[Dictatorship, Health and Propaganda: The National Immunization Program (PNI) and the media campaign for compulsory vaccination]. / Ditadura, Saúde e Propaganda: O Programa Nacional de Imunização (PNI) e a campanha midiática de vacinação obrigatória.

This article analyzes the films produced and broadcast between 1976 and 1978 by the National Agency and the Public Relations Office (ARP) for the campaign to publicize the mandatory vaccination that was instituted by the National Immunization Plan (PNI), created in 1975 and regulated by Decree No. 78,231 of August 12, 1976. The objective is to understand the narrative constructed through images and speeches aimed at convincing the population to make vaccination a culturally accepted practice. To achieve this, we examine the legislation on the subject during the period under analysis, namely the civil-military dictatorship. The dictatorial regime is approached based on the conceptual aspects that guide the analysis of the appropriation of health campaigns as propaganda and investments in a private and curative health model. We can therefore conclude that the initiative to create the PNI is a hiatus in this process of privatizing health, since it is not an action guided by the dictatorship's responsibility for the health of the population, but an action that involved the management of multiple actors in the health field, and which was embraced by the regime because it was a process directly linked to interests connected to the country's conservative modernization project.

Este artigo analisa os filmes produzidos e veiculados, entre 1976 e 1978, pela Agência Nacional e pela Assessoria de Relações Públicas (ARP) para a campanha de divulgação da vacinação obrigatória que foi instituída pelo Plano Nacional de Imunizações (PNI), criado em 1975, e regulamentado pelo Decreto nº 78.231, de 12 de agosto de 1976. O objetivo é compreender a narrativa construída através de imagens e discursos visando tornar a vacina uma prática culturalmente aceita. Para isso, recorre-se à legislação que versa sobre o tema no período analisado, qual seja na ditadura civil-militar. O regime ditatorial é abordado a partir dos aspectos conceituais que orientam as análises sobre a apropriação das campanhas de saúde como propaganda e dos investimentos em um modelo de saúde privada e curativista. Conclui-se, assim, que a iniciativa de criação do PNI trata-se de um hiato nesse processo de privatização da saúde, já que não é uma ação orientada pela responsabilidade da ditadura para com a saúde da população, mas sim, uma ação que envolveu a gerência de múltiplos atores do campo da saúde, e que foi encampada pelo regime por se tratar de um processo diretamente atrelado a interesses ligados ao projeto de modernização conservadora do país.

Voluntary versus mandatory food labels, Australia.

Objective: To compare uptake of the voluntary Health Star Rating front-of-pack nutrition labelling system with uptake of a mostly mandatory country-of-origin label in Australia over a similar period. Methods: We used data on numbers and proportions of products carrying health stars and country-of-origin labelling recorded annually between 2015 and 2023 through surveys of four large Australian food retailers. We determined the proportion of products with health stars and country-of-origin labels for each year by dividing the number of products carrying each label by the total number eligible to carry that label. Findings: The uptake of the voluntary Health Star Rating increased steadily between 2014 and 2018, reaching a maximum of 42% (8587/20 286) of products in 2021 before decreasing to 39% (8572/22 147) in 2023. Mandatory country-of-origin labelling uptake rose rapidly and was found on 93% (17 567/18 923) of products in 2023. In categories where country-of-origin labelling was voluntary, uptake by 2023 was 48% (3313/6925). In our 2023 sample of 22 147 products, 11 055 (50%) carried country-of-origin labelling only, 7466 (35%) carried both health star and country-of-origin labelling, 1106 (5%) carried health star labels only and 2520 (11%) carried neither label. Conclusion: The experience with country-of-origin labelling shows that widespread and rapid food labelling change can be achieved when required by law. The Australian government should mandate the Health Star Rating without delay. Australia's experience supports other jurisdictions in implementing mandatory front-of-pack nutrition labelling as well as updates to global guidance to recognize mandatory labelling as best-practice in delivering benefits to consumers.

State COVID-19 Vaccine Mandates and Uptake Among Health Care Workers in the US.

Importance: Seventeen states introduced COVID-19 vaccine mandates for health care workers (HCWs) in mid-2021. Prior research on the effect of these mandates was centered on the nursing home sector, and more evidence is needed for their effect on the entire HCW population. Objective: To examine the association between state COVID-19 vaccine mandates for HCWs and vaccine uptake in this population. Design, Setting, and Participants: This repeated cross-sectional study included biweekly, individual-level data for adults aged 25 to 64 years who were working or volunteering in health care settings obtained from the Household Pulse Survey between May 26 and October 11, 2021. Analyses were conducted between November 2022 and October 2023. Exposure: Announcement of a state COVID-19 vaccine mandate for HCWs. Main Outcomes and Measures: An indicator for whether a sampled HCW ever received a COVID-19 vaccine and an indicator for whether an HCW completed or intended to complete the primary COVID-19 vaccination series. Event study analyses using staggered difference-in-differences methods compared vaccine uptake among HCWs in mandate and nonmandate states before and after each mandate announcement. The sample was further stratified by the availability of regular COVID-19 testing in place of a vaccination (ie, a test-out option) and by the ages of HCWs (25-49 or 50-64 years) to examine heterogeneous associations. Results: The study sample included 31 142 HCWs (mean [SD] age, 45.5 [10.6] years; 72.1% female) from 45 states, 16 of which introduced COVID-19 vaccine mandates for HCWs. Results indicated a mandate-associated 3.46-percentage point (pp) (95% CI, 0.29-6.63 pp; P = .03) increase in the proportion of HCWs ever vaccinated against COVID-19 and a 3.64-pp (95% CI, 0.72-6.57 pp; P = .02) increase in the proportion that completed or intended to complete the primary vaccination series 2 weeks after mandate announcement from baseline proportions of 87.98% and 86.12%, respectively. In the stratified analyses, positive associations were only detected in mandate states with no test-out option and among HCWs aged 25 to 49 years, which suggested vaccination increases of 3.32% to 7.09% compared with baseline proportions. Conclusions and Relevance: This repeated cross-sectional study found that state COVID-19 vaccine mandates for HCWs were associated with increased vaccine uptake among HCWs, especially among younger HCWs and those in states with no test-out option. These findings suggest the potential for vaccine mandates to further promote vaccinations in an already highly vaccinated HCW population, especially when no test-out option is in place.

Public values to guide childhood vaccination mandates: A report on four Australian community juries.

OBJECTIVE: Governments use vaccination mandates, of different degrees of coerciveness, to encourage or require childhood vaccination. We elicited the views of well-informed community members on the public acceptability of using childhood vaccination mandates in Australia. METHODS: Four community juries were conducted in Canberra, Launceston, Cairns and Melbourne, Australia between 2021 and 2022. We recruited 51 participants from diverse backgrounds, genders and ages through random digit dialling and social media. Two juries were held in metropolitan areas, and two in regional/rural settings. Outcome measures included jury verdicts and reasons in response to structured questions. RESULTS: All juries were concerned about collective protection and individual rights but prioritised the former over the latter. A majority in all juries supported mandates but juries disagreed with respect to the appropriate mandate types. All juries endorsed using the least restrictive or coercive means to encourage vaccination (providing incentives or education, e.g.) before imposing penalties such as financial losses and school exclusions. The overriding view was that it is fairer to place a direct burden on parents rather than children and that mandates should be designed to avoid inequitable impacts on less advantaged groups in society. Many jurors found conscientious objection acceptable as a controlled option for resolute refusers, provided that overall vaccination coverage remains high. CONCLUSION: This paper gives policymakers access to the reasons that Australians have for supporting or opposing different mandates under conditions of high knowledge, understanding and deliberation regarding policy options. Sustaining high rates of vaccination requires high levels of co-operation between governments, public health actors and the public. Our findings highlight the importance of considering public values in the design and implementation of vaccination mandates. PATIENT AND PUBLIC INVOLVEMENT: We sought input from individuals who did and did not vaccinate during the study design. The views and perspectives of nonvaccinating parents were presented in the evidence to juries. We deliberately excluded nonvaccinating individuals from participating, as the divisive and often hostile nature of the topic, and their minority status, made it difficult to ensure they would feel safe as members of the jury without overrepresenting their perspective in the sample. Two related projects engaged directly with these parents.

Newspaper Representation of Mandatory Vaccination Against COVID-19 for Healthcare Workers in England: A Qualitative Framing Analysis.

In 2021, vaccination against COVID-19 became mandatory for healthcare workers in England. The media coverage of the mandate was extensive and became an issue of public interest. This study aimed to understand the United Kingdom (UK) debate on mandatory COVID-19 vaccination through a framing analysis of UK media coverage. Articles written between November 2021 and April 2022 were identified from UK national newspapers: The Daily (and Sunday) Telegraph, the Times (and Sunday Times), the Guardian (and the Observer), the Independent, the Daily Mail (and Mail on Sunday), the Daily Mirror, the Daily Express, and the Sun. Articles were selected using eligibility criteria before framing analysis was undertaken. The sample included 204 articles. Safe Staffing, Treatment of Staff, Change in Covid Context, and Protect Patient Safety were identified as frames used to stimulate debate on the mandatory vaccination policy. Such frames established three broader concepts in the media: civil liberty theory, duty-based ethics, and social-vulnerability theory. This study analyzed how mandatory COVID-19 vaccination for healthcare workers in England was framed in the UK national media. The broader concepts built in the media heightened debate on the policy, creating a voluminous amount of coverage and criticism that may have played a role in the mandate's reversal.

Possible counter-intuitive impact of local vaccine mandates for vaccine-preventable infectious diseases.

We modeled the impact of local vaccine mandates on the spread of vaccine-preventable infectious diseases, which in the absence of vaccines will mainly affect children. Examples of such diseases are measles, rubella, mumps, and pertussis. To model the spread of the pathogen, we used a stochastic SIR (susceptible, infectious, recovered) model with two levels of mixing in a closed population, often referred to as the household model. In this model, individuals make local contacts within a specific small subgroup of the population (e.g., within a household or a school class), while they also make global contacts with random people in the population at a much lower rate than the rate of local contacts. We considered what would happen if schools were given freedom to impose vaccine mandates on all of their pupils, except for the pupils that were exempt from vaccination because of medical reasons. We investigated first how such a mandate affected the probability of an outbreak of a disease. Furthermore, we focused on the probability that a pupil that was medically exempt from vaccination, would get infected during an outbreak. We showed that if the population vaccine coverage was close to the herd-immunity level, then both probabilities may increase if local vaccine mandates were implemented. This was caused by unvaccinated pupils possibly being moved to schools without mandates.

The Influence of a COVID-19 Vaccine Mandate on Vaccination Rates in a University Setting.

We surveyed (September 9-17, 2021) students, staff, and faculty at the University of Minnesota, a large, highly vaccinated university, to evaluate whether the COVID-19 vaccine mandate increased self-reported vaccine uptake. Vaccine mandates have the potential to improve public health but should consider the context of implementation and costs associated with infringements on personal choice. Policymakers need to be equipped with data to inform decisions about vaccine mandates in light of contextual factors and potential backlash affecting public health interventions. (Am J Public Health. 2024;114(11):1222-1227. https://doi.org/10.2105/AJPH.2024.307804).

Increasing vaccination coverage among healthcare workers: Active call and mandatory laws. Data from a large general hospital in Southern Italy.

Influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are respiratory pathogens which significantly impact healthcare systems. Seasonal vaccination is recommended for all healthcare workers (HCWs) to reduce the risk for both operators and patients. Puglia, a region in Southern Italy, has been enforcing since 2018 a law mandating influenza vaccination in healthcare workers. However, vaccination coverages for this category have always been suboptimal. Our study tests the effectiveness of an active recall intervention on vaccination coverage for influenza and SARS-CoV-2 in the HCWs of a large Apulian hospital (Southern Italy). During the 2023-2024 influenza vaccination season, unvaccinated HCWs of Bari's Policlinico General Hospital were contacted. The e-mail reminded them of a regional law mandating influenza vaccination to all HCWs and offered an appointment for vaccination. SARS-CoV-2 vaccination was also offered. In 2022-2023, 43.16 % of HCWs were vaccinated against influenza and 21.87 % against SARS-CoV-2. Coverage changed during the 2023-2024 season to 54.11 % and 13.58 %, respectively. A regression model showed that vaccination uptake's increase was associated with the e-mail reception and with the operator being a physician vs. non-medical personnel. On the contrary, subjects who received the e-mail did not show an increased SARS-CoV-2 vaccination uptake, which was on the contrary influenced by the worker's age, sex, job title, and area of risk. Our soft-mandate intervention was effective in increasing vaccination uptake by HCWs. Communication with a trained specialist was probably useful, and the possibility to access vaccination services with dedicated appointments increased convenience. Mandatory vaccination policies and active recall seem to synergically impact vaccination uptake.

Effects of Medicaid managed care on early detection of cancer: Evidence from mandatory Medicaid managed care program in Pennsylvania.

OBJECTIVE: To examine changes in late- versus early-stage diagnosis of cancer associated with the introduction of mandatory Medicaid managed care (MMC) in Pennsylvania. DATA SOURCES AND STUDY SETTING: We analyzed data from the Pennsylvania cancer registry (2010-2018) for adult Medicaid beneficiaries aged 21-64 newly diagnosed with a solid tumor. To ascertain Medicaid and managed care status around diagnosis, we linked the cancer registry to statewide hospital-based facility records collected by an independent state agency (Pennsylvania Health Care Cost Containment Council). STUDY DESIGN: We leveraged a natural experiment arising from county-level variation in mandatory MMC in Pennsylvania. Using a stacked difference-in-differences design, we compared changes in the probability of late-stage cancer diagnosis among those residing in counties that newly transitioned to mandatory managed care to contemporaneous changes among those in counties with mature MMC programs. DATA COLLECTION/EXTRACTION METHODS: N/A. PRINCIPAL FINDINGS: Mandatory MMC was associated with a reduced probability of late-stage cancer diagnosis (-3.9 percentage points; 95% CI: -7.2, -0.5; p = 0.02), particularly for screening-amenable cancers (-5.5 percentage points; 95% CI: -10.4, -0.6; p = 0.03). We found no significant changes in late-stage diagnosis among non-screening amenable cancers. CONCLUSIONS: In Pennsylvania, the implementation of mandatory MMC for adult Medicaid beneficiaries was associated with earlier stage of diagnosis among newly diagnosed cancer patients with Medicaid, especially those diagnosed with screening-amenable cancers. Considering that over half of the sample was diagnosed with late-stage cancer even after the transition to mandatory MMC, Medicaid programs and managed care organizations should continue to carefully monitor receipt of cancer screening and design strategies to reduce barriers to guideline-concordant screening or diagnostic procedures.

Some issues of compulsory vaccination of adults.

Legal regulation, whether we want it or not, plays a role in protecting and promoting individual and public health. This also applies to legislation involving vaccination, especially compulsory vaccination. It is appropriate that legislation should not create barriers to the provision of health care. Where there is legal ambiguity, problems can arise that make the provision of health care more difficult, as we have seen, for example, in the context of the COVID pandemic. Furthermore, in the case of compulsory vaccination, there is a conflict between fundamental rights and freedoms. On the one hand, the right to the protection of personal freedom and bodily integrity, and on the other, the right to life and health. Most compulsory vaccinations concern children. As far as adult vaccination is concerned, this mainly includes compulsory vaccination of medical and social staff caring for patients and operating at biological risk, as well as patient groups also at risk of serious infectious disease. For these reasons, it is essential that the legislation is such that it does not impose a burden where it is not necessary and, on the contrary, allows for optimal protection of persons at biological risk.

State-level factors associated with implementation of prescription drug monitoring program integration and mandatory use policies, United States, 2009-2020.

BACKGROUND: Prescription drug monitoring programs (PDMPs) have been widely adopted as a tool to address the prescription opioid epidemic in the United States. PDMP integration and mandatory use policies are 2 approaches states have implemented to increase use of PDMPs by prescribers. While the effectiveness of these approaches is mixed, it is unclear what factors motivated states to implement them. This study examines whether opioid dispensing, adverse health outcomes, or other non-health-related factors motivated implementation of these PDMP approaches. METHODS: Time-to-event analysis was performed using lagged state-year covariates to reflect values from the year prior. Extended Cox regression estimated the association of states' rates of opioid dispensing, prescription opioid overdose deaths, and neonatal opioid withdrawal syndrome with implementation of PDMP integration and mandatory use policies from 2009 to 2020, controlling for demographic and economic factors, state government and political factors, and prior opioid policies. RESULTS: In our main model, prior opioid dispensing (HR 2.31, 95% CI 1.17, 4.57), neonatal opioid withdrawal syndrome hospitalizations (HR 1.55, 95% CI 1.09, 2.19), and number of prior opioid policies (HR 2.13, 95% CI 1.13, 4.00) were associated with mandatory use policies. Prior prescription opioid overdose deaths (HR 1.21, 95% CI 1.08, 1.35) were also associated with mandatory use policies in a model that did not include opioid dispensing or neonatal opioid withdrawal syndrome. No study variables were associated with implementation of PDMP integration. CONCLUSION: Understanding state-level factors associated with implementing PDMP approaches can provide insights into factors that motivate the adoption of future public health interventions.

How Bodily Autonomy Can Fail Against Vaccination Mandates: The Few vs. the Many.

Humans have been a communal species since inception and continue to be so to this day. Because of this, if even a small scale of a measured population becomes severely ill, the entire remaining population and surrounding area is thrown into absolute chaos. In fact, we have seen these circumstances throughout history and in the recent COVID-19 pandemic yet, some of us have forgotten that the only way this chaos can be curbed, is by enacting a mandatory vaccination policy. Since COVID-19 however, vaccination mandates have become an uneasy topic of conversation in the United States for essentially one main reason, some U.S citizens do not like to be told what to do with their body and what to place inside it, further believing their bodily autonomy to be absolute. Data shows that this ideology recently became more widespread from an increase of mistrust of government and pharmaceutical companies, and from political beliefs and affiliations. Nevertheless, what the data also shows is that these same individuals were asserting their right to bodily autonomy against a vaccination mandate in an unduly aggressive manner, and on a very erroneous understanding of the governing jurisprudence, policies and modern scientific data surrounding said vaccination mandates and large scale disease outbreaks. This article therefore aims to provide a clear and extensive understanding of the proposition that, while bodily autonomy is favored in other aspects of life, this right can fail with respect to deadly disease outbreaks and mandatory vaccinations as there is presently no other practical or feasible alternative. Specifically, this article introduces and/or reminds the U.S. public of well-established governing case law, relevant historical and scientific information and the pertinent legislative authority surrounding vaccines, bodily autonomy, and vaccination mandates.

Mandatory large-scale food fortification programmes can reduce the estimated prevalence of inadequate zinc intake by up to 50% globally.

Large-scale food fortification (LSFF) can increase dietary micronutrient intake and improve micronutrient status. Here we used food balance sheet data from the Food and Agriculture Organization of the United Nations to estimate current country-specific prevalences of inadequate zinc intake. We assessed the potential effects of improving existing LSFF programmes for cereal grains or implementing new programmes in 40 countries where zinc deficiency is a potential public health problem. Accounting for LSFF programmes as currently implemented, 15% of the global population (1.13 billion individuals) is estimated to have inadequate zinc intake. In countries where zinc deficiency is a potential public health problem, the implementation of high-quality mandatory LSFF programmes that include zinc as a fortificant would substantially increase the availability of zinc in the national food supply, reducing the estimated prevalence of inadequate zinc intake by up to 50% globally. Investments in strong LSFF programmes could have a substantial impact on population zinc status.

Mandated Parent Education: Applications, Impacts, and Future Directions.

Mandated participation in parent education programs is a common practice across the United States for families who are undergoing divorce or who are involved in the child welfare or juvenile justice systems. Mandates to participate in parenting programs create substantial challenges for families, service providers, and service systems. Furthermore, the type and quality of the parenting services accessed vary widely, and their impacts need to be better understood. To address this need, an overview of the current state of the empirical literature on the impacts and outcomes of mandated parenting interventions for divorce and in child welfare and juvenile justice settings is provided, and suggestions to the field are offered to refine research related to mandated parenting programs. Given the challenges that mandated parenting programs pose, an alternative approach that views parenting through a public health lens is highlighted to build on the growing body of research on the impacts of population-wide applications of parenting support programs, and as a possible way to decrease the number of parents who are required to attend parenting programs. Opportunities to advance universal parenting support within a range of community settings, including primary care, early childhood education, and community mental health systems are offered. Gaps in knowledge regarding mechanisms of action of universal supports and impacts on the number of parents mandated to treatment are highlighted, and future directions for research in this area are suggested.