Addressing an urgent global public health need: Strategies to recover routine vaccination during the COVID-19 pandemic

Influence of the COVID-19 pandemic on caregiver beliefs and experiences of routine childhood immunisation in Indonesia

The COVID-19 pandemic contributed to significant health services declines in South-East Asia including Indonesia, which experienced a decline in routine immunisation of children. This study investigated the influence of the pandemic on the beliefs and experiences of caregivers of children related to routine immunisation. This study involved a cross-sectional survey among 1399 caregivers of children aged 0-24 months in Central Java and West Nusa Tenggara provinces from March-April 2022. Data on beliefs and experiences of childhood immunizations were captured using core items from the WHO/UNICEF Behavioural and Social Drivers of Immunization (BeSD) survey. Bivariate and multivariate logistic regression analyses identified factors associated with uptake of routine immunisations. While nearly all caregivers (95.7%) reported wanting their child to receive all recommended routine immunisations, only 40.3% of children aged 2-24 months were up-to-date with all vaccines for age. Factors associated with up-to-date included higher parental education (aOR: 1.76, 95% CI 1.02-3.05), higher household income (aOR: 1.54, 95% CI 1.09-2.18), and caregivers who found it moderately or very easy to get immunisations (aOR: 2.26/2.22, 95% CI 1.06-4.83/1.06-4.69). Recovery efforts should prioritise responding to the factors associated with immunisation status (e.g., perceived ease of access) and on families experiencing disadvantage (e.g., caregivers with lower education and household income) to ensure protections against future outbreaks that are responsive to the context-specific needs and priorities of districts and communities.

Comparison of adult hesitancy towards COVID-19 vaccines and vaccines in general in the USA

BACKGROUND

Adults who are hesitant toward routinely recommended vaccines for adults may also be hesitant toward COVID-19 vaccines. However, the distribution and differences in hesitancy between routinely recommended vaccines and COVID-19 vaccines, and the association of hesitancy regarding routinely recommended vaccines and hesitancy with COVID-19 vaccination status and intent, is unknown.

METHODS

Using the Research and Development Survey (RANDS) during COVID-19, Round 3, a probability-sampled, nationally representative, web and phone survey fielded from May 17 - June 30, 2021 (n = 5,434), we examined the distribution and difference in prevalence of hesitancy towards COVID-19 and vaccines in general, beliefs associated with vaccine hesitancy, and factors impacting plans to be vaccinated against COVID-19.

RESULTS

Reported hesitancy towards COVID-19 vaccines (42.2%) was 6-percentage points higher than hesitancy towards vaccines in general (35.7%). Populations who were most hesitant toward COVID-19 vaccines were younger adults, non-Hispanic Black adults, adults with lower education or income, and adults who were associated with a religion. Beliefs in the social benefit and the importance of vaccination, and the belief that COVID-19 vaccines lower risk for infection, were strongly associated with COVID-19 vaccination and intent to be vaccinated.

CONCLUSIONS

Vaccine hesitancy for both COVID-19 vaccines and vaccines in general is common. Health providers and public health officials should utilize strategies to address vaccine hesitancy, including providing strong clear recommendations for needed vaccines, addressing safety and effectiveness concerns, and utilizing trusted messengers such as religious and community leaders to improve vaccine confidence.

Effectiveness of a vaccine recovery plan after the COVID-19 pandemic in the Siracusa Local Health Authority, Italy. Results of one year follow-up

Introduction

The COVID-19 pandemic has strongly impacted on the immunization services around the world, threatening the gains made in the control of vaccine-preventable diseases.

Methods

A vaccination recovery plan of missed vaccinations has been put in place in the LHA of Siracusa after the pandemic. We compared 2021 and 2020 vaccination coverage by age group and vaccine type after one year of follow-up of the recovery plan. The Chi-square test was executed on proportions for the years 2021 vs 2020. Results were considered statistically significant at a two-tailed p-value ≤ 0.05.

Results

36-month coverage rates were 92.5% for polio and 93.7% for measles-containing-vaccine, representing -0.3% and -1.8% decreases, respectively, as compared to 2020. By 8 years of age (booster doses), immunisation coverage was 80.7% for polio and 80.1% for measles, representing a -5.7% and -3.7%, respectively, compared to 2020. 36-month coverage was 56.6% for Men B (-5.0% as compared to 2020), 73.2% for Men ACW135Y/C (+1.1% as compared to 2020) and 86.9% for PNC vaccine (-1.7%, as compared to 2020). Regarding HPV vaccination, in 2021, vaccine coverage was 44.2% (-4.4% compared to 2020). Compared to the previous report, the VC difference among the cohorts narrowed for all almost vaccinations, except for the anti-men B and the anti-HPV vaccination, for which we recorded an increase in VC difference, and for men ACW135Y/C, for which a significant increase has been recorded.

Conclusions

Despite the efforts to organize and realize an extensive and well-designed vaccination recovery, our data show that even after the 1-year follow-up, globally deficits in coverage for these routine vaccinations persist, although there has been a substantial and significant recovery of missed vaccinations, especially among younger children and for primary cycles.

From Polio to COVID-19: Examining the Impact of Pandemics on Childhood Vaccination Programs

This review article aims to examine the impact of pandemics on childhood vaccination programs, specifically looking at the examples of polio and coronavirus disease 2019 (COVID-19). The article provides a comprehensive overview of the history of polio vaccination programs, including the challenges of eradicating the disease and the barriers to vaccine uptake. The article also looks at the global efforts to eradicate polio, such as the Global Polio Eradication Initiative, and the progress made in reducing the number of polio cases worldwide. The article reviews the impact of the COVID-19 pandemic on childhood vaccination programs and how the pandemic has disrupted routine vaccination services. Lockdowns and travel restrictions have contributed to this, which has reduced access to medical facilities and vaccine uptake. The article also explores how the prioritization of COVID-19 vaccines has led to a diversion of resources away from routine childhood immunization programs. The article highlights the need to address these challenges to prevent a resurgence of vaccine-preventable diseases. Furthermore, the article discusses the lessons learned from these pandemics, such as the importance of global collaboration, vaccine equity, addressing vaccine hesitancy, pandemic preparedness, and embracing technology. The article emphasizes the need to prioritize vaccine equity and ensure that vulnerable populations have access to vaccines. Additionally, the article stresses the importance of addressing vaccine hesitancy and providing effective communication and education about vaccines. The article also advocates for pandemic preparedness, emphasizing the need to invest in research and development of vaccines for emerging infectious diseases. Finally, the article suggests embracing technology as a means to improve vaccine accessibility and distribution.

Past and Future Influenza Vaccine Uptake Motivation: A Cross-Sectional Analysis among Italian Health Sciences Students

Despite its effectiveness in the prevention of seasonal flu, influenza vaccination uptake remains low, even among healthcare workers (HCWs), despite their occupational risk. The aim of this study was to explore the association between main reasons for accepting or refusing influenza vaccination and the decision to receive the vaccination during both previous and following year among health sciences students. A multi-center, cross-sectional study was performed using a validated online questionnaire. Data were analyzed by performing univariable and multivariable logistic analysis. Data from over 3000 participants showed that avoiding the spread of infection to family members and the general population (aOR: 43.55), as well as to patients (aOR: 16.56) were the main reasons associated with the highest probability of taking the influenza vaccination the following year. On the contrary, not considering influenza as a severe disease was the reason associated with the lowest probability for past (aOR: 0.17) and future vaccination (aOR: 0.01). Therefore, the importance of vaccination to protect others should always be the core of vaccination campaigns for health sciences students, together with tools to increase their awareness of the severity of this disease.

Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions

Background

Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021.

Methods

It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis.

Results

The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively.

Conclusions

Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

BACKGROUND

Health challenges like coronavirus disease 2019 (COVID-19) are becoming increasingly complex, transnational, and unpredictable. Studying health system responses to the COVID-19 pandemic is an opportunity to enhance our understanding of health system resilience and establish a clearer link between theoretical concepts and practical ideas on how to build resilience.

METHODS

This narrative literature review aims to address four questions using a health system resilience framework: (i) What do we understand about the dimensions of resilience? (ii) What aspects of the resilience dimensions remain uncertain? (iii) What aspects of the resilience dimensions are missing from the COVID-19 discussions? and (iv) What has COVID-19 taught us about resilience that is missing from the framework? A scientific literature database search was conducted in December 2020 and in April 2022 to identify publications that discussed health system resilience in relation to COVID-19, excluding articles on psychological and other types of resilience. A total of 63 publications were included.

RESULTS

There is good understanding around information sharing, flexibility and good leadership, learning, maintaining essential services, and the need for legitimate, interdependent systems. Decision-making, localized trust, influences on interdependence, and transformation remain uncertain. Vertical interdependence, monitoring risks beyond the health system, and consequences of changes on the system were not discussed. Teamwork, actor legitimacy, values, inclusivity, trans-sectoral resilience, and the role of the private sector are identified as lessons from COVID-19 that should be further explored for health system resilience.

CONCLUSION

Knowledge of health system resilience has continued to cohere following the pandemic. The eventual consequences of system changes and the resilience of subsystems are underexplored. Through governance, the concept of health system resilience can be linked to wider issues raised by the pandemic, like inclusivity. Our findings show the utility of resilience theory for strengthening health systems for crises and the benefit of continuing to refine existing resilience theory.