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Background During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake. Methods We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake. Results The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P  = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57–1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated. Conclusion Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions. [ABSTRACT FROM AUTHOR]

Background: Political polarization may result in increased confirmation bias, strengthening of disinformation mechanisms or policy distortion. This raises the question whether it may influence the vaccination programmes. This study investigates the relationship between the level of political polarization and coronavirus disease 2019 vaccine behaviour and vaccine acceptance. Methods: In our study, we use the Partisan Polarization Index (PPI). The PPI aims to measure the gap between satisfaction with the government expressed by supporters of the ruling parties and that expressed by supporters of the opposition parties. We use the data from the latest round of the European Social Service from 23 countries. The effect of the PPI on the variability of vaccination declarations and intent across countries was verified based on a linear regression model. Results: The linear regression score for 23 countries revealed a statistically significant relationship between the vaccination variable and the level of political polarization. The model explains the variability in the vaccination levels based on the PPI in a given country at 38.6%. Conclusions: Political polarization can contribute to shaping negative attitudes towards vaccination through policy distortion, undermining the effectiveness of compliance against regulation, undermining trust in science and increasing the public's susceptibility to conspiracy theories. [ABSTRACT FROM AUTHOR]

Background: High rates of vaccination are worldwide required to establish a herd immunity stopping the current COVID-19 pandemic evolution. Vaccine hesitancy is a major barrier in achieving herd immunity across different populations. This study sought to conduct a systematic review of the current literature regarding attitudes and hesitancy to receiving COVID-19 vaccination worldwide. Methods: A systematic literature search was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched, namely PubMed and Web of Science, on February 24th, 2021 using a set of developed keywords. Inclusion criteria included the study to be 1) conducted in English; 2) investigated attitudes, hesitancy, and/or barriers to COVID-19 vaccine acceptability among a given population; 3) utilized validated measurements techniques; 4) have the full text paper available and 5) be peer-reviewed prior to final publication. The Newcastle Ottawa (NOS) scale for cross sectional studies was used to assess the quality of the studies. Results: 73 studies were included in qualitative synthesis. Overall, vaccine acceptance rates ranged from 23.6% in Kuwait to 94.3% in Malaysia and Nepal. A variety of different factors contributed to increased hesitancy, some of which included having negative perception of vaccine efficacy, safety, convenience and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, less educated, with lower income, with no insurance, living in the rural area and self-identified as a racial/ethnic minority. Conclusions: Vaccine hesitancy rates against COVID-19 vaccine ranged widely among across different populations. Identifying the factors that interplay and result in high hesitancy rates among a population can allow formulating a directed intervention to increase their vaccination uptake rates. Key messages: • It is necessary to understand the factors that contribute to the COVID-19 vaccine hesitancy. • It is important to inform policy-makers and formulate direct intervention measures that will successfully handle the pandemic. [ABSTRACT FROM AUTHOR]

Background: Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrantsensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic. Methods: We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out. Results: We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns [ABSTRACT FROM AUTHOR]

It is well known how vaccines typically require many years of research and testing before being on the market, but in 2020 the COVID-19 pandemic pushed scientists to embark on a race to produce safe and effective SARS-CoV-2 vaccines in record time. In such an emergency situation, striking the right balance between urgency and acceptable safety and efficacy evidence is challenging. Furthermore, other relevant issues need to be more comprehensively addressed, including cost-effectiveness of vaccination campaigns and real-world data on effectiveness and safety. Currently the European Medicines Agency (EMA) has approved for use four vaccines against COVID-19. Data on their efficacy and safety will continue to be collected beyond licensure and submitted to EMA, but the need for a more complete assessment, which includes contextual and societal considerations (e.g. impact on population health, population’s demand, attitudes and behaviours, ethical considerations) and economic analysis, is unquestionable to support national decision-maker processes. In this kind of ‘‘holistic’’ approach, the Health Technology Assessment (HTA) could be the answer in order to support the allocation of resources into different COVID-19 vaccines and to make it possible a timely and equitable access to vaccination. As also stated in the HTAi Position Paper on ‘‘HTA’s Critical Role in the (Early) Assessment of (potential) Vaccines to prevent the spread of COVID-19 globally’’, the following issues should be carefully tackled: 1) affordability, sustainability and distributional effects; 2) cost-effectiveness considerations; 3) fostering HTA collaborations; 4) need for early, adaptive and living HTA. Accounting for such issues is essential to ensure that HTA is successfully implemented in the field of COVID-19 vaccines, at the present time and in its future developments on a national and international scale. This workshop will discuss how HTA could help the EU-wide and national decision-making process about COVID-19 vaccines. Key messages: An adapted and living HTA framework considering the unique characteristics of COVID-19 vaccines could be an answer to current and future challenges in vaccination campaigns. There are several challenges in current and future HTA of COVID-19 vaccines, namely the evaluation of their broad economic impacts, their effectiveness and safety and organization issues. [ABSTRACT FROM AUTHOR]

Background The Covid-19 pandemic is an economic and a health crisis. Households reduced consumption expenditures as large-scale physical distancing measures, lower disposable incomes and fear of infection when engaging in many types of economic activity took hold. This, in turn, reduced domestic tax revenues at a time when governments were facing increased financial pressures to strengthen and sustain welfare states. Methods We developed a simulation model, the Covid-19 Taxination Simulator, to estimate potential economic gains and tax revenues attributable to vaccine rollouts. We apply the model to 12 European Union countries which had low vaccination rates at the beginning of 2022. Results The highest growth in aggregate personal consumption expenditure attributable to Covid-19 vaccines administered as of January 2022 is in Greece (10.8%), Slovenia (8.6%) and Czechia (8.6%), while the lowest is in Bulgaria (2.2%) and Slovakia (2.1%). If countries had vaccinated 85% of their adult population, the largest gains in consumption tax revenues would be expected in Romania (830 million Euros) and Poland (738 million Euros). Consumption tax revenues generated by meeting the 85% of the adult population target would, on their own, be large enough to fully cover the costs of expanding the vaccine rollout itself in Estonia, Latvia, Slovenia, Croatia, Czechia, Hungary and Greece. Conclusion Covid-19 vaccination rollouts not only save lives and relieve pressures on health systems, they also support economic growth and generate additional tax revenues. These revenues can partially offset the costs of vaccines programmes themselves. [ABSTRACT FROM AUTHOR]

Background In 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective. Methods A combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association). Results Vaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines. Conclusions There are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession. [ABSTRACT FROM AUTHOR]

This section offers public health-related news briefs in Europe as of December 1, 2021. The World Health Organization (WHO) Global Air Quality Guidelines was launched in September 2021 offering updated air quality guideline (AQG) levels for six key air pollutants. The European Union (EU) vaccines strategy has led to the delivery of over 890 million COVID-19 vaccine doses to Member States, vaccinating over 290 million citizens. The 15th European Public Health Conference will be held in Germany.

In this article, we examine what the role of the private sector in times of crises is and whether the private sector is, and can be held to be, accountable. COVID-19 has amplified the difficulties with public–private partnerships and this article addresses several aspects concerning business enterprises, in particular transnational corporations, human rights and health sector activities, highlighting the key aspects to understand and address accountability issues. The article also explores accountability for the private sector, the processes to ensure accountability, and the relevance of regulation and self-regulation. [ABSTRACT FROM AUTHOR]

Problem: The COVID-19 pandemic highlighted existing healthcare disparities in the US, with people of color dying from COVID-19 at twice the rate of white people. A striking disparity in vaccination rates for racial minorities followed, with vaccination rates among white people over 2.5 times that for Latinx and nearly twice that for Black people (March 2021). It is vital we ensure tailored public health messaging regarding the COVID-19 vaccine is delivered to all communities. Facebook provides an opportunity for large-scale, targeted health promotion. Description of practice: Our goal is to increase COVID-19 vaccination uptake across the US, with a specific focus on reaching underrepresented communities most affected by the pandemic. We created a public health campaign centered on a representative group of physicians conveying their own short (<1 minute) video messages that the COVID-19 vaccine is safe and effective. We placed these videos as advertisements on Facebook and directed them using geotargeting to reach zip codes in the US with the highest COVID-19 death rates cross-referenced with zip codes in which >50% of the population is Black or Latinx. We launched the campaign in California on April 9, and nationwide on April 12 2021. The primary outcome measures of the campaign were reach (number of individuals exposed, frequency and duration of views) and engagement (number of likes and shares). Results: During our campaign (April 9-April 30), the videos appeared on Facebook newsfeeds 54.4 million times, reaching 9.9 million individuals an average of 5.5 times each. Overall, the videos received 10,053 reactions and 1,161 shares. 1.8 million video plays ran for at least 25% of the video. Lessons: We demonstrate the feasibility of rapid, social media-based dissemination of tailored public health messages regarding the COVID-19 vaccine to communities in need. We are now focusing efforts on strategies to assess the impact of such messaging on vaccination uptake. Key messages: Geotargeting on social media enabled rapid dissemination of COVID-19 vaccine uptake messages to underrepresented communities. Further work is required to evaluate behavioral change impact. [ABSTRACT FROM AUTHOR]

The article offers information on a workshop at the 16th World Congress on Public Health 2020 on COVID-19 immunization.

Background: Compartmental models are the simplest in the mathematical study of infectious disease dynamics. Using an age-stratified compartmental model allows us to understand which population groups to target and to what extent to act, in order to achieve predefined goals in line with policy and/or health choices. In fact, the vaccination strategies of most countries are age dependent. With this study we want to show that the optimal vaccination strategy should be different depending on the type of health or social objective to be achieved. Methods: A time varying susceptible-infected-recovered-deceased (SIRD) compartmental models, stratified into ten age groups of ten years was developed on Italian data. An optimal vaccination strategy was obtained minimizing deaths or infectious starting from April 11, 2021, considering the total doses due to Italy by the European contract for each type of vaccine from April to June. The efficacy of each vaccine and the days between administration and the beginning of immunization were also considered. Results: On April 11, about 75% of over-80 Italian population have received at least the first dose of vaccine. Concerning the minimization of death, the model gives the priority to the older people (>60-year-old). This confirms the Italian vaccination strategy by completing the remaining vaccinations of over-80s and then vaccinating those between 60 and 80. Instead, if the priority were to reduce the infected, the model would recommend vaccinating the most of over-80s and the classes aged 20-30 and 40-60. Conclusions: In conclusion, the use of this model can help to vary vaccine strategies by adopting targeted approaches to effectively achieve specific objective. For example, given the different age destination of some vaccine types, a good vaccination strategy might have been to vaccinate the over 90s with one type of vaccine to protect them from high risk of death while simultaneously vaccinating younger people to contain the spread. Key messages: The modelling approach is an excellent decision support tool for pandemic containment. The compartmentalized model stratified by age allows to act more efficiently on subpopulations. [ABSTRACT FROM AUTHOR]

Developments in COVID-19 have gone unprecedently fast, and HTAs have tried to keep pace, for example, in HTAcommittees like the Joint Committee of Vaccination & Immunization. Necessarily, HTAs of COVID-19 related issues have been numerous and of a dynamic character to adequately cope with the rapidly changing landscape. HTAi drafted a statement on COVID-19 vaccines in the 2nd half of 2020 and an update in the 1st half of 2021. Here, we will address the role of real-world data (RWD) on effectiveness, safety and benefit/risk coming from the close monitoring programs around implementation in selected countries. Notably, an abundance of data came from Israel and the United Kingdom. Where the initial vaccination programs were designed based on clinical trials, HTA-committees continuously monitored observational data and dynamically redesigned the programs based on these. RWD have sometimes enhanced an increasing generic view on the vaccines, for example, concerning the use in older adults, as well as prioritizing specific ones for specific groups. RWD clearly show the effects of the vaccination programs on hospitalizations and deaths, in particular in those countries with an early kick-start of vaccination. Typically, cost-effectiveness analysis has so far not played any role in HTAs within crisis situations. We will address this in our presentation, illustrating potential value-for-money of the current vaccines in various countryspecific settings looking at dynamic modelling and extensive data needs underlying economic assessments. Correspondingly, these models were initially populated with clinical trial data and are currently undergoing continuous updates as RWD come. Increasing interest in cost-effectiveness, dynamic pricing, tiered pricing in different parts of the world and enhanced competition will further shift attention to the economic aspects, further illustrating the dynamic character of HTAs in this field and HTAi’s statement as an overall concept. [ABSTRACT FROM AUTHOR]