COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada: A Longitudinal Urban versus Rural Analysis of the Impact of the Vaccine Mandate

Purpose: Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health authorities in British Columbia (BC), Canada. We also analyzed the impact of a vaccine mandate for HCWs. Methods: We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates, and vaccine uptake in 29,021 HCWs in Interior Health (IH) and 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age, and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results: By October 27, 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH yet 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1,800 workers, comprising 6.4% of rural HCWs and 3.3% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in second doses, the impact on the unvaccinated was less clear. Conclusions: As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy as the pandemic continues.

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Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189904 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9904

Author(s):

Anuli Njoku ◽

Marcelin Joseph ◽

Rochelle Felix

Keyword(s):

Minority Groups ◽

Ethnic Disparities ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Structural Barriers ◽

Structural Racism ◽

Vaccination Rates ◽

Promising Solution ◽

The Impact

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.

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Attitudes and Beliefs of COVID-19 and Vaccine Uptake among Amish Women

The Journal of Plain Anabaptist Communities ◽

10.18061/jpac.v2i1.8310 ◽

2021 ◽

Vol 2 (1) ◽

pp. 28-41

Author(s):

Melissa Thomas ◽

Iva Byler ◽

Kayla Marrero ◽

Janet Miller ◽

Joseph F. Donnermeyer

Keyword(s):

Rural Areas ◽

Access To Health Care ◽

Group Living ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Health Clinics ◽

Raising Awareness ◽

Before And After ◽

Canadian Provinces

The Amish, a Christian religious group living in rural areas with distinct beliefs about remaining separate from the outside world, have communities in 31 states and four Canadian provinces with just over 600 settlements. Their access to health care and technology is often limited. Several studies have noted low vaccination rates for preventable diseases among the Amish, often due to lack of knowledge about efficacy and safety of vaccines. To gain an understanding of beliefs surrounding COVID-19 and attitudes toward vaccine uptake, we surveyed 863 Amish and Mennonite women throughout Ohio who participated in rural mobile health clinics between 2015 and 2019 at two time periods: before and after the 2020 election. We received 372 completed surveys, 252 of which were completed by respondents who identified themselves as Amish. While 100% of the Amish respondents had heard of COVID-19 and 90% reported knowing someone who had contracted the disease, a mere 1.7% (4) indicated a willingness to get vaccinated. In terms of COVID-19 diagnosis, post-election participants were two times more likely to report having a positive test than pre-election respondents (p = .011). Qualitative analyses revealed significant differences in keywords used to describe COVID-19. Post-election respondents were less likely to use words like "evil" and "bad" and associate COVID-19 with the flu. A notable shift in vaccine hesitancy among Amish participants centered on the perceived politicization of the pandemic and safety/efficacy of the vaccines. Public health efforts should center on raising awareness of the severity of COVID-19 and the benefits of vaccine uptake for distinctive subcultures like the Amish.

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Online misinformation is linked to COVID-19 vaccination hesitancy and refusal (Preprint)

10.2196/preprints.32237 ◽

2021 ◽

Author(s):

Francesco Pierri ◽

Brea Perry ◽

Matthew DeVerna ◽

Kai-Cheng Yang ◽

Alessandro Flammini ◽

...

Keyword(s):

Herd Immunity ◽

Negative Relationship ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Causality Analysis ◽

Vaccination Rates ◽

Uptake Rates ◽

Geographical Regions ◽

Control And Prevention ◽

The Impact

BACKGROUND Widespread uptake of vaccines is necessary to achieve herd immunity. However, uptake rates varied across U.S. states during the first six months of the COVID-19 vaccination program. Online misinformation may play an important role in vaccine hesitancy, and there is a need to comprehensively quantify the impact of misinformation on beliefs, behaviors, and health outcomes. OBJECTIVE This work investigates the extent to which COVID-19 vaccination rates and vaccine hesitancy are associated with levels of online misinformation about vaccines across geographical regions. We also look for evidence of directionality from online misinformation to vaccine hesitancy. METHODS Vaccine uptake recordings were taken from Centers for Disease Control and Prevention (CDC) data over the week of March 19 to 25, 2021. Vaccine hesitancy data and misinformation data were taken over the period, Jan 4th to March 25th, 2021. We leverage over 22 M individual responses to surveys administered on Facebook to assess vaccine hesitancy rates, and we identify online misinformation by focusing on low-credibility sources shared on Twitter by over 1.67M users geolocated within U.S. regions. Statistical analysis was done using multivariate regression models adjusting for socioeconomic, demographic and political confounding factors. RESULTS We find a negative relationship between misinformation and vaccination uptake rates. Online misinformation is also correlated with vaccine hesitancy rates taken from survey data. Associations between vaccine outcomes and misinformation remain significant when accounting for political as well as demographic and socioeconomic factors. While vaccine hesitancy is strongly associated with Republican vote share, we observe that the effect of online misinformation on hesitancy is strongest across Democratic rather than Republican counties. Granger causality analysis shows evidence for a directional relationship from online misinformation to vaccine hesitancy. CONCLUSIONS These results indicated that there are geographically located hotspots of vaccine refusal which are associated with online misinformation and unexplained by other factors. Our results support a need for interventions that address online misinformation, allowing individuals to make better-informed health decisions. COVID-19 | Facebook | misinformation | Twitter | vaccine hesitancy | vaccines

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BNT162b2 vaccine uptake and effectiveness in UK healthcare workers – a single centre cohort study

Nature Communications ◽

10.1038/s41467-021-23927-x ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Tariq Azamgarhi ◽

Michelle Hodgkinson ◽

Ashik Shah ◽

John A. Skinner ◽

Iva Hauptmannova ◽

...

Keyword(s):

Cohort Study ◽

Healthcare Workers ◽

Cox Regression ◽

Age Groups ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Single Centre ◽

Cox Regression Analysis ◽

Vaccination Rates ◽

Job Roles

AbstractIn this single centre cohort study we assessed BNT162B2 vaccine uptake and effectiveness among UK healthcare workers (HCWs) during a time of high community COVID-19 prevalence. Early uptake among HCWs was 62.3% (1409/2260), however there were significant differences in uptake between age groups, ethnic origins, and job roles. Uptake increased to 72.9% after a vaccine hesitancy working group implemented specific measures. In the 42 days after vaccination, 49 new cases of COVID-19 were identified, of which 7 (14.3%) occurred in HCWs who were beyond 10 days of vaccination. Kaplan–Meier curves for partially vaccinated and unvaccinated groups were congruent until day 14 and continued to diverge up to 42 days. Cox regression analysis showed a 70.0% (95%CI 6.0–91.0; p=0.04) risk reduction for COVID-19 infection in partially vaccinated HCWs. Here we report early vaccination rates among HCWs are generally high although uptake is lower in certain groups. It is possible to improve vaccine uptake and efforts should focus on this, however, significant resource is required. The BNT162B2 vaccine is effective from 14 days post-vaccination in a frontline clinical setting and protection continues beyond 21 days post 1st dose without a 2nd dose, being given.

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Adenovirus and RNA-based COVID-19 vaccines’ perceptions and acceptance among healthcare workers in Saudi Arabia: a national survey

BMJ Open ◽

10.1136/bmjopen-2020-048586 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048586

Author(s):

Mohamad-Hani Temsah ◽

Mazin Barry ◽

Fadi Aljamaan ◽

Abdullah Alhuzaimi ◽

Ayman Al-Eyadhy ◽

...

Keyword(s):

Saudi Arabia ◽

Healthcare Workers ◽

Online Survey ◽

Healthcare Providers ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Validated Questionnaire ◽

Vectored Vaccine ◽

To Receive

ObjectivesThe aim of this study was to compare the perception, confidence, hesitancy and acceptance rate of various COVID-19 vaccine types among healthcare workers (HCWs) in Saudi Arabia, a nation with Middle East respiratory syndrome coronavirus experience.DesignNational cross-sectional, pilot-validated questionnaire.SettingOnline, self-administered questionnaire among HCWs.ParticipantsA total of 2007 HCWs working in the Kingdom of Saudi Arabia participated; 1512 (75.3%) participants completed the survey and were included in the analysis.InterventionData were collected through an online survey sent to HCWs during 1–15 November 2020. The main outcome measure was HCW acceptance of COVID-19 candidate vaccines. The associated factors of vaccination acceptance were identified through a logistic regression analysis and via measurement of the level of anxiety, using the Generalised Anxiety Disorder 7 scale.ResultsAmong the 1512 HCWs who were included, 62.4% were women, 70.3% were between 21 and 40 years of age, and the majority (62.2%) were from tertiary hospitals. In addition, 59.5% reported knowing about at least one vaccine; 24.4% of the participants were sure about their willingness to receive the ChAdOx1 nCoV-19 vaccine, and 20.9% were willing to receive the RNA BNT162b2 vaccine. However, 18.3% reported that they would refuse to receive the Ad5-vectored vaccine, and 17.9% would refuse the Gam-COVID-Vac vaccine. Factors that influenced the differential readiness of HCWs included their perceptions of the vaccine’s efficiency in preventing the infection (33%), their personal preferences (29%) and the vaccine’s manufacturing country (28.6%).ConclusionsAwareness by HCWs of the several COVID-19 candidate vaccines could improve their perceptions and acceptance of vaccination. Reliable sources on vaccine efficiency could improve vaccine uptake, so healthcare authorities should use reliable information to decrease vaccine hesitancy among frontline healthcare providers.

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Dome effect of black carbon and its key influencing factors: A one-dimensional modelling study

10.5194/acp-2017-967 ◽

2017 ◽

Author(s):

Zilin Wang ◽

Xin Huang ◽

Aijun Ding

Keyword(s):

Boundary Layer ◽

Air Pollution ◽

Black Carbon ◽

Rural Areas ◽

Land Surface ◽

Critical Role ◽

Aerosol Layer ◽

Near Surface ◽

Haze Pollution ◽

The Impact

Abstract. Black carbon (BC) has been identified to play a critical role in aerosol-planet boundary layer (PBL) interaction and further deterioration of near-surface air pollution in megacities, which has been named as its dome effect. However, the impacts of key factors that influence this effect, such as the vertical distribution and aging processes of BC, and also the underlying land surface, have not been quantitatively explored yet. Here, based on available in-situ measurements of meteorology and atmospheric aerosols together with the meteorology-chemistry online coupled model, WRF-Chem, we conduct a set of parallel simulations to quantify the roles of these factors in influencing the BC's dome effect and surface haze pollution, and discuss the main implications of the results to air pollution mitigation in China. We found that the impact of BC on PBL is very sensitive to the altitude of aerosol layer. The upper level BC, especially those near the capping inversion, is more essential in suppressing the PBL height and weakening the turbulence mixing. The dome effect of BC tends to be significantly intensified as BC aerosol mixed with scattering aerosols during winter haze events, resulting in a decrease of PBL height by more than 25 %. In addition, the dome effect is more substantial (up to 15 %) in rural areas than that in the urban areas with the same BC loading, indicating an unexpected regional impact of such kind of effect to air quality in countryside. This study suggests that China's regional air pollution would greatly benefit from BC emission reductions, especially those from the elevated sources from the chimneys and also the domestic combustions in rural areas, through weakening the aerosol-boundary layer interactions that triggered by BC.

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A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccines ◽

10.3390/vaccines9111362 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1362

Author(s):

Elena Petrova ◽

Timothy Farinholt ◽

Tejas P. Joshi ◽

Hannah Moreno ◽

Mayar Al Mohajer ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Air Filtration ◽

Clinical Environment ◽

Mobile Clinic ◽

Community Based ◽

Community Healthcare

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

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COVID-19 Vaccination of HCWs in the First Phase of a Large-Scale Mass Vaccination Program within a Healthcare System

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.20 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s11-s11

Author(s):

Kimberly Korwek ◽

E. Jackie Blanchard ◽

Julia Moody ◽

Katherine Lange ◽

Ryan Sledge ◽

...

Keyword(s):

Human Resources ◽

Healthcare Workers ◽

Large Scale ◽

Rapid Development ◽

Vaccination Strategy ◽

State Level ◽

Mass Vaccination ◽

Vaccine Uptake ◽

Vaccination Program ◽

Vaccination Rates

Background: The approval of the first SARS-COV-2 vaccines for COVID-19 were accompanied by unprecedented efforts to provide vaccination to healthcare workers and first responders. More information about vaccine uptake in this group is needed to better refine and target educational messaging. Methods: HCA Healthcare used federal guidance and internal experience to create a systemwide mass vaccination strategy. A closed point-of-dispensing (POD) model was developed and implemented. The previously developed enterprise-wide emergency operations strategy was adapted and implemented, which allowed for rapid development of communications and operational processes. A tiering strategy based on recommendations from the National Academies was used in conjunction with human resources data to determine vaccine eligibility for the first phase of vaccination. A comprehensive data and reporting strategy was built to connect human resources and vaccine consent data for tracking vaccination rates across the system. Results: Vaccination of employed and affiliated colleagues began December 15, 2020, and was made available based on state-level release of tiers. Within the first 6 weeks, in total, 203,544 individuals were eligible for vaccine based on these criteria. Of these, 181,282 (89.1%) consented to and received vaccine, 19,788 (9.7%) declined, and 2,474 (1.2%) indicated that they had already been vaccinated. Of those eligible, the highest acceptance of vaccine was among the job codes of specialists and professionals (n = 7,914 total, 100% consent), providers (n = 23,335, 99.6%,), and physicians (n = 3,218, 98.4%). Vaccine was most likely to be declined among job codes of clerical and other administrative (n = 12,889 total, 80.1% consent), clinical specialists and professionals (n = 22,853, 81.0%,) and aides, orderlies and technicians (n = 17,803, 82.6%,). Registered nurses made up the largest eligible population (n = 56,793), and 89.5% of those eligible consented to receive vaccination. Average age among those who consented was slightly older (48.3 years) than those that declined (44.7 years), as was length of employment tenure (6.9 vs 5.0 years). Conclusion: A large-scale, closed POD, mass vaccination program was able to vaccinate nearly 200,000 healthcare workers for SARS-CoV-2 in 6 weeks. This program was implemented in acute-care sites across 20 different US states, and it was able to meet the various state-level requirements for management of processes, product, and required reporting. The development of a standardized strategy and custom, centralized monitoring and reporting facilitated insight into the characteristics of early vaccine adopters versus those who decline vaccination. These data can aid in the refining and targeting of educational materials and messaging about the SARS-CoV-2 vaccine.Funding: NoDisclosures: None

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Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/663210 ◽

2012 ◽

Vol 33 (1) ◽

pp. 63-70 ◽

Cited By ~ 46

Author(s):

Kathleen Quan ◽

David M. Tehrani ◽

Linda Dickey ◽

Eugene Spiritus ◽

Denise Hizon ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccination Campaign ◽

Vaccine Uptake ◽

Healthcare Personnel ◽

Vaccination Policy ◽

Vaccination Rates ◽

Hospital Policies ◽

Mandatory Vaccination ◽

Vaccination Campaigns ◽

The Impact

Background.Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.Objective.To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.Design.Retrospective cohort study.Methods.We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during die 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.Results.HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of die surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.Conclusions.A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of die vaccine but who have not made vaccination a priority.Infect Control Hosp Epidemiol 2012;33(1):63-70

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Spatial Modeling of COVID-19 Vaccine Hesitancy in the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189488 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9488

Author(s):

Abolfazl Mollalo ◽

Moosa Tatar

Keyword(s):

United States ◽

Healthcare Providers ◽

Vulnerability Index ◽

The United States ◽

Vaccine Hesitancy ◽

Social Vulnerability Index ◽

Vaccination Programs ◽

Public Health Decision ◽

Vaccination Rates ◽

The Impact

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite the availability of vaccine services. Despite the efforts of United States healthcare providers to vaccinate the bulk of its population, vaccine hesitancy is still a severe challenge that has led to the resurgence of COVID-19 cases to over 100,000 people during early August 2021. To our knowledge, there are limited nationwide studies that examined the spatial distribution of vaccination rates, mainly based on the social vulnerability index (SVI). In this study, we compiled a database of the percentage of fully vaccinated people at the county scale across the continental United States as of 29 July 2021, along with SVI data as potential significant covariates. We further employed multiscale geographically weighted regression to model spatial nonstationarity of vaccination rates. Our findings indicated that the model could explain over 79% of the variance of vaccination rate based on Per capita income and Minority (%) (with positive impacts), and Age 17 and younger (%), Mobile homes (%), and Uninsured people (%) (with negative effects). However, the impact of each covariate varied for different counties due to using separate optimal bandwidths. This timely study can serve as a geospatial reference to support public health decision-makers in forming region-specific policies in monitoring vaccination programs from a geographic perspective.

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