Addressing vaccine hesitancy: the LEARN approach

Immunization programs today stand at crossroads. Even as COVID vaccine campaigns continue, inequity, concerns and confusion around them seems ever expanding. While vaccine hesitancy in some form or the other has existed since the inception of vaccination, the complex and dynamic world that we live in now has resulted in hesitancy to vaccines become an outcome of myriad interactions that we encounter in our day to day lives. Factors extraneous to health systems are major determinants and it is essentially the culmination of economics, politics, science, and technology impacting human behaviors and emotions which result in a parent, family or a community arrive at the decision of whether to or not to vaccinate. Vaccine hesitancy is on the rise, it is becoming more organized and now is not just a problem of high- income countries. It is imperative that as public health advocates, academicians, policy makers, managers and implementers we recognize it and adopt a non-judgmental and non-partisan approach built on empathy, respect and trust and not just scientific knowledge and theorems to address it. The current paper puts forward a novel approach to address hesitancy, the LEARN approach: and advocates that we need to ‘Listen’ to the voices of concern, ‘Engage’ with all stakeholders, ‘Articulate’ and communicate better in a language which is simple and comprehensible, ‘Reflect’ on what works and what does not and at the same time ‘Negate’ events and episodes which dent confidence in science and promote complacency.

Key Challenges and Opportunities for Implementing School Located Vaccination Clinics for COVID-19 and Influenza: Roundtables With School Nurses and Immunization Programs

School-located vaccination clinics (SLVs) are an established strategy to offer influenza and routine vaccinations and improve student and community health. The COVID-19 pandemic has led many communities to expand SLVs to include COVID-19 vaccines. However, these SLVs are less documented than in the past due to the fast-paced nature of the pandemic and the additional pressures put on schools and public health organizations. We conducted five virtual roundtables with 30 school nurses and state immunization program managers from across the United States to gain insight into SLVs occurring during the COVID-19 pandemic. Roundtables explored participants’ experiences planning and implementing SLVs, including factors influencing success and available resources. Findings highlighted SLVs as an opportunity to increase access and equity for vaccines. Participants shared strategies for School-located vaccination (SLV) funding, partnership building, vaccine storage and management, consent, data sharing, messaging, and promotion. These shared experiences offer useful insights for those interested in future and sustained SLV implementation.

The Landscape of State and Local School-Located Vaccination Clinics: Practices, Policies, and Lessons Learned for Providing COVID-19 and Routine Vaccinations

For decades, school-located vaccinations clinics (SLVs) have successfully offered influenza and routine childhood immunizations that have contributed to lowering the morbidity and mortality of vaccine-preventable diseases. These SLVs laid the foundation for state and local health departments and school districts to quickly implement SLVs in response to COVID-19. To support school nurses and immunization programs in implementing future SLVs during the COVID-19 pandemic, we explored the landscape of SLVs between August 2019 and late summer 2021 using publicly available information from school and health department websites, news articles reporting on SLVs, and internal documents provided by school nurses and immunization programs who hosted SLVs. Our scan identified variability in the reach, scope, and approach to SLVs, but consistent themes persist such as the importance of partnerships and SLVs as an opportunity to promote equitable access to vaccinations. Useful documents and resources for planning and hosting SLV clinics were compiled into a table. With COVID-19 vaccines now available to all school-age children, SLVs provide an even greater opportunity to improve school and community health. The included resources are designed to provide support for those interested in SLV implementation.

Side Effects After Vaccination Using the Pfizer-Biontech (Bnt162b2) Against Sars-Cov-2 in the Young Adults

Background: In order to limit the spread of the SARS-CoV-2 virus, national immunization programs have started in many countries. Vaccinations are effective in preventing infection and severe clinical form of COVID-19, which affects 15% of patients. Despite the high efficacy of The Pfizer-BioNTech (BNT162b2) vaccine, the characterization of side effects in age-stratified populations is still not exhaustive in the literature.Aim: The aim of our study is to determine what side effects affect the population of young adults following vaccination with the Pfizer-BioNTech vaccine (BNT162b2).Material and methods: An anonymous survey was conducted. People vaccinated with two doses of the SARS-CoV-2 vaccine (BNT162b2) were qualified for the study. The Paired Wilcoxon and Fisher's exact tests were used for statistical analysis.Results: The main side effects after the first dose were increased pain, pain and swelling at the injection site. After the 2nd dose, the dominant side effects were weakness, fever and headache. In the case of the 2nd dose, no difference in side effects was observed between those who suffered of COVID-19 and those who had no symptoms of COVID-19 in their past medical history.

Clostridium Tetani and Tetanus

Tetanus is acquired through exposure to the environmental spore-forming Gram-positive bacillus Clostridium tetani, which may infect human wounds and cause disease by production of an exotoxin (tetanospasmin). There is no human-to-human transmission. The disease occurs worldwide and it is sporadic in high-income countries with universal access to well-accepted immunization programs. It is more common in agricultural regions and in low-income countries where contact with animal excreta is more likely and immunization programs are inadequate. Neonatal tetanus (NNT) following unclean deliveries and poor postnatal hygiene is still responsible for the majority of tetanus cases and deaths; the majority of NNT occurs in poor Asian and African countries, whereas in high-income countries the disease is extremely rare. Three forms of clinical disease can be distinguished: the most common form is generalized tetanus, whereas local tetanus and cephalic tetanus are rare. Neonatal tetanus (NNT) is a form of generalized tetanus in newborns. The case fatality rate of tetanus is high, 3%–95% depending on age, immune- and immunization-status, form of disease, and availability of proper medical care. The efficacy of tetanus toxoid vaccines was never formally studied, but cases in adequately vaccinated subjects are extremely rare and impact data (e.g. for NNT) convincingly show high vaccine effectiveness. WHO estimates that in 2018, 25,000 newborns died from NNT, an 88% reduction from the situation in 2000.

Vaccine Hesitancy: Past and Present in the COVID-19 Era

Vaccine-hesitant individuals are a heterogeneous group that are indecisive in varying degrees – more of a spectrum – about specific vaccines or vaccination in general. Vaccine hesitancy is complex, varying by vaccine, time, context, geographic region, and sub-population. There is an “infodemic” that needs to be fought alongside the pandemic as exposure to misinformation is linked to a reduction in an individual’s intentions to vaccinate. In addressing vaccine hesitancy, it is key to 1) identify the subpopulations susceptible to vaccine hesitancy, 2) diagnose issues through various research methods – surveys, in-depth interviews, focus groups, or media monitoring – and 3) develop context-tailored, evidence-based interventions to address those reasons. Sensitivity to the context and effective communication are key to successful immunization programs, alongside other critical factors (confidence, complacency and convenience – the 3Cs model); engaging stakeholders in dialogue is critical to intervention design and implementation.

Analysing the Launch of COVID-19 Vaccine National Rollouts: Nine Case Studies

In late 2020 and early 2021, with the eagerly anticipated regulatory approval of vaccines against SARS-CoV-2, the urgent global effort to inoculate populations against this devastating virus was underway. These case studies examine the early stages of COVID-19 vaccine rollouts across nine regions from around the world (Brazil, India, Indonesia, Ireland, Israel, Nigeria, Taiwan, United Kingdom and United States). By evaluating and comparing different approaches used to immunize against a novel pathogen, it is possible to learn a great deal about which methods were successful, and in which areas strategies can be improved. This information is applicable to the ongoing global vaccination against this virus, as well as in the event of future pandemics. Research was conducted by following and tracking the progress of vaccine rollouts in the nine regions, using published clinical trials, government documents and news reports as sources of data. Results relate to the proportion of populations that had received at least one COVID-19 dose by 28 February 2021. Outcomes are discussed in the context of three key pillars integral to all immunization programs: procurement of vaccines, communication with the public and distribution of doses to individuals.

Assessing Vaccine Coverage and Timeliness in Bamako, Mali after the Introduction of Rotavirus Vaccine: A Modified Immunization Cluster Survey

Vaccine coverage and timeliness are critical metrics for evaluating the performance of immunization programs. Following the introduction of rotavirus vaccine in Bamako, Mali, we conducted two cluster surveys spaced approximately 1 year apart to evaluate these metrics among children 9 to 20 months of age. Using the child’s immunization card or the medical record at the center of administration, each selected child’s immunization status was determined at 9 and 12 months of age. Deviations from the WHO-recommended immunization schedule were described by the median delay and fraction of children receiving doses outside of recommended age ranges. Overall, 1,002 children were enrolled in the two surveys combined; 80.1% of children born 7 to 12 months after introduction (survey 1) received three doses of pentavalent rotavirus vaccine (ROTA3) by 9 months of age, which increased to 86.1% among children born 17 to 26 months after introduction (survey 2). Concomitantly, coverage with the third dose of diphtheria-pertussis-tetanus-containing vaccine (DPT3) by age 9 months was 86.5% (survey 1) and 88.9% (survey 2); by age 12 months, 61.3% and 72.4% of children, respectively, had received all scheduled immunizations. The median delay in ROTA3 and DPT3 administration were similar at about 3.4 weeks. Within 3 years of introduction, coverage of rotavirus vaccine among Bamako infants achieved coverage similar to DPT3 and is approaching the Global Vaccine Action Plan goal of 90% coverage by 2020. However, timeliness of coverage remains a concern.