Identifying factors that can be used to assess a country's readiness to deploy a new vaccine or improve uptake of an underutilised vaccine: a scoping review.

OBJECTIVES: Identifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping review aims to identify common themes that emerge across articles, which include tools or guidance that can be used to establish whether a country is ready to deploy a new vaccine or increase uptake of an underutilised vaccine. DESIGN: Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. DATA SOURCES: Embase, CINAHL, Cochrane Library, Google Scholar, MEDLINE, PsycINFO and Web of Science were searched for articles published until 9 September 2023. Relevant articles were also identified through expert opinion. ELIGIBILITY CRITERIA: Articles published in any year or language that included tools or guidance to identify factors that influence a country's readiness to deploy a new or underutilised vaccine. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened records and performed data extraction. Findings were synthesised by conducting a thematic analysis. RESULTS: 38 articles met our inclusion criteria; these documents were created using methodologies including expert review panels and Delphi surveys and varied in terms of content and context-of-use. 12 common themes were identified relevant to a country's readiness to deploy a new or underutilised vaccine. These themes were as follows: (1) legal, political and professional consensus; (2) sociocultural factors and communication; (3) policy, guidelines and regulations; (4) financing; (5) vaccine characteristics and supply logistics; (6) programme planning; (7) programme monitoring and evaluation; (8) sustainable and integrated healthcare provision; (9) safety surveillance and reporting; (10) disease burden and characteristics; (11) vaccination equity and (12) human resources and training of professionals. CONCLUSIONS: This information has the potential to form the basis of a globally applicable evidence-based vaccine readiness assessment tool that can inform policy and immunisation programme decision-makers.

Guaranteed Cash Incentives Boosted COVID-19 Vaccinations Of Young Adults: Evidence From West Virginia.

Guaranteed small cash incentives were widely employed by policy makers during the COVID-19 vaccination campaign, but the impact of these programs has been largely understudied. We were the first to exploit a statewide natural experiment of one such program implemented in West Virginia in 2021 that provided a $100 incentive to fully vaccinated adults ages 16-35. Using individual-level data from the Census Bureau's Household Pulse Survey, we isolated the policy effect through a difference-in-discontinuities design that exploited the discontinuity in incentive eligibility at age thirty-five. We found that the $100 incentive was associated with a robust increase in the proportion of people ever vaccinated against COVID-19 and the proportion who completed or intended to complete the primary series of COVID-19 vaccines. The policy effects were also likely to be more pronounced among people with low incomes, those who were unemployed, and those with no prior COVID-19 infection. The guaranteed cash incentive program may have created more equitable access to vaccines for disadvantaged populations. Additional outreach may also be needed, especially to unvaccinated people with prior COVID-19 infections.

An evaluation of physical access barriers to COVID-19 vaccines uptake among persons with physical disabilities in western Kenya.

BACKGROUND: Physically disabled persons continue to be discriminated, excluded and neglected based on design of structures and their location. This hampers equitable access to services and disproportionately affect them during a pandemic. This study aimed to evaluate physical access barriers to COVID-19 vaccines among persons with physical disabilities during the COVID-19 pandemic, (March 2020 to March 2022) in Ugenya Sub-county, Siaya County in Western Kenya. METHODS: The study design was cross-sectional. 108 physically disabled participants were selected using systematic sampling technique. Data was collected using structured questionnaires. RESULTS: Vaccination location (χ2 = 95.480, p = 0.001), access to the vaccination room (χ2 = 84.098, p = 0.001) and mobility impaired (χ2= 16.168, p = 0.001) had statistically significant associations with uptake of COVID-19 vaccine. Income levels, belief in existence of COVID-19, information from mass media and being married increased the odds of becoming vaccinated (AOR = 1.5, 95% CI 0.7-3.4), (AOR = 1.8, 95% CI 0.8-4.0) (AOR = 2.5, 95% CI 1.5-4.2) and (AOR = 2.2, 95% CI 1.3-3.9) respectively. The binary logistic regression analysis showed that transport cost and age (p = 0.001) had statistically significant associations with COVID-19 vaccine access and uptake. Those who had difficulty in movement and speaking found uptake of COVID-19 vaccine hard (p = 0.001). CONCLUSION: Marital status, information from reliable sources, belief in existence of COVID-19 were associated with access to and uptake of COVID-19 vaccine. Additionally, nonpayment of transport cost increased the odds of becoming vaccinated. Therefore, mobile health teams should be put in place to reach the physically disabled who are hard-to-leave home. Additionally, reimbursement of amount spent on transportation can be adopted to boost access to healthcare services by the physically disabled persons.

The health economic-industrial complex: production and innovation for universal health access, Brazil.

Problem: The coronavirus disease 2019 (COVID-19) pandemic has highlighted global disparities in accessing essential health products, demonstrating the critical need for low- and middle-income countries to develop local production and innovation capabilities. Approach: The health economic-industrial complex approach changed the values that guided innovation and industrial policies in Brazil. The approach directed health production and innovation to universal access; the health ministry led a whole-of-government approach; and public procurement was strategically applied to stimulate productive public and private investments. The institutional, technological and productive capacities built up by the health economic-industrial complex allowed the country to quickly establish local COVID-19 vaccines production and guarantee access for the population. Local setting: Brazil has a universal health system that guarantees access to health for its 215 million population. Relevant changes: Public policies and actions, based on the health economic-industrial complex, guided investment projects in line with health demands, strengthened local producers, and increased autonomy in the production of health products in areas of greater technological dependence. During the COVID-19 pandemic, the country was able to rapidly scale up local vaccine production. By August 2021, Brazil had produced 74.8% (151 463 502/202 437 516) of the vaccine doses used in the country. Lessons learnt: The Brazilian example shows that low- and middle-income countries can build systemic development policies that increase their capability to produce and innovate in concert with universal health systems. This increased capacity can guarantee access to health products and supplies that are critical during global health emergencies.

Last-mile delivery increases vaccine uptake in Sierra Leone.

Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development1. Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties2, we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48-72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services3.

Designing the global vaccine supply chain: balancing intellectual property rights with post COVID-19 vaccine equity.

This article aims to propose practical solutions that coordinate the conflicting interests between the global community and the pharmaceutical industry on the intellectual property (IP) waiver for COVID-19 vaccines and facilitate a more equitable vaccine supply chain in the post-COVID-19 world. We critically conducted a narrative literature review to identify procedural and practical issues in the current vaccine supply chain. The search was conducted across various academic disciplines, including biomedical science, life science, law and social science, using resources such as PubMed, Web of Science, Scopus and Westlaw. After screening 731 articles, 55 studies were selected for review. The narrative review revealed several critical barriers that hinder vaccine supply in less-developed countries (LDCs) as follows: (1) WTO Trade-Related Aspects of Intellectual Property Rights (TRIPs) waiver requests may not be granted due to its stringent consensus rule; (2) the current compulsory license system may not work due to the complexity of IP rights covering COVID-19 vaccine technologies; (3) only a few LDCs have domestic companies capable of manufacturing vaccines, and (4) political and economic tensions among countries exacerbate existing barriers to vaccine distribution in LDCs. Based on these findings, we proposed a comprehensive compulsory license system, which combines TRIPS's compulsory license system with the third-party beneficiary mechanism under Common Law. This integrated approach offers a balanced solution that ensures fair compensation for vaccine developers while facilitating broader vaccine access.

Updated COVID-19 Vaccine Now Available in US, Recommended for Everyone Older Than 6 Months.

This Medical News article discusses the new COVID-19 vaccine and recommendations for fall 2023.

Social justice in medical education: a student-led approach to addressing COVID-19 vaccine equity in the Hispanic/Latinx community.

The current healthcare system disproportionately affects vulnerable populations, leading to disparities in health outcomes. As a result, medical schools need to equip future physicians with the tools to identify and address healthcare disparities. The University of Nevada, Reno School of Medicine implemented a Scholarly Concentration in Medical Social Justice (SCiMSJ) program to address this issue. Three medical students joined the program and pioneered a project to address the equitable vaccine distribution within the local Hispanic/Latinx community. After identifying the disparity in vaccine uptake and high levels of vaccine hesitancy, they collaborated with local organizations to address vaccine misinformation and accessibility. They organized outreach events, provided vaccine education, and hosted a vaccine clinic at a Catholic church with a high Hispanic/Latinx congregation. Through their efforts, they administered 1,456 vaccines. The estimated economic and societal impacts of their work was 879 COVID-19 cases avoided, 5 deaths avoided, 45 life years saved, and $29,286 in economic value. The project's success highlights the effectiveness of a student-led approach to promote skill development in social justice training. Leadership skills and coalition building were crucial in overcoming resource limitations and connecting organizations with the necessary volunteer force. Building trust with the Hispanic/Latinx community through outreach efforts and addressing vaccine hesitancy contributed to the well-attended vaccine clinic. The project's framework and approach can be adopted by other medical students and organizations to address health disparities and improve health outcomes in their communities.

Addressing Racial Capitalism's Impact on Black Essential Workers During the COVID-19 Pandemic: Policy Recommendations.

Black Americans are more likely to be essential workers due to racial capitalism. Because of the COVID-19 pandemic, essential workers are less able to adhere to social distancing and stay-at-home guidelines due to the nature of their work, because they are more likely to occupy crowded households, and are more likely to possess pre-existing health conditions. To assist Black essential workers in preventing infection or reducing the intensity of symptoms if contracted, vaccination against the virus is essential. Unfortunately, Black essential workers face considerable barriers to accessing vaccinations and are hesitant to receive the vaccine due to widespread misinformation and justified historical mistrust of the American medical system. The purpose of this work is to (1) describe the disproportionate impact of COVID-19 on Black essential workers due to racial capitalism, (2) outline the socioeconomic and racial barriers related to vaccination within this population, and (3) to suggest policy-related approaches to facilitate vaccination such as access to on-site vaccination opportunities, the funding of community outreach efforts, and the mandating of increased employee benefits.

Protocolo de Revisão de Escopo: a experiência internacional no desenvolvimento e produção de vacina para COVID-19 / Protocol scoping review: the international experience in vaccine development and production for COVID-19

Este protocolo teve como objetivo estruturar as etapas de elaboração de um Scoping Review que pretende estudar as experiências de desenvolvimento e produção de vacinas em 5 países selecionados, comparando com o Brasil. Sendo assim, a introdução buscou contextualizar a questão de desenvolvimento e produção de vacinas no mundo. Posteriormente, foi apresentado o método do trabalho que, neste caso perpassa por uma explanação da escolha prévia dos 5 países selecionados, além de uma busca em 5 repositórios, seguida de busca manual. A pergunta de pesquisa e as palavras chaves foram apresentadas em conjunto com descrição dos critérios de inclusão e exclusão, que levaram a uma seleção final de 25 documentos completos. Por fim, foram apresentados os resultados esperados, quanto ao que se espera encontrar na análise de atores e ações realizadas nos países investigados

This protocol aimed to structure the steps of a Scoping Review that intends to study the experiences of vaccine development and production in 5 selected countries, comparing with Brazil. Thus, the introduction sought to contextualize the issue of vaccine development and production in the world. Afterwards, the method of the work was presented, which in this case involves an explanation of the previous choice of the 5 selected countries, besides a search in 5 repositories, followed by a manual search. The research question and the key words were presented together with a narrative of the inclusion and exclusion criteria, which led to a total selection of 25 full documents. Finally, the expected results were presented, which indicates what is expected to be found in the analysis of actors and actions taken in the countries in question

Inequality in the distribution of Covid-19 vaccine: a systematic review.

BACKGROUND: The equality in the distribution of vaccines between and within countries along with follow sanitation tips and observe social distance, are effective strategies to rid the world of COVID-19 pandemic. Inequality in the distribution of COVID-19 vaccine, in addition to causing inequity to the population health, has a significant impact on the process of economic recovery. METHODS: All published original papers on the inequality of Covid-19 vaccine distribution and the factors affecting it were searched in PubMed, Web of Science, Scopus and ProQuest databases between December 2020 to 30 May 2022. Selection of articles, extraction of their data and qualitative assessment (by STROBE) were performed by two researchers separately. Data graphing form was used to extract detailed data from each study and then, the collected data were classified. RESULTS: A total of 4623 articles were evaluated. After removing duplicates and screening the title, abstract and full text of articles, 22 articles were selected and entered into the study. Fifteen (68.17%) studies were conducted in the United States, three (13.64%) in Europe, three (13.64%) in Asia and one (6.66%) in Oceania. Factors affecting the inequality in the distribution of COVID-19 vaccine were classified into macro and micro levels determinants. CONCLUSION: Macro determinants of inequality in the Covid-19 vaccine distribution were consisted of economic (stability and country's economic status, Gross Domestic Product (GDP) per capita, financial support and human development index), infrastructure and health system (appropriate information system, functional cold chains in vaccine transport, transport infrastructure, medical and non-medical facilities per capita, healthcare access and quality), legal and politics (vaccination allocation rules, health policies, political ideology and racial bias), and epidemiologic and demographic factors (Covid-19 incidence and deaths rate, life expectancy, vulnerability to Covid-19, working in medical setting, comorbidities, social vulnerability, incarceration and education index). Moreover, micro/ individual level factors were included in economic (household's income, home ownership, employment, poverty, access to healthy food and residency in the deprived areas) and demographic and social characteristics (sex, age, race, ethnic, religion, disability, location (urban/rural) and insurance coverage).

Predictors of COVID-19 Vaccination Among EMS Personnel.

INTRODUCTION: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake. METHODS: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression. RESULTS: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of vaccination to protect patients (OR 15.5, P=<0.001); perceived personal risk of infection (OR 1.8, P=0.04); previous receipt of influenza vaccine (OR 2.5, P=0.003); and sufficient knowledge to make an informed decision about vaccination (OR 2.4, P=0.024). CONCLUSION: In this survey of EMS professionals, over a quarter remained unvaccinated for COVID-19. Given the identified predictors of vaccine acceptance, EMS systems should focus on countering misinformation through employee educational campaigns as well as on developing policies regarding workforce immunization requirements.