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Objective: To support immunisation providers through a cold chain management audit. Methods: An electronic audit survey using the National Vaccine Storage Guidelines as a gold standard was developed for general practice (GP) and community pharmacy. It included automated feedback, with individualised support from a clinical nurse specialist as required. Responses were analysed to determine the proportion of providers meeting criteria in four categories: procedures, refrigerators and equipment, temperature monitoring and emergency storage. Results: Of 818 providers invited, 420 GPs (89.6%) and 276 pharmacies (82%) responded. Over 70% met all procedural and emergency storage criteria. Although most providers (98.1% GPs, 97.0% pharmacies) used a data logger, the proportion measuring at 5-minute intervals, reviewing data logger printouts weekly and manually recording minimum and maximum temperatures was lower. In total, 58% of providers required follow-up by the clinical nurse specialist, most regarding the need for equipment. Conclusion: An electronic audit enabled public health to engage with a large number of immunisation providers. Most reported high compliance with the national guidelines although opportunities for education were identified and actioned. Implications for Public Health: Electronic solutions can support public health units to engage with providers to ensure vaccines remain effective and wastage is limited.

COVID-19 vaccine boosters are recommended because the protection provided by previous doses eventually decreases, posing a threat to immunity. Some people, however, remain hesitant or unwilling to get vaccinated. The present study sought to investigate factors associated with the intention to receive the COVID-19 booster vaccine based on (1) the constructs of the Health Belief Model, and (2) trust in healthcare workers and science. A sample of 165 adults with two doses of the COVID-19 vaccine were recruited using convenience sampling. Data was collected using an online survey from November 2021 to January 2022. The survey included questions about participants' socio-demographic details, health beliefs, trust, history of COVID-19 vaccination, and the intention to receive a third dose of the COVID-19 vaccine. Ordinal logistic regression analysis showed that higher perceived benefits, severity, and trust in healthcare workers, and lower perceived barriers predicted higher willingness to get a third dose of the vaccine whereas perceived susceptibility and trust in science did not. Understanding the factors and health beliefs that underlie vaccine hesitancy are vital when developing effective interventions with the aim of increasing uptake of COVID-19 booster vaccines.

Background: The World Health Organization has recommended the inclusion of human papillomavirus (HPV) vaccines in national immunization programs to address the global problem of cervical cancer. In the Philippines, HPV vaccination was introduced in a phased approach in 2015. This study seeks to estimate the cost of delivery of the HPV vaccination program and its operational context in the Philippines. Methods: This was a retrospective, cross-sectional micro-costing study focused on ongoing HPV vaccination delivery and its operational context across all levels of the health system. Using structured questionnaires and data collection from secondary sources, the weighted mean financial and economic costs and costs per dose at the national, subnational, and health facility levels were estimated. Results: The weighted mean financial and economic costs per dose of the HPV vaccination program aggregated across all levels of the health system were $US3.72and $29.74, respectively. Activities contributing most significantly to costs were service delivery and vaccine collection or distribution and storage at the health facility and administrative levels, respectively. The opportunity costs for health worker and non-health worker time accounted for 77% of the economic cost per dose. Conclusion: The total weighted mean financial and economic costs of HPV delivery are within range of those reported in other countries. Costing studies can help identify cost drivers with local operational context to help inform policymakers and program managers in budgeting and planning interventions to improve program implementation.

Vaccination is the most cost-effective method for preventing various infectious diseases. Compared with conventional vaccines, new-generation vaccines, especially recombinant protein or synthetic peptide vaccines, are safer but less immunogenic than crude inactivated microbial vaccines. The immunogenicity of these vaccines can be enhanced using suitable adjuvants. This is the main reason why adjuvants are of great importance in vaccine development. Several novel human emulsion-based vaccine adjuvants (MF59, AS03) have been approved for clinical use. This paper reviews the research progress on emulsion-based adjuvants and focuses on their mechanism of action. An outlook can be provided for the development of emulsion-based vaccine adjuvants.

The COVID-19 pandemic has had a seismic effect on public healthcare, vaccine production, and on society. However, the pandemic has also had a methodological impact on social researchers, including those seeking to better understand vaccine hesitancy in relation to childhood vaccines. In this short communication, we describe the challenging experience of recruiting and conducting qualitative interviews with UK healthcare professionals and vaccine hesitant parents in early 2022. We also explore the way in which the context of COVID influenced our data analysis. Finally, we make recommendations for how researchers, including those using qualitative or quantitative methods, might learn from our experiences, as the complex and delicate relationship between society and vaccines continues to evolve in the wake of the pandemic.

Whilst it is now widely recognised that routine immunisation (RI) was disrupted by the COVID-19 pandemic in 2020, and further so in 2021, the extent of continued interruptions in 2022 and/or rebounds to previous trends remains unclear.We modelled country-specific RI trends using validated estimates of national coverage from the World Health Organisation and United Nation Children’s Fund for 182 countries (accounting for > 97% of children globally), to project expected diphtheria, tetanus, and pertussis-containing vaccine first-dose (DTP1), third-dose (DTP3) and measles-containing vaccine first-dose (MCV1) coverage for 2020–2022 based on pre-pandemic trends (from 2000 to 2019).We provide further evidence of peak pandemic immunisation disruption in 2021, followed by tentative recovery in 2022. We report a 3.4% (95 %CI: [2.5%; 4.4%]) decline in global DTP3 coverage in 2021 compared to 2000–2019 trends, from an expected 89.8% to reported 86.4%. This coverage gap reduced to a 2.7% (95 %CI: [1.8%; 3.6%]) decline in 2022, with reported coverage rising to 87.2%. Similar results were seen for DTP1 and MCV1. Whilst partial rebounds are encouraging, global coverage decline translates to a 17-year setback in RI to 2005 levels, and the majority of countries retain coverage at or lower than pre-pandemic levels. The Americas, Africa, and Asia were the most impacted regions; and low- and middle-income countries the most affected income groups.The number of annual Zero Dose (ZD) children – indicating those receiving no immunisations – increased from 12.1 million (M) globally in 2019 to a peak of 16.7 M in 2021, then reduced to 13.1 M in 2022. Overall, we estimate an excess of 8.8 M ZD children cumulatively in 2020–2022 compared to pre-pandemic levels.This work can be used as an objective baseline to inform future interventions to prioritise and target interventions, and facilitate catch-up of growing populations of under- and un-immunised children.

This study evaluated the performance, acceptability, costs, and systems fit of three new cold chain devices in India: a second-generation ice-lined refrigerator (ILR), a solar direct drive (SDD) refrigerator, and a long-term passive device (LTPD). The evaluation was conducted over 15 months during 2016–2017. Sites were selected for their diversity in climate, terrain, and grid electrical supply, and 31 cold chain devices were deployed, 1 to each site. Results showed that all three technologies maintained correct temperatures. The SDD refrigerators had no malfunctions, whilst the ILRs had at least one malfunction, mostly due to the printed circuit board’s sensitivity to the erratic power supply. The LTPD temperature display panel caused challenges initially that required replacement of all solar panels with lithium batteries. Yet the devices’ long holdovers helped ensure vaccine potency. One challenge, particularly with the ILRs and SDD refrigerators, was condensation. The passively cooled LTPD was valued in settings with smaller populations and unreliable or no power; however, some its features, including the need to condition ice blocks, made it challenging to operate. In addition, the acceptable temperature range for the LTPD, as for all passively cooled devices (greater than 0 °C and less than + 10 °C), was confusing for some health workers due to the decades-long emphasis on maintaining temperatures at + 2 °C to + 8 °C. The greatest system-related benefit was establishment of new cold chain points (CCPs) at locations with intermittent or no grid electricity, bringing immunisation services closer to hard-to-reach areas. A key limitation of all three devices was the inability to freeze ice packs, which are required for vaccine carriers, somewhat restricting the potential of these technologies to reach underserved populations. Moreover, establishing new CCPs added costs to the health system. Results from this study, including costing data, can help guide decision-making.

India's immunisation programme is one of the largest in the world and achieved great success over the years, however, some significant gaps are still observable in terms of achieving universal immunisation of children. Religion has emerged as a strong correlate for immunisation rates at national, state and global level. It has been observed that the rate of immunisation among children from Muslim families is comparatively less at global as well as at national level. Therefore, the paper attempts to understand immunisation trends among Muslims children from the north-western Indian state of Punjab. Based on the cross-sectional study of 400 households from district Sangrur of Punjab, results of the study show that rate of full immunisation among children from Muslim families was 88 per cent and none of the children were non-immunised. Reasons stated for partial immunisation of children included distrust of the government and belief that it would cause infertility amongst children. The present study reveals that religion per se does not appear to be influence rates of full immunisation. Geographical location, embeddedness of the community in the larger political and social milieu of their area, reach and acceptance of health workers at grassroots level emerge as strong factors contributing to higher rates of immunisation amongst Muslim children of Malerkotla.

Summary: Background: Population groups that are underserved by England's childhood vaccination programme must be identified to address the country's declining vaccination coverage. We examined routine childhood vaccination coverage in England by maternal ethnicity between 2006 and 2021. Methods: We created first, second and fifth birthday cohorts using mother-child linked electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum. After validation against the UK Health Security Agency (UKHSA) and National Health Service England (NHSE) annual statistical reports, we described vaccination coverage for each vaccine by ethnicity and year. We used modified Poisson regression to analyse the effect of ethnicity on receiving the primary and full course of each vaccine. Findings: Up to 1,170,804 children born after 1 April 2006 were included in the first birthday cohort, reducing to 645,492 by the fifth birthday. Children were followed up until 31 March 2021 at the latest. Children born to mothers in 9 minority ethnic groups and those of unknown ethnicity had lower vaccination coverage (61.3–97.5%) than the White British group (79.9–97.8%) for all vaccines. Indian, Pakistani, Bangladeshi, Chinese, Any other Asian background, and White and Asian ethnic groups had similar vaccination coverage to the White British group (above 90% for most vaccines in most years). Inequities particularly affected the Caribbean group (e.g. 61% coverage for the 6/5/4-in-1 full course in 2020–21 by children's fifth birthday; RR 0.66, 95% CI 0.6–0.74 compared with the White British group) and Any other Black, African and Caribbean background (e.g. coverage 68% for the MMR primary course in 2020–21; RR 0.71, 95% CI 0.64–0.78). These inequities widened over the study period. For example, the absolute difference in coverage between the Caribbean and White British groups for the full course of MMR increased from 12% in 2011–12 to 22% in 2019–20. These inequities remained even after accounting for sociodemographic, maternal and birth related factors, and also widened from primary course to full course. Interpretation: Our findings suggest that urgent policy action is needed to address the ethnic inequities throughout England's routine childhood vaccination programme, which have been worsening over time. Funding: University of Oxford Clarendon Fund, St Cross College and Nuffield Department of Population Health.

Background: COVID-19 immunisation providers have been at the forefront of the pandemic, and their ability to communicate effectively with patients is key to encouraging COVID-19 vaccine acceptance and uptake. This study explored providers’ perspectives on the factors influencing communication with patients about COVID-19 vaccines. Methods: We used an explanatory-sequential mixed-methods approach to conduct the study between December 2021 and March 2022. Phase I involved a cross-sectional survey with immunisation providers in New South Wales (n = 341; 189 general practitioners, 118 nurses and 34 pharmacists), followed by Phase II: semi-structured, in-depth qualitative interviews (n = 19; 10 nurses, 9 pharmacists). We generated descriptive results for the survey. We analysed the qualitative data thematically using an inductive approach. Results: Almost half of survey participants reported communicating often with people who were hesitant about COVID-19 vaccines (49 %; 166/341), however, 21 % (71/341) reported inadequate time to address concerns during consultations. Interview participants reported communication challenges, including time constraints, difficulties addressing and eliciting patient concerns, and keeping up to date with changing information. Conversely, interview participants reported that easy access to government information resources, time to learn about COVID-19 vaccines proactively, knowing about and being able to use tailored strategies to support Aboriginal and Torres Strait Islander and CALD patients were helpful when communicating with patients. Conclusions: Immunisation providers play an important role in patient vaccine acceptance and uptake. Our findings indicate that whilst providers were largely confident in their interactions with patients, further communication support would strengthen providers’ skills in communicating with patients who have questions and concerns about COVID-19 vaccines.

Abstract Objective: The objective of this study was to determine the impact the COVID‐19 pandemic had on the delivery of adult, maternal and childhood immunisation services in Australia in 2020 prior to the rollout of COVID‐19 vaccines, and to understand the adaptations made at a service delivery level that may have contributed to the successful delivery of immunisation services during the first year of the pandemic. Methods: An electronic survey was sent to immunisation providers and pharmacists in all states and territories in Australia between November 2020 and December 2020. It explored interruption to the delivery of immunisation services, strategies implemented to maintain services, prioritisation of populations, and self‐reported challenges and solutions initiated by providers. Results: A total of 850 people responded to the survey. Of these, the most common professional groups identified were pharmacists followed by nurse immunisers, nurses/midwives and general practitioners. Several changes were implemented including relocation of vaccination clinics, change to bookings rather than walk‐in appointments, infection prevention measures, clients waiting in cars pre‐ and post‐vaccination and reduced observation period post‐vaccination. Conclusion: The pandemic has provided opportunities for services to trial new and innovative strategies such as electronic pre‐assessment, electronic consent and drive‐through vaccination services. Implications for public health: Immunisation providers mostly viewed these changes positively and intend to continue many post‐pandemic. The experience gained from the trialling of these strategies may be adapted for vaccine delivery and National Immunisation Program vaccines beyond the pandemic.

Salmonellosis is a leading cause of foodborne disease and is often associated with contaminated chicken meat. Research to reduce the risk of Salmonella contamination of chicken products has led to the development of various through-chain control measures. This review aimed to statistically investigate and evaluate the effects of dietary additives, vaccines, and processing aids on Salmonella contamination in chickens.Eligibility criteria was set to include randomised controlled trials (published 2009-2019 in English) that treated meat chickens or products with a dietary additive, vaccine or processing aid and measured Salmonella in the ceca or product within 24 hours. The confidence in cumulative evidence was evaluated based on the GRADE method. Meta-analyses were performed for the effects of each intervention on Salmonella using standardised mean differences (SMD). Additional sub-categories were also meta-analysed and included in a random effects regression model to investigate interactions between intervention effects and subgroups.Many eligible studies included multi-arm interventions, where a total of 20 dietary additive (from 13 studies), 12 vaccination (from 9 studies) and 70 processing aid (from 27 studies) outcomes were synthesised. Most of the outcomes were judged as having an unclear risk of bias, mostly due to no mention of treatment allocation concealment or blinding. The random effects meta-analysis estimated that the average effect of dietary additives (SMD = -1.99; 95% CI: -2.66 to -1.33; P value < 0.001), vaccinations (SMD = -1.21; 95% CI: -1.74 to -0.69; P value < 0.001) and processing aids (SMD = -1.27; 95% CI: -1.57 to -0.97; P value

Summary: Background: Refugee children may be under-immunised against common vaccine-preventable diseases due to a myriad of factors related to their migration journey. Methods: This retrospective cohort study explored the rates and determinants of enrolment on the National Immunisation Register (NIR) and measles, mumps and rubella (MMR) coverage among refugee children up to 18 years old who resettled in Aotearoa New Zealand (NZ) from 2006 to 2013. Univariate and multivariable logistic regression were conducted to determine associations. Findings: Of the cohort (N = 2796), two thirds of the children (69%) were enrolled on the NIR. Among this sub-cohort (n = 1926), less than one third (30%) were age-appropriately vaccinated with MMR. MMR coverage was highest among younger children and improved over time. Logistic modelling revealed that visa category, year of arrival, and age group were significant factors that influenced NIR enrolment and MMR vaccine uptake. Those arriving via asylum seeking, family reunification and humanitarian pathways were less likely to be enrolled and vaccinated compared to refugees who entered under the national quota programme. More recent arrivals and younger children were more likely to be enrolled and vaccinated compared to children who arrived in NZ longer ago and were older. Interpretation: Resettled refugee children have suboptimal NIR enrolment and MMR coverage rates which varied significantly by visa category, highlighting the need for immunisation services to better engage with all refugee families. These findings suggest that broad structural factors related to policy and immunisation service delivery may influence the differentials seen. Funding: Health Research Council of New Zealand (18/586).

Understanding the level of investment needed for the next decade is vital to achieve the goal of Immunization Agenda 2030 (IA2030). Through the immunization funder perspective, this study estimates both global and regional economic resources required to achieve IA2030 coverage among 194 WHO member countries from 2021 to 2030, against 14 pathogens: Hepatitis B (Hep B), Haemophilus influenzae type b (Hib), Human papillomavirus (HPV), Japanese encephalitis (JE), Measles, Meningitis A (Men A), Streptococcus pneumoniae, Rotavirus, Rubella, Yellow Fever (YF), Diphtheria, Tetanus, Pertussis, and Tuberculosis.The total cost of immunization program, routine vaccine, routine delivery, and non-routine costs (SIA and stockpile) were estimated using WHO coverage forecast for IA2030. Incremental costs of achieving IA2030 for all vaccines and cost per immunized child were also assessed. All costs were calculated for each income and regional level, as well as global level. Scenario analysis and sensitivity analysis were conducted to account for uncertainty in future vaccine pricing and delivery costs.The total cost of immunization programs is $269.8 billion (95% confidence interval: $247.1 - $311.8), of which $152.8 billion is considered as routine vaccine cost, $114.9 billion is routine delivery cost. Non– routine cost for LICs and LMICs totaled $2.1 billion. The incremental cost of achieving coverage goals after 2020 is $89.9 billion ($27.7-$110.1), with upper-middle income countries requiring the largest increase in investment (56.2% of incremental costs). The average immunization cost per child across all countries is $192.6. Scenario analysis using the minimum and maximum vaccines price for fully self-financing countries resulted in total costs ranging from $193.6 and $552.2 billion.The immunization program cost among 194 WHO member countries is expected to increase during this decade. The strategy for resource mobilization and increasing investment from country governments and donors are essential to achieving IA2030 coverage and ensuring sustainable immunization programs.

Abstract Objective: Tailored communication is necessary to address COVID‐19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID‐19 vaccination of people prioritised, but hesitant to receive the vaccine. Method: In this qualitative study in Victoria, Australia (February‐May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18‐69 with comorbidities or aged ≥70 years (‘prioritised adults’; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. Results: Prioritised adults and health and aged care workers had short‐ and long‐term safety concerns specific to personal circumstances, and felt like “guinea pigs”. They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID‐19 vaccines.

Objective: To support immunisation providers through a cold chain management audit., Methods: An electronic audit survey using the National Vaccine Storage Guidelines as a gold standard was developed for general practice (GP) and community pharmacy. It included automated feedback, with individualised support from a clinical nurse specialist as required. Responses were analysed to determine the proportion of providers meeting criteria in four categories: procedures, refrigerators and equipment, temperature monitoring and emergency storage., Results: Of 818 providers invited, 420 GPs (89.6%) and 276 pharmacies (82%) responded. Over 70% met all procedural and emergency storage criteria. Although most providers (98.1% GPs, 97.0% pharmacies) used a data logger, the proportion measuring at 5-minute intervals, reviewing data logger printouts weekly and manually recording minimum and maximum temperatures was lower. In total, 58% of providers required follow-up by the clinical nurse specialist, most regarding the need for equipment., Conclusion: An electronic audit enabled public health to engage with a large number of immunisation providers. Most reported high compliance with the national guidelines although opportunities for education were identified and actioned., Implications for Public Health: Electronic solutions can support public health units to engage with providers to ensure vaccines remain effective and wastage is limited., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: Pharmacists are involved in immunisation programmes for a variety of diseases. However, some patient populations may be considered at high risk of complications from vaccination and are excluded from these programmes. The study aimed to explore pharmacists' roles in a vaccination programme to identify factors that influence their involvement. Methods: Phenomenological qualitative semi-structured interviews were conducted online with a convenience sample of pharmacists working in a COVID-19 vaccination centre in January and February 2021, by a single researcher. Recordings of the interviews were transcribed automatically, manually quality checked and thematically analysed using NVivo Version 1 by all authors. Data were repeatedly read to identify what pharmacists did and how they did it. Results: Seventeen pharmacists were interviewed, and transcript analysis identified 1) What pharmacists did in the Vaccination Centre, 2) Barriers to involvement in the Vaccination Centre and 3) Enablers to being involved in the Vaccination Centre. Key findings indicate pharmacists adopted the roles of information counsellors, supporting patients with vaccine hesitancy, making autonomous prescribing decisions as well as documenting product administration and manipulation. Limited free time at work and desk-based roles for senior pharmacists were barriers to taking on a patient-facing role. National recognition of pharmacists' skills, access to information through official and unofficial networks and a sense of duty, or zeitgeist, enabled pharmacists' to be involved. Discussion: Pharmacists can support immunisation for patients during pandemics if given appropriate autonomy and recognition. Further work is needed to explore how pharmacists may be recognised for their work and use information obtained through informal networks.

Abstract Objective: Student healthcare worker immunisation ensures the protection of students, their patients and the wider community. This audit assessed allied health students’ records of immunisation against national standards. Methods: This audit examined clinical students’ immunisation records at a University Department of Rural Health and assessed their compliance with the national Australian Immunisation Handbook recommendations. Gaps in processes were assessed through a review of forms, guidelines and stakeholder feedback. Results: Around one‐quarter (26%) of healthcare students provided evidence that they were immunised in line with national standards. Inconsistency of immunisation recommendations across universities, states and disciplines were identified. Conclusions: This audit highlighted gaps in healthcare student immunisation assurance processes at both local and national levels, and we recommend key elements that would be required for a more consistent, streamlined and coordinated approach. Implications for public health: As a pillar of communicable disease control, immunisation compliance continues to pose important public health challenges. Without further work towards coordination of healthcare students’ immunisation assurances, there is a risk of preventable morbidity and mortality in vulnerable communities, as well as suboptimal student and worker safety in an environment that poses high risks.

Summary: Background: Measles outbreaks increased worldwide during 2017-19. The largest outbreak in the World Health Organisation Western Pacific region occurred in the Philippines where first-dose measles-containing vaccine (MCV1) coverage had reduced to 75% in 2018. The aim of this study was to summarise paediatric measles admissions to the national infectious diseases referral hospital in Manila during 2016 to 2019. Methods: A retrospective single-centre observational study including 5,562 children aged under five years admitted with measles from January 2016 to December 2019. We summarised sociodemographic and clinical characteristics, vaccine status, reported exposures, and outcomes. Univariable and multivariable logistic regression analyses were undertaken to assess associations between different characteristics of hospitalised children and death. Findings: The median age of children hospitalised with measles was 11 months (interquartile range: 7-28). 84·5% of cases were reported not to have received any MCV. The risk of mortality was 3·2%, with 41% of deaths occurring among children aged less than 9 months. No children died who had received two MCV. The following characteristics were significantly associated with mortality in the multivariable analysis: age group, residence outside of the national capital region, not having received any MCV, duration between onset of fever and hospital admission of 7-14 days compared with 0-3 days, not receiving vitamin A supplementation, having pneumonia, and gastroenteritis. Interpretation: The Philippines remains at risk of future measles epidemics. Routine immunization needs to be strengthened and earlier timing of MCV1 requires further evaluation to reduce measles incidence and mortality. Funding: This work is in part funded by Nagasaki University (salary support for CS, KAA, RN, SS, KA, KT).

The improving outcome of childhood cancers has led to increase in number of survivors needing comprehensive care during and after treatment of cancer. Immunisation is an important tenet of this and is often neglected especially in the resource constrained settings due to preoccupation with treatment and disease related aspects in these children. In this narrative review we review the existing evidence on this important subject. It includes a brief account of the effects of chemotherapy on various components of immune function as well as the current evidence based recommendations on immunisation of children undergoing chemotherapy both during and after end of treatment. It also reviews the literature on recommendations for immunisation of contacts of children undergoing chemotherapy.

Abstract Objective: This report describes a mobile outreach influenza immunisation program for vulnerable populations in a resource‐rich setting. It explores vaccine recipients’ demographics, comorbidities and vaccination histories, and the factors influencing their decision to receive vaccine during outreach. Methods: Teams of nurse immunisers visited and provided influenza vaccines to clients from 21 sites (18 community centres for migrants, refugees and the homeless; and three outpatient clinics). Risk factors for severe influenza, vaccination histories and perceived barriers and facilitators to vaccines were collected from vaccine recipients. Results: A total of 1,032 vaccine recipients participated in the survey with responses collected from April to October 2018. Of these, 54% reported at least one risk factor for severe influenza. Sixty per cent of recipients had not received an influenza vaccine in 2017, with most of them reporting ‘not worried about influenza’ as a reason. Pregnant participants most frequently reported a healthcare provider’s recommendation as the reason to receive the vaccine. Conclusion: An outreach program comprising of a means of taking vaccines to the population was a successful strategy to deliver influenza vaccines to high‐risk populations. It needs to be considered in the full range of delivery models to improve influenza vaccine coverage, even in resource‐rich settings. Implication for public health: Strategies reaching out to vulnerable populations are crucial to maximise vaccine uptake.

Abstract Objective: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). Methods: A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed‐methods approach. Results: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. Conclusion: Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow‐up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. Implications: The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.

Introduction: Prior to the COVID-19 pandemic, it took at least several years to develop vaccines for prevention of infectious diseases. The COVID-19 vaccine is the first to be developed within a period of one year. The expediency associated with the development of the COVID-19 vaccine has however been hampered by vaccine hesitancy and other relevant factors that could influence consequent immunisation. This study aimed at investigating factors associated with vaccine hesitancy and willingness to pay for COVID-19 vaccination. Methods: A cross-sectional approach was used to undertake online and physical data collection with a validated questionnaire. Results: A total of 1767 valid responses were received, female participants were in the minority (42.2%), majority (54.9%) of the study participants were between the ages of 18 and 30 years, and more than half (53.8%) of the participants were educated up to first degree level. Slightly above half (52.9%) of the study participants indicated that they were worried about side effects that may be associated with COVID-19 vaccines, and this may likely prevent them from taking the vaccine. A strong majority (85.1%) of the study participants indicated that COVID-19 vaccine should be administered at no cost to citizens. Only a quarter (26%) of the participants were willing to pay a fee for COVID-19 vaccination. Also, older participants and those that had been previously infected with COVID-19 were more likely to pay for COVID-19 vaccination. Conclusion: This study provides critical insights which could influence immunisation efforts during the pandemic. An early understanding of population perceptions of the COVID-19 vaccine can be invaluable in designing successful campaigns. This is even more critical, given supply limitations, access issues and vaccines’ inequity occasioned by the international scramble.

Many health technology assessment (HTA) agencies limit their assessments of vaccines to the health benefits for the vaccinated individual, the costs associated with vaccine administration and the disease avoided. However, because the value of vaccines tends to accrue to a large extent beyond the vaccinated individual, they are systematically undervalued in many current HTA processes. This is also the case in the UK, where the Joint Committee on Vaccination and Immunisation (JCVI) is in charge of assessing preventative vaccines, while therapeutic vaccines fall in the realm of the National Institute for Clinical Excellence (NICE).To contribute to a forward-looking perspective, we designed a framework to capture the broader value of vaccination. We reviewed the current state of the global vaccines pipeline and selected seven preventative and three therapeutic vaccines that are likely to enter the UK market within five years. We assessed on which value elements the selected vaccines would potentially generate value, and compared those against the novel broader value framework. A review of the current value elements considered by the JCVI and NICE allowed identifying the critical gaps between potential value generation and value recognition.To our knowledge, this is the first time that the broader value of vaccination has been pro-actively assessed for pipeline vaccinations. Our findings show that the existing narrow evaluation frameworks are likely to systematically undervalue the value of potential future vaccines coming to the UK market. This is particularly relevant, where their impact on AMR and other health interventions, and on the productivity of the workforce is of concern. Recommendations to overcome this include an explicit and more consistent inclusion of, and data collection on, the impact of vaccines on AMR and other health interventions by JCVI and NICE; the consideration of a societal perspective and the fiscal impact of vaccines to societies.

Abstract Objective: To determine the proportion of healthcare workers (HCWs) in smaller Victorian public healthcare facilities with documented evidence of measles immunity. Methods: A cross‐sectional survey, developed by the Victorian Healthcare Associated Surveillance System Coordinating Centre, was completed by all eligible facilities. HCWs were reported as having evidence or no evidence of measles immunity. Those without evidence of immunity were sub‐classified as incomplete, declined or unknown status. Results: Seventy‐five facilities reported measles immunity status of 17,522 employed HCWs. Of these, 11,751 (67.1%) had documented evidence of immunity. The proportion with evidence of immunity was lowest (45.6%) in facilities with ≤50 HCWs. The majority of HCWs without evidence of immunity (88.2%) had ‘unknown’ status. Declination or incomplete status comprised very low overall proportions (0.3% and 3.6%, respectively). Conclusions: Reported evidence of HCW measles immunity was moderate in surveyed facilities, with a large proportion having unknown status. HCW immunisation programs in some facilities require refinement to appropriately support public health responses to measles cases and prevention of occupational acquisition of measles. Implications for public health: Non‐immune HCWs are at increased risk for acquiring and transmitting measles. Timely access to accurate HCW immunisation records is required to ensure that public health responses are effective.

Background: Data on COVID-19-induced disruption to routine vaccinations in the South-East Asia and Western Pacific regions (SEAR/WPR) have been sparse. This study aimed to quantify the impact of COVID-19 on routine vaccinations by country, antigen, and sector (public or private), up to 1 June 2020, and to identify the reasons for disruption and possible solutions. Methods: Sanofi Pasteur teams from 19 countries in SEAR/WPR completed a structured questionnaire reporting on COVID-19 disruptions for 13–19 routinely delivered antigens per country, based on sales data, government reports, and regular physician interactions. Data were analysed descriptively, disruption causes ranked, and solutions evaluated using a modified public health best practices framework. Findings: 95% (18/19) of countries reported vaccination disruption. When stratified by country, a median of 91% (interquartile range 77–94) of antigens were impacted. Infancy and school-entry age vaccinations were most impacted. Both public and private sector healthcare providers experienced disruptions. Vaccination rates had not recovered for 39% of impacted antigens by 1 June 2020. Fear of infection, movement/travel restrictions, and limited healthcare access were the highest-ranked reasons for disruption. Highest-scoring solutions were separating vaccination groups from unwell patients, non-traditional vaccination venues, virtual engagement, and social media campaigns. Many of these solutions were under-utilised. Interpretation: COVID-19-induced disruption of routine vaccination was more widespread than previously reported. Adaptable solutions were identified which could be implemented in SEAR/WPR and elsewhere. Governments and private providers need to act urgently to improve coverage rates and plan for future waves of the pandemic, to avoid a resurgence of vaccine-preventable diseases. Funding: Sanofi Pasteur.

Abstract Objective: Vaccinations in Australia are reportable to the Australian Immunisation Register (AIR). Following major immunisation policy initiatives, the New South Wales (NSW) Public Health Network undertook an audit to estimate true immunisation coverage of NSW children at one year of age, and explore reasons associated with under‐reporting. Methods: Cross‐sectional survey examining AIR immunisation records of a stratified random sample of 491 NSW children aged 12≤15 months at 30 September 2017 who were >30 days overdue for immunisation. Survey data were analysed using population weights. Results: Estimated true coverage of fully vaccinated one‐year‐old children in NSW is 96.2% (CI:95.9‐96.4), 2.1% higher than AIR reported coverage of 94.1%. Of the children reported as overdue on AIR, 34.9% (CI:30.9‐38.9) were actually fully vaccinated. No significant association was found between under‐reporting and socioeconomic status, rurality or reported local coverage level. Data errors in AIR uploading (at provider level) and duplicate records contributed to incorrect AIR coverage recording. Conclusions: Despite incentives to record childhood vaccinations on AIR, under‐reporting continues to be an important contributor to underestimation of true coverage in NSW. Implications for public health: More reliable transmission of encounters to AIR at provider level and removal of duplicates would improve accuracy of reported coverage.

Innovations in vaccine product attributes could play an important role in addressing coverage and equity (C&E) gaps, but there is currently a poor understanding of the full system impact and trade-offs associated with investing in such technologies, both from the perspective of national immunisation programmes (NIPs) and vaccine developers. Total Systems Effectiveness (TSE) was developed as an approach to evaluate vaccines with different product attributes from a systems perspective, in order to analyse and compare the value of innovative vaccine products in different settings.The TSE approach has been advanced over the years by various stakeholders including the Bill and Melinda Gates Foundation (BMGF), Gavi, PATH, UNICEF and WHO. WHO further developed the TSE approach to incorporate the country perspective into immunisation decision-making, in order for countries to evaluate innovative products for introduction and product switch decisions, and for vaccine development stakeholders to conduct their assessments of product value in line with country preferences. This paper describes the original TSE approach, development of the tool and processes for NIPs to apply the WHO TSE approach, and results from piloting in 12 countries across Africa, Asia and the Americas. The WHO TSE framework emerged from this piloting effort.The WHO TSE approach has been welcomed by NIP and vaccine development stakeholders as a useful tool to evaluate trade-offs between different products. It was emphasised that the concept of “total systems effectiveness” is likely to be context-specific and that TSE is valuable in facilitating a deliberative process to articulate NIP priorities, for decisions around product choice, and for prioritising the development of future vaccine innovations.

Abstract Objective: Although the number of national measles cases has greatly decreased since 1980s, there has been resurgence in disease incidence in recent years. While parental knowledge and attitudes toward both disease and vaccinations are known to influence vaccine uptake, the contribution of these factors toward vaccination rates in NSW populations has not been studied. The aim of this study was to investigate the knowledge and opinions on measles and MMR vaccine in NSW Central and North Coast regions. Methods: Parents (n=201) of children

Abstract Objective: Although people of refugee background are likely to be under‐immunised before and after resettlement, no study to date has evaluated refugee specific immunisation policies in Australia. We developed a framework to analyse immunisation policies across Australia to highlight the strengths and gaps so as to inform development of more effective refugee specific immunisation policies. Methods: We sourced publicly available immunisation policy documents from state and territory government websites. Content analysis of seven policy documents was undertaken using a developed framework comprising crucial policy determinants. Results: Immunisation policy differed substantially across the jurisdictions. While most policies did not highlight the importance of data collection on immunisation for refugees and the public funding of vaccines for refugees, policy determinants such as accessibility and obligations were fulfilled by most jurisdictions. Conclusion: Our findings indicate stark differences in immunisation policy for people of refugee background across Australia. Highlighted gaps demonstrate the need to revise current policies so that they are aligned with their intended outcome of enhancing uptake of vaccines and improving immunisation coverage among resettled refugees in Australia. Implications for public health: Immunisation policy development for refugees needs to be robust enough to ensure equitable health services to this group.

Objective: Children with migrant and refugee backgrounds may experience immunisation inequities due to barriers to accessing and accepting vaccines. In Aotearoa New Zealand (NZ), national reporting can mask inequities in coverage by migration background. This study explored paediatric COVID-19 vaccine uptake among children with migrant and refugee backgrounds., Methods: This population-level retrospective cohort study compared rates and determinants of paediatric COVID-19 vaccine uptake as of July 2022 amongst migrant and non-migrant children who were aged between 5 and 11 years as of January 2022. Linked de-identified administrative and health data available in Statistics NZ's Integrated Data Infrastructure were used, and univariate and multivariable logistic regression were conducted to determine associations., Results: Of the total study population (N = 451,323), 3.5% were overseas-born migrant children, 31.3% were NZ-born migrant children, and 65.3% were NZ-born non-migrant children. Only 50.8% (229,164 out of 451,323) of children had received at least one dose. Migrant children were significantly more likely to have received a COVID-19 vaccination than non-migrant children. Logistic modelling revealed that all factors, including ethnicity, gender, age, family type, household income, deprivation, region, parent COVID-19 vaccination status, and child's previous COVID-19 infection, significantly influenced COVID-19 vaccine uptake. The largest contributing factor was parents' COVID-19 vaccination status., Conclusions: The findings suggest that NZ's paediatric COVID-19 vaccination programme was able to address logistical and motivational barriers commonly identified amongst migrants and refugees., Implications for Public Health: As parents' vaccination status is an important factor in vaccinating their own children, continuous efforts are needed to support confident parental COVID-19 vaccine decision-making. To address social inequities, engagement with marginalised communities to co-design tailored and localised approaches is recommended., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Abstract Objective: To determine seroprotection for the vaccine‐preventable diseases (VPDs) measles, mumps, rubella, varicella and hepatitis B among new employees seen at a Victorian tertiary hospital staff clinic. Methods: Employees who presented to the staff clinic for immunisation assessment between 1 January 2012 and 31 December 2013 were included. Demographic data, self‐reported disease history and previous vaccination status were reviewed retrospectively to determine impact on serological results. Results: A total of 1,901 new employees were included, 83% of whom were at risk of direct contact with blood or body substances. Overall, the proportion of workers seropositive to measles was 88%, mumps 90%, rubella 78%, varicella 93% and hepatitis B 80%. Staff born before 1966 were more likely to have positive measles or mumps serology but negative rubella or hepatitis B serology (p

Context: Children with cancer, when on treatment and immunosuppressed, are at risk of infection from live vaccines and do not mount an adequate protective response to inactivated vaccines. Hence, immunizing them during and after treatment requires special considerations. Aim: We wanted to assess the current practice of clinicians caring for children with cancer in India regarding immunisation in these children during and after treatment. Methods and material: Clinicians from India attending the various pediatric cancer conferences in 2013 were invited to complete a questionnaire. Statistical analysis used: Data was analysed using software SPSS version 16 and GraphPad InStat version 3.05. Conventional statistics were used for analysis. Variation in practice was assessed by Fisher's exact test. Results: Responses form 37 institutes (response rate 74%) in 21 cities across India showed that there is variable practice of immunising children with cancer. There were areas of homogeneity (discontinuing all live vaccines during treatment and recommencing immunisation six months after end of treatment) and heterogeneity (continuation of inactivated vaccines and use of the hepatitis B vaccine during treatment). The variation was seen mainly among clinicians from public and private centres with no significant variation by annual caseload or duration of practice of the responding clinician. Variations were also observed in relation to sibling and parent vaccination. Conclusions: There is variation in the immunization practices in India in relation to children with cancer. Development and dissemination of immunisation guidelines specific to India would be useful in standardizing practice.

Abstract Objective: To describe the realities of conducting a cross‐jurisdictional data linkage project involving state and Australian Government‐based data collections to inform future national data linkage programs of work. Methods: We outline the processes involved in conducting a Proof of Concept data linkage project including the implementation of national data integration principles, data custodian and ethical approval requirements, and establishment of data flows. Results: The approval process involved nine approval and regulatory bodies and took more than two years. Data will be linked across 12 datasets involving three data linkage centres. A framework was established to allow data to flow between these centres while maintaining the separation principle that serves to protect the privacy of the individual. Conclusions: This will be the first project to link child immunisation records from an Australian Government dataset to other administrative health datasets for a population cohort covering 2 million births in two Australian states. Implications: Although the project experienced some delays, positive outcomes were realised, primarily the development of strong collaborations across key stakeholder groups including community engagement. We have identified several recommendations and enhancements to this now established framework to further streamline the process for data linkage studies involving Australian Government data.

Abstract Objectives: Testing is the first step in treatment and care for blood‐borne viruses (BBVs) and sexually transmitted infections (STIs). As new treatments for viral hepatitis emerge, it is important to document effective models for BBV/STI testing. A nurse‐led intervention was implemented across three prisons in Victoria to improve BBV/STI testing. We evaluated the impact of the intervention on BBV/STI testing rates and hepatitis B (HBV) vaccination for reception prisoners. Methods: BBV/STI testing and HBV vaccination data were collected from the medical files of 100 consecutive reception prisoners at three prisons (n=300) prior to and after the intervention was implemented. Results: BBV testing increased significantly from 21% of prisoners to 62% post‐intervention. Testing for some STIs increased significantly, but remained low: 5% to 17% for chlamydia and 1% to 5% for gonorrhoea. HBV vaccination increased significantly from 2% to 19%. Conclusions: The nurse‐led intervention resulted in substantially increased testing and vaccination, demonstrating the benefits of a concerted effort to improve BBV and STI management in correctional settings. Implications: The availability of new treatments for hepatitis C has precipitated expansion of treatment in prisons. Improving the testing rate of prisoners, the first step in the treatment cascade, will maximise the benefits.

Objectives: To identify technologies used in vaccine safety communication and evaluate their impact on vaccination intention, uptake, knowledge, attitude, and perceptions of consumers., Methods: We searched 6 electronic databases to identify randomised controlled trials assessing the impact of using technology in vaccine safety communication. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate each study., Results: We included 22 studies involving 27,109 participants from 8 countries; 15 studies assessed the use of videos and 7 examined innovative technologies. Using videos significantly improved knowledge (n = 3) and participant engagement (n = 2) compared to printed material. Among the innovative technologies, the use of virtual reality, and smartphone applications incorporating social networking or gamification significantly increased vaccination knowledge, confidence, and engagement. The studies showed that narrative messaging increased perceived disease severity (n = 2) and vaccination intention (n = 2)., Conclusions: While the use of innovative technologies is increasing, videos currently remain the most popular technology for vaccine safety communication. Communication technology, particularly with narrative messaging, improves patient engagement and comprehension., Practice Implications: Health authorities should increase focus on using videos and smartphone applications for vaccine safety communication. Collaboration among stakeholders is essential to develop guidelines on effective message content to complement the technology., 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., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Abstract Objectives: There is limited epidemiological data on the performance of different refrigerator types for vaccine storage in the real world. This study aims to measure if the introduction of purpose‐built vaccine refrigerators has reduced the cost of vaccine losses in South Australia. Methods: Data were taken from a register for all recorded vaccine storage cold chain events in South Australia from 2008 to 2009 and a survey of vaccine providers conducted in 2009. Results: There were 531 respondents to the survey (51% response rate). A greater proportion of cold chain breaches in purpose‐built vaccine refrigerators did not lead to a loss of vaccine (10.3%) compared with the other refrigerator types. Purpose‐built vaccine refrigerators had a relative risk of 3.31 (95% CI, 2.15–5.11) of a heat event (as opposed to cold event) and were more likely to have a cold chain breach from electrical failure (relative risk ratio 15.05, 95% CI 4.04–56.05) than bar refrigerators. The average cost of loss of vaccine for purpose‐built vaccine refrigerators was $2,321.20, which was greater than the cost of vaccine loss from a bar refrigerator of $1,339.06 (95% CI $61.47–1,902.82). Conclusions: Although purpose‐built vaccine refrigerators were less likely to lead to vaccine loss per cold chain breach, they had a greater average cost of vaccine loss per cold chain event because they held a greater volume of vaccine. There is a need for development of Standards to guide purpose‐built vaccine refrigerators manufacturing and a review of the National Vaccine Storage Guidelines to place a greater emphasis on the need for back up plans in the event of electrical failure.

Abstract Objective: To identify and critique interventions to improve vaccination uptake in Australia. Methods: Peer‐reviewed and grey literature from 1997 to May 2011 was searched to identify evaluations of one or more interventions to improve vaccination uptake among any target group in Australia. Studies were categorised by intervention type and target group. Recommended tools for assessing quality in public health interventions were used in the methodological critique of included studies. Results: Forty‐nine studies met the inclusion criteria, two‐thirds of which were published in peer‐reviewed journals. Evidence for strategies that increase community demand for vaccination was most common. Multi‐component strategies, patient and provider reminders, plans for catch‐up vaccination and accelerated schedules were identified as most effective. There was a lack of evidence for strategies to improve coverage in Aboriginal and Torres Strait Islander peoples, behaviourally at‐risk groups and pregnant women. Major limitations of identified studies were the lack of baseline coverage for comparison, limited use of controlled designs and measurement biases. Conclusion: The evidence, while limited, suggests that the most effective strategies are those which increase community demand for and enhance access to vaccines. Strategies to increase vaccination uptake are infrequently and often inadequately evaluated, despite the need for evidence to support their use. Implications: The results of this review, used in conjunction with international evidence, can guide those desiring to improve the performance of vaccination programs and suggest priorities for future evaluation of strategies to improve vaccination uptake.

Abstract Objective: To determine hepatitus B virus (HBV) vaccine‐induced immunity and infection in people who inject drugs (PWID) screened for a prospective observational study in Sydney. Method: 227 PWID completed a brief demographic and risk behaviour survey and provided blood for HBV, hepatitis C virus antibody (anti‐HCV) and HIV testing. Correlates of HBV status were examined in the overall sample and HBV protective immunity was assessed in a subset of anti‐HCV negative participants (n=124); a population with typically shorter injecting histories but at potentially high risk for HBV and HCV. Results: Almost half (45%) were susceptible to HBV infection. Only 84 (37%) had evidence of vaccine‐induced immunity (HBV surface antibody ≥10 mLU/mL and HBV core antibody (anti‐HBc) negative) and 40 (18%) tested anti‐HBc positive, of whom 7 (4%) were also HBV surface antigen positive. HBV vaccine‐induced immunity was associated with a history of incarceration (AOR 1.98; 95% CI 1.05–3.71, p=0.034) while HBV infection was associated with prior HCV infection (AOR 6.29; 95% CI 2.29–17.24, p

Non-human primates have an important translational value given their close phylogenetic relationship to humans. Studies in these animals remain essential for evaluating efficacy and safety of new therapeutic approaches, particularly in aging primates that display Alzheimer's disease (AD) -like pathology. With the objective to improve amyloid-β (Aβ) targeting immunotherapy, we investigated the safety and efficacy of an active immunisation with an Aβ derivative, K6Aβ1-30-NH 2 , in old non-human primates. Thirty-two aged (4-10 year-old) mouse lemurs were enrolled in the study, and received up to four subcutaneous injections of the vaccine in alum adjuvant or adjuvant alone. Even though antibody titres to Aβ were not high, pathological examination of the mouse lemur brains showed a significant reduction in intraneuronal Aβ that was associated with reduced microgliosis, and the vaccination did not lead to microhemorrhages. Moreover, a subtle cognitive improvement was observed in the vaccinated primates, which was probably linked to Aβ clearance. This Aβ derivative vaccine appeared to be safe as a prophylactic measure based on the brain analyses and because it did not appear to have detrimental effects on the general health of these old animals., Competing Interests: Declaration of Competing Interest EMS is an inventor on patents on Aβ immunotherapies that are assigned to New York University. The other 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., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic has highlighted the importance of coordinating policies on vaccinations at the national level. In Australia, the regulation and management of pharmacist-administered vaccination programs are the responsibility of each of the eight jurisdictions (six states and two territories), and have been developed independently of each other, leading to substantial variation. Consequently, there are variations regarding which vaccines pharmacists can administer, the minimum age, and whether these vaccines are publicly funded., Objective(s): To identify opportunities for a nationally consistent approach to pharmacist-administered vaccinations in Australia., Methods: This policy analysis used the Multiple Streams Framework to identify barriers and enablers within the three "streams" of problem, policy, and politics, and how they affected the development of a national approach. Data were drawn from semi-structured interviews with 13 key policy actors and documents (pre-budget submissions and parliamentary inquiry reports). Themes were generated around actor interests, current and proposed pharmacist vaccination programs, and policymaking processes., Results: From the pharmacy sector, there was little clarity around the need for a nationally consistent approach. This issue was linked to their ultimate goal of expanding pharmacist vaccination programs; it was seen as a means for states/territories with smaller programs to 'catch up' to other jurisdictions. There was also no unified policy approach from this sector; additionally, decision-makers within jurisdictional health departments faced different service delivery models, policy priorities, agendas, and policy actor relationships. Lastly, there was no federal body that had the capacity to coordinate a national approach. Possible enablers include refining the problem definition and re-framing it to a patient-centric model., Conclusions: Coordination of vaccination policies is an ongoing policy issue with implications for pharmacist vaccination programs and other health policy areas in which a national approach is being considered. This analysis provides insight into how this may be developed in the future., (Copyright © 2022. Published by Elsevier Inc.)

Background: Health care workers (HCWs) are at an increased risk of catching and spreading Coronavirus Disease 2019 (COVID-19) compared with the general community, putting health systems at risk. Several jurisdictions globally have mandated or are looking to mandate COVID-19 vaccines for this cohort, but little is known about the acceptability of this measure, especially in different contexts, and there is little qualitative data to explore nuance, depth, and the reasons behind HCWs' opinions., Methods: In-depth semi-structured qualitative interviews were undertaken with 39 HCWs in Western Australia (WA) between February-August 2021, ascertaining their views on the prospective introduction and implementation of mandates for COVID-19 vaccines. Data were thematically analysed using NVivo 20., Results: There was broad support for COVID-19 vaccine mandates for HCWs amongst our participants, but also different views about what such a mandate would mean (redeployment versus termination) and how it would impact the rest of the workforce. One vaccine hesitant participant said that mandates would be their prompt to get vaccinated. Other participants invoked an informal code whereby HCWs have an obligation to be seen to support vaccination and to protect public health more broadly. However, they also raised concerns about implementation and procedural and policy fairness., Conclusion: Policymakers should consider how to mobilise the informal code of health promotion and public health support if introducing mandates. They should also consider whether HCWs will bring the same attitudes and approaches to mandates for additional vaccine doses., Competing Interests: A/Prof Katie Attwell is funded by the Australian Research Council of the Australian Government under grant number DE19000158. A/Prof Attwell and the Coronavax project receive research funding from the Department of Health, Government of Western Australia. Professor Chris Blyth is the chair of the Australian Technical Advisory Group on Immunisation (ATAGI) as well as the former chair of the COVID-19 Vaccine ATAGI, on which A/Prof Attwell sat and is now a technical advisor. The other authors have no financial or personal relationships to declare., (© 2022 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to determine the impact the COVID-19 pandemic had on the delivery of adult, maternal and childhood immunisation services in Australia in 2020 prior to the rollout of COVID-19 vaccines, and to understand the adaptations made at a service delivery level that may have contributed to the successful delivery of immunisation services during the first year of the pandemic., Methods: An electronic survey was sent to immunisation providers and pharmacists in all states and territories in Australia between November 2020 and December 2020. It explored interruption to the delivery of immunisation services, strategies implemented to maintain services, prioritisation of populations, and self-reported challenges and solutions initiated by providers., Results: A total of 850 people responded to the survey. Of these, the most common professional groups identified were pharmacists followed by nurse immunisers, nurses/midwives and general practitioners. Several changes were implemented including relocation of vaccination clinics, change to bookings rather than walk-in appointments, infection prevention measures, clients waiting in cars pre- and post-vaccination and reduced observation period post-vaccination., Conclusion: The pandemic has provided opportunities for services to trial new and innovative strategies such as electronic pre-assessment, electronic consent and drive-through vaccination services., Implications for Public Health: Immunisation providers mostly viewed these changes positively and intend to continue many post-pandemic. The experience gained from the trialling of these strategies may be adapted for vaccine delivery and National Immunisation Program vaccines beyond the pandemic., (© 2022 The Authors.)

Objective: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine., Method: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations., Results: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines., (© 2021 The Authors.)