Coronavirus pandemic in the South Asia region: Health policy and economy trade-off.

Background: The South Asian Association for Regional Cooperation (SAARC) covers Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. We conducted a comparative analysis of the trade-off between the health policies for the prevention of COVID-19 spread and the impact of these policies on the economies and livelihoods of the South Asia populations. Methods: We analyzed COVID-19 data on epidemiology, public health and health policy, health system capacity, and macroeconomic indicators from January 2020 to March 2021 to determine temporal trends by conducting joinpoint regression analysis using average weekly percent change (AWPC). Results: Bangladesh had the highest statistically significant AWPC for new COVID-19 cases (17.0; 95% CI = 7.7-27.1, P < 0.001), followed by the Maldives (12.9; 95% CI = 5.3-21.0, P < 0.001) and India (10.0; 95% CI = 8.4-11.5, P < 0.001). The AWPC for COVID-19 deaths was significant for India (6.5; 95% CI = 4.3-8.9, P < 0.001) and Bangladesh (6.1; 95% CI = 3.7-8.5, P < 0.001). Nepal (55.79%), and India (34.91%) had the second- and third-highest increase in unemployment, while Afghanistan (6.83%) and Pakistan (16.83%) had the lowest. The rate of change of real GDP had the highest decrease for Maldives (557.51%), and India (297.03%); Pakistan (46.46%) and Bangladesh (70.80%), however, had the lowest decrease. The government response stringency index for Pakistan had a see-saw pattern with a sharp decline followed by an increase in the government health policy restrictions that approximated the test-positivity trend. Conclusions: Unlike developed economies, the South Asian developing countries experienced a trade-off between health policy and their economies during the COVID-19 pandemic. South Asian countries (Nepal and India), with extended periods of lockdowns and a mismatch between temporal trends of government response stringency index and the test-positivity or disease incidence, had higher adverse economic effects, unemployment, and burden of COVID-19. Pakistan demonstrated targeted lockdowns with a rapid see-saw pattern of government health policy response that approximated the test-positivity trend and resulted in lesser adverse economic effects, unemployment, and burden of COVID-19.

COVID-19 vaccine hesitancy among non-refugees and refugees in Kenya.

Factors associated with COVID-19 vaccine hesitancy (which we define as refusal to be vaccinated when asked, resulting in delayed or non- vaccination) are poorly studied in sub-Saharan Africa and among refugees, particularly in Kenya. Using survey data from wave five (March to June 2021) of the Kenya Rapid Response Phone Survey (RRPS), a household survey representative of the population of Kenya, we estimated the self-reported rates and factors associated with vaccine hesitancy among non-refugees and refugees in Kenya. Non-refugee households were recruited through sampling of the 2015/16 Kenya Household Budget Survey and random digit dialing. Refugee households were recruited through random sampling of registered refugees. Binary response questions on misinformation and information were transformed into a scale. We performed a weighted (to be representative of the overall population of Kenya) multivariable logistic regression including interactions for refugee status, with the main outcome being if the respondent self-reported that they would not take the COVID-19 vaccine if available at no cost. We calculated the marginal effects of the various factors in the model. The weighted univariate analysis estimated that 18.0% of non-refugees and 7.0% of refugees surveyed in Kenya would not take the COVID-19 vaccine if offered at no cost. Adjusted, refugee status was associated with a -13.1[95%CI:-17.5,-8.7] percentage point difference (ppd) in vaccine hesitancy. For the both refugees and non-refugees, having education beyond the primary level, having symptoms of COVID-19, avoiding handshakes, and washing hands more often were also associated with a reduction in vaccine hesitancy. Also for both, having used the internet in the past three months was associated with a 8.1[1.4,14.7] ppd increase in vaccine hesitancy; and disagreeing that the government could be trusted in responding to COVID-19 was associated with a 25.9[14.2,37.5]ppd increase in vaccine hesitancy. There were significant interactions between refugee status and some variables (geography, food security, trust in the Kenyan government's response to COVID-19, knowing somebody with COVID-19, internet use, and TV ownership). These relationships between refugee status and certain variables suggest that programming between refugees and non-refugees be differentiated and specific to the contextual needs of each group.

COVID-19 vaccine hesitancy among non-refugees and refugees in Kenya

Factors associated with COVID-19 vaccine hesitancy (which we define as refusal to be vaccinated when asked, resulting in delayed or non- vaccination) are poorly studied in sub-Saharan Africa and among refugees, particularly in Kenya. Using survey data from wave five (March to June 2021) of the Kenya Rapid Response Phone Survey (RRPS), a household survey representative of the population of Kenya, we estimated the self-reported rates and factors associated with vaccine hesitancy among non-refugees and refugees in Kenya. Non-refugee households were recruited through sampling of the 2015/16 Kenya Household Budget Survey and random digit dialing. Refugee households were recruited through random sampling of registered refugees. Binary response questions on misinformation and information were transformed into a scale. We performed a weighted (to be representative of the overall population of Kenya) multivariable logistic regression including interactions for refugee status, with the main outcome being if the respondent self-reported that they would not take the COVID-19 vaccine if available at no cost. We calculated the marginal effects of the various factors in the model. The weighted univariate analysis estimated that 18.0% of non-refugees and 7.0% of refugees surveyed in Kenya would not take the COVID-19 vaccine if offered at no cost. Adjusted, refugee status was associated with a -13.1[95%CI:-17.5,-8.7] percentage point difference (ppd) in vaccine hesitancy. For the both refugees and non-refugees, having education beyond the primary level, having symptoms of COVID-19, avoiding handshakes, and washing hands more often were also associated with a reduction in vaccine hesitancy. Also for both, having used the internet in the past three months was associated with a 8.1[1.4,14.7] ppd increase in vaccine hesitancy;and disagreeing that the government could be trusted in responding to COVID-19 was associated with a 25.9[14.2,37.5]ppd increase in vaccine hesitancy. There were significant interactions between refugee status and some variables (geography, food security, trust in the Kenyan government's response to COVID-19, knowing somebody with COVID-19, internet use, and TV ownership). These relationships between refugee status and certain variables suggest that programming between refugees and non-refugees be differentiated and specific to the contextual needs of each group.

COVID-19 vaccination refusal trends in Kenya over 2021.

BACKGROUND: Vaccination refusal exacerbates global COVID-19 vaccination inequities. No studies in East Africa have examined temporal trends in vaccination refusal, precluding addressing refusal. We assessed vaccine refusal over time in Kenya, and characterized factors associated with changes in vaccination refusal. METHODS: We analyzed data from the Kenya Rapid Response Phone Survey (RRPS), a household cohort survey representative of the Kenyan population including refugees. Vaccination refusal (defined as the respondent stating they would not receive the vaccine if offered to them at no cost) was measured in February and October 2021. Proportions of vaccination refusal were plotted over time. We analyzed factors in vaccination refusal using a weighted multivariable logistic regression including interactions for time. FINDINGS: Among 11,569 households, vaccination refusal in Kenya decreased from 24 % in February 2021 to 9 % in October 2021. Vaccination refusal was associated with having education beyond the primary level (-4.1[-0.7,-8.9] percentage point difference (ppd)); living with somebody who had symptoms of COVID-19 in the past 14 days (-13.72[-8.9,-18.6]ppd); having symptoms of COVID-19 in the past 14 days (11.0[5.1,16.9]ppd); and distrusting the government in responding to COVID-19 (14.7[7.1,22.4]ppd). There were significant interactions with time and: refugee status and geography, living with somebody with symptoms of COVID-19, having symptoms of COVID-19, and believing in misinformation. INTERPRETATION: The temporal reduction in vaccination refusal in Kenya likely represents substantial strides by the Kenyan vaccination program and possible learnt lessons which require examination. Going forward, there are still several groups which need specific targeting to decrease vaccination refusal and improve vaccination equity, including those with lower levels of education, those with recent COVID-19 symptoms, those who do not practice personal COVID-19 mitigation measures, refugees in urban settings, and those who do not trust the government. Policy and program should focus on decreasing vaccination refusal in these populations, and research focus on understanding barriers and motivators for vaccination.

Coronavirus pandemic in the Nordic countries: Health policy and economy trade-off.

Background: Countries making up the Nordic region - Denmark, Finland, Iceland, Norway, and Sweden - have minimal socioeconomic, cultural, and geographical differences between them, allowing for a fair comparative analysis of the health policy and economy trade-off in their national approaches towards mitigating the impact of the COVID-19 pandemic. Methods: This study utilized publicly available COVID-19 data of the Nordic countries from January 2020 to January 3, 2021. COVID-19 epidemiology, public health and health policy, health system capacity, and macroeconomic data were analysed for each Nordic country. Joinpoint regression analysis was performed to identify changes in temporal trends using average monthly percent change (AMPC) and average weekly percent change (AWPC). Results: Sweden's health policy, being by far the most relaxed response to COVID-19, was found to have the largest COVID-19 incidence and mortality, and the highest AWPC increases for both indicators (13.5, 95% CI = 5.6, 22.0, P < 0.001; 6.3, 95% CI = 3.5, 9.1, P < 0.001). Denmark had the highest number of COVID-19 tests per capita, consistent with their approach of increased testing as a preventive strategy for disease transmission. Iceland had the second-highest number of tests per capita due to their mass-testing, contact tracing, quarantine and isolation response. Only Norway had a significant increase in unemployment (AMPC = 2.8%, 95% CI = 0.7-4.9, P < 0.009) while the percentage change in real Gross Domestic Product (GDP) was insignificant for all countries. Conclusions: There was no trade-off between public health policy and economy during the COVID-19 pandemic in the Nordic region. Sweden's relaxed and delayed COVID-19 health policy response did not benefit the economy in the short term, while leading to disproportionate COVID-19 hospitalizations and mortality.