The COVID-19 vaccination campaign in Bhutan: strategy and enablers

Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15, 2021. With support from India, the United States, Denmark, the People’s Republic of China, Croatia and other countries, Bhutan was able to conduct two rounds of nationwide vaccination campaign. While many countries struggle to overcome vaccine refusal or hesitancy due to complacency, a lack of trust, inconvenience and fear, escalated in some countries by anti-vaccine groups, Bhutan managed to inoculate more than 95% of its eligible populations in two rounds of vaccination campaign. Enabling factors of this successful vaccination campaign were strong national leadership, a well-coordinated national preparedness plan, and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures, volunteers and local leaders. In this short report, we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.

Sociodemographic Predictors Associated with the Willingness to Get Vaccinated against COVID-19 in Peru: A Cross-Sectional Survey

During the race for the development of a vaccine against COVID-19, even before its commercialization, part of the population has already shown a growing fear of its application. We designed an analytical cross-sectional study using an anonymous survey in the 25 departments of Peru. We surveyed whether the participants were planning on getting vaccinated, as well as other characteristics that were cross-checked in a uni-, bi- and multivariate manner. Of the 1776 respondents, 70% (1251) stated that they were planning to be vaccinated, 20% (346) did not know yet or doubted it, and 10% (179) did not want to be vaccinated. We observed that those who did not get infected with COVID-19 exhibited a higher frequency to not wanting or were uncertain about getting vaccinated (aPR: 1.40; 95% CI: 1.09–1.81; p-value = 0.008). In contrast, there was a lower frequency of vaccine refusal among university students (aPR: 0.75; 95% CI: 0.61–0.92; p-value = 0.005) and healthcare workers (aPR: 0.59; 95% CI: 0.44–0.80; p-value = 0.001); adjusted by place of residence. There is still an important percentage of respondents who do not want to be vaccinated or are hesitant to do it, which was associated with educational level, being a healthcare worker and if they were previously infected with COVID-19. Our results could offer useful information about COVID-19 vaccination campaigns.

Factors associated with COVID-19 vaccine hesitancy in Senegal: a mixed study

Introduction: The most effective way to control the COVID-19 pandemic in the long term is through vaccination. Two of the important components that can hinder it are vaccine hesitancy and vaccine refusal. This study, conducted before the arrival of the vaccines in Senegal, aims to assess and identify factors associated with hesitancy to the COVID-19 vaccine. Methods: This study was an explanatory, sequential, mixed-methods design. We collected quantitative data from December 24, 2020, to January 16, 2021, and qualitative data from February 19 to March 30, 2021. We conducted a marginal quota sampling nationwide. We used a structured questionnaire to collect data for the quantitative phase and an interview guide with a telephone interview for the qualitative phase. We performed descriptive, bivariate, and multivariate analyses with R software version 4.0.5 for the quantitative phase; and performed manual content analyses for the qualitative phase. Results: We surveyed 607 people for the quantitative phase, and interviewed 30 people for the qualitative phase. Individuals who hesitated or refused to be vaccinated represented 12.9% and 32.8%, respectively. Vaccine hesitancy was related to gender, living in large cities, having a poor attitude towards the vaccine, thinking that the vaccine would not help protect them from the virus, being influenced by people important to them, and lacking information from health professionals. Vaccine refusal was related to living in large cities, having a poor attitude towards the vaccine, thinking that the vaccine would not help protect them from the virus, thinking that the vaccine could endanger their health, trusting opinions of people who were important to them, and lacking information from health professionals. Conclusion: The results of the study show that the factors associated with hesitancy and refusal to be vaccinated against COVID-19 are diverse and complex. Reducing them will help to ensure better vaccination coverage if the current challenges of vaccine accessibility are addressed. Therefore, governments and health authorities should intensify their efforts to promote vaccine confidence and reduce misinformation. Keywords: Vaccine hesitancy, COVID-19, Mixed method, Senegal

Suspicion

In 2014 Barbados introduced a vaccine to prevent certain strains of the human papillomavirus (HPV) and reduce the risk of cervical cancer in young women. Despite the disproportionate burden of cervical cancer in the Caribbean, many Afro-Barbadians chose not to immunize their daughters. In Suspicion, Nicole Charles reframes Afro-Barbadian vaccine refusal from a question of hesitancy to one of suspicion. Drawing on ethnographic fieldwork, black feminist theory, transnational feminist studies and science and technology studies, Charles foregrounds Afro-Barbadians' gut feelings and emotions and the lingering trauma of colonial and biopolitical violence. She shows that suspicion, far from being irrational, is a fraught and generative affective orientation grounded in concrete histories of mistrust of government and coercive medical practices foisted on colonized peoples. By contextualizing suspicion within these longer cultural and political histories, Charles troubles traditional narratives of vaccine hesitancy while offering new entry points into discussions on racialized biopolitics, neocolonialism, care, affect, and biomedicine across the Black diaspora. Duke University Press Scholars of Color First Book Award recipient

Gewetensbezwaarden onder vuur

Conscientious objectors under fire. Vaccine refusal among orthodox-Protestant soldiers in the Dutch Armed Forces, 1945-1950 During the Indonesian War of Independence (1945-1949), the Dutch government deployed 220,000 soldiers in the Indonesian archipelago. Among them was a group of conservative Christian soldiers who refused vaccinations against smallpox for religious reasons. Initially this caused no problems, but the situation changed after the outbreak of a smallpox epidemic in Indonesia in 1948. The non-vaccinated soldiers could not return to the Netherlands due to international restrictions. Although compulsory vaccination was abolished in 1939, some soldiers were forced to accept vaccination. In the Netherlands, representatives of the Reformed Political Party (SGP) and the conservative churches accused the Army of illegal actions. The central question in the debate was the space for religious minorities and divergent views on vaccination in the Dutch Armed Forces. This article studies the process of negotiation between the Dutch Armed Forces and the political and ecclesiastical representatives of this conservative religious group. Finally, this article argues for more research into religious diversity in the Dutch Armed Forces.

COVID-19 vaccine hesitancy and refusal and associated factors in an adult population in Saskatchewan, Canada: Evidence from predictive modelling

Background A high population level of vaccination is required to control the COVID-19 pandemic, but not all Canadians are convinced of the value and safety of vaccination. Understanding more about these individuals can aid in developing strategies to increase their acceptance of a COVID-19 vaccine. The objectives of this study were to describe COVID-19 vaccine acceptance, hesitancy and refusal rates and associated factors in Saskatchewan, Canada. Methods This is a cross-sequential study that consisted of pooled responses from weighted samples of 9,252 Saskatchewan adults (≥18 years) across nine rounds of data collection between May 4, 2020 and April 3, 2021. The outcome variable was vaccine intention: vaccine acceptance, hesitancy, and refusal. The independent variables were layered into socio-demographic factors, risk of exposure to coronavirus, mitigating behaviours, and perceptions of COVID-19. Data were analyzed using multinomial logistic regression and a classification and regression tree. Results Seventy-six percent of the respondents indicated that they had been or were willing to be vaccinated, 13% had not yet decided, and the remaining 11% said they would not be vaccinated. Factors that increased the likelihood of vaccine refusal and hesitancy were lower education level, financial instability, Indigenous status, and not being concerned about spreading the coronavirus. Perceiving COVID-19 to be more of a threat to one’s community and believing that one had a higher risk of illness or death from COVID-19 decreased the likelihood of both vaccine refusal and hesitancy. Women and newcomers to Canada were more likely to be unsure about getting vaccinated. Respondents who did not plan to be vaccinated were less likely to wear face masks and practice physical distancing. Conclusion While many Canadians have voluntarily and eagerly become vaccinated already, reaching sufficient coverage of the population is likely to require targeted efforts to convince those who are resistant or unsure. Identifying and overcoming any barriers to vaccination that exist within the socio-demographic groups we found were least likely to be vaccinated is a crucial component.

Social and Demographic Factors Contributing to COVID-19 Vaccine Hesitancy in Patients with Hematologic Malignancies

Background Vaccine hesitancy, defined as the delay in acceptance or refusal of safe vaccines, remains a challenge in the general population. Given that patients with hematologic malignancies frequently encounter healthcare professionals and are at high risk of severe COVID-19 infection, their attitudes towards vaccines may differ from other patient groups. We therefore performed a survey-based study to investigate vaccine hesitancy within an ethnically diverse group of patients diagnosed with hematologic malignancies. Methods We administered a 122-item questionnaire from December 2020 to January 2021 (prior to commercial availability of the COVID-19 vaccines) to 60 patients with hematologic malignancies. Questions were separated into the following categories: demographic and socioeconomic data; personal impact of COVID-19 infection; COVID-19 pandemic experience; COVID-19 infection perceptions; COVID-19 vaccine perceptions; and baseline COVID-19 vaccine knowledge. Results The majority of patients were Black (n=33, 55%) or Hispanic (n=11, 18.3%) and were undergoing active treatment (n=43, 71.7%) or had received prior hematopoietic stem cell transplantation (n=9, 15%). Eight (13.3%) patients had prior COVID-19 infection. Sixteen (26.7%) patients reported infection in an immediate family member while 15 (25%) reported infection in a friend. 20 of these cases were moderate in severity requiring healthcare interaction, and 17 of these cases were reported to result in severe infection (n=7, 9.6%) or death (n=10, 13.7%). Only 16 (29.6%) patients perceived themselves to be at high or very high risk of COVID-19 infection. The COVID-19 pandemic was reported to moderately or severely affect employment/income in 10 (22.8%) patients and led to worse mental health in 10 (22.3%) patients. However, the majority of patients reported no negative impact on their cancer treatment (n=37, 88.1%) or prognosis (n=45, 93.8%). Of the 60 patients, 22 (40.7%) reported that if a COVID-19 vaccine was made publicly available in the next 30 days, they would not vaccinate themselves, either due to safety concerns (n=4, 20%) or indifference (n=6, 30%). Despite this, 43 (78.2%) patients stated that vaccination was an important tool in ending the pandemic. More patients agreed to accept the vaccine if it was made available in 6 months from the time of survey (n=40, 76.9%). Only 32 (59.3%) patients were extremely or very likely to accept a yearly vaccine. In terms of perception on cancer outcomes, 31 (62%) patients were uncertain if the vaccine would interact negatively with their current chemotherapy treatment, while 27 (52.9%) believed the vaccine would make their cancer worse. The biggest fear patients had about COVID-19 vaccines were side effects or death (n=15, 38.5%) and complications to cancer/cancer therapy (n=5, 12.8%). Only 6 (15.4%) patients stated they had no fears related to COVID-19 vaccination. In fact, only 21 (39.6%) patients agreed or strongly agreed that the side effects of most vaccines outweigh the benefits. In a modified (age- and sex-adjusted) Poisson regression model (Table 1) that included baseline demographics and answers to select survey questions, older age was associated with a stronger likelihood of vaccine acceptance (RR 1.73, 95% CI 1.11-2.71; p=0.016), while female gender was associated with less likelihood to accept the vaccine (RR 0.58, 95% CI 0.37-0.90; p=0.016). Patients reported as "other" race (e.g., Asian) were more inclined to accept the vaccine (RR. 2.21, 95% CI 1.16-4.20; p=0.016) compared to White patients. Finally, when compared to patients who receive information primarily from medical professionals, those patients who received their information from social media or friends were far less likely to accept the vaccine (RR 0.02, 95% CI 0.01-0.04; p<0.001). Conclusion This is the first study to report that although patients with hematologic malignancies experienced significant medical and social burdens from the COVID-19 pandemic and have frequent interaction with healthcare professionals, a high rate of COVID-19 vaccine hesitancy still exists. We provide in depth information on the potential reasons for vaccine refusal in a diverse patient population and highlight potential areas for improvement in patient education. In particular, we show that vaccine disinformation received from friends and social media is a significant reason for vaccine refusal. Figure 1 Figure 1. Disclosures Calip: Pfizer: Research Funding; Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment. Rondelli: Vertex: Membership on an entity's Board of Directors or advisory committees. Patel: Celgene: Consultancy.