COVID-19 Denialism, Vaccine Scepticism and the Regulation of Health Practitioners.

During a pandemic such as COVID-19 fear, anxiety and paranoia can become prevalent within the community. Agnotology has taught us that in such times science denialism and vaccination scepticism can gain a foothold and discourage the undiscerning and the uninformed from receiving the treatment and prophylactic public health measures that are essential to community health and safety. When health practitioners endorse such attitudes they pose a serious risk to not only their patients but the whole community. This requires a robust response from health practitioner regulators, disciplinary tribunals and courts. This column identifies such a sensible and proportionate response from the Irish High Court in Medical Council v Waters [2021] IEHC 252 when a general practitioner's registration to practise was suspended for promoting such views. The decision, along with a comparable decision by the Victorian Civil and Administrative Tribunal in 2020 constitute potent international examples of a robust and commonsense regulatory endorsement of science during a time of public health crisis.

Vaccine Inequity and Hesitancy: A Vicious Cycle Undermining the Fight Against the COVID-19 Pandemic.

The world has come a long way in the fight against the COVID-19 pandemic by averting the initially feared humanitarian crisis and by producing effective vaccines in a record time. Paradoxically, more new daily cases are being reported today than when there was not any effective vaccine around. The success against the pandemic so far is dented by inadequate vaccine supply in most low-income countries and widespread vaccine hesitancy. By the end of 2021, only half of WHO Member States have reached the target of immunizing 40% of their populations, while only less than 10% of the population in low-income countries have received at least one dose of the vaccine. This happened while more than nine billion doses of the vaccines were administered globally, predominantly in rich countries. On the backdrop of these man-made factors, the evolution of highly mutated variants of the virus is causing more uncertainties than the pre-vaccine time. If the vaccine inequities and hesitancy are not properly addressed, we are likely to enter into the vicious cycle of inequitable vaccine distribution leading to low vaccination rates in most low-income countries where the majority of the world population resides. This will ultimately enhance sustained transmission of the virus, leading to evolution of new variants of concern. As the highly mutated variants are likely to infect both vaccinated and unvaccinated individuals, it will inevitably lead to major doubts in the effectiveness and acceptance of the vaccines. In this review, we present how this vicious cycle may prolong the pandemic and discuss the importance of concerted global action to tackle it.

A Needs-Based Analysis of Teaching on Vaccinations and COVID-19 in German Medical Schools.

The COVID-19 pandemic highlights the need for improving public confidence in vaccines. Academic gaps and redundancies on vaccinations must be identified to revise the medical curriculum for up-to-date training of medical students. This cross-sectional survey assessed the status of vaccine-related teaching in general and specific to COVID-19 in medical schools across Germany. A total of 4313 medical students completed a questionnaire comprising items on national learning goals and perceived needs for teaching on vaccinations. Mixed methods were used to analyse data quantitatively for relative frequencies (%) and correlations between teaching items and semesters (Spearman's rho), and qualitatively (content analysis). Our findings showed that 38.92% of the students were dissatisfied with teaching on vaccine-preventable diseases, but the perceived satisfaction increased in later semesters (r = 0.46, p < 0.001). Moreover, 75.84% and 68.15% of the students were dissatisfied with teaching related to vaccine scepticism and vaccine-related communication strategies, respectively. Furthermore, 63.79% reported dissatisfaction with teaching on COVID-19 disease and 72.93% with teaching on COVID-19 vaccines. A total of 79.12% stated they educated others on COVID-19 and its vaccines and 75.14% felt responsible to do so. A majority of the medical students were dissatisfied with teaching on dealing with vaccine scepticism, communication strategies and COVID-19 vaccines. We recommend practice-oriented vaccine education, especially for teaching communication skills to medical students.

Cutaneous diphtheria: three case-reports to discuss determinants of re-emergence in resource-rich settings.

Diphtheria is a re-emerging disease in resource-rich settings. We here report three cases of cutaneous diphtheria diagnosed and managed in our infectious disease department and discuss the determinants of its re-emergence. Migration, travel and vaccine scepticism are key factors not only for diphtheria re-emergence, but for the future of most preventable diseases.

Impact of COVID-19 and intensive care unit capacity on vaccination support: Evidence from a two-leg representative survey in the United Kingdom.

BACKGROUND: Overcoming coronavirus disease (COVID-19) will likely require mass vaccination. With vaccination scepticism rising in many countries, assessing the willingness to vaccinate against COVID-19 is of crucial global health importance. OBJECTIVE: The goal of this study was to examine how personal and family COVID-19 risk and ICU (intensive care unit) availability just before the pandemics influence the acceptance of future COVID-19 vaccines. METHODS: A two-leg survey was carried out for comparing vaccination attitudes pre-and post-COVID-19. UK residents were surveyed in October 2019 about their vaccination attitudes, and again in a follow-up survey in April 2020, containing the previous questions and further ones related to COVID-19 exposure and COVID-19 vaccine attitudes. The study combined survey results with local COVID-19 incidence and pre-COVID-19 measures of ICU capacity and occupancy. Regression analysis of the impact of individual and public health factors on attitudes towards COVID-19 vaccination was performed. RESULTS: The October 2019 survey included a nationally representative sample of 1653 UK residents. All of them were invited for the follow-up survey in April 2020, and 1194 (72%) participated. The April 2020 sample remained nationally representative. Overall, 85% of respondents (and 55% of vaccine sceptics) would be willing to be vaccinated against COVID-19. Higher personal and family risk for COVID-19 was associated with stronger COVID-19 vaccination willingness, whereas low pre-COVID-19 ICU availability was associated with lower trust in medical experts and lower COVID-19 vaccine support. Further, general vaccination support has risen during the COVID-19 pandemic. CONCLUSION: Support for COVID-19 vaccination is high amongst all groups, even vaccine sceptics, boding well for future vaccination take-up rates. Vaccination willingness is correlated with health care availability during the COVID-19 crisis, suggesting a powerful synergy between health care system performance during crisis and the general population's trust in the medical profession - as reflected in vaccination support.

Epistemic divides and ontological confusions: The psychology of vaccine scepticism.

Vaccine scepticism is an increasingly important barrier to optimal coverage in developed countries. In this commentary, we make the case that negative attitudes towards vaccines reflect a broader and deeper set of beliefs about health and wellbeing. We suggest that this alternative worldview is influenced by ontological confusions (e.g. regarding purity, natural energy), and knowledge based on personal lived experience and trusted peers, rather than the positivist epistemological framework. Our view is supported by recent social-psychological research, including strong correlations of vaccine scepticism with adherence to complementary and alternative medicine, magical health beliefs, and conspiracy ideation. For certain well-educated and well-resourced individuals, opposition to vaccines represents an expression of personal intuition and agency, in achieving a positive and life-affirming approach to health and wellbeing. These core beliefs are not amenable to change - and especially resistant to communications from orthodox, authoritative sources. Although this view does suggest tactical improvements to messaging, we suggest that a better long-term strategy is to combine with other disciplines in order to address the root causes of vaccine scepticism. Vaccine scepticism is unlikely to thrive in a cultural context that trusts and values the scientific consensus.

Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey.

OBJECTIVE: Understanding the factors that influence human papillomavirus (HPV) vaccination uptake is critically important to the design of effective vaccination programmes. In Switzerland, HPV vaccination uptake (≥1 dose) by age 16 years among women ranges from 31% to 80% across 26 cantons (states). Our objective was to identify factors that are associated with the spatial variation in HPV vaccination uptake. METHODS: We used cross-sectional data from the Swiss National Vaccination Coverage Survey 2009-2016 on HPV vaccination status (≥1 dose) of 14-17-year-old girls, their municipality of residence and their nationality for 21 of 26 cantons (n=8965). We examined covariates at municipality level: language, degree of urbanisation, socioeconomic position, religious denomination, results of a vote about vaccination laws as a proxy for vaccine scepticism and, at cantonal level, availability of school-based vaccination and survey period. We used a series of conditional autoregressive models to assess the effects of covariates while accounting for variability between cantons and municipal-level spatial autocorrelation. RESULTS: In the best-fit model, living in cantons that have school-based vaccination (adjusted OR 2.51; 95% credible interval 1.77 to 3.56) was associated with increased uptake, while living in municipalities with lower acceptance of vaccination laws was associated with lower HPV vaccination uptake (OR 0.61; 95% credible interval 0.50 to 0.73). Overall, the covariates explained 88% of the municipal-level variation in uptake. CONCLUSIONS: In Switzerland, both cantons and community opinion about vaccination play a prominent role in the variation in HPV vaccination uptake. To increase uptake, efforts should be made to mitigate vaccination scepticism and to encourage school-based vaccination.

Anti-vaccination and pro-CAM attitudes both reflect magical beliefs about health.

We examined the relationship between complementary and alternative medicine (CAM) use and vaccination scepticism; and specifically whether a person's more general health-related worldview might explain this relationship. A cross-sectional online survey of adult Australians (N = 2697) included demographic, CAM, and vaccination measures, as well as the holistic and magical health belief scales (HHB, MHB). HHB emphasises links between mind and body health, and the impact of general 'wellness' on specific ailments or resistance to disease, whilst MHB specifically taps ontological confusions and cognitive errors about health. CAM and anti-vaccination were found to be linked primarily at the attitudinal level (r = -0.437). We did not find evidence that this was due to CAM practitioners influencing their clients. Applying a path-analytic approach, we found that individuals' health worldview (HHB and MHB) accounted for a significant proportion (43.1%) of the covariance between CAM and vaccination attitudes. MHB was by far the strongest predictor of both CAM and vaccination attitudes in regressions including demographic predictors. We conclude that vaccination scepticism reflects part of a broader health worldview that discounts scientific knowledge in favour of magical or superstitious thinking. Therefore, persuasive messages reflecting this worldview may be more effective than fact-based campaigns in influencing vaccine sceptics.