As the flu season approaches, experts are advocating annual Influenza vaccination for all children aged 6 months to 5 years of age as it is a known fact that the symptoms of influenza virus and Covid-19 tend to mimic each other, leading to fear and anxiety among parents of young children. The flu shot acts as a vital defense, significantly reducing the risk of influenza-related complications in children so, read on as we help you to understand the importance of flu vaccination for children before monsoon.
In an interview with HT Lifestyle, Dr Anish Pillai, Lead Consultant- Neonatology and Paediatrics at Motherhood Hospitals in Kharghar and Navi Mumbai, shared, Even though monsoon is known to provide that much-needed relief from the scorching summer heat, it is known to set the stage for a plethora of health problems, one of them being the common cold or flu infection. Flu cases in children are common in every household during the rainy season. Thus, managing a child with runny nose, cough, and fever has become a part and parcel of a parents life.
Dr Anish Pillai answered, Influenza or flu is a contagious viral infection that takes a toll on the airways and lungs of a child and is the most common respiratory illness seen in children during monsoon. Flu leads to discomfort, and school absenteeism in children and impacts their quality of life. Also, some children may encounter severe symptoms such as breathlessness, hypoxia, irritability, and decreased appetite, requiring hospital admission. The flu virus spreads through the droplets released when a patient with flu tends to cough, sneeze or even talk. Hence, by being around an infected person, one can be at a greater risk of acquiring the flu.
He explained, The droplets in the air can spread up to about 7 feet away and reach others who are in the vicinity. So, for kids going to daycare or school, the monsoon season becomes a constant cycle of repeated flu infections and recovery. The flu vaccine not only protects the child but also shields those around them, including older family members and classmates. Flu vaccines are meticulously developed each year to target prevalent strains, ensuring best protection. The traditional flu shot contains inactivated (killed) flu viruses (influenza A and B), making it extremely safe and efficacious.
Dr Anish Pillai elaborated, Parents should not skip the flu vaccination fearing side effects, as they are minimal in the form of fever, headache and swelling for a day or two at the injection site. Getting vaccinated against Influenza annually will boost immunity and prevent severe symptoms or complications. So, parents, what are you waiting for? Schedule an appointment with the Pediatrician today and get your child vaccinated without any further delay to help him/her have a healthy monsoon. Other measures: To prevent flu, parents should teach children to cover their mouth and nose while coughing/ sneezing, wash hands regularly, maintain a safe distance from people, wear a mask if unwell, avoid crowded places or being around sick people and eat a nutritious diet to boost immunity.
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In the late 20th century, Switzerland faced a formidable public health challenge: rabies. This deadly virus, primarily transmitted through the bites of infected animals, poses a significant threat to both wildlife and humans. The Swiss authorities, determined to combat the disease, devised an innovative and unconventional strategy: air-dropping vaccine-laced chicken heads across the countrys forests and countryside. The operation was set against the backdrop of a Europe grappling with rabies outbreaks, particularly in wild fox populations. Switzerlands approach was groundbreaking. In the 1960s and 1970s, the countrys Federal Veterinary Office ordered that chicken heads stuffed with vaccine be placed on the ground in high-risk areas. This method was not only inventive but also effective, marking the beginning of a campaign that would eventually lead to the eradication of rabies in Switzerland. The bait, designed to attract foxes, was laced with a vaccine that, once ingested, would immunize the animal against rabies. The strategy relied on the natural behavior of foxes to scavenge for food, thus ensuring the vaccines distribution among the target population. The use of aerial distribution methods allowed for a wide coverage area, reaching even the most remote and inaccessible regions where foxes roamed. This method of vaccination was a departure from traditional approaches, which often involved trapping and inoculating individual animalsa labor-intensive and less efficient process. By contrast, the Swiss method allowed for mass vaccination of wildlife without the need for direct human-animal contact, significantly reducing the risk of transmission to veterinarians and wildlife officers.
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May 03, 2024 -Research presented at the European Society of Clinical Microbiology and Infectious Diseases Global Congress in Barcelona on April 27, 2024, revealed that a dose-sparing mpox vaccine regimen offered the same antibody response as the standard protocol at six weeks, deeming the dose-sparing method as safe and effective.
While mpox originated in West, Central, and East Africa, with the first human cases identified in the 1970s, a recent resurgence of the virus in May 2022 presented a global threat. The 2022 outbreak was tied to the clade IIb strain of the virus, impacting communities far beyond the historically affected regions.
Rapid efforts from the biopharmaceutical industry and FDA helped address this epidemic by approving a mpox vaccine: the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN, sold as JYNNEOS) vaccine. The vaccine is a two-dose series given four weeks apart, with maximum protection occurring two weeks after the final vaccine. The CDC recommends the vaccine for certain populations at greater risk of contracting the virus, including men who have sex with men (MSM) and transgender, gender non-binary, or gender-diverseindividuals who have had one or more sexually transmitted infections or more than one sexual partner in the past six months. However, much like other highly demanded pharmaceutical products, the mpox vaccines are in short supply.
To address the supply chain issues, the National Institute of Allergy and Infectious Diseases (NIAID), a subset of the NIH, sponsored a study that explored dose-sparing vaccine regimens to extend the existing supply.
The study recruited 225 adults between 18 and 50 years who were not vaccinated against mpox or smallpox across the United States. The randomized study assigned some participants to receive the FDA-approved vaccine regimen, one-fifth of the standard dose or one-tenth of the standard dose. The standard dose was delivered subcutaneously, while the dose-sparing alternatives were injected intradermally. All patients received a two-dose series 28 days apart.
Two weeks after the second dose, those given one-fifth of the standard dose had antibody levels that were comparable to those of the FDA-approved regimen. However, those who received one-tenth of the dose did not have similar benefits.
The NIH press release concluded that because there are no defined correlates of protection against mpox immune processes confirmed to prevent disease these findings cannot predict the efficacy of dose-sparing regimens with certainty. Real-world data from the Centers for Disease Control and Prevention and others have shown similar vaccine effectiveness for the dose-sparing regimen given intradermally and the standard regimen given subcutaneously. A study of the standard MVA-BN regimen in adolescents is ongoing and will report findings later this year.
What You Need to Know About the Mpox Outbreak in Cuyahoga County
Outbreak of Mpox in the U.S.
In 2022, an outbreak of Mpox was reported in the U.S. Mpox is a virus related to monkeypox, which used to be called monkeypox. It typically starts with the appearance of pimples or blister-like rashes on the body.
Symptoms and Spread
According to Joyous Van Meter, supervisor of disease & emergency preparedness at the Cuyahoga County Board of Health, Mpox can cause itching or pain in various areas such as the hands, feet, chest, face, genitals, and more. The flu can sometimes mimic these symptoms, including fever, chills, and body aches.
The transmission of Mpox usually occurs through skin-to-skin contact. However, it can also spread through respiratory secretions like coughs and sneezes. It takes weeks for an infected person to become contagious after all scabs have fallen off and a new layer of skin has formed. Van Meter advises isolating infected individuals as long as they are contagious.
High-Risk Groups
People at higher risk for Mpox include those who have had multiple sexual partners, especially within the past six months, those who have been diagnosed with a sexually transmitted infection, and those who have engaged in anonymous or commercial sex.
Diagnosis and Treatment
The Jynneos vaccine is highly effective in preventing Mpox in the medical community. Proper diagnosis and treatment can also help reduce the risk of spread.
Cleveland Public Health and County Reporting
Cleveland Public Health has received three Mpox cases, while the county has reported six cases so far. The patients affected range in age from 17 to 44.
Testing and Vaccine Availability
CCBH clinics in Warrensville Heights and Parma offer diagnostic testing for Mpox, as well as the Jynneos vaccine. To schedule a nursing appointment, individuals can contact 216-201-2041 or ccbhnurse@ccbh.net.
Efforts of Local Centers
The Central Outreach Wellness Center in Cleveland Heights provides sexual health care services to the LGBTQ+ community. They have been actively vaccinating their patients and educating them about Mpox. The center hosted special vaccine clinics during the 2022 outbreak and is prepared to handle an increase in cases this summer.
The LGBT Community Center of Greater Cleveland has also organized education sessions and vaccine events focused on Mpox. They are collaborating with the Cuyahoga County Board of Health to disseminate more information and messaging about the local Mpox outbreak.
Conclusion
While the Mpox outbreak poses a risk to the community, efforts are being made to raise vaccine rates, provide proper care, and educate the public. It is crucial for individuals to seek testing and vaccination if they are at higher risk or exhibit symptoms related to Mpox. By taking these precautions, the number of Mpox cases can be minimized, ensuring the health and safety of the community.
Indeed, some public health officials exaggerated the benefits and underplayed some of the risks. Thrombosis caused by the AstraZeneca vaccine and myocarditis caused by the messenger-RNA vaccines of BioNTech and Pfizer have emerged as rare but serious side effects.
The pandemics legacy now seems to include greater public mistrust of vaccines in general. Measles is on the rise. More people are refusing the MMR jab. A recent Unicef survey found that vaccine confidence had fallen in 52 out of 55 countries.
Who is responsible? Public health officials tend to blame antivaxx campaigners with lurid conspiracy theories about Bill Gates, and they are partly right. But perhaps they should also look in the mirror. Misinformation came from both sides, and by overpromising what the vaccines could do, and demanding vaccine mandates, many scientists and government officials contributed to scepticism.
For example, the US government tried to reassure people about messenger-RNA vaccines by implicitly criticising live vaccines like those used for measles: The mRNA vaccines do not contain any live virus. Instead, they work by teaching our cells to make a harmless piece of a spike protein. So, live vaccines are not harmless?
Americas leading infectious-disease expert, Anthony Fauci, said in May 2021 that vaccination makes it extremely unlikely not impossible, but very, very low likelihood that theyre going to transmit it In other words, you become a dead end to the virus. That turned out to be wrong, as he later admitted, with the jab doing little to prevent reinfection and transmission.
Preventing transmission was the excuse used for vaccinating children, yet when that excuse evaporated, the policy continued. For young age groups, wrote a clutch of doctors in the BMJ in December 2021, the harms of taking a vaccine are almost certain to outweigh the benefits.
Authoritarianism made the problem worse. France criminalised criticism of vaccine mandates; Canada froze the bank accounts of truckers for protesting against them. Part of the reason governments were so reckless in forcing vaccines was probably that they wanted an exit from lockdowns, which were imposed for longer and more often than promised.
Some of us urged ministers not to claim too much for vaccines or pretend there would be no side effects as that would backfire. But the Government pressed ahead with mandates to prevent care-home workers going to work unless vaccinated. A study by doctors concluded: Our data suggest that debate around mandates can arouse strong concerns and could entrench scepticism. Policymakers should proceed with caution.
This was compounded by a baffling refusal to acknowledge that natural immunity from Covid itself had a role in protecting people. In 2020 a paper in The Lancet stated that there is no evidence for lasting protective immunity to SARS-CoV-2 following natural infection. Yet we now know that it lasts longer and is more effective than the protection provided by a jab.
The backlash against vaccines will go too far. Italys former health minister Roberto Speranza, who imposed vaccine mandates, can no longer walk in a street without angry Italians calling him a murderer. But public health officials worldwide must concede that overblown claims and underestimated risks of the vaccines developed during Covid have hurt the reputation of a valuable medical technology.
To hear more on this story, listen to Episode 6 of The Lockdown Files podcast, The Forgotten Victims, using the audio player in this article, or on Apple Podcasts, Spotify, or wherever you get your podcasts.
UK-headquartered pharmaceutical giant AstraZeneca has admitted that in "very rare cases" its COVID vaccine can cause a blood clot related side effect in a recent court filing in London. The AstraZeneca vaccine, also manufactured by the Serum Institute of India, was marketed in India as Covishield. The rare side effect linked to the vaccine is known as Thrombosis with Thrombocytopenia Syndrome or TTS. TTS is a rare but serious condition characterised by blood clotting or thrombosis, combined with low levels of platelets or thrombocytopenia.TTS seems to occur because the body's immune system reacts to the vaccine by making antibodies that attack a protein involved in blood clotting.
The latest NSW Health respiratory surveillance report released on Thursday shows the JN.1 variant now accounts for almost all COVID-19 cases in NSW.
The World Health Organisation reported last week that nearly all circulating COVID variants were derived from JN.1, and recommended future vaccine formulations should target the variant that has rapidly displaced all others since it was first declared a variant of interest in December.
While those updated vaccines may be available for the northern-hemisphere winter, Deakin University epidemiologist Professor Catherine Bennett said it was more likely to be the vaccine Australians get next year or in six months time.
The point is, dont wait for this next magic booster, she said. Its good to see weve got this capacity now to keep monitoring whats happening with the virus [variants] but ... for now, the main focus is to try and get ahead of a wave with your vaccination to give yourself time before your exposure risk goes up in the community.
Bennett said current vaccines still worked well but a monovalent immunisation () would be more effective at creating an antibody response to the virus and any future variants that evolve from it.
It becomes more like the annual flu shot where we try and build our vaccines to be closest to the circulating strains, Bennett said. You just want to try and get the greatest effectiveness you can from your vaccines particularly for people who are really still relying on vaccine-induced immunity as their main protection.
Associate Professor Stuart Turville, a virologist at Sydneys Kirby Institute, said the pace at which JN.1 had spread and evolved to better evade the bodys immune system showed it would be difficult to predict what future variants should be targeted by new vaccines.
By the time we get it [a monovalent JN.1 vaccine], theres going to be another variant, and that will be a bit different again, he said.
Turville said older vaccines shouldnt be ignored when updated versions come out as its important we build a broad response across multiple variants.
I agree with the approach, we should change it over time but I think sometimes the vaccine thats available to you still does a pretty good job, he said. Just because one vaccine is the new beaut thing on the market, it doesnt always turn out that its the one that reacts best to the thing thats circulating in the future.
Overall COVID cases remain well down on the mid-January peak, falling by 9 per cent in NSW in the past week. The trend is reflected in emergency department visits and NSW Healths sewage surveillance program.
Cases of the flu rose by 24 per cent over the past week, while there was a 15 per cent decrease in RSV.
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The emergence of the severe acute respiratory syndrome coronavirus 2 virus in late 2019 precipitated a global health emergency that contributed to more than 7 million reported deaths globally as of 19 January 2024 (ref. 1) and an estimated 18.2 million excess deaths between 1 January 2020 and 31 December 2021 (ref. 2). The coronavirus disease 2019 (COVID-19) pandemic, requiring urgent international intervention, led to an accelerated pace of research and development of multiple safe, effective COVID-19 vaccines, which were first authorized for emergency use in December 20203. The expeditious vaccine development and limited availability resulted in serious challenges in the equitable global distribution of vaccines, coupled with vaccine-related misinformation and mistrust of the science behind vaccine safety4.
Vaccine hesitancy5, pandemic fatigue6 and vaccine fatigue, defined as the inertia or inaction toward vaccine information or instruction due to perceived burden and burnout7, continue to present challenges to vaccine uptake in 2023. Although COVID-19 has been deprioritized as a substantial public health threat since 2023, the virus strains continue to circulate and, in some settings, lead to new increases in hospitalization and intensive care unit admission1. The potential impact of vaccine hesitancy on confidence in booster doses remains substantial8. In addition, documented spillover effects on routine immunization pose a threat for the reemergence of some childhood and adult vaccine-preventable diseases9,10.
In this Brief Communication, the fourth study in a series of annual global surveys across 23 countries (Brazil, Canada, China, Ecuador, France, Germany, Ghana, India, Italy, Kenya, Mexico, Nigeria, Peru, Poland, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Trkiye, the United Kingdom and the United States)11,12,13, we report perspectives of adults in the general public on COVID-19 and routine immunization in late 2023, trust in pandemic information sources and collective preparedness to address any possible future pandemic. We also compare COVID-19 vaccine acceptance in 2023 to that in previous years to promote a better understanding of the current and future challenges public health authorities may face in encouraging vaccine uptake.
The reported uptake of at least one COVID-19 vaccine dose rose to 87.8% in 2023 across the 23 countries (Fig. 1a), as compared with 36.9% in 2021 (P<0.001) and 70.4% in 2022 (P=0.002). The reported uptake of at least one COVID-19 vaccine was similar in middle-income countries (MICs; 86.9%) and high-income countries (HICs; 87.5%) (P=0.381). COVID-19 vaccine booster acceptance among those vaccinated decreased from 87.9% in 2022 to 71.6% in 2023 (P<0.001) (Fig. 1b). This decrease was most profound in HICs (from 85.1% to 63.3%, P<0.001), compared with MICs (from 90.5% to 78.9%, P=0.010). The perspectives on willingness to get vaccinated against diseases other than COVID-19 (for example, influenza, measles and hepatitis B) indicate that 60.8% of respondents may be more and 23.1% less willing to get vaccinated in 2023, following their experience during the COVID-19 pandemic (Fig. 1c). Individual country analyses on vaccine acceptance are available in Extended Data Fig. 1.
a, COVID-19 vaccine acceptance among 23 countries, HICs and MICs. b, COVID-19 booster vaccine acceptance among 23 countries, HICs and MICs. c, Reported pandemic influence toward routine immunization. Four countries (Ghana, Kenya, Peru and Trkiye) were not included in the 2020 global survey. HICs: Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, the United Kingdom and the United States. Routine immunization referrs to other diseases (for example, flu, measles and viral hepatitis B) in the survey item.
The COVID-19 pandemic led to widespread disruptions in routine immunization services globally, including for childhood doses, resulting in delayed and reduced vaccine uptake10. The results of this study demonstrate that 23.1% of respondents are less likely to accept vaccines for diseases other than COVID-19. Experience from the diversion of healthcare resources during the pandemic, along with lockdown measures and concerns about infection, highlights the need for resilient primary care systems, especially in maintaining access to crucial prevention interventions, such as routine childhood and adult vaccination. Other challenges, including disruptions to vaccine supply chains, underscore the importance of strengthening immunization systems and services to prevent future outbreaks14,15. Moreover, the extension of COVID-19 vaccine skepticism to other vaccines, including among parents who make vaccination decisions for their children10, signals a crucial need for ongoing efforts in vaccine education and trust building. Looking ahead, these insights should inform strategies to fortify healthcare systems against similar challenges to minimize disruptions and ensure continuity of essential health services, including routine vaccinations. Meanwhile, many communities are facing increased vulnerability to vaccine-preventable diseases10, highlighting the need for innovative strategies to ensure the continuity of routine immunization and COVID-19 vaccination campaigns to improve vaccine confidence.
The survey responses on trust in sources that provide information or guidance on pandemic interventions revealed generally high levels of trust in those close to the individual, although all 11 studied sources averaged less than seven points on a ten-point scale. For example, my doctor or nurse ranked highest at 6.9 and my family and friends ranked at 6.4 (Extended Data Fig. 2d). Similarly, established health institutions such as the World Health Organization (WHO) (6.5) and the US Centers for Disease Control and Prevention (6.4) ranked high. Social media platforms (5.0) and religious leaders (5.0) each ranked neutrally (Extended Data Fig. 2d). There was variability across countries, for example, religious leaders ranked 3.16 in Sweden and 3.19 in Germany but 6.57 in Nigeria and 6.72 in India, whereas my doctor or nurse ranked 4.95 in Russia and 7.70 in Kenya (Extended Data Fig. 2e). Trust in health authorities that recommended COVID-19 vaccination was higher than trust in governments management of the COVID-19 pandemic at 65.4% and 56.4%, respectively (Extended Data Fig. 3). General trust in health authorities was 66.8% and 63.9% in MICs and HICs, respectively (P=0.542), while general trust in government was 60.7% and 51.7% in MICs and HICs, respectively (P=0.073). A decrease in perceived trust in science as a result of COVID-19 vaccine development was reported by 13.9% of respondents (MICs 13.4% and HICs 14.3%, P=0.674). A decrease in perceived trust in the pharmaceutical industry as a result of COVID-19 vaccine development was reported by 18.7% of respondents (MICs 18.4% and HICs 19.1%, respectively, P=0.772) (Extended Data Fig. 3). Trust in the science behind available COVID-19 vaccines was reported by 71.6% of respondents on average, with this value being 74.5% and 68.4% among MICs and HICs, respectively (P=0.115) (Extended Data Fig. 3). The unprecedented speed of development, the novel application of mRNA technology and the proliferation of misinformation, particularly on social media, raised concerns among some about the thoroughness of testing and long-term safety of COVID-19 vaccines and contributed to increased skepticism regarding science generally, as well as its application to preventive and therapeutic applications in particular16,17,18. Moreover, factors such as prepandemic vaccine-related controversies and mistrust in pharmaceutical companies, governments and health institutions, sometimes the result of cultural beliefs or past negative experiences, have further complicated public health communication16,19.
Perspectives on future pandemic preparedness reveal a mixed picture of confidence and trust among global populations. Approximately three-quarters (74.9%) of respondents are confident that society collectively will manage the next health crisis better than the COVID-19 pandemic, yet only 63.3% reported trusting a hypothetical WHO recommendation to vaccinate if such a crisis was announced (Fig. 2). Approximately a quarter of respondents in Russia (26.6%) and the United States (25.5%) express low trust in the WHO as a reliable source of information to announce a new pandemic threat (Extended Data Fig. 2a). Approximately half of respondents in Ghana (51.5%), India (51.3%) and Kenya (49.2%) report a high level of confidence in our collective ability to better manage the next potential health crisis (Extended Data Fig. 2c). A 2023 analysis in Kenya reporting 49.6% of respondents rating their own governments management of the pandemic as very good or excellent may inform public confidence in future management capabilities20. Confidence in Ghana may be attributable to the governments approach in preparing early readiness assessments, strategic and substantial investments in response planning and the effective use of surveillance technology21. Indias confidence in pandemic preparedness might be higher due to vaccine production capacity and public health investments in massive awareness campaigns and the rapid expansion of testing and contact tracing capabilities, despite having a large population and fragmented health system22. By contrast, 30.2% of respondents to our survey in France and 28.9% of respondents in Poland are not at all confident in our collective ability, the highest percentages among the countries studied. These findings are comparable to panel data in France and Poland demonstrating low and decreasing trust in scientists among these populations during COVID-1923. Trust in the collective scientific and health communities to respond effectively to pandemic threats will require country-specific approaches that consider relevant sociocultural factors. How much individuals trust scientists and governments, respectively, has been observed as weakly related in Brazil and the United States, suggesting populations in these countries distinguish between these two health communicator groups, whereas the relationship was stronger in France, and populations view them as more closely aligned23. For example, in the United States and Brazil, a trend toward privatization and the erosion of the governments role in mitigating public health threats exacerbated racial inequities and contributed to a fragmented response to the COVID-19 pandemic24,25. Ongoing global efforts to prepare for future global health threats promote a comprehensive vaccines plus approach that incorporates social and behavioral preventive measures alongside rigorous testing and treatment26. Heightened vaccine hesitancy relative to COVID-19, pandemic fatigue and concerted disinformation campaigns have strong implications for plans to prevent or manage future pandemics, as well as a degree of spillover effect on our collective ability to control other vaccine-preventable diseases27. This may be particularly important as it pertains to routine childhood immunizations.
MICs: Brazil, China, Ecuador, Ghana, India, Kenya, Mexico, Nigeria, Peru, Russia, South Africa and Trkiye. Four countries (Ghana, Kenya, Peru and Trkiye) were not included in the 2020 global survey. HICs: Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, the United Kingdom and the United States.
A vocal minority of vaccine-resistant populations continue to believe inaccurate and disproven claims, such as the effectiveness of ivermectin as a treatment for COVID-19 and some conspiracy theories, that drive resistance to vaccination28,29. Disinformation aiming to influence public opinion poses major challenges for communication campaigns that require heterogeneous data-driven precision public health approaches30,31. These strategies should focus on delivering clear, accurate and culturally sensitive information to specific communities through their preferred information channels and via trusted sources and on exposing the motivation of those behind disinformation. It is important to acknowledge that individuals often show a preference for information that aligns with their existing beliefs and perceive such information as more credible32. This biased selection and perception is more pronounced among those with higher health literacy32, which is a factor that health communication professionals must consider.
The critical need to catch up on routine immunizations and prepare for potential new pandemic threats, coupled with the continued spread of COVID-19, requires maintaining vigilance in addressing vaccine hesitancy globally. The varying degrees of hesitancy observed across different demographic groups and countries emphasize the importance of culturally and contextually relevant strategies that include the selection of welcomed credible sources as primary conduits of information to address and mitigate vaccine hesitancy. The findings of this study demonstrate that the WHO and the US Centers for Disease Control and Prevention, as well as the respondents personal doctor, were more highly trusted as sources of pandemic information. The communication of accurate and timely information, as well as countering misinformation, are pivotal in guiding public perception and behavior toward COVID-19 vaccination acceptance.
Furthermore, whole-of-society action has been recommended by pandemic researchers to address the thus far fragmented approaches seen in relation to pandemic preparedness and response33,34. Such an approach involves various sectors and actors in decision-making processes to build resilient systems and takes life risks other than health, such as employment, housing and food security status, into consideration. A proposed pandemic agreement is currently being debated in advance of the May 2024 World Health Assembly. It aims to strengthen global collaboration between countries and global health organizations, including the WHO, around improving One Health data monitoring and sharing, toward ensuring equitable access to preventive and therapeutic measures and strengthening health systems35. The intent of such an agreement would signal to Member States and their populations that pandemic preparedness to address the shortcomings of the COVID-19 pandemic response is being taken seriously, including the rapid, real-time country collaboration on surveillance and the equitable distribution of vaccines and other mitigation and elimination efforts.
Limitations to interpreting these data include the recognition of a fundamental discrepancy that may exist between the respondents reported willingness to receive the vaccine and their actual vaccination behavior. What people express in surveys can differ meaningfully from their actions27. Therefore, the findings regarding vaccine acceptance and hesitancy should not be directly equated with actual vaccine uptake; rather, the reported responses reflect attitudes and opinions at a specific point in time. As public perceptions of the COVID-19 pandemic and vaccination evolves, so too might their willingness to be vaccinated. This temporal aspect suggests that the acceptance levels reported in our study are subject to change due to a variety of factors, including new information about the virus and the vaccine, changes in public health recommendations and shifts in societal norms and attitudes toward vaccination. While our study assessed individuals perceptions of trust in sources of pandemic information, including governments and health authorities, we did not investigate the quality of country responses to the pandemic, which may be an important determinant of such trust, given its independent association with COVID-19 vaccination20. Our studys design did not allow for a detailed analysis of the nuanced relationship between language, trust and cultural context, while early research on the impact of health communication language on vaccine hesitancy in bilingual settings may be mediated by cultural factors regarding trust in health and governing institutions36. We permitted participants to respond using their preferred language within their country.
This study reveals that a substantial proportion of individuals express resistance to vaccination and that concerns about COVID-19 vaccination appear to have spilled over to affect other vaccine-preventable diseases. This underscores the increasingly urgent necessity for sustained vaccine education and trust-building efforts. Moreover, although we found that people were generally confident that society will handle future health crises better, there remains a notable lack of trust and potential adherence to the recommendations of public health authorities. Health system preparedness for future outbreaks and global health threats should include improving vaccine accessibility and vaccine demand through effective, culturally and contextually relevant public communication strategies and innovative use of digital and social media in health education employing infodemic countermeasures.
Covid-19 epidemic and vaccination campaign
At the end of the study period (July 2, 2022), 14,981,425 (95%) out of 15,740,549 Chileans aged 16 years or older had received at least one dose, 14,761,706 (94%) had received at least two doses, 13,510,471 (86%) had received at least three doses and 9,393,909 (60%) had received four doses. Vaccine doses were initially administered to healthcare workers starting on December 20, 2020, and the mass vaccination campaign began in early February 2021, prioritizing the elderly and individuals with comorbidities (Fig.2). At the end of August 2021, the first-booster (third-dose) vaccination campaign began, which continued to prioritize older individuals and vulnerable groups. The second-booster (fourth-dose) campaign commenced at the beginning of January, 2022, coinciding with the start of the Omicron wave in Chile.The second analysis modifies the assumptions by substituting the age pyramid from the 2021 census for the two-to-one combination of 2021 and 2022 census data used in the baseline scenario.
Cumulative proportion of the population vaccinated by age and each week in Chile
We estimated that 1,030,648 cases (95% ConfidenceInterval: 1,016,975-1,044,321), 268,784 (95% CI:264,524-273,045) hospitalizations, 85,830 (95% CI:83,466-88,194) ICU admissions, and 75,968 (95% CI:73,909-78,028) deaths related to COVID-19 were directly averted by vaccination among individuals aged 16 years or older between December 20, 2020 and July 2, 2022. It represents a reduction of 26% of cases, 66% of hospitalizations, 70% of ICU admissions and 67% of deaths with respect to a scenario without vaccination. Figure 3 shows a three-stage time series of the averted events. The first increase in the cumulative number of averted events between March and July 2021 corresponds to the administration of the second dose during the mass vaccination campaign and a wave of new cases due to the Lambda and Gamma variants. A second rise starting from October 2021 coincides with the booster-dose vaccination campaign and the Delta-variant wave while the third increase starting from January 2022 corresponds to the wave caused by the Omicron-variant.
Cumulative averted events in individuals 16 years of age and older in Chile. Each plot represents respectively the cumulative number of cases, hospital admissions, ICU admissions and deaths related to COVID-19 averted between December 20, 2020, and July 2, 2022, due to vaccination against COVID-19
Most preventions of severe outcomes were observed in individuals vaccinated with two doses: 125,472 (95% CI:123,453-127,491) hospitalizations, 43,113 (95% CI:41,955-44,272) ICU admissions and 40,036 (95% CI:38,806-41,267) deaths related to COVID-19 (Figure S1). Individuals 55 years old or older represented 30% of the Chilean population over 16 years old, but accounted for 42% of cases, 67% of hospitalizations, 73% of ICU admissions and 89% of deaths related to COVID-19 prevented (Table 1).
The first sensitivity analysis assumed a scenario in which the entire population remains susceptible to reinfection and severe outcomes over time (see counterfactual scenario A in Section 1.2 of the Supplementary Material 1 for more details). Under this assumption, we estimated that a total of 1,124,060 (95% CI:1,108,627-1,139,492) cases, 290,142 (95% CI:285,460-294,824) hospitalizations, 92,065 (95% CI:89,485-94,645) ICU admissions, and 80,979 (95% CI:78,745-83,214) deaths related to COVID-19 were prevented (Table S1). These estimates represent an increase of 9% for cases, 8% for hospitalizations, 7% for ICU admissions and 7% for deaths averted relative to the baseline scenario where infections detected over time were excluded. Thus, the results are fairly robust with respect to the population assumed to be susceptible.
The second analysis modifies the assumptions by substituting the age pyramid from the 2021 census for the two-to-one combination of 2021 and 2022 census data used in the baseline scenario. This adjustment yields a slightly different count of averted events spanning the study period (Figure S2), but the difference becomes much more pronounced with the onset of the Omicron wave in January 2022.
At the end of the study period, we estimate that 1,281,719 (95% CI:1,264,750-1,298,689) cases were averted, 329,941 (95 % CI:324,111-335,770) hospitalizations, 106,553 (95% CI:103,236-109,870) ICU admissions and 95,571 (95% CI:92,753-98,389) deaths were directly averted by vaccination. This connotes an importantincrease of 24% in cases, 23% in hospitalizations, 24% in ICU admissions and 26% in deaths averted with respect to the baseline scenario.
The substantial difference is due to the continuing reduction in the unvaccinated population as the vaccination campaign progresses. Consequently, the impact of the choice of census estimate used to compute this population becomes increasingly important over time.
The implications of such speculation are profound. If indeed these incidents are vaccine-related, who then bears the enduring burden of responsibility? Moreover, how can we trust the reliability and objectivity of those tasked with investigating these interconnections? These questions strike at the very core of the urgent need for thorough and transparent research, as well as accountability from all stakeholders involved in the development, distribution, and monitoring of vaccines.
The approval of Covishield for emergency use in early 2021, coupled with the waiver of traditional vaccine trial protocols by drug regulators, has the potential to profoundly affect public confidence in the vaccine. Or for that matter, any vaccine or medicine in the future. Such expedited measures, while aimed at swiftly delivering vital vaccines to the populace during the pandemic, raise citizenry concerns regarding consumer recourse in the event of adverse effects.
During a pandemic, the prevailing sentiment of overwhelming gratitude towards vaccines probably inadvertently overshadowed the need to conduct a fair and comprehensive assessment of potential side effects. It is all too convenient for some to attribute medical conditions solely to familial medical history and genetic predispositions, while disregarding the potential impact of vaccinations.
Any scepticism regarding vaccine safety has been met with resistance or even disdain.While vaccines undoubtedly play a crucial role in mitigating the spread of infectious diseases, including Covid-19, it is essential to maintain a balanced perspective.Acknowledging and thoroughly investigating potential side effects is not an indictment of vaccines themselves but rather a fundamental aspect of ensuring public health and safety. But where does one even start with this fundamental task?
While governments acted out of necessity to address the urgent health crisis, the focus on vaccine deployment must not overshadow the plight of individuals suffering from various side effects.While it may be theoretically untenable to hold governments solely accountable, questions arise regarding the accountability of vaccine manufacturers and distributors, entities with decades of clinical expertise and responsibility in ensuring product safety.
In medico-legal contexts, it is often tempting to dismiss adverse events as isolated incidents. However, in the case of vaccine design, where meticulous testing is paramount, the impact of Covid-19 vaccines on individuals' lives, including ongoing health challenges, cannot be disregarded. Families grappling with potential vaccine-related fatalities deserve answers and support, as do those contending with the enduring consequences of vaccine-related health issues.
In a humanitarian plea, one may ask: Is it too much to expect vaccine makers to acknowledge that testing may have been insufficient? After all, each vial of vaccine, while undoubtedly saving countless lives, may also carry the weight of families mourning lost loved ones or individuals grappling with vaccine-related health issues. But vaccines, as much as any healthcare, is a hard-nosed business. Such an expectation is a flawed contradiction to the principles of justice. At the altar of a legal framework, such expectations would need time and financial resources.
The prospect of pursuing a medico-legal case can feel daunting for families already burdened by the consequences of vaccine-related adverse events. The pharmaceutical industry, with its considerable resources and legal expertise, may seem formidable in comparison. Yet, it is essential to remember that every individual impacted by vaccine-related issues deserves to have their concerns heard and addressed with empathy and fairness. Do we have such fairness in the Indian society?
(Srinath Sridharan is a policy researcher and corporate adviser. X: @ssmumbai.)
Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.
