Understanding the COVID-19 Vaccine Policy Terrain in Ontario Canada: A Policy Analysis of the Actors, Content, Processes, and Context.

(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review.

BACKGROUND: Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. METHODS: A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. RESULTS: Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. CONCLUSIONS: Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

Prevalence of Anxiety in University Students during the COVID-19 Pandemic: A Systematic Review.

There is a dearth of evidence synthesis on the prevalence of anxiety among university students even though the risk of psychological disorders among this population is quite high. We conducted a quantitative systematic review to estimate the global prevalence of anxiety among university students during the COVID-19 pandemic. A systematic search for cross-sectional studies on PubMed, Scopus, and PsycINFO, using PRISMA guidelines, was conducted from September 2020 to February 2021. A total of 36 studies were included, using a random-effects model to calculate the pooled proportion of anxiety. A meta-analysis of the prevalence estimate of anxiety yielded a summary prevalence of 41% (95% CI = 0.34-0.49), with statistically significant evidence of between-study heterogeneity (Q = 80801.97, I2 = 100%, p ≤ 0.0001). A subgroup analysis reported anxiety prevalence in Asia as 33% (95% CI:0.25-0.43), the prevalence of anxiety in Europe as 51% (95% CI: 0.44-0.59), and the highest prevalence of anxiety in the USA as 56% (95% CI: 0.44-0.67). A subgroup gender-based analysis reported the prevalence of anxiety in females as 43% (95% CI:0.29-0.58) compared to males with an anxiety prevalence of 39% (95% CI:0.29-0.50). University students seem to have a high prevalence of anxiety, indicating an increased mental health burden during this pandemic.

What Demographic, Social, and Contextual Factors Influence the Intention to Use COVID-19 Vaccines: A Scoping Review.

BACKGROUND: During the COVID-19 crisis, an apparent growth in vaccine hesitancy has been noticed due to different factors and reasons. Therefore, this scoping review was performed to determine the prevalence of intention to use COVID-19 vaccines among adults aged 18-60, and to identify the demographic, social, and contextual factors that influence the intention to use COVID-19 vaccines. METHODS: This scoping review was conducted by using the methodological framework for scoping review outlined by Arksey and O'Malley. A search strategy was carried out on four electronic databases: PubMed, Scopus, CINAHL, and PsycINFO. All peer-reviewed articles published between November 2019 and December 2020 were reviewed. Data were extracted to identify the prevalence of, and factors that influence, the intention to use COVID-19 vaccines. RESULTS: A total of 48 relevant articles were identified for inclusion in the review. Outcomes presented fell into seven themes: demographics, social factors, vaccination beliefs and attitudes, vaccine-related perceptions, health-related perceptions, perceived barriers, and vaccine recommendations. Age, gender, education level, race/ethnicity, vaccine safety and effectiveness, influenza vaccination history, and self-protection from COVID-19 were the most prominent factors associated with intention to use COVID-19 vaccines. Furthermore, the majority of studies (n = 34/48) reported a relatively high prevalence of intention to get vaccinated against COVID-19, with a range from 60% to 93%. CONCLUSION: This scoping review enables the creation of demographic, social, and contextual constructs associated with intention to vaccinate among the adult population. These factors are likely to play a major role in any targeted vaccination programs, particularly COVID-19 vaccination. Thus, our review suggests focusing on the development of strategies to promote the intention to get vaccinated against COVID-19 and to overcome vaccine hesitancy and refusal. These strategies could include transparent communication, social media engagement, and the initiation of education programs.

Dentists' Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists.

BACKGROUND: Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control. OBJECTIVE: This study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists. METHODS: The study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists' demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19. RESULTS: This study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission. CONCLUSIONS: Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches.