A medical worker administers a dose of the "Cominarty" Pfizer-BioNTech coronavirus disease (COVID-19) vaccine to a patient at a vaccination center in Ancenis-Saint-Gereon, France, November 17, 2021. REUTERS/Stephane Mahe/File Photo/File Photo
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July 28 (Reuters) - The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.
Reinfections, severe outcomes may be more common with BA.5
Compared with the earlier Omicron BA.2 subvariant, currently dominant Omicron BA.5 is linked with higher odds of causing a second SARS-COV-2 infection regardless of vaccination status, a study from Portugal suggests.
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From late April through early June, researchers there studied 15,396 adults infected with the BA.2 variant and 12,306 infected with BA.5. Vaccines and boosters were equally effective against both sublineages, according to a report posted on Monday on medRxiv ahead of peer review. However, 10% of BA.5 cases were reinfections, compared to 5.6% of BA.2 cases, which suggests a reduction in protection conferred by previous infection against BA.5 compared to BA.2, the researchers said. Moreover, the vaccines appeared to be less effective in reducing the risk of severe outcomes for BA.5 compared with BA.2.
"Among those infected with BA.5, booster vaccination was associated with 77% and 88% reduction in risk of COVID-19 hospitalization and death, respectively, while higher risk reduction was found for BA.2 cases, with 93% and 94%, respectively," the researchers wrote. While "COVID-19 booster vaccination still offers substantial protection against severe outcomes following BA.5 infection," they said, their findings provide "evidence to adjust public health measures during the BA.5 surge."
Virus spike protein damages heart muscle cells
The spike protein on its surface that the coronavirus uses to break into heart muscle cells also triggers a damaging attack from the immune system, according to new research.
The SARS-CoV-2 spike protein interacts with other proteins in cardiac myocytes to cause inflammation, researchers said on Wednesday in a presentation at the American Heart Association's Basic Cardiovascular Sciences Scientific Sessions 2022. In experiments with mice hearts, comparing the effects of SARS-CoV2 spike proteins and spike proteins from a different, relatively harmless coronavirus, the researchers found that only the SARS-CoV-2 spike protein caused heart dysfunction, enlargement, and inflammation. Further, they found, in infected heart muscle cells only the SARS-CoV-2 spike interacted with so-called TLR4 proteins (Toll-like receptor-4) that recognize invaders and trigger inflammatory responses. In a deceased patient with COVID-19 inflammation, the researchers found the SARS-CoV-2 spike protein and TLR4 protein in both heart muscle cells and other cell types. Both were absent in a biopsy of a healthy human heart.
"That means once the heart is infected with SARS-CoV-2, it will activate the TLR4 signaling," Zhiqiang Lin of the Masonic Medical Research Institute in Utica, New York said in a statement. "We provided direct evidence that spike protein is toxic to the heart muscle cells and narrowed down the underlying mechanism as spike protein directly inflames the heart muscle cells," he told Reuters. "More work is being done in my lab to test whether and how spike protein kills heart muscle cells."
Omicron-targeted antibody combo nears human trials
A new monoclonal antibody combination can prevent and treat Omicron infections in monkeys, researchers reported on Monday in Nature Microbiology.
The antibodies, called P2G3 and P5C3, recognize specific regions of the spike protein the SARS-CoV-2 virus uses to enter cells. "P5C3 alone can block all SARS-CoV-2 variants that had dominated the pandemic up to Omicron BA.2," said Dr. Didier Trono of the Swiss Institute of Technology in Lausanne. "P2G3 then comes to the rescue as it not only can neutralize all previous SARS-CoV-2 variants of concern, but it can also block BA.4 and BA.5," he said. "P2G3 is even effective against some BA.2 or BA.4/BA.5 mutants capable of escaping (Eli Lilly's (LLY.N)) bebtelovimab, the only antibody approved for the clinics still displaying activity against the currently dominant BA.4/BA.5 subvariants."
In lab experiments, mutations that might make SARS-CoV-2 variants resistant to P2G3 did not allow escape from P5C3, and P5C3 escape mutants were still blocked by P2G3, Trono said. "In essence, the two antibodies cover for each other, one filling in for the lapses of the other and vice versa."
Aerium Therapeutics plans to start testing the combination in humans next month, said Trono, who is among the company's founders. If larger trials eventually confirm its effectiveness, the P5C3/P2G3 combination will be given by injection every three-to-six months to people who are immunocompromised and do not have a strong response to COVID-19 vaccines, the company has said.
Click for a Reuters Global COVID-19 Tracker and for a Reuters COVID-19 Vaccination Tracker.
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Reporting Nancy Lapid; Editing by Bill Berkrot
Our Standards: The Thomson Reuters Trust Principles.
Introduction
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the novel coronavirus (SARS-CoV-2) and was first identified in December 2019 in Wuhan, China.1 The World Health Organization (WHO) declared COVID-19 as a global pandemic on 11 March 2020.2 The virus infects millions of people and kills millions since its inception.3 Vaccines effectively reduce the risk of serious illness and death from COVID-19. The COVID-19 vaccine is also safe and has a low risk of serious adverse events.46
Vaccines provide great protection in terms of public health, however, to be successful, the vaccine level must be high.7 Especially relevant in the context of the current COVID-19 epidemic, high vaccination coverage rates are needed to provide indirect protection to society as a whole, bring society back to a normal way of life, and to re-open the world economy to the general population.8 High vaccination rates are also important in achieving herd immunity to reduce the spread of COVID-19 and to create a lower risk of infection in the general population and those most susceptible to transmission.810
The success of the COVID-19 vaccination program depends on the proportion of people who prefer to be vaccinated, and recent estimates suggest that up to 70% of the population may need to be vaccinated to end the current epidemic.11 COVID-19 vaccines need to be released as quickly as possible to bring the public back to normal as soon as possible. However, vaccine hesitancy poses a major threat to the effectiveness of the vaccine in preventing disease and death from COVID-19.12,13 Studies conducted in 2021 show that between 40% and 50% of respondents worldwide are reluctant to receive the COVID-19 vaccine with wide variations across countries.14,15 In Ethiopia, a survey found that only 31% of the general population was willing to receive the COVID-19 vaccine.16
The WHO defines vaccine hesitancy as delay in acceptance or rejection of safe vaccines despite the availability of vaccine services.17 COVID-19 vaccine hesitancy is thought to be a multi-factor event influenced by a range of factors. It includes cognitive, psychological, socio-demographic, political, and cultural factors and varies among different populations.18 Numerous studies have shown that public concern about the safety and/or side effects of COVID-19 vaccines, widespread misinformation about COVID-19 vaccines, and distrust in governments are the factors contributing to the growing hesitancy toward COVID-19 vaccines.1922 Overcoming vaccine hesitancy is complex, so no single intervention can be completely resolved, especially in the case of COVID-19 where the evidence for effective strategies to address it is currently limited.23 Hence, a multi-component approach tailored to the local population is required to effectively address vaccine hesitancy.23 Accordingly, it is essential to understand the proportion and determinants of the COVID-19 vaccine hesitancy to inform policymakers and formulate direct intervention measures that can successfully combat the COVID-19 pandemic.
Despite the growing literature, examining the prevalence and determinants of the COVID-19 vaccine in Ethiopia, limited comprehensive evidence has been presented to provide an in-depth and systematic summary of important factors driving vaccine hesitancy specific to the Ethiopian population. This systematic review aimed to examine the proportion of COVID-19 vaccine hesitancy and its associated factors among the Ethiopian population. This review provides valuable insights for policymakers to design and implement targeted and holistic interventions to combat the COVID-19 epidemic in Ethiopia. It helps and facilitates the planning of vaccination campaigns to improve the uptake of the COVID-19 vaccine. Furthermore, our result can not only increase COVID-19 vaccine coverage but also improve the readiness of the existing health system for routine and emergency vaccination.
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.24 By using these guidelines, we have developed a search strategy and eligibility criteria before review. Then, the search was conducted through a two-step selection process based on the pre-defined eligibility criteria and evaluated the returned articles. After identifying studies relevant to this review, relevant data were collected from each study. Details of the review process are provided below.
PubMed, EBSCO, Google Scholar, and Semantic Scholar were searched by using the following search strategy: (COVID-19 OR SARS-CoV-2 OR corona virus disease 2019 OR nCOV OR 2019-nCOV) AND (vaccine OR vaccination) AND (acceptance OR willingness OR intention OR hesitancy) AND (associated factors OR determinant factors) AND (Ethiopia).
The inclusion criteria for this systematic review were peer-reviewed journal articles, survey studies done among the Ethiopian population (general population, health care workers, teachers, students, drivers, lactating mothers, adults, bankers, pregnant women, and patients), studies that investigated the prevalence and/or determinants of COVID-19 vaccine hesitancy/acceptance/willingness, and studies published in English until January 18, 2022. Unpublished manuscripts (preprints), non-empirical studies, articles studying vaccine hesitancy other than COVID-19 disease, studies conducted in other countries, and articles that did not report the outcome of interest were excluded from the present systematic review.
The identified articles were selected in two stages. The first step involves screening all article titles and abstracts based on eligibility criteria, followed by reviewing the full text of articles with similar criteria. Initially, two independent reviewers examined all titles and abstracts for eligible articles. Disputes regarding exclusions between the two reviewers were resolved through discussions. Finally, all the reviewers individually evaluated the full text of each article and made a final selection of articles to be included.
In this systematic review, the primary outcome was the prevalence of the COVID-19 vaccine hesitancy, which was reported in the included studies. The secondary outcome was determinants of COVID-19 vaccine hesitancy, which has been reported in included studies.
Studies that met the inclusion criteria were further analyzed and the following items were extracted from each study: authors, year of publication, study period, data collection method, target population, study design, sample size, prevalence, and determinants of COVID-19 vaccine hesitancy. The Strategic Advisory Group of Experts (SAGE) determinants of vaccine hesitancy model25 was used to categorize the determinants. Using this model, the determinants of COVID-19 vaccine hesitancy were categorized into three groups: contextual factors, individual/group factors, and vaccine/vaccination-related factors. Finally, the factors were analyzed according to the frequency of occurrences in the studies.
Quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Study.26 There are nine criteria in the checklist to assess the quality of cross-sectional studies. Each item in the evaluation criterion is represented by yes,no, unclear or not available. The score is one (1) for yes and zero (0) for the rest. A quality score is calculated for each article by dividing the total score by the total possible score. Each article is classified as low quality (<50%), medium quality (5069%), or high quality (7 0%).
The selection process and relevant eligibility criteria are presented in Figure 1. A total of 1801 articles were identified for initial screening. Of this, 903 articles were excluded due to duplication. Following the removal of the duplicates, the titles and abstracts of 898 articles were evaluated for eligibility. Leaving 824 articles based on title and abstract screening, 74 articles were retained for full-text screening. Subsequently, 54 studies were excluded after the full-text screening. Finally, 20 articles have been included in the present systematic review.
Figure 1 PRISMA flow chart of study selection process for systematic review of the prevalence and determinants of COVID-19 vaccine hesitancy among the Ethiopian population.
Notes: Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.24 Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode).
A total of 20 cross-sectional studies published up to January 18, 2022, were analyzed in this review. Most studies have been conducted on health workers. The paper questionnaire is a commonly used data collection tool in the included studies. The largest sample size was 1184 and the smallest sample size was 323. More than half of the studies were conducted in the SNNPR (n = 7) and Amhara regions (n = 6) in Ethiopia. Further details of the included studies are shown in Table 1.
Table 1 Characteristics of Studies Included in the Systematic Review of Prevalence and Determinants of COVID-19 Vaccine Hesitancy in Ethiopia, 2022
The proportion of COVID-19 vaccine hesitancy from different parts of Ethiopia is presented in Table 1. The highest level of COVID-19 vaccine hesitancy was reported among pregnant women in SNNPR (68.7%)27 and the lowest level of COVID-19 vaccine hesitancy was recorded among cancer patients in Addis Ababa (14.1%).28
A total of 12 factors were identified under contextual determinants of COVID-19 vaccine hesitancy (Table 2). Among the contextual factors being young appeared in seven of the 20 studies (35%).2935 Lower educational status appeared in six of the 20 studies (30%).16,27,3639 Lack of adequate information on COVID-19 vaccination appeared in four of the 20 studies (20%).28,32,39,40 Being females,16,39,41 living in rural areas,16,27,38 and religious beliefs,16,30,37 each appeared in three of the 20 studies (15%). Lack of trust in government33,40 and being only academic staff in university hospitals34,36 appeared in two of the 20 studies (10%). Four factors, namely: being married,16 not having health insurance,42 being a non-health science student,35 and unclear information by public health authorities,29 each appeared in one of the 20 articles (5%).
Table 2 Contextual Determinants of COVID-19 Vaccine Hesitancy in Ethiopia
Ten factors were identified for the individual determinants of COVID-19 vaccine hesitancy (Table 3). Among the ten factors under this category poor knowledge about the COVID-19 vaccine27,30,35,36,38,41,42 and low perceived risk of being infected with COVID-192830,32,37,43,44 appeared in seven of the 20 studies (35%). Poor compliance with COVID-19 prevention measures27,29,35,38,44 and negative attitude towards COVID-19 vaccine30,40,4244 appeared in five of the 20 studies (25%). Not having a history of chronic illness appeared in three of the 20 studies (15%).36,41,44 Not having close relatives or friends diagnosed with COVID-1939,42 and not having COVID-19 infection experience28,34 appeared in two of the 20 studies (10%). Three factors, namely: believing that other non-vaccine preventive mechanisms are sufficient to prevent COVID-19 infection,45 belief in having adequate natural immunity,45 and lesser trust in science,33 each appeared in one of the 20 articles (5%).
Table 3 Individual/Group Related Determinants of COVID-19 Vaccine Hesitancy in Ethiopia
A total of 3 factors were identified under vaccine-related determinants of COVID-19 vaccine hesitancy (Table 4). Among the three factors under this category concern about the safety and/or side effect of the vaccine appeared in six of the 20 studies (30%).29,33,37,39,40,45 Doubts about the effectiveness of the vaccine appeared in four of the 20 studies (20%).32,37,40,45 Lack of advocacy for COVID-19 vaccination from health professionals appeared in one of the 20 studies (5%).38
Table 4 Vaccine/Vaccination-Related Determinants of COVID-19 Vaccine Hesitancy in Ethiopia
The JBI critical appraisal checklist for analytical cross-sectional studies included the following eight criteria. (#1) Was the criteria for inclusion in the sample clearly defined? (#2) Were the study subjects and the setting described in detail? (#3) Was the exposure measured validly and reliably? (#4) Were objective, standard criteria used for measurement of the condition? (#5) Were confounding factors identified? (#6) Were strategies to deal with confounding factors stated? (#7) Were the outcomes measured validly and reliably? (#8) Was appropriate statistical analysis used? Based on the above criteria, the quality score of included studies is given in (Table 5). Of the included studies, 15 were rated as high quality, five as moderate quality, and no studies were rated as poor quality.
Table 5 Quality Assessment Results of the Included Studies Using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies
In this review, we examined the proportion and determinants of COVID-19 vaccine hesitancy in Ethiopia. The overall proportion of COVID-19 vaccine hesitancy ranged from 14.1% to 68.7%, as reported in Addis Ababa and SNNPR, respectively. This finding suggests that vaccine hesitancy poses a serious challenge to COVID-19 pandemic management and control. Many countries are developing vaccines to protect their populations from the current COVID-19 pandemic.46 The widespread use of the COVID-19 vaccine is believed to boost herd immunity and protect the population from COVID-19.47 However, with this high level of COVID-19 vaccine resistance, the current COVID-19 pandemic is becoming increasingly difficult to manage and control. Therefore, the establishment of educational resources should be implemented to improve the use of the COVID-19 vaccine to make the population aware of its safety, the importance of the vaccine, and the adverse effects of vaccine rejection.
In this study, the proportion of the COVID-19 vaccine hesitancy in the general population in Ethiopia ranged from 35% to 68%. Similarly, previous studies show that between 40% and 50% of the worlds population are reluctant to receive the COVID-19 vaccine, with variations in different countries.14,15 In addition, our results were similar to another study conducted in Germany, with 42.5% of the participants reporting that they were hesitant to vaccinate against COVID-19.48 On the contrary, the acceptance rate of the COVID-19 vaccine was observed to be high in the USA (81%)49 and the Chinese population (91.3).50 This can be attributed to differences in the spread and burden of the COVID-19 pandemic between countries. In addition, the variation can be explained by differences in awareness of the severity of COVID-19 and access to healthcare. This discrepancy may also be due to differences in respondents local traditions, cultures, and beliefs about the benefits and risks of the COVID-19 vaccine. For example, the Chinese population had strong beliefs about the effectiveness of the COVID-19 vaccine, as 89.5% thought the vaccine was an effective way to prevent and control COVID-19.50 This positive attitude towards COVID-19 vaccination and the perceived major pandemic impact may explain the high acceptance of the COVID-19 vaccine among the Chinese population compared to the Ethiopian population.
Our review also indicated that the proportion of COVID-19 vaccine hesitancy among healthcare workers in Ethiopia ranged from 36% to 60.3%. The result of this study was in line with a previous systematic review which reported the proportion of COVID-19 vaccine hesitancy as 49%.51 This implies that a considerable proportion of healthcare workers were hesitant towards the COVID-19 vaccine, which hinder their recommendation of vaccination to their patients. Evidence shows that the attitude of the healthcare workers toward the COVID-19 vaccine was found to influence their intention to suggest the vaccine to their patients and the general population.52 This problem is alarming due to the position of health care workers at the forefront in combating the spread and impact of the COVID-19 epidemic, which puts them at risk of infection.5355 Therefore, health workers need to be involved in future priority education so that they can influence the use of vaccines and be approved by the population.
The widespread prevalence of COVID-19 vaccine hesitancy observed in our study is due to the following factors: contextual factors, individual factors, and vaccine-specific factors. Younger age, being females, living in rural areas, lack of adequate information, and lower education were common contextual factors associated with COVID-19 vaccine hesitancy. Poor knowledge about the COVID-19 vaccine, lower self-perceived risk of infection with COVID-19, poor adherence to COVID-19 prevention rules, and negative attitude towards COVID-19 vaccine were most frequently mentioned individual and group related factors associated with increased COVID-19 vaccine hesitancy. Common vaccine/vaccination-specific determinants included concerns about the safety and/or side effects of the vaccine and worries about the effectiveness of the vaccine.
Being young was the most frequently mentioned determinant of COVID-19 vaccine hesitancy. This is in line with previous systematic reviews of COVID-19 vaccine hesitancy.5660 This increase in the hesitancy of the COVID-19 vaccine among young people may be due to the WHO announcement about groups at high risk of COVID-19 infection and death. The WHO has declared that the COVID-19 pandemic is more prevalent and worse for older people than for younger ones. This leads to younger participants being more hesitant than older participants.61 This finding also means that older people may have more responsibility and accountability towards themselves and their families. Therefore, an in-depth understanding of the potential factors influencing adolescents hesitancy to take the COVID-19 vaccine and their vaccine intent will contribute to the development and implementation of effective methods to promote the COVID-19 vaccine in this group.
Our review also confirmed that females were more hesitant to the COVID-19 vaccine. This is consistent with the findings of various systematic reviews,5660 which identified being females as one of the most frequently reported factors associated with increased COVID-19 vaccine hesitancy. Studies conducted in Bangladesh and Vietnam also reported higher COVID-19 vaccine hesitancy among female respondents.62,63 The main reasons may be the apparent low-risk perception of COVID-19, high beliefs of conspiracy-related theories about the pandemic in women than men,64 and concerns about the safety of vaccination during pregnancy and lactation.65
The current study also identified a low level of education as a major determinant of COVID-19 vaccine hesitancy. This is in line with the findings of some systematic reviews,57,58,66 which identified a low level of education among commonly cited determinants of COVID-19 vaccine hesitancy. In a US study, high levels of hesitancy against the COVID-19 vaccine were shown in people with limited education.67 This may be because more educated people have better access to vaccine information and can understand information about the benefits and safety of the COVID-19 vaccine; on the contrary, the uneducated are more likely to be misinformed about the vaccine. Thus, individuals should be aware of herd immunity, vaccine safety, and how vaccines can help people return to their daily lives.
Consistent with the findings in many systematic reviews;5759,66,68 living in rural areas was one of the most frequently reported determinants of COVID-19 vaccine hesitancy. Further, a study from Bangladesh reported that rural residents were more reluctant to vaccinate than those living in urban areas.62 The high prevalence of vaccination among urban dwellers can be explained as people living in urban areas have improved access to health care and are more exposed to different media than the rural population. In addition, compared with the urban community, rural communities may be reluctant to vaccinate because of certain cultural practices and religious beliefs that prevent vaccination.69
Poor knowledge of the COVID-19 vaccine was also an important factor associated with the growing hesitancy against the COVID-19 vaccine. This result is consistent with previous studies conducted in Southeast Asia and England.70,71 These findings are explained by having good knowledge of the COVID-19 vaccine will help people to know the benefits of the COVID-19 vaccine. Hence, improving public awareness of the benefits, efficacy, and safety of the COVID-19 vaccine is one of the strategies to achieve targeted vaccine coverage. To increase public awareness about the COVID-19 vaccination, there need to be frequent social campaigns that highlight the vaccines usefulness.
Poor adherence to COVID-19 prevention measures was one of the most frequently stated factors influencing COVID-19 vaccine hesitancy. Consistent with this, a high hesitancy of the COVID-19 vaccine was found among people who showed poor adherence to COVID-19 protection measures such as social isolation, face masking, and frequent hand washing.72 Our study found that low trust in the government and the actions they took, the health care response, and the information provided by health officials were associated with the rejection of the COVID-19 vaccine. Other studies have also reported a lack of trust in government/health officials as a factor in the COVID-19 vaccine reluctance.73,74 Evidence suggests that people who trust the governments message are more likely to adhere to disease prevention practices. Therefore, the Ethiopian government and health authorities should work to build public trust and explicitly state the effectiveness of the vaccine, adverse effects, and safety through traditional media and other means.
The perception of a low risk of being infected with COVID-19 was found to be associated with COVID-19 vaccine hesitancy. This is consistent with studies conducted in Vietnam and South Italy.75,76 This is because people who find themselves at low risk are less concerned about getting infected with COVID-19. As a result, they will not fully participate in COVID-19 prevention strategies, including vaccination.77 Therefore, interventions with different communication methods should be implemented to explain the risk of COVID-19 to the population.
Concerns about the safety and side effects of the vaccines were recognized as a major determinant of COVID-19 vaccine hesitancy. This is in line with a study conducted among healthcare workers in Egypt.78 Another systematic review found that the main reasons for vaccine rejection were concerns about vaccine safety and efficacy.21 This is because hesitancy is largely caused by concerns about the safety, efficiency, and side effects of the vaccine. People who are unsure whether the side effects of the COVID-19 vaccine are tolerable or not are very reluctant to take this vaccine.79,80 Therefore, the provision of clear and scientifically valid information about the safety of the COVID-19 vaccine and its adverse outcomes should be a priority task for public health authorities. Since willingness to take the COVID-19 vaccine and its perceived safety and efficacy are strongly linked, it is important to build confidence in the vaccine. The high efficacy and safety of COVID-19 vaccines increase public confidence in the vaccines, thus reducing vaccine hesitancy. The government should continue to educate the public about the safety and side effects to boost confidence in vaccines. It is also important to understand how the implementation of public health measures affects vaccination hesitancy.
Overall, this review has briefly summarized the level of COVID-19 vaccine hesitancy among the Ethiopian population and associated factors. These findings will make a significant contribution to health policymakers, health authorities, researchers, health care providers, and the entire population. All relevant organs should be actively involved to overcome the COVID-19 vaccine hesitancy that can minimize the morbidity and mortality associated with this pandemic and halt this period of the pandemic. Identifying factors based on their frequency of occurrence in the literature can help policymakers prioritize effort levels for maximum effectiveness, and the results of this review should enable future studies to explore the significance and order of importance. In addition, public health authorities should encourage the uptake of the COVID-19 vaccine by providing reliable information about the COVID-19 vaccine. The population needs to be educated about the efficacy, benefits, and safety of the COVID-19 vaccine to increase acceptance rates of this vaccine. It is also imperative to disseminate better public health messages to raise awareness and change the negative attitudes of the population towards the COVID-19 vaccine. Furthermore, future studies may use our findings to explore strategies to address COVID-19 vaccine hesitancy in Ethiopia.
To our knowledge, our study is the first to bring together key factors of COVID-19 vaccine hesitancy across contextual, individual, and vaccine-specific effects among the Ethiopian population to shed light on the design of targeted intervention programs. Another strength of this review lies in the analysis of factors based on the frequency of occurrence in the literature, which facilitates the understanding of the most important factors causing COVID-19 vaccine hesitancy in Ethiopia. Despite its strength, our review has some limitations. Some of the studies included in this review were subject to selection bias because people required internet access to participate in the study and complete the survey. Moreover, the protocol for this review has not been prospectively registered in PROSPERO.
Overall, COVID-19 vaccine hesitancy is quite common and differs in different parts of Ethiopia. Younger age, being female, living in a rural area, lack of adequate information, and low education were the most common contextual determinants of COVID-19 vaccine hesitancy. Insufficient knowledge about the COVID-19 vaccine, low self-perceived risk of contracting COVID-19, poor adherence to COVID-19 prevention measures, and negative attitude toward the COVID-19 vaccine were the most frequently studied individual factors. Common vaccine-specific determinants included concerns about vaccine safety and side effects, and doubts about vaccine efficacy.
Healthcare managers should acknowledge the widespread prevalence of COVID-19 vaccine hesitancy in Ethiopian regions and be aware of the factors we identified when formulating policies regarding the COVID-19 vaccine. Although we present our identified factors as separate factors, each factor alone does not affect COVID-19 vaccine hesitancy. Therefore, understanding the relationships between our identified factors and knowing how our factors affect each population group is crucial to improving COVID-19 vaccine uptake and addressing vaccine hesitancy among the Ethiopian population.
The data used to support the findings of this study are included in the manuscript.
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
The authors declare no conflicts of interest in this work.
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CAIRO - 28 July 2022: Hossam Hosni, head of the Supreme Committee for Combating Corona at the Ministry of Health and Population, revealed that the rates of COVID infection among children under 12 years old do not exceed 1 percent, indicating that children from 12 to 15 years old are currently vaccinated with Pfizer vaccine.
Dr. Hossam Hosni said in press statements, that the benefit of the vaccine is that it prevents complications during infection, and also reduce the symptoms to be mild and moderate, which is easy to treat and recover from quickly.
"Citizens will receive booster doses every 6 months for people under 60 years old who do not suffer from chronic diseases, and 3 months for those over 60 who suffer from chronic diseases," adding that if the epidemic turns into a seasonal flu, the vaccine will be taken annually.
He added, it is expected that there will be a 5th dose of the Corona vaccine if the infections continue to increase, which means that the epidemic has not become a seasonal epidemic.
Dr. Hosni further explained that the drugs for the therapeutic protocol for Corona and its variants are available at all hospitals and are dispensed free of charge, and continued: "The therapeutic protocol will be updated in its seventh version within hours, and new drugs will be added."
He continued: There is a new mutant from "Omicron" that has led to an increase in the number of infections during the past period, and this mutant is called "B4-B5".
"The new Omicron mutant "B4-B5" is characterized by an increase in proliferation and reproduction, but on the other hand, it attacks the upper respiratory tract, and attacks the lungs only at a very slow rate," he added.
Regarding the most prominent symptoms of the new mutant, he said the symptoms are a rise in body temperature for a period of 24 to 48 hours, up to above 37.6 degrees Celsius, with sore throat, and this is enough to diagnose the case as suspected of being infected with the new mutant.
He continued: We do not wait for the rest of the symptoms to appear, such as body pain, excessive sleep, persistent cough and runny nose, but the necessary precautions must be taken immediately, home isolation, and health follow-up with a specialized doctor.
The Ministry of Health and Population continues to raise its preparations in all governorates of the country, follow up on the situation first-hand regarding the emerging corona virus, and take all necessary preventive measures against any viruses or infectious diseases.
The ministry has also allocated a number of means of communication to receive citizens inquiries about the emerging corona virus and infectious diseases, including: the hotline 105, 15335 and the WhatsApp number 01553105105, in addition to the Health Egypt application available on phones.
The U.S. Centers for Disease Control and Prevention(CDC)has endorsedNovavaxs two-doseCOVID-19 vaccine as another COVID-19 vaccine primaryseries option for adults ages 18 and older, following its Advisory Committee on Immunization Practices (ACIP) recommendation and the U.S. Food and Drug Administrations emergency use authorization (EUA).
Now Louisianans have a fourth option when it comes to the COVID-19 vaccine, one that uses a more traditional, familiar vaccine technology.Unlike the mRNA vaccines developed by Pfizer-BioNTech and Moderna, the Novavax vaccine is a protein-based shot. Protein-based vaccines have been used for decades to combat diseases including Hepatitis B and influenza.
"We welcome this news from CDC.Now, residentshave even more options to keep themselves and their families safeagainst severe complications fromCOVID-19, which continues to surge in Louisiana," said State Health Officer Dr. Joseph Kanter. "If you have been waiting for a COVID-19 vaccine built on a different technology than those previously available, now is the time to join the millionsofLouisiananswho have been vaccinated."
LDH has notified all healthcare providers that this guidance is effective immediately, and they can start ordering the vaccine now. The Novavax vaccine is expected to become available in the coming weeks.
Both CDC and LDH recommend that everyone ages 6 months and up get vaccinated against COVID-19 and that everyone ages 5 and up get a booster as soon as they are eligible.
A coalition of advocacy groups on Tuesday implored U.S. President Joe Biden not to give control of emerging, publicly funded coronavirus vaccine technology to profit-seeking corporations, warning such a move would double down on a privatized approach that has failed to ensure equitable vaccine access worldwide.
Released ahead of the White House's Summit on the Future of Covid-19 Vaccines that kicked off Tuesday morning, a new open letter signed by 29 progressive organizations argues "there is no compelling reason to offer this technology on a monopoly basis to a corporation, and a profoundly compelling reason to make the technology as open and readily accessible as possible across the globe."
"It is crucial that we learn from earlier mistakes in managing publicly funded vaccine technology."
The technology in question is the so-called pan-coronavirus vaccine that the U.S. Army's Walter Reed Institute of Research has been developing and testing in recent months.
Dubbed a potential "super vaccine," the Walter Reed shot is aimed at providing protection against all current and future strains of Covid-19 as well as other coronaviruses. The vaccine has reportedly yielded promising results in early trials.
The advocacy coalitionwhich includes Public Citizen, Physicians for Human Rights, Health GAP, and the Revolving Door Projectwrote in their letter Tuesday that the Biden administration must "maintain public control of the Walter Reed vaccine and share its benefits and technology openly with the world."
Such a strategy would contrast sharply with the current, deeply unequal coronavirus vaccination effort, which is dominated by a handful of pharmaceutical corporations that are reaping huge profits.
Even though they received massive sums of federal funding and made use of government technology to develop their shots, companies such as Pfizer and Moderna have monopoly control over vaccine production, artificially constraining supply as billions of people around the world go without access to the lifesaving shots more than two years into the pandemic.
"The public investments in coronavirus research, dating back nearly two decades and including the period after the origin of Covid-19, helped spur amazing inventions that have saved millions of lives," the new letter notes. "However, private, monopoly control over those vaccines contributed to shortages, rationing, and excessive prices. It is crucial that we learn from earlier mistakes in managing publicly funded vaccine technology."
"To date, development of the Walter Reed vaccine has been a triumph of government investment in public health," the letter continues. "We ask for it to remain that way as the Army seeks partners for further trials and mass production."
Peter Maybarduk, director of the Access to Medicines program at Public Citizen, said Tuesday that "the first task in preparing for the future of Covid vaccines is learning from the calamitous past, including the failure to share vaccines early in the pandemic and equip the world against the virus."
"The White House has the power and responsibility to ensure publicly-developed Covid technologies are made available to everyone, everywhere," Maybarduk added.
Revolving Door Project senior researcher Timi Iwayemi agreed, pointing out that "current production and distribution agreements have empowered corporations while limiting the promise of lifesaving coronavirus vaccines."
"Continuing down a path that restricts widespread manufacturing and distribution of Covid vaccines," Iwayemi said, "would lead to unnecessary deaths and easier opportunities for the virus to mutate."
In a column for The American Prospect earlier this year, Iwayemi observed that "so far, development of the [Walter Reed] vaccine has been a public triumph."
"But this next phase is where the pharmaceutical industry can get in on a vaccine developed by and for the public," Iwayemi cautioned. "To protect the broader public, governments must adopt an open system that will support smooth transfer of vital technologies globally. This would mean choosing public funding, open-source research, and transparent nonexclusive licensing contracts over restrictive government-granted monopolies."
White House issues warning on new COVID variants
The Biden administration is calling on people to exercise caution about COVID-19, emphasizing the importance of getting booster shots for those who are eligible and wearing masks indoors as two new transmissible variants are spreading rapidly. (July 12)
AP
COVID-19 isonce again surging around the country, asBA.4 and BA.5, two highly infectioussubvariants of omicron, are responsible for a majority of new cases.
Currently, only adults ages 50 and older and a few younger groupsmoderately or severely immunocompromised are eligible to receive a second booster. But what about everyone else?
Here's what the Centers for Disease Control and Prevention recommends as we face the latest variant of COVID-19.
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BA.5 may be the most infectious strain of COVID-19 to date, according to Yale Medicine.
The CDC's COVID-19 data tracker Nowcast estimates circulating variants, and it is updated every Tuesday. According to the most recent update, the BA.5 variant currently makes up around 81.9% of cases, while the BA.4 variant is responsible for 12.9%.
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The CDC's tracking map shows that in the Midwest, which includes Ohio, BA.5 is responsible for 83.4% of cases and BA.4 is responsible for 11.3%.
The CDC currentlyrecommends for anyone ages 5 and older to get one booster after completing their primary COVID-19 vaccine series.
Adults ages 50 and older and some people ages 12 and older who are moderately or severely immunocompromised are recommended to get a second booster, and have been able to get one since March.
Here's which vaccines are authorized for a first or second booster dose, and for whom:
Novavax is currently not authorized to be used as a booster.
In June, members of the Food and Drug Administration's advisory panel voted to reformulate COVID-19 booster shots for the fall to more directly target the omicron variant.
No final decision has been made yet about boosters for people younger than 50. The Biden administration and federal officials are still deciding whether to recommend a second booster shot for people under 50 before the fall, when the redesigned boosters that target omicron will probably be available for distribution.
The CDC does not recommend mixing vaccines for the primary series for example, you shouldn't get Pfizer as a first dose and Moderna as a second but people 18 and older can get a different vaccine as a booster.
Children and teens ages 5 to 17 who got Pfizer as their primary vaccine must get a Pfizer booster, the CDC says.
Period of engagement: Consultant will work on average 20 hours per/week for 12 to 20 weeks.
Project Description/Background:
The INGO COVID-19 Vaccine Collaborative is a group of six organizations (CARE, Catholic Relief Services, International Rescue Committee, Mercy Corps, Save the Children, and World Vision) working together to advocate for and implement programming related to equitable COVID-19 Vaccine uptake. One major undertaking by the collaborative has been to develop a COVID-19 Vaccine Information and Response Dashboard which presents the work done by both local and international NGOs, while providing greater insight into what is happening in countries utilizing a unique viewpoint that only these organizations can provide. This mapping exercise will help large international donors better direct resources to address the issues which are most impacting communities.
Description of Services:
The consultant will be responsible for collecting and organizing data utilizing pre-written surveys and informal interviews to input into the dashboard. This individual will work closely with all members of the Collaborative and other international and national NGOs to gather information, focusing primarily on the 18 countries that have been prioritized by GAVI and other countries where the Collaborative is working. The consultant will contact and interview an initial set of contacts from collaborative members and may also collect input from other local NGOs as necessary. The countries are list in the full SOW here. Note that the country list may expand or contract.
The consultant will display strong interview and data collection skills to gather information about the work done in these priority countries by as many NGOs in each country as possible. They will also document observations by the Country Offices and work with the Dashboard team to craft succinct and effective narratives detailing the barriers to vaccination, and how these INGOs are well placed to address the barriers.
Deliverables and Timeline:
By October 31, the consultant will have completed the following:
Qualifications:
The successful consultant will have the following qualifications:
Management of Consultancy:
The consultants technical work will be managed by Jeanne Koepsell, Senior Advisor, Digital Health and Community Case Management. All operational aspects will be managed by Daniel Sweeney, Sr. Administrator, Program Operations.
Submit your resume detailing your relevant qualifications and proposed daily rate to Daniel Sweeney (dsweeney@savechildren.org) by Friday, August 5.
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Companies across the U.S. are contending with acute staffing challenges as some workers call out sick with COVID-19 while others take planned summer vacations.
The latest wave of COVID-19 infections, driven by the spread of the BA.5 subvariant, has left some businesses so short-staffed that they've had to reduce their normal business hours or even close temporarily.
Robert Fleming, owner of Capri Club in Los Angeles which opened in June, said he has so few workers that in addition to owning the restaurant, he's also bussing tables.
"I'm the owner-operator and now that means I'm the busboy, the food runner and I'm sweeping and mopping. It means that everyone's got to pitch in and you do what you got to do to keep the doors open," Fleming told CBS MoneyWatch.
Earlier this month, after a number of his staffers were either exposed to or infected with COVID-19, Fleming had to close the restaurant for a night.
"Many staffers were exposed and got sick, and with a skeleton crew, you have no backups," he said. "If someone goes on vacation or calls in sick and you're barely getting by as it is, then you have to make the decision as to whether or not you keep your doors open."
Restaurateurs and other business owners across the U.S. are fielding increased calls from workers who say they can't come to work because they have coronavirus.
From June 29 to July 11, 3.9 million Americans said they did not work because they had COVID-19 or were caring for someone with symptoms, according to the latest U.S. Census Bureau Household Pulse Survey. That's more than double the 1.8 million people who didn't work for the same reasons during the same period last year.
In addition to being absent from work due to COVID-19, employees are also taking planned summer breaks.
During the same week as the Census Bureau's household survey, 4.8 million U.S. workers took vacation or personal days, according to the U.S. Department of Labor. That's up from 3.7 million workers who took time off during the same period a year earlier.
Many business owners were already challenged by staffing shortages before the new COVID subvariant arrived, just as the summer season was swinging into gear.
Fleming acknowledged an exodus of restaurant industry workers who, at the beginning of the pandemic, traded their jobs for more flexible gig economy work.
"Peoples' lifestyles changed and operating a restaurant at night is maybe not as enticing as it once was for someone's employment," he said. "A lot of back-of-house staff found other jobs in the gig economy or driving for Uber or doing other work during the day, and they get to go home and spend time with their families at night. It's hard for those people to come back to going home at 12 or 1 in the morning."
Americans are also taking the opportunity to travel internationally again, finally taking trips originally scheduled for the summer of 2020.
Steven Hartenstein, who operates Lucca Osteria & Bar in Oak Brook, Illinois, said that all things considered, he is relatively well-staffed.
"We are fortunate to have a decent amount of loyalty," he told CBS MoneyWatch. "About 70% of my original staff is still with me, which for this industry and these times is pretty huge."
Still, this past Tuesday, Hartenstein found himself short three servers, a bartender and a busser.
Two of the servers and the busser were on vacation. The bartender had recently quit and an additional server was sick with a cold.
The rest of the team rallied: the restaurant's general manager tended bar and a hostess helped clear tables.
It was a record night of business at Lucca Osteria.
"We got through it and it was actually a great night," Hartensteain said. "We don't mind being hands-on but it's tough and you struggle. You can't do it every night."
