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African nations have struggled to secure lifesaving COVID-19 vaccines, while rich nations have purchased more than they needed, depleting the global supply. High vaccine prices and intellectual property regulations that block the production of cheaper generics have contributed to a condition of African waithood. Hagan examines this waithood, which characterizes the disjuncture between African countries’ existential and humanitarian need for COVID-19 vaccines and corporations’ quest for profits in the pandemic. African waithood, produced by pharmaceutical companies including Moderna and Pfizer, is a direct product of colonialism. Waithood echoes the ongoing colonial relations between African nations and the corporations that continue to exploit them.
Vaccine mandates played a critical role in the success of New York City’s COVID-19 response. By relying on evidence as a substantive basis for the mandates and adhering to procedural requirements and precedent, New York City leveraged its position and expertise as a local governmental authority to devise mandatory vaccine policies that withstood numerous legal challenges. New York City’s experience highlights the role of municipal government in mounting a meaningful public health response, and the strategies adopted by NYC may provide a blueprint for municipalities around the world facing the ongoing COVID-19 pandemic and the threat of future public health emergencies.
This article critically examines the proposed waiver of intellectual property (IP) rights for COVID-19 vaccines under the World Trade Organization Agreement's Trade-Related Aspects of Intellectual Property Rights (TRIPS), which was initiated in October 2020 when the pandemic raged and vaccines were unavailable. However, the landscape has now changed and the waiver may no longer be necessary. The Outcome Document, introduced in the TRIPS Council in May 2022, along with Ministerial Decision of June 2022 recognizes this by focusing on easing the requirements to use TRIPS-flexibilities to accomplish wider and cheaper access. In so doing, the Ministerial Decision reinforces the notion that TRIPS flexibilities can be a useful part of the policy toolkit, even in times of crisis. After providing an overview of the context and outlining justifications for the waiver proposal, the article analyses and identifies key implications and possible effects of the Ministerial Decision. The article concludes that while the Document may not be a perfect solution to the issue of access to vaccines, flexible application of TRIPS-flexibilities is a better resolution in the current environment, especially given the need for further innovation to combat COVID-19 and future pandemics.
A significant issue in combatting the Covid-19 pandemic is the need to enhance developing states’ access to Covid-19 vaccines. The present paper considers the request for a temporary waiver of intellectual property rights in relation to Covid-19 technologies and treatments submitted to the World Trade Organization and analyses a key argument against the proposed waiver: that the compulsory licensing provisions set out in the TRIPS Agreement are sufficiently flexible to help states get access to vaccines. The compulsory licensing flexibilities set out in TRIPS, including the amendment to TRIPS in Article 31bis, are evaluated, to explore whether compulsory licensing could be an effective tool in helping developing states to access Covid-19 vaccines. Key issues are explored from a human rights perspective to examine whether a rights-based approach to the compulsory licensing provisions could offer further insights as to how the provisions could be more workable, to enhance access to medicines and vaccines for developing states.
Approximately one-quarter of annual global cervical cancer deaths occur in India, possibly due to cultural norms promoting vaccine hesitancy. We sought to determine whether people of Indian ancestry (POIA) in the USA exhibit disproportionately lower human papilloma virus (HPV) vaccination rates than the rest of the US population. We utilised the 2018 National Health Interview Survey to compare HPV vaccine initiation and completion rates between POIA and the general US population and determined factors correlating with HPV vaccine uptake among POIA. Compared to other racial groups, POIA had a significantly lower rate of HPV vaccination (8.18% vs. 12.16%, 14.70%, 16.07% and 12.41%, in White, Black, Other Asian and those of other/mixed ancestry, respectively, P = 0.003), but no statistically significant difference in vaccine series completion among those who received at least one injection (3.17% vs. 4.27%, 3.51%, 4.31% and 5.04%, P = 0.465). Among POIA, younger individuals (vs. older), single individuals (vs. married), those with high English proficiency (vs. low English proficiency), those with health insurance and those born in the USA (vs. those born outside the USA) were more likely to obtain HPV vaccination (P = 0.018, P = 0.006, P = 0.029, P = 0.020 and P = 0.019, respectively). Public health measures promoting HPV vaccination among POIA immigrants may substantially improve vaccination rates among this population.
Once vaccines against COVID-19 became available in many countries, a new challenge has emerged – how to increase the number of people who vaccinate? Different policies are being considered and implemented, including behaviourally informed interventions (i.e., nudges). In this study, we have experimentally examined two types of nudges on representative samples of two countries – descriptive social norms (Israel) and saliency of either the death experience from COVID-19 or its symptoms (UK). To increase the legitimacy of nudges, we have also examined the effectiveness of transparent nudges, where the goal of the nudge and the reasons of its implementation (expected effectiveness) were disclosed. We did not find evidence that informing people that the vast majority of their country-people intend to vaccinate enhanced vaccination intentions in Israel. We also did not find evidence that making the death experience from COVID-19, or its hard symptoms, salient enhanced vaccination intentions in the UK. Finally, transparent nudges as well did not change the results. We further provide evidence for the reasons why people choose not to vaccinate, and whether different factors such as gender, belief in conspiracy theories, political ideology, and risk perception, play a role in people's intentions to vaccinate or susceptibility to nudges.
The complexity and inefficiency of the U.S. health care system complicates the distribution of life-saving medical technologies. When the public health is at stake, however, there are alternatives. The proposal for a national PrEP program published in this issue of the Journal applies some of the lessons of the national COVID vaccine campaign to HIV prevention. In doing so, it draws on other examples of public health approaches to the financing of medical technology, from vaccines for children to hepatitis C treatment.
The current debate over the global distribution of COVID-19 vaccines once again highlights the many shortcomings of the modern intellectual property (IP) system, especially when it comes to equitable access to medicines. This essay argues that the (unspoken) conceptual center of struggles over access to new pharmaceuticals rests in the IP system's colonial legacy, which perceives the world as uncharted territory that is ripe for discovery and ownership. This vision of the world as a blank canvas, or terra nullius, sets aside any other models of ownership and devalues other traditional modes of relating to territory and nature. Several examples show the long-lasting exclusionary effects of this hidden legacy of colonial conquest in the field of public health, ranging from the spiraling price of insulin to the distribution of COVID-19 vaccines to the negotiation of sharing mechanisms for virus samples. In all of these cases, the continuing marginalization of other interests by the IP system can lead to exploitation, without either the “sources” of materials, such as those from whom the samples were taken, or the recipients of the eventual product having any say in matters of price and access. This legacy of fundamental exclusion needs to be recognized and addressed in order to arrive at more equitable solutions to public health emergencies such as the current pandemic.
The coronavirus disease 2019 (COVID-19) pandemic had a global impact. The study explores the various COVID-19 experiences in Malta over the past year and provides a snapshot of acute and post-acute COVID-19 symptoms, as well as national vaccination roll-out and hesitancy.
Data on medical access, lifestyle habits, acute and post-acute COVID-19 symptoms, and vaccination hesitancy was gathered through a social media survey targeting adults of Malta. COVID-19 data were gathered from the Malta Ministry of Health COVID-19 dashboard.
Malta controlled COVID-19 spread exceptionally well initially. Since August 2020, the positivity rate, mortality, and hospital admission rates saw a fluctuating incline. From COVID-19 onset, a decrease in physical activity and an increase in body weight was reported. Most participants acquiring COVID-19 were asymptomatic but nontrivial proportion experienced post-acute symptoms. The majority opted to take the COVID-19 vaccine with only a minority expressing safety concerns.
Malta has experienced roller coaster events over a year. The population faced elevated levels of morbidity, mortality, and economic hardship along with negative and positive risk-associated behaviors. Vaccination in combination with population adherence to social distancing, mask wearing, and personal hygiene are expected to be the beacons of hope in the coming months.
The coronavirus disease 2019 (COVID-19) pandemic requires urgent implementation of effective community-engaged strategies to enhance education, awareness, and inclusion of underserved communities in prevention, mitigation, and treatment efforts. The Texas Community-Engagement Alliance Consortium was established with support from the United States’ National Institutes of Health (NIH) to conduct community-engaged projects in selected geographic locations with a high proportion of medically underserved minority groups with a disproportionate burden of COVID-19 disease and hospitalizations. The purpose of this paper is to describe the development of the Consortium. The Consortium organized seven projects with focused activities to address COVID-19 clinical and vaccine trials in highly affected counties, as well as critical statewide efforts. Five Texas counties (Bexar, Dallas, Harris, Hidalgo, and Tarrant) were chosen by NIH because of high concentrations of underserved minority communities, existing community infrastructure, ongoing efforts against COVID-19, and disproportionate burden of COVID-19. Policies and practices can contribute to disparities in COVID-19 risk, morbidity, and mortality. Community engagement is an essential element for effective public health strategies in medically underserved minority areas. Working with partners, the Consortium will use community engagement strategies to address COVID-19 disparities.
Pathogens and humans have coexisted for a long time. Studies suggest that, even before recorded history, nomadic populations are likely to have suffered from a plethora of diseases, such as malaria and perhaps yellow fever. The transition to a sedentary lifestyle anchored around small villages, and later on the establishment of large urban centers from Mesopotamia to the Indus Valley and what is modern-day China, paved the way for the increased spread and diversification of these pathogens. High population density, the comingling of humans and animals, and the proliferation of trade routes linking once-distant urban areas enabled viruses, bacteria, and other pathogens to propagate quickly and travel progressively farther. To this day, these dynamics set forth in antiquity continue to play out in similar ways in a world that has become more connected and densely populated.
This study explored how a subsection of Canadians perceive older adults’ vaccines through a qualitative analysis of comments posted in response to national online news articles. We used reflexive thematic analysis to analyse 147 comments from 31 news article comments sections published between 2015 and 2020 from five different national online news sources (CBC, National Post, Global News, Globe & Mail, and Huffington Post Canada) that focused on three older adults’ diseases and vaccines: influenza, pneumococcal pneumonia, and herpes-zoster. Three themes encompassed the similarities and differences in how these three diseases were discussed: (1) the importance of personal experiences on stated stance in vaccine uptake or refusal, (2) questioning vaccine research and recommendations, and (3) criticisms of the government’s unequal vaccine opportunities across different Canadian provinces. Our findings identified that perceptions regarding older adult vaccination were dependent on the vaccine type, and, therefore, we make suggestions for future researchers to build on our findings, particularly the need not to treat the research subject of “older adults’ vaccines” as one entity. Gaining a better understanding of how older adults’ vaccines are perceived in Canada will enable public health professionals to develop effective communication strategies that should ultimately improve vaccination rates for older adults.
The ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global public health crisis. The objectives of this study were to analyse the dynamic trend in specific antibodies in the serum of patients infected with SARS-CoV-2 within 12 months after recovery and to make a preliminary assessment of the protective effect of vaccination. Eighty-seven patients with confirmed COVID-19 who were admitted to our hospital from January to February 2020 were followed after recovery. Three-millilitre blood samples were collected for specific antibody detection at four time points: 1, 6 and 12 months after recovery and 1 month after vaccination. The changes in specific immunoglobulin G (IgG) antibody and total antibody levels over 12 months were analysed. Moreover, an independent comparison of the neutralising antibody levels of patients after vaccination with those of healthy medical staff after vaccination was performed to compare the inhibition rates of the neutralising antibody to the virus. No statistically significant difference in the sex distribution between groups was observed (P > 0.05). Older patients had a greater risk of developing severe and critical COVID-19 (P < 0.05). The percentages of subjects positive for IgG antibodies at 1, 6 and 12 months after recovery were 88.5%, 75.9% and 50.6%, respectively. The rate of IgG antibody conversion from positive to negative was not uniform across time points: the change was slow in the first 6 months but increased significantly in the last 6 months (P < 0.05). The positive rate of critically ill patients in the first 6 months was 100.0%. The trend over time in total antibody levels was similar to that of IgG antibody levels. Over 12 months, the sample/cut off value of total antibodies continued to decrease, while that of different disease severities was significantly different (P < 0.05). After vaccine administration, the total antibody level exceeded the detection level in the first month, which was independent of disease severity (P > 0.05). Significant differences were observed in the inhibition rate of the neutralising antibody against the virus in the disease group and the control group (P < 0.05). IgG antibody produced by patients naturally infected with SARS-CoV-2 has a duration of no less than 1 year, and the change trend graph of total antibody levels was the same as that of IgG antibody levels. Under vaccine stimulation, the positive rate of IgG antibody was as high as 100%, and the total antibody concentration reached the highest level, which was independent of disease severity. Neutralising antibodies following vaccination in patients who recovered from COVID-19 had a higher inhibition rate against SARS-CoV-2 than those of vaccinated healthy controls, indicating that these COVID-19 patients had a lower risk of reinfection and were better protected.
Vaccines have continued to play a crucial global role in preventing infectious diseases in the twenty-first century. The Covid-19 pandemic has underlined their importance, with vaccines seen as the best way to protect the public from coronavirus. A longstanding problem of governments has been the extent to which they should assume responsibility for the compensation of those injured by vaccines. This paper reappraises the vaccine damage schemes currently available in the US and UK in the light of the Covid-19 pandemic. It argues that any improvements to both US and UK schemes should be included in a revised national vaccine policy which takes into consideration their respective long-term national vaccine strategies to prepare for future pandemics. It supports the adoption of a UK-wide National Vaccine Injury Compensation Programme, similar to the one in the US, to be administered by the Secretary of State for Health and Social Care. To balance the need for rigorous criteria to determine causation with the need for fairness, the programme should adopt the US practice of allowing negotiated settlements between parties in circumstances where review of the evidence has not concluded that the vaccine(s) caused the alleged injury but there are close calls concerning causation.
Coronavirus disease 2019 (COVID-19) has disproportionately affected people with mental health conditions.
We investigated the association between receiving psychotropic drugs, as an indicator of mental health conditions, and COVID-19 vaccine uptake.
We conducted a cross-sectional analysis of a prospective cohort of the Northern Ireland adult population using national linked primary care registration, vaccination, secondary care and pharmacy dispensing data. Univariable and multivariable logistic regression analyses investigated the association between anxiolytic, antidepressant, antipsychotic, and hypnotic use and COVID-19 vaccination status, accounting for age, gender, deprivation and comorbidities. Receiving any COVID-19 vaccine was the primary outcome.
There were 1 433 814 individuals, of whom 1 166 917 received a COVID-19 vaccination. Psychotropic medications were dispensed to 267 049 people. In univariable analysis, people who received any psychotropic medication had greater odds of receiving COVID-19 vaccination: odds ratio (OR) = 1.42 (95% CI 1.41–1.44). However, after adjustment, psychotropic medication use was associated with reduced odds of vaccination (ORadj = 0.90, 95% CI 0.89–0.91). People who received anxiolytics (ORadj = 0.63, 95% CI 0.61–0.65), antipsychotics (ORadj = 0.75, 95% CI 0.73–0.78) and hypnotics (ORadj = 0.90, 95% CI 0.87–0.93) had reduced odds of being vaccinated. Antidepressant use was not associated with vaccination (ORadj = 1.02, 95% CI 1.00–1.03).
We found significantly lower odds of vaccination in people who were receiving treatment with anxiolytic and antipsychotic medications. There is an urgent need for evidence-based, tailored vaccine support for people with mental health conditions.
In a bid to end the ongoing coronavirus disease 2019 pandemic, many countries, including the UK, have rolled out mass immunisation programmes. While considered generally safe and effective, vaccines against coronavirus disease 2019 have been reported to be associated with rare and potentially adverse reactions and side effects.
This paper reports an unusual case of a patient who developed a unilateral vocal fold paralysis shortly after receiving the first dose of the Oxford-AstraZeneca ChAdOx1 nCov-19 vaccine.
To our knowledge, this is the first reported case of vocal fold paralysis following administration of the Oxford-AstraZeneca vaccine. The authors support the position that currently approved coronavirus disease 2019 vaccines remain safe and effective; however, further surveillance and vigilance using real-world data are highly encouraged.
Disruptions in routine immunization caused by COVID-19 put African countries with large vaccine-preventable disease burdens at high risk of outbreaks. Abbas et al. (2020) showed that mortality reduction from resuming immunization outweighs excess mortality from COVID-19 caused by exposure during immunization activities. We leverage these estimates to calculate benefit-cost ratios (BCRs) of disrupted immunization and apply cost of illness (COI) and value of statistical life-year (VSLY) approaches to estimate the cost of excess child deaths from eight vaccine-preventable diseases. BCRs were computed for each country, vaccine, and Expanded Program on Immunization visit. Secondary estimates that include the cost of providing immunization are presented in scenario analysis. Suspended immunization may cost $4949 million due to excess mortality using the COI approach, or $34,344 million using the VSLY approach. Likewise, excess COVID-19 deaths caused by exposure from immunization activities would cost $53 and $275 million using the COI and VSLY approaches, respectively. BCRs of continuing routine immunization are 94:1 using COI and 125:1 using VSLY, indicating that the economic costs of suspending immunization exceed that of COVID-19 deaths risked by routine immunization. When including the costs of providing routine immunization during the COVID-19 pandemic, the BCRs are 38:1 and 97:1 using the COI and VSLY approaches, respectively.
This study examines the factors associated with the willingness to get the coronavirus vaccine among individuals aged 18 and above.
This cross-sectional study was conducted in Turkey. The participants aged 18 and older were recruited between December, 2020 and January, 2021 through conventional social media sites. Snowball sampling was used. An anonymous questionnaire consisted of demographics, vaccination experiences, and perceived risk of coronavirus disease.
1202 women and 651 men were included in the data analysis. Findings showed that demographics, vaccination experience, and perceived risk of getting COVID-19 were explained. 37% of the variance in people’s willingness to get the COVID-19 vaccination was according to hierarchical logistic regression. Furthermore, increasing age, being male, acquiring positive information about COVID-19 vaccines, having a lower level of vaccine hesitancy, the high level of worry about COVID-19, and low level of perceptions of the possibility of becoming infected by the COVID-19 were the main predictors of COVID-19 vaccine willingness.
Factors affecting adults’ willingness to be inoculated with COVID-19 vaccines were related to demographics, vaccination experiences, and perceived risk of getting COVID-19. We recommend that public health authorities and practitioners should consider these multiple factors regarding vaccine confidence to achieve herd immunity.
This article argues that the Supreme Court should not require a religious exemption from vaccine mandates. For children, who cannot yet make autonomous religious decision, religious exemptions would allow parents to make a choice that puts the child at risk and makes the shared environment of the school unsafe — risking other people’s children. For adults, there are still good reasons not to require a religious exemption, since vaccines mandates are adopted for public health reasons, not to target religion, are an area where free riding is a real risk, no religion actually prohibits vaccinating under a mandate, and policing religious exemptions is very difficult.
Parental confidence in vaccines is waning. To sustain and improve childhood vaccine coverage rates, insights from multiple disciplines are needed to understand and address the socio-cultural factors contributing to decreased vaccine confidence and uptake.