVID-19 vaccines and its source of information. Chi-square tests and logistic regression were used for analysis. About 53% of the participants were planning to get vaccinated and a significantly greater proportion of better educated, higher income, and healthier participants in the vaccine acceptance group (p < .05). The odds of knowing the vaccine they should get, having the confidence in the vaccine to stop the pandemic, and understanding the way vaccines work, were greater in the vaccine acceptance group than the vaccine-hesitant group (OR: 5.4; 3.5, 2.1, 3.1, respectively). Most participants (52.3%) obtained the information regarding the COVID-19 vaccine from the print and live news media (52.3%) followed by social media (23.7%). The lack of knowledge, understanding, and perception of the risk, safety partly explains the low rate of vaccine acceptance in the Pakistani population. Strategies to raise awareness of the benefits of vaccination should target individuals in the lower socioeconomic group and those with chronic disease.

"The Risk Seems Too High": Thoughts and Feelings about COVID-19 Vaccination

The purpose of this study was to describe the thoughts and feelings of individuals expressing concerns about the COVID-19 vaccine. A qualitative descriptive study was conducted in order to examine the thoughts and feelings of participants who are hesitant about the COVID-19 vaccine. Data were collected from 754 participants using an online instrument. Emergent themes included a lack of knowledge about the safety of the COVID-19 vaccine; concerns over the speed of development, testing, and approval of these vaccines; reluctance to be among the first vaccinated; concerns about the motivations of government actors, pharmaceutical companies, and others involved in producing the COVID-19 vaccine; and hesitancy about vaccines generally.

Should nurses take a COVID-19 vaccine?

The issue as to whether health care professionals have a moral obligation to take a vaccine for a communicable disease is not new. Nonetheless, this issue takes on a fresh urgency within nursing practice in the context of the present COVID-19 pandemic, i.e., is there an ethical requirement for nurses to take a COVID-19 vaccine? This paper approaches the issue by using a hypothetical example of Nurse X who has inadvertently infected Patient Y. French's (1984a) Principle of Responsive Adjustment is adapted to claim that there would be a moral expectation that Nurse X takes a COVID-19 vaccine (unless there are justifiable reasons not to). The proposition is also made that, should Nurse X not take a COVID-19 vaccine, they could be morally associated with originally infecting Patient Y.

Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon

The discovery and development of vaccines remain one of the major successes of global health with millions of lives saved every year through routine vaccination. Although vaccines provide a safe and cost-effective solution to vaccine-preventable diseases (VPDs), VPDs are still a serious public health problem in most parts of the world, especially in sub-Saharan Africa (SSA) and Asia. In this review, we discuss the burden of VPDs and vaccine coverage several decades after the introduction of the Expanded Program on Immunization (EPI) in Cameroon. We also discuss how different factors affect the implementation of the EPI, highlighting context-specific factors such as the ongoing civil conflict in Cameroon, and the presence of other infectious diseases like COVID-19.

Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.

Cancer immunotherapy from biology to nanomedicine

With the significant drawbacks of conventional cancer chemotherapeutics, cancer immunotherapy has demonstrated the ability to eradicate cancer cells and circumvent multidrug resistance (MDR) with fewer side effects than traditional cytotoxic therapies. Various immunotherapeutic agents have been investigated for that purpose including checkpoint inhibitors, cytokines, monoclonal antibodies and cancer vaccines. All these agents aid immune cells to recognize and engage tumor cells by acting on tumor-specific pathways, antigens or cellular targets. However, immunotherapeutics are still associated with some concerns such as off-target side effects and poor pharmacokinetics. Nanomedicine may resolve some limitations of current immunotherapeutics such as localizing delivery, controlling release and enhancing the pharmacokinetic profile. Herein, we discuss recent advances of immunotherapeutic agents with respect to their development and biological mechanisms of action, along with the advantages that nanomedicine strategies lend to immunotherapeutics by possibly improving therapeutic outcomes and minimizing side effects.

Review: Vaccine Myth-Buster - Cleaning Up With Prejudices and Dangerous Misinformation

Although vaccines have already saved and will continue to save millions of lives, they are under attack. Vaccine safety is the main target of criticism. The rapid distribution of false information, or even conspiracy theories on the internet has tremendously favored vaccine hesitancy. The World Health Organization (WHO) named vaccine hesitancy one of the top ten threats to global health in 2019. Parents and patients have several concerns about vaccine safety, of which the ubiquitous anxieties include inactivating agents, adjuvants, preservatives, or new technologies such as genetic vaccines. In general, increasing doubts concerning side effects have been observed, which may lead to an increasing mistrust of scientific results and thus, the scientific method. Hence, this review targets five topics concerning vaccines and reviews current scientific publications in order to summarize the available information refuting conspiracy theories and myths about vaccination. The topics have been selected based on the author's personal perception of the most frequently occurring safety controversies: the inactivation agent formaldehyde, the adjuvant aluminum, the preservative mercury, the mistakenly-drawn correlation between vaccines and autism and genetic vaccines. The scientific literature shows that vaccine safety is constantly studied. Furthermore, the literature does not support the allegations that vaccines may cause a serious threat to general human life. The author suggests that more researchers explaining their research ideas, methods and results publicly could strengthen the general confidence in science. In general, vaccines present one of the safest and most cost-effective medications and none of the targeted topics raised serious health concerns.

Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies

Importance

The success in ending the COVID-19 pandemic rests partly on the mass uptake of the COVID-19 vaccine. Little work has been done to understand vaccine willingness among older adolescents and young adults. This is important since this age group may be less likely to adhere to public health guidelines.

Objective

To understand willingness of getting a vaccine and reasons for vaccine hesitancy among a sample of older adolescents and young adults.

Design

Data were from the Well-Being and Experiences study (The WE Study), a longitudinal community-based sample of older adolescents and young adults collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664).

Setting

The study setting was a community-based observational longitudinal study.

Participants

Participants for the study were aged 14 to 17 years old at baseline in 2016–17 (n = 1000). Data were also collected on one parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 2020, respectively.

Exposures

The main exposures were sociodemographic factors, health conditions, COVID-19 knowledge, and adversity history.

Main Outcomes

The main outcomes were COVID-19 vaccine willingness, hesitancy, and reasons for hesitancy.

Results

Willingness to get a COVID-19 vaccine was 65.4%. Willingness did not differ by age, sex, or mental health conditions, but did differ for other sociodemographic characteristics, physical health conditions, COVID-19 knowledge, practicing social/physical distancing, and adversity history. The most common reasons for not wanting a vaccine were related to safety, knowledge, and effectiveness. Sex differences were noted.

Conclusions and Relevance

Increasing uptake of the COVID-19 vaccine among older adolescents and young adults may rely on targeting individuals from households with lower income, financial burden, and adversity history, and generating public health messaging specifically aimed at vaccine safety, how it works to protect against illness, and why it is important to protect oneself against a COVID-19 infection.

Parents' willingness to pay for a COVID-19 vaccine for themselves and their children in the United States

Differences in obtaining a vaccine vary based on a multitude of factors including perceptions of vaccine safety, efficacy and willingness to pay (WTP). This study focuses on parent perceptions toward a vaccine for COVID-19 including their WTP decisions for their children and themselves. A mixed methods design using a cross-sectional survey was used to assess the perceptions of US parents, with children under 18, in response to the COVID-19 pandemic. The survey was administered online in November 2020 and 584 final responses were collected. The questionnaire consisted of approximately 37 closed and open-ended questions regarding personal background information; awareness, knowledge, and experience of the virus; perception toward vaccines and COVID-19; and the contingent valuation of a hypothetical COVID-19 vaccine. WTP was found to be higher for children and a direct relationship between the number of children and WTP was observed. Parents were willing to pay US$228-$291 for a vaccine for themselves and US$243-US$321 for their children. A positive impact on WTP was found with self-reported parent health status but not children. The findings of this study have important implications for policy programs which require detailed cost-benefit analyses. WTP for a COVID-19 vaccine is crucial to determine the partial benefits of vaccinating to reduce the risk of repetitive widespread outbreaks.

Microneedles: A New Generation Vaccine Delivery System

Transdermal vaccination route using biodegradable microneedles is a rapidly progressing field of research and applications. The fear of painful needles is one of the primary reasons most people avoid getting vaccinated. Therefore, developing an alternative pain-free method of vaccination using microneedles has been a significant research area. Microneedles comprise arrays of micron-sized needles that offer a pain-free method of delivering actives across the skin. Apart from being pain-free, microneedles provide various advantages over conventional vaccination routes such as intramuscular and subcutaneous. Microneedle vaccines induce a robust immune response as the needles ranging from 50 to 900 μm in length can efficiently deliver the vaccine to the epidermis and the dermis region, which contains many Langerhans and dendritic cells. The microneedle array looks like band-aid patches and offers the advantages of avoiding cold-chain storage and self-administration flexibility. The slow release of vaccine antigens is an important advantage of using microneedles. The vaccine antigens in the microneedles can be in solution or suspension form, encapsulated in nano or microparticles, and nucleic acid-based. The use of microneedles to deliver particle-based vaccines is gaining importance because of the combined advantages of particulate vaccine and pain-free immunization. The future of microneedle-based vaccines looks promising however, addressing some limitations such as dosing inadequacy, stability and sterility will lead to successful use of microneedles for vaccine delivery. This review illustrates the recent research in the field of microneedle-based vaccination.

Increased COVID-19 Vaccination Hesitancy and Health Awareness amid COVID-19 Vaccinations Programs in Israel

In January 2021, Israel started vaccinating healthcare workers (HCWs) and individuals older than 65 years with COVID-19 vaccines. Scientific literature points to vaccine hesitancy as being a major health concern. During time of pandemics, increased consciousness of health behaviors may be encountered. The current study aimed to assess attitudes to general vaccines and to COVID-19 vaccines in particular among adult (>18) Israeli general public, and among Israeli dentists and dental hygienists. Cross-sectional surveys were filled out by a total of 501 participants (361 Israeli adults >18 years, 73 dental hygienists, and 67 dentists). Along with basic demographics, participants responded to the Hebrew VAX, COVID-VAX and HCS scales. Group comparisons were analyzed using t tests and ANOVAs with Scheffe's test used for post hoc comparisons. Dental hygienists demonstrated significantly higher anti-vaccinations approaches than both dentists (p < 0.01) and the general public (p < 0.05). In all groups, attitudes towards the COVID-19 vaccines were more negative compared to attitudes towards general vaccines, with hygienists demonstrating significant negative attitudes compared to dentists (p < 0.05). The general public (p = 0.56) and hygienists demonstrated increased health awareness compared to dentists (p < 0.05). As health awareness has increased during the COVID-19 pandemic primary strategies to combat vaccine hesitancy should be implemented in the general public, and in particular, an dental teams.