The Model of "Informed Refusal" for Vaccination: How to Fight against Anti-Vaccinationist Misinformation without Disregarding the Principle of Self-Determination

Examining double standards in layoff preferences and expectations for gender, age, and ethnicity when violating the social norm of vaccination

Whether vaccination refusal is perceived as a social norm violation that affects layoff decisions has not been tested. Also unknown is whether ascribed low-status groups are subject to double standards when they violate norms, experiencing stronger sanctions in layoff preferences and expectations, and whether work performance attenuates such sanctioning. Therefore, we study layoff preferences and expectations using a discrete choice experiment within a large representative online survey in Germany (N = 12,136). Respondents chose between two employee profiles, each with information about ascribed characteristics signaling different status groups (gender, age, and ethnicity), work performance (work quality and quantity, and social skills), and whether the employees refused to vaccinate against COVID-19. We found that employees who refused vaccination were more likely to be preferred and expected to be laid off. Respondents also expected double standards regarding layoffs due to vaccination refusal, hence, harsher treatment of females and older employees. Nonetheless, their preferences did not reflect such double standards. We found little support that high work performance attenuates these sanctions and double standards, opening questions about the conditions under which social biases arise. Our results suggest detrimental consequences of vaccination refusal for individuals, the labor market, and acceptance of health policies.

Learning from the Past to Improve the Future—Vaccine Hesitancy Determinants in the Italian Population: A Systematic Review

WHO identifies vaccine hesitancy (VH) as one of the ten threats to global health. The authors bring to the international scientific community an Italian episode that offers the opportunity to renew the discussion on the extent of the VH matter. The purpose of this systematic review is to analyze the factors determining vaccine hesitancy in the Italian population, to understand its roots, and suggest potential strategies to mitigate it. A systematic review of the literature according to the PRISMA guidelines was carried out using the SCOPUS and Medline (via PubMed) databases, using the following strategy: (COVID-19 vaccines) AND (vaccination hesitancy) AND (Italy). After the selection process, 36 articles were included in this systematic review. The most frequently detected factors associated with VH in the Italian population can be grouped as vaccine-related factors, socio-cultural factors, and demographic factors. Currently, we are facing a gap between the population and science, governments, and institutions. To heal this breach, it is necessary to strengthen the trust of the population through the implementation of health communication and public education strategies, while scientific literacy must continue to support families and individuals in discerning evidence from opinions to recognize the real risks and balance them with the benefits.

Parents' and Health Professionals' Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age-A Qualitative Thematic Analysis Embedded in a Randomized Trial

Declining levels and duration of passively acquired maternal antibodies prompted a Danish trial to test the feasibility of advancing administration of the first measles, mumps, and rubella vaccine (MMR1) from 15 to 6 months of age. A trial-embedded qualitative study aimed to understand parents' (N = 24) and health professionals' (N = 11) attitudes about the measles, mumps, and rubella vaccine (MMR) in general and about advancing MMR1 administration. Overly positive parent attitudes were contrasted by members of a vaccine-skeptical organization including parents considering that their child was seriously vaccine-injured long ago. Parents' attitudes to advancing MMR1 mirrored their attitudes about the MMR vaccine in general, with four positions along a continuum of trust in the healthcare system: unquestioning trust, acceptance after careful consideration, challenging indecisiveness, and defensive rejection. Low tolerance was identified between vaccine supporters and vaccine opponents. Parents of children with perceived serious vaccine-related injuries described lifelong unresolved feelings of guilt. Supporters of advanced MMR1 saw it as a timely and convenient administration of a well-known vaccine, whereas opponents feared it would disturb the children's immature immune systems and emphasized difficulties in recognizing side effects so early in life. Health professionals were supportive of advancing the MMR1 vaccine and they carefully challenged the parents. Current MMR vaccine supporters show readiness to advance MMR1 administration.

Prevention and management of adverse events following COVID-19 vaccination using traditional Korean medicine: An online survey of public health doctors

BACKGROUND

Since February 2021, vaccination against coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has started in Korea.

AIM

To perform a questionnaire survey about the prevention and management of adverse events of COVID-19 vaccination among public health doctors of Korean Medicine (PHKMDs).

METHODS

An online questionnaire was developed, comprising categories about adverse events of vaccination (AEVs) and perception of using Korean medicine (KM) in managing vaccine adverse events (AEs) among PHKMDs. PHKMDs’ experience of AEVs, usage of Korean medicine for AEVs, and perception and attitude in using KM for AEVs were surveyed. The survey web-link was emailed to the association of PHKMDs. Online links were sent through Survey Monkey to all PHKMDs in Korea.

RESULTS

A total of 143 participants were recruited for this study; 65% of participants were vaccinated at the same of the survey (n = 93). Although most participants did not take any medication for prevention of the adverse events, 62% (n = 58) of participants had taken herbal medicine to treat the adverse events (n = 52). Approximately 35% of participants (n = 33) said that they would recommend taking herbal medicine to prevent any AEVs. From various KM interventions, the participants strongly recommended taking an herbal medicine (n = 69, 74.19%) to treat AEs, and the second-highest was acupuncture treatment (n = 19, 20.43%).

CONCLUSION

Overall, this research demonstrated a high prevalence of KM usage by the PHKMDs. Hence, this study's results may serve as fundamental evidence for health professionals to consider using KM treatments when treating or preventing AEVs in the near future.

An Overview of Strategies to Improve Vaccination Compliance before and during the COVID-19 Pandemic

The debate on vaccination mandate was fuelled over the past two years by the COVID-19 pandemic. This study aimed at overviewing vaccination strategies and corresponding vaccine coverages for childhood vaccinations before the pandemic and for SARS-CoV-2 in high-income countries. A qualitative comparison was also performed between the two contexts: unlike for childhood vaccinations, only one European country (Austria) imposed generalised COVID-19 mandates, most countries preferring targeted mandates for higher-risk categories (Italy, Greece) or workers in key public services (Finland, Australia, New Zealand, UK, Germany). Many countries (Norway, Sweden, Netherlands, Portugal, Spain) confirmed their traditional voluntary vaccination approach also for COVID-19, while others (Slovenia and Hungary), historically relying on compulsory vaccination strategies, surprisingly opted for voluntary SARS-CoV-2 vaccination, with unsatisfactory results in terms of immunisation rates. However, no tangible relationship was generally found between vaccination policies and immunisation coverages: data show that, unlike some countries with mandates, countries where vaccinations are merely recommended could achieve higher coverages, even beyond the recommended 95% threshold. The COVID-19 experience has enriched pre-existent vaccination strategy debates by adding interesting elements concerning attitudes towards vaccines in a novel and unexplored context. Interpreting the available results by considering the different cultural contexts and vaccine hesitancy determinants can help to better understand the complexity of the relationship between policies and achieved coverages.

The Role of Needle Fear in Pediatric Flu Vaccine Hesitancy: A Cross-Sectional Study in Bologna Metropolitan Area

(1) Background: vaccination is the most effective way to prevent influenza and reduce its complications. The main aim of the study is to assess a possible increase of parents’/caregivers’ pediatric flu vaccination adherence due to a nasal administration as an alternative to injection in Bologna. (2) Methods: 169 parents/guardians of children who were joining the COVID-19 pediatric vaccination session in Bologna were interviewed. The results were summarized using descriptive statistics. A multiple logistic regression model was used to assess the determinants of the change in flu vaccine uptake if offered without injection administration. All analyses were conducted using STATA and R-Studio software. (3) Results: Only 29.0% of parents were informed about pediatric flu vaccination by pediatricians, and 32.5% heard about pediatric flu vaccination. Almost 72.2% of parents declared that they would not have their children vaccinated against influenza. Thus, 40.2% of them changed their opinion after being informed about the existence of a non-injective vaccine. Needle fear in children turned out to be a determinant of this opinion change (OR = 3.79; 95% CI = 1.63–9.43; p = 0.003). (4) Conclusions: the study has confirmed that needle fear is a determinant of vaccine hesitancy and that a different method of administration may increase parents’/guardians’ adherence.

No-Fault Compensation and Anti-COVID-19 Compulsory Vaccination: The Italian Context in a Broad View

Italy, like other European countries, has produced a series of regulations during the COVID-19 pandemic. Compulsory vaccination has been introduced for the Italian population. Meanwhile, the Decree-Law 27 January 2022 n. 4 provided for the compensation mechanism for those who have received damage of the psycho-physical integrity due to the anti-SARS-CoV-2 vaccination recommended by the Italian Health Authority. Law 1992 no. 210 already provided for the indemnity system for persons damaged by irreversible complications due to compulsory vaccinations, transfusions, and the administration of blood products. The legislator intended to attribute the right to an indemnity that is not compensatory in order to repair a wrong connected to some hypothesis of liability, but it rather has a welfare character in the broad sense, being attributable to Constitutional fundamentals. In the Italian panorama, although the vaccination damages have been fully included in the already existing law no. 210/1992, to date, no precise indications have been provided regarding the ascertainment of the causal link and the extent of the compensable damage. In the near future, the interest of the scientific community will focus on the evaluation of applications for access to the benefit.

Debate on mandatory COVID-19 vaccination

BACKGROUND

Since January 2020, worldwide public health has been threatened by COVID-19, for which vaccines have been adopted from December 2020.

DISCUSSION

Although vaccines demonstrate effectiveness against this disease, vaccine hesitancy reveals concerns towards short-term and long-term side effects or adverse reactions such as post-inoculation death. Mandatory vaccination is used to provide herd immunity, but is refutable due to infringement of human rights and autonomy. Furthermore, the evidence testifies that vaccination cannot guarantee prevention of infection or re-infection, resulting in public resentment against this coercive measure, whilst post-inoculation anxiety continues.

PERSPECTIVE

This discussion suggests a holistic approach, involving the collective efforts of governments, medical experts and individuals, through basic preventive measures and alternative therapy to live with COVID-19 in a healthy and resourceful manner.

Death after the Administration of COVID-19 Vaccines Approved by EMA: Has a Causal Relationship Been Demonstrated?

More than eight billion doses of COVID-19 vaccines have been administered globally so far and 44.29% of people are fully vaccinated. Pre-authorization clinical trials were carried out and the safety of vaccines is still continuously monitored through post-commercialization surveillance. However, some people are afraid of vaccine side effects, claiming they could lead to death, and hesitate to get vaccinated. Herein, a literature review of COVID-19-vaccine-related deaths has been carried out according to the PRISMA standards to understand if there is a causal relationship between vaccination and death and to highlight the real extent of such events. There have been 55 cases of death after COVID-19 vaccination reported and a causal relationship has been excluded in 17 cases. In the remaining cases, the causal link between the vaccine and the death was not specified (8) or considered possible (15), probable (1), or very probable/demonstrated (14). The causes of deaths among these cases were: vaccine-induced immune thrombotic thrombocytopenia (VITT) (32), myocarditis (3), ADEM (1), myocardial infarction (1), and rhabdomyolysis (1). In such cases, the demonstration of a causal relationship is not obvious, and more studies, especially with post-mortem investigations, are needed to deepen understanding of the possible pathophysiological mechanisms of fatal vaccine side effects. In any event, given the scarcity of fatal cases, the benefits of vaccination outweigh the risks and the scientific community needs to be cohesive in asserting that vaccination is fundamental to containing the spread of SARS-CoV-2.

SARS-CoV2 Vaccination Adverse Events Trend in Italy: A Retrospective Interpretation of the Last Year (December 2020–September 2021)

At the end of 2020, a vaccination campaign against COVID-19 was launched. In 2021, legal obligations for health workers, as well as specific regulations for all workers, were introduced. The global SARS-CoV-2 pandemic was followed by epochal changes in life, school, and work habits in Italy. Therefore, the pharmacovigilance work currently being conducted in Italy by the AIFA concerning the recording and analysing of adverse reactions related to the use of vaccines has proved to be very important. The latest report, including a period of 10 months from December 2020 to September 2021, has allowed us to combine the results received so far, and to compare the safety of all vaccines currently available in Italy. The results of this analysis are highly encouraging and reveal the statistical reliability of the safety of the COVID-19 vaccines currently used in Italy. The dissemination of these findings could increase the public’s awareness of vaccines and their ability to make free and informed choices concerning vaccination. The potential increase in the Italian population’s adherence to the vaccination campaign could ultimately be a decisive factor in achieving herd immunity and the final resolution of the pandemic.

"First Do No Harm". No-Fault Compensation Program for COVID-19 Vaccines as Feasibility and Wisdom of a Policy Instrument to Mitigate Vaccine Hesitancy

Vaccines are so far proven to be safe, although related adverse events cannot be excluded. The urgency for COVID-19 vaccines determined a dilution of the general expectations of safety and efficacy of vaccination (from safe and effective to safe and effective enough). In many countries, a no-fault program was established to compensate individuals who experienced serious vaccine-related injuries. The impressive number of administrations worldwide and the legal indemnity afforded to manufacturers of approved vaccines that cannot be pursued for compensation fed the debate about the availability of a compensation model for COVID-19 vaccine-related injuries. Several European countries have long introduced a system, Vaccine Injury Compensation Programs, to compensate people who suffer physical harm because of vaccination. In Europe, COVID-19 vaccination is strongly recommended for the general population and in many states is declared mandatory for healthcare workers. In 1992, Italy edited Law no. 210 providing legal protection for individuals who reported injuries after mandatory and recommended vaccinations as a no-fault alternative to the traditional tort system. Despite its recommended nature, COVID-19 vaccination is excluded from the no-fault model in several European states, and the Italian government is called to provide clear and firm instructions for the management of the many requests for compensation. The authors provide an overview of the existing compensation models in Europe and analyse available legislative proposals.

Compulsory Vaccination for Healthcare Workers in Italy for the Prevention of SARS-CoV-2 Infection

The European Convention on Human Rights (ECHR) judgement no. 116(2021) of 8 April 2021 establishes the principle of mandatory vaccination, indicating the criteria that national legislation must comply with, following the principle of non-interference in the private life of the individual. Vaccination for the prevention of SARS-CoV-2 infection appears to be an essential requirement for providing healthcare assistance. The European experience with compulsory vaccinations, offers a composite panorama, as the strategy of some European countries is to make vaccinations compulsory, including financial penalties for non-compliance. As in other countries, there is a clear need for Italy to impose compulsory vaccination for healthcare workers, in response to a pressing social need to protect individual and public health, and above all as a defense for vulnerable subjects or patients, for whom health workers have a specific position of guarantee and trust. The Italian Republic provided for mandatory vaccinations for health professionals by Decree-Law of 1 April 2021 no. 44, to guarantee public health and adequate safety conditions. As stated by ECHR, the Italian State, despite having initially opted for recommendation as regards to SARS-CoV-2 vaccination, had to adopt the mandatory system to achieve the highest possible degree of vaccination coverage among health professionals to guarantee the safety of treatments and protection of patients' health. We present the Italian situation on vaccine hesitation in healthcare workers, with updated epidemiological data as well as the doctrinaire, social, and political debate that is raging in Italy and Europe.

Using a Harm Reduction Model to Reduce Barriers to Vaccine Administration

Vaccination is a strategic public health measure designed to reduce the adverse effects of many infectious diseases. Although national recommendations exist for vaccine administration across the life span, immunization rates are affected by barriers to vaccine access and hesitancy in vaccine acceptance. Midwives and women's health clinicians are optimally poised to assess their client's vaccination status and provide vaccinations during clinical encounters. In order to address client concerns about vaccine safety and administration, each clinician is expected to be knowledgeable about vaccine benefits, recommendations, side effects, and potential adverse reactions. Socioeconomic factors, social policies, and historic and continued experiences related to racism have been identified as barriers to ready access to vaccinations and vaccine acceptance. Midwives can act as leaders within their practice sites and communities through participation in projects that reduce barriers to vaccine access and uptake. Community vaccine outreach programs and relationship-based care can increase vaccine uptake through improved health literacy and associated behavioral changes including greater vaccine acceptance. This article focuses on identifying barriers to vaccine uptake and describing harm reduction measures designed to improve uptake of vaccines. A variety of leadership activities are discussed that can improve clinicians' understanding of their role in optimizing vaccination.

Nursing Home and Vaccination Consent: The Italian Perspective

Since the beginning of the Covid-19 pandemic, many countries have begun vaccination campaigns, with different methods and timelines, with the goal of vaccinating over 75% of the population and thus achieving herd immunity. Initially it was necessary to identity the categories of citizens who should be the first to receive the vaccines, on the basis of scientific evidence. On the basis of this information, elderly residents in nursing homes and the staff who care for them should be the highest priority subjects for vaccination. In this context, obtaining informed consent to Covid-19 vaccination presents a considerable challenge, as the advanced age and frequent comorbidities of a significant number of the residents may mean that they are incapable of expressing consent themselves. The legislation of various Western nations substantially agrees on the general principle that those capable of judgement must be asked for their consent for healthcare services, and that even those with psychological weaknesses that limit their full ability to decide must be involved in these decision-making processes. The article can help systematize the processes to be implemented to protect the health of individuals as members of a close and fragile community.