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Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA., Competing Interests: Declaration of interests The Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA is co-hosted by the Yale Institute for Global Health (New Haven, CT) and the Baylor College of Medicine (Houston, TX). PJH is a developer of a COVID-19 vaccine construct that was licensed by the Baylor College of Medicine to Biological E, a commercial vaccine manufacturer, for scale-up, production, testing, and licensing. NTB reports personal fees from WHO, Centers for Disease Control and Prevention, and Merck, outside the submitted work. RMC reports research grant funding from the Novo Nordisk Foundation outside the submitted work. RL reports grants from Pfizer, GlaxoSmithKline, Sanofi Pasteur, and Merck; and personal fees from Biotechnology Innovation Organization, outside the submitted work. YAM is a member of a Data Safety Monitoring Board for Pfizer and a site principal investigator for a Pfizer vaccine trial unrelated to the submitted work. MMM reports personal fees from law firms representing retail pharmacies and generic drug companies that have sued other drug companies for anti-trust law violations, outside the submitted work. DJO reports grants from the US National Institutes of Health outside the submitted work. DRR reports that herself, her spouse, and her children own stocks in GlaxoSmithKline, a vaccine manufacturer. DRR also reports serving in an unpaid volunteer capacity on Moderna's ethics allocation committee. DAS reports grants from Merck and personal fees from Pfizer, outside the submitted work. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This article argues that the Supreme Court should not require a religious exemption from vaccine mandates. For children, who cannot yet make autonomous religious decision, religious exemptions would allow parents to make a choice that puts the child at risk and makes the shared environment of the school unsafe - risking other people's children. For adults, there are still good reasons not to require a religious exemption, since vaccines mandates are adopted for public health reasons, not to target religion, are an area where free riding is a real risk, no religion actually prohibits vaccinating under a mandate, and policing religious exemptions is very difficult.

This article draws on a broadcast popular among the anti-vaccine community to map out six themes used by the broadcast to mislead viewers about COVID-19. The themes are the claim that "they" - government and pharma - are lying to you, claims that COVID-19 is an excuse to remove civil liberties, viewing everyone as an expert, claiming that science cannot save us, skewing the science, and a claim that "they" are out to harm the viewers. The article points out that similar themes are used to mislead followers with anti-vaccine information. It highlights the concern that these themes will not only mislead people who are already anti-vaccine about the pandemic, but may draw in people who are not anti-vaccine but are seeking information about COVID-19, and suggests some options for dealing with the misinformation. Scientists benefit from understanding these claims, as we are often tasked with providing rebuttals to this misinformation., Competing Interests: Declaration of competing interest TCS: No conflicts to disclose. DRR: Dorit Reiss’ family owns some regular stock in GSK., (Copyright © 2020. Published by Elsevier Masson SAS.)

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dorit Reiss owns stock in GSK, a vaccine manufacturer, as part of a diverse portfolio.

Vaccine refusal is a serious public health problem, especially in the context of diseases with potential to spark global pandemics, such as Ebola virus disease in the Democratic Republic of the Congo. This article examines whether and when compelling vaccination through mandates and criminalization, for example, are appropriate. It argues that some legal approaches are ethical when they preserve social stability, trust in government, therapeutic research opportunities, or when they diminish disease severity., (© 2020 American Medical Association. All Rights Reserved.)

Informed consent matters - so does protecting people from infectious diseases. This paper examines what the appropriate informed consent process for vaccines should look like and how the process is conceptualized by law and health authorities. Drawing on the extensive theoretical and empirical literature on informed consent and vaccination, this article sets out what an ideal informed consent process for vaccination would consist of, highlighting the need for autonomous decisions. To be autonomous, decisions need to be based on full, accessible information and reached without coercion. We suggest that the information provided must address the nature of the procedure - including benefits to the child, benefits to society, and risks. Parents should have their concerns and misconceptions addressed. The information needs to be accessible and include an opportunity to ask questions. Based on this ideal model we examined in detail the legal framework surrounding informed consent to vaccination and the process as conceptualized by health authorities in two countries, Israel and the United States, to assess whether they meet the requirements. These two countries are similar in some of their values, for example, the importance of individual autonomy, and face similar problems related to vaccine hesitancy. At the same time, there are meaningful differences in their vaccine policies and the current structures of their informed consent processes, allowing for a meaningful comparison. We found neither country met our ideal informed consent process, and suggested improvements both to the materials and to the processes used to obtain informed consent.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Pan authored legislation (Senate Bill 277) to abolish nonmedical exemptions; Dr Reiss’s family owns regular stock in GlaxoSmithKline.

Influenza mandates in health care institutions are recommended by professional associations as an effective way to prevent the contraction of influenza by patients from health care workers. Health care institutions with such mandates must operate within civil rights frameworks. A recent set of cases against health care institutions with influenza mandates reveals the liabilities posed by federal law that protects employees from religious discrimination. This article examines this legal framework and draws important lessons from this litigation for health care institutions. We argue counterintuitively that providing religious exemptions from influenza mandates may expose health care institutions to more liability than not providing a formal exemption.

Rates of vaccine-preventable diseases have increased in the United States in recent years, largely due to parental refusals of recommended childhood immunizations. Empirical studies have demonstrated a relationship between nonvaccination rates and permissive state vaccine exemption policies, indicating that legal reforms may promote higher immunization rates. This article reviews relevant data and considers the legal landscape. It analyzes federal and state Constitutional law, concluding that religious and personal belief exemptions to school-entry vaccine mandates are not constitutionally required. It identifies public health, bioethical, and policy considerations relevant to the choice among legal approaches employed by states to promote parental compliance. The article describes a range of legal tools that may help promote parental cooperation with immunization recommendations.