Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the United Kingdom: findings from the UK-REACH prospective longitudinal cohort study

Background Several countries now have mandatory SARS-CoV-2/COVID-19 vaccination for healthcare workers (HCWs) or the general population. HCWs' views on this are largely unknown. Methods We administered an online questionnaire to 17891 United Kingdom (UK) HCWs in Spring 2021 as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question 'What should society do if people don't get vaccinated against COVID-19?' using content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not and used logistic regression to calculate its demographic predictors, and occupational, health and attitudinal predictors adjusted for demographics. Findings Of 5633 questionnaire respondents, 3235 answered the freetext question; 18% (n=578) of those favoured mandatory vaccination but the most frequent suggestion was education (32%, n=1047). Older HCWs, HCWs vaccinated against influenza (OR 1.48; 95%CI 1.10-1.99, vs none) and with more positive vaccination attitudes generally (OR 1.10; 95%CI 1.06-1.14) were more likely to favour mandatory vaccination (OR 1.26; 95%CI 1.17-1.37, per decade increase), whereas female HCWs (OR= 0.80, 95%CI 0.65-0.99, vs male), Black HCWs (OR= 0.48, 95%CI 0.26-0.87, vs White), those hesitant about COVID-19 vaccination (OR= 0.56; 95%CI 0.43-0.71, vs not hesitant), in an Allied Health Profession (OR 0.67; 95%CI 0.51-0.88, vs Medical), or who trusted their organisation (OR 0.78; 95%CI 0.63-0.96) were less likely to. Interpretation Only one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating and supporting HCWs who are hesitant about vaccination may be more acceptable, effective and equitable. Funding MRC-UK Research and Innovation grant (MR/V027549/1) and the Department of Health and Social Care via the National Institute for Health Research.

Relief After COVID-19 Vaccination: A Doubtful or Evident Outcome?

Background: Since development of the first COVID-19 vaccine, the landscape of public confidence in these vaccines is uncertain. Building confidence is crucial for better preparedness of future pandemics. Following the mandatory COVID-19 vaccination policy in the country, the aim of this study was to examine whether the Saudi public feels relieved post-vaccination and to identify the factors predicting such relief.Methods: An online cross-sectional survey was conducted in July 2021 among COVID-19 vaccine recipients in Saudi Arabia. A multivariable logistic regression analysis was employed to examine and identify the variables associated with feeling relieved post-vaccination.Results: Most of the respondents (66%) stated feeling more relieved post-vaccination. Male gender [adjusted odds ratio (AOR): 1.380; 95% confidence interval (CI): 0.981–1.943], being a student (AOR: 3.902; 95% CI: 1.674–9.096), and received two doses of the vaccine (AOR: 2.278; 95% CI: 1.630–3.182) were associated with feeling more relieved after getting vaccinated. Respondents who were anxious about the vaccine before receiving it (AOR: 0.220; 95% CI: 0.160–0.302), and experienced a severe reaction after vaccination (AOR: 0.288; 95% CI: 0.165–0.504) had lower odds of feeling relieved post-vaccination. Respondents who relied on social media as the main source of vaccine-related information and those having no information about the vaccine were also less likely to feel relieved post-vaccination.Conclusions: Individuals' attitudes toward COVID-19 vaccines may not necessarily alter post-vaccination. Although mandatory vaccination policies can significantly contribute to achieving herd immunity, public confidence toward vaccines might be eroded, which could in turn impose significant challenges in future pandemics efforts.

Healthcare Workers Attitudes, Practices and Sources of Information for COVID-19 Vaccination: An Italian National Survey

Vaccination of healthcare workers (HCWs) is a crucial element to overcome the COVID-19 pandemic. The aim of this survey was to assess attitudes, sources of information and practices among Italian Healthcare workers (HCWs) in relation to COVID-19 vaccination. Methods: From 19 February to 23 April 2021, an anonymous voluntary questionnaire was sent to the mailing list of the main National Health Service structures. Data were collected through the SurveyMonkey platform. Results: A total of 2137 HCWs answered. Hesitancy towards COVID-19 vaccination was more frequent in females, in those with lower concern about COVID-19, and in nurses, auxiliary nurses (AN) and healthcare assistants. Hesitant professionals were more likely to not recommend vaccination to their patients or relatives, while a high concern about COVID-19 was related to an increased rate of recommendation to family members. HCWs were mostly in favor of mandatory vaccination (61.22%). Female sex, a lower education level, greater hesitancy and refusal to adhere to flu vaccination campaigns were predictors influencing the aversion to mandatory vaccination. All categories of HCWs referred mainly to institutional sources of information, while scientific literature was more used by professionals working in the northern regions of Italy and in infection control, infectious diseases, emergencies and critical areas. HCWs working in south-central regions, nurses, AN, healthcare technicians, administrators and HCWs with a lower education level were more likely to rely on internet, television, newspapers, and the opinions of family and friends. Conclusions: Communication in support of COVID-19 immunization campaigns should consider the differences between the various HCWs professional categories in order to efficiently reach all professionals, including the most hesitant ones.

Inclusive Education for Health: Analysis of the Mandatory Nature of Vaccination and Its Regulation by Administrations, and Implications and Considerations for Vaccination against COVID

In the process of vaccination against COVID-19, the problem of parents who do not want to vaccinate their school-age children has been evident. A conflict arises between two fundamental rights: the right to ideological freedom, privacy, and physical integrity of parents and minors who do not opt for vaccination; and the right to health of the rest of the children who attend the same school, provoking a social debate on the need to introduce regulatory changes that favor the mandatory imposition of vaccination in certain cases. This research offers an observational study through a cross-sectional design of a quantitative nature, in which one thousand people belonging to the education, health, and economy sectors from seventy-six countries of five continents have participated. The instrument used was a previously validated questionnaire: VACUNASEDUCA. It was considered essential to know the awareness of vaccination processes of professionals from essential social sectors. Therefore, the objectives were: to reflect on the measures of mandatory vaccination, to know the importance of teachers being able to demand a regulated vaccination card from students, to study the need for regulation by administrations of compliance with vaccines, and to analyze the importance of health education. It has been shown that women and those under thirty years of age are the least in favor of compulsory vaccination, with the health sector being the most defending of their demand, and with Europe with the lowest means. It is concluded that mandatory vaccination could be an acceptable tactical option to prevent high-risk situations.

Predicting the impact of COVID-19 vaccination campaigns - a flexible age-dependent, spatially-stratified predictive model, accounting for multiple viral variants and vaccines

Background: After COVID-19 vaccines received approval, vaccination campaigns were launched worldwide. Initially, these were characterized by a shortage of vaccine supply, and specific risk groups were prioritized. Once supply was guaranteed and vaccination coverage saturated, the focus shifted from risk groups to anti-vaxxers, the underaged population, and regions of low coverage. At the same time, hopes to reach herd immunity by vaccination campaigns were put into perspective by the emergence and spread of more contagious and aggressive viral variants. Particularly, concerns were raised that not all vaccines protect against the new-emerging variants. Methods and findings: A model designed to predict the effect of vaccination campaigns on the spread of viral variants is introduced. The model is a comprehensive extension of the model underlying the pandemic preparedness tool CovidSim 2.0 (http://covidsim.eu/). The model is age and spatially stratified, incorporates a finite (but arbitrary) number of different viral variants, and incorporates different vaccine products. The vaccines are allowed to differ in their vaccination schedule, vaccination rates, the onset of vaccination campaigns, and their effectiveness. These factors are also age and/or location dependent. Moreover, the effectiveness and the immunizing effect of vaccines are assumed to depend on the interaction of a given vaccine and viral variant. Importantly, vaccines are not assumed to immunize perfectly. Individuals can be immunized completely, only partially, or fail to be immunized against one or many viral variants. Not all individuals in the population are vaccinable. The model is formulated as a high-dimensional system of differential equations, which is implemented efficiently in the programming language Julia. As an example, the model was parameterized to reflect the epidemic situation in Germany until November 2021 and predicted the future dynamics of the epidemic under different interventions. In particular, without tightening contact reductions, a strong epidemic wave is predicted. At the current state, mandatory vaccination would be too late to have a strong effect on reducing the number of infections. However, it would reduce mortality. An emergency brake, i.e., an incidence-based stepwise lockdown would be efficient to reduce the number of infections and mortality. Furthermore, to specifically account for mobility between regions, the model was applied to two German provinces of particular interest: Saxony, which currently has the lowest vaccine rollout in Germany and high incidence, and Schleswig-Holstein, which has high vaccine rollout and low incidence. Conclusions: A highly sophisticated and flexible but easy-to-parameterize model for the ongoing COVID-19 pandemic is introduced. The model is capable of providing useful predictions for the COVID-19 pandemic, and hence provides a relevant tool for epidemic decision-making. The model can be adjusted to any country, to derive the demand for hospital and ICU capacities as well as economic collateral damages.

SARS-CoV-2 Omicron variant: healthcare workers' perceptions and beliefs of vaccine effectiveness and advocacy: a national survey during the first week of the World Health Organization variant alert

Background: As COVID-19 Omicron variant spread in several countries, healthcare workers' (HCWs) perceptions of vaccine effectiveness, booster and worries warrant reassessment. Methods: Online questionnaire among HCWs in Saudi Arabia (KSA) was collected between Dec 1-6, 2021, aiming to assess their Omicron variant's perceptions, worries, and booster-vaccine advocacy. Results: Among the 1285 HCWs participants in the study, two-thirds were females, 41% were nurses,46.4% were physicians, and 50% worked in tertiary care hospitals. Vaccination was perceived to be the most effective way to prevent the spread of Omicron variant and future variants by 66.9%. The respondents perceived social distancing (78%), universal masking (77.8%), and avoiding unnecessary travel (71.4%), slightly superior to vaccination to prevent COVID-19 variants spread. Of the respondents, 99.5% received two doses of COVID-19 vaccine. Regarding the booster dose, 96% either received it or planned to receive it once they are eligible. 57.7% of the respondents agreed that Omicron could cause a new COVID-19 wave worldwide, 45.9% agreed it may cause another COVID-19 wave in Saudi Arabia and 46.1% indicated the possibility of another lockdown. Overall, the HCWs worry level of the Omicron variant correlated significantly and strongly with their perception of the effectiveness of vaccination and preventive measures. Male HCWs had a significant agreement with mandatory vaccination of all eligible adult populations while HCWs who are unwilling to receive the vaccine had a strong disagreement with mandatory vaccination. Conclusions: The current study was conducted in the first week of Omicron variant discovery in KSA and only two-thirds of HCWs felt that vaccination is the best option to prevent the variant spread, indicating the need to further motivation campaigns for vaccination and booster doses education among HCWs. HCWs had a strong belief in non-pharmacologic interventions that should be encouraged and augmented. It is important to further study and enhance coping strategies for HCWs as we move through the third year of the pandemic with more potential variants, to protect HCWs from fatigue and burnout.

Socio-demographic determinants of COVID-19 vaccine uptake in Russia in the context of mandatory vaccination of employees

The paper offers an analysis of socio-demographic factors determining uptake of COVID-19 vaccine in Russia in 2021. The study focuses in particular on the role of mandatory vaccination of workers in certain sectors of the economy. The study is empirically based on three rounds of a nationally representative telephone survey, conducted in February–October 2021, which investigated the situation and behaviour of a cross section of the Russian adult population in the context of the spread of coronavirus. The paper shows that the key factors behind vaccine uptake are age and education of the individual. People in older age groups and people with higher education are most inclined towards vaccination. By contrast, young people and people with low levels of education are least likely to be vaccinated. Other significant determinants of vaccination are experience of COVID-19 infection (self or a household member) and elderly or chronically ill members of the household. Among the employed, the economic sector where they work is an important determinant: workers in education, health care, and state and municipal administration are more likely to be vaccinated. The introduction of mandatory vaccination at a firm/organization with sanctions for unvaccinated employees has significant positive effect: the likelihood of an employee being vaccinated increases by 10 percentage points. The effect of mandatory vaccination is slightly greater for men than for women.

Parental preferences for a mandatory vaccination scheme in England; a discrete choice experiment

Background: Mandatory vaccination has been mooted to combat falling childhood vaccine uptake rates in England. This study investigated parental preferences for a mandatory vaccination scheme. Methods: Discrete choice experiment. Six attributes were investigated: vaccine (MMR, 6-in-1), child age group (2 years and older, 5 years and older), incentive (130 GBP cash incentive for parent, 130 GBP voucher incentive for child, no incentive), penalty (450 GBP fine, parent not able to claim Child Benefits for an unvaccinated child, unvaccinated child not able to attend school or day care), ability to opt out (medical exemption only, medical and religious belief exemption), and compensation scheme (not offered, offered). Mixed effects conditional logit regression models were used to investigate parental preferences and relative importance of attributes. Findings: Participants were 1,001 parents of children aged 5 years and under (53% female, mean age=33.6 years, SD=7.1, 84% white British). Parental preferences were mostly based on incentives (slight preference for cash pay-out for the parent versus a voucher for the child) and penalties (preference for schemes that did not allow unvaccinated children to attend school or day care and those that withheld financial benefits for parents of unvaccinated children). Parents also preferred schemes that: offered a compensation scheme, mandated the 6-in-1 vaccine, mandated vaccination in children aged 2 years and older, and that offered only medical exemptions. Interpretation: Results can inform policymakers' decisions about how best to implement a mandatory childhood vaccination scheme in England. Funding: Data collection was funded by a British Academy/Leverhulme Small Research Grants (SRG1920\101118).

Mandatory vaccination against COVID-19 would be supported by less than fifty per cent: A Twitter poll analysis on public health opinion. (Preprint)

BACKGROUND On January 30, 2020, the World Health Organization (WHO) Emergency Committee declared the rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, global vaccination coverage rates have remained below expectations. Mandatory vaccination is now being controversially discussed and has been enacted in some developed countries, while the vaccination rate is very low in many developing countries. We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. OBJECTIVE The purpose of this study was to understand better the public's perception of mandatory COVID-19 vaccination in real-time utilizing Twitter polls. METHODS Two Twitter polls were developed to seek the public's opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform's Twitter timeline for one week in mid-November 2021, three days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. RESULTS Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the respondents (49% [1,246/2,545]) favour mandatory vaccination, at least in certain areas. This attitude is in contrast to the 45.7% (1,162/2,545) who categorically reject mandatory vaccination. 26.3% (621/2,365) of participating Twitter users said they would never get vaccinated, which is reflected by the current vaccination coverage rate. Concatenating interpretation of these two polls needs to be done cautiously as participating populations might greatly differ. CONCLUSIONS Mandatory vaccination against COVID-19 (in at least certain areas) is favoured by less than 50%, whereas it is vehemently opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views through and social media discussions and surveys specifically susceptible to the "echo chamber effect", the results can be seen as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity.

Mandatory Vaccination during the Period of a Pandemic: Legal and Ethical Considerations in Europe

The present study explores the pressing matter of mandatory vaccination in Europe from an ethical–constitutional perspective. To start with, it considers the bases of the concerns that have been raised to date, as well as those of the documented opposition. This is followed by an analysis of the applicable European legal framework and a discussion on mandatory vaccination in the workplace, education and the leisure industry, before outlining the conclusions reached. The position taken by this paper is that as long as certain conditions are met, mandatory vaccination does not violate fundamental rights. On the contrary, provided that the principle of proportionality is satisfied, mandatory vaccination as a form of medical intervention constitutes a manifestation of the obligation on the part of the state to protect the fundamental rights to life and health.