Auswahl der wissenschaftlichen Literatur zum Thema „Vacciner mot covid-19“

The coronavirus pandemic, one of the biggest pandemics of the last century, which emerged in Wuhan, China in the last months of 2019, continues to negatively affect life all over the world. The measures taken for the pandemic did not stop the spread of the disease and revealed medical requirements. Vaccines have been one of the most effective medical ways of preventing diseases. Vaccination studies for coronavirus disease started shortly after the emergence of the disease, and more than a hundred vaccine candidates were announced in about a year, and the distribution of those who passed the necessary stages was approved. However, the storage, transportation and distribution of some of these vaccines required very low temperatures below zero degrees, unlike the previous ones. The distribution and delivery of vaccines under these conditions has revealed the importance of cold chain logistics applications infrastructure. In this study, based on the priority issues of the World Health Organization in the logistics of vaccines, the potential difficulties that will arise in the production, allocation, distribution and application processes of coronavirus vaccines have been investigated.The data source of the study was the guidelines of the World Health Organization and various industry reports, which were secondary data previously revealed through primary research. Lack of cold chain infrastructure in storage and distribution activities, unequal distribution and anti-vaccination were found to be the biggest challenges facing vaccination activities.

Background Vaccination is a cornerstone of the prevention of communicable infectious diseases; however, vaccines have traditionally met with public fear and hesitancy, and COVID-19 vaccines are no exception. Social media use has been demonstrated to play a role in the low acceptance of vaccines. Objective The aim of this study is to identify the topics and sentiments in the public COVID-19 vaccine–related discussion on social media and discern the salient changes in topics and sentiments over time to better understand the public perceptions, concerns, and emotions that may influence the achievement of herd immunity goals. Methods Tweets were downloaded from a large-scale COVID-19 Twitter chatter data set from March 11, 2020, the day the World Health Organization declared COVID-19 a pandemic, to January 31, 2021. We used R software to clean the tweets and retain tweets that contained the keywords vaccination, vaccinations, vaccine, vaccines, immunization, vaccinate, and vaccinated. The final data set included in the analysis consisted of 1,499,421 unique tweets from 583,499 different users. We used R to perform latent Dirichlet allocation for topic modeling as well as sentiment and emotion analysis using the National Research Council of Canada Emotion Lexicon. Results Topic modeling of tweets related to COVID-19 vaccines yielded 16 topics, which were grouped into 5 overarching themes. Opinions about vaccination (227,840/1,499,421 tweets, 15.2%) was the most tweeted topic and remained a highly discussed topic during the majority of the period of our examination. Vaccine progress around the world became the most discussed topic around August 11, 2020, when Russia approved the world’s first COVID-19 vaccine. With the advancement of vaccine administration, the topic of instruction on getting vaccines gradually became more salient and became the most discussed topic after the first week of January 2021. Weekly mean sentiment scores showed that despite fluctuations, the sentiment was increasingly positive in general. Emotion analysis further showed that trust was the most predominant emotion, followed by anticipation, fear, sadness, etc. The trust emotion reached its peak on November 9, 2020, when Pfizer announced that its vaccine is 90% effective. Conclusions Public COVID-19 vaccine–related discussion on Twitter was largely driven by major events about COVID-19 vaccines and mirrored the active news topics in mainstream media. The discussion also demonstrated a global perspective. The increasingly positive sentiment around COVID-19 vaccines and the dominant emotion of trust shown in the social media discussion may imply higher acceptance of COVID-19 vaccines compared with previous vaccines.

Background The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19–related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective Using Google’s RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods We searched COVID-19 vaccine terms on Google and used the “People also ask” box to obtain FAQs generated by Google’s machine learning algorithms. FAQs are assigned an “answer” source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association’s (JAMA’s) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine–related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (χ24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions The most frequently asked COVID-19 vaccine–related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine–related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts.

Background With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75% of people in Canada plan to receive one of the vaccines. Objective The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. Methods We screened 3915 tweets from public Twitter profiles in Canada by using the search words “vaccine” and “COVID.” The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. Results Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. Conclusions With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines.

Vaccine hesitancy is a major threat to the success of COVID-19 vaccination programs. The present cross-sectional online survey of adult Poles (n = 1020) expressing a willingness to receive the COVID-19 vaccine was conducted between February and March 2021 and aimed to assess (i) the general trust in different types of vaccines, (ii) the level of acceptance of the COVID-19 vaccines already in use in Poland (BNT162b2 by BioNTech/Pfizer, mRNA-1273 by Moderna and AZD1222 by Oxford/AstraZeneca) as well as eight vaccines approved outside European Union (EU) or in advanced stages of clinical trials, (iii) level of fear of vaccination against COVID-19, and (iv) main sources of information on COVID-19 vaccination. Among all major vaccine technology, the highest level of trust was observed for the mRNA platform, with a considerable number of surveyed (>20%) not aware of the existence of vaccines produced using the traditional approach (inactivated and live attenuated vaccines). The age of participants was the main factor differentiating the level of trust in a particular vaccine type. Both BNT162b and mRNA-1273 received a high level of acceptance, contrary to AZD1222. From eight vaccines unauthorized in the EU at the moment of study, the CVnCoV (mRNA; CureVac) was met with the highest level of trust, followed by Ad26.COV2.S (vector; Janssen/Johnson&Johnson) and NVX-CoV2373 (protein; Novavax). Sputnik V (vector; Gamaleya Research Institute) was decidedly the least trusted vaccine. The median level of fear (measured by the 10-point Likert-type scale) in the studied group was 4.0, mostly related to the risk of serious allergic reactions, other severe adverse events and unknown long-term effects of vaccination. Female, individuals with a lower level of education and those not seeking any information on the COVID-19 vaccines revealed a higher fear of vaccination. Experts’ materials were the major source of information on COVID-19 vaccines in the studied group. The study shows the level of trust in COVID-19 vaccines can vary much across the producers while the mRNA vaccines are received with a high level of acceptance. It also emphasizes the need for effective and continuous science communication when fighting the pandemic as it may be an ideal time to increase the general awareness of vaccines.

COVID-19 vaccinations are about to begin in various countries or are already ongoing. This is an unprecedented operation that is also met with a loud response from anti-vaccine communities—currently using all available channels to manipulate public opinion. At the same time, the strategy to educate on vaccinations, explain their mechanism of action, and build trust in science is subdued in different world parts. Such actions should go much beyond campaigns promoting the COVID-19 vaccines solely on the information provided by the health institutions and national authorities. In this paper, actions provided by independent expert groups needed to counteract the anti-vaccine propaganda and provide scientific-based information to the general public are offered. These actions encompass organizing groups continuously communicating science on COVID-19 vaccines to the general public; tracking and tackling emerging and circulating fake news; and equipping celebrities and politicians with scientific information to ensure the quality of messages they communicate, as well as public letters, and statements of support for vaccination by healthcare workers, recognized scientists, VIPs, and scientific societies; and no tolerance to false and manipulated claims on vaccination spread via traditional and social media as well as by health professionals, scientists, and academics. These activities should be promptly implemented worldwide, regardless of the current status and availability of the COVID-19 vaccine in a particular region. If we are about to control the pandemic for the sake of public benefit, it is high time to collectively speak out as academic and medical societies with support from decision-makers. Otherwise, the battle will be lost to those who stand against scientific evidence while offering no feasible solution to the problem.

Abstract Background An increased appreciation for vaccines could be expected due to COVID-19. However, surveys show a polarization in opinions with about 20% of Americans preemptively rejecting any COVID-19 vaccine, partly due to inconsistent risk communication. While Health Care Professionals (HCPs) will be heavily relied upon to encourage uptake of a COVID-19 vaccine and 70% of Americans receive their vaccine information from HCPs, 84% also rely on peer networks. Understanding that HCPs have an important, but not exclusive, influence on health decision making can signal a new approach. This study provides data on where women, the main decision-makers regarding immunization in most families access information about vaccination. Methods Through an online survey conducted in UK, Brazil, Germany, Italy and Canada from 10 to 19-March 2020, we collected data on where, and from whom, women aged 25–54 years access information about vaccination. We set 1000 respondents/country quotas to reflect regional differences with data weighted as necessary. Results 5,036 women who met inclusion criteria responded: from the UK (1,003), Brazil (1,002), Germany (1,008), Italy (1,007), and Canada (1,016). Though most likely to receive vaccination info via their HCP: in Germany, women are least likely to be influenced by HCPs, with those aged 25–34 years more likely to turn to family members or online sources; in the UK, they are more likely to find info via a health authority’s website; and in Brazil, they are more likely to see info in traditional media and on Facebook. Only 50% ranked vaccine efficacy and disease risk in the Top 5 factors influencing their vaccine decisions, alongside the opinion of an HCP, recommendation of a Public Health Authority and impact of the disease. Conclusion HCPs, families and peers are important sources of info regarding vaccination. COVID-19 is unlikely to improve vaccine confidence as the issue becomes increasingly polarized and communications more inconsistent. We can respond by investing in health promotion and harmonized communications through peer networks. Since caregivers, their families and peers have increased weight in vaccination decisions, then they should have increased weight in preventive health strategies. Disclosures Ivo Vojtek, PharmD, PhD, MSc, FRSM, RPh, GSK Vaccines (Employee, Shareholder) Vanessa Palsenbarg, MA, GSK Vaccines (Employee, Shareholder) Joe Smyser, PhD, Public Good Project (Board Member, Employee)

Covid-19 vaccines are a critical tool for controlling the pandemic. While safe and effective vaccines have been developed, research is expected to continue for many years regarding the optimal implementation of existing vaccines in specific settings, and the development of second-generation vaccines that may offer advantages in terms of either efficacy or ease of implementation. Given this context, some commentators have argued that new Covid vaccine trials should be able to use placebo controls, and that existing studies should be able to continue with blinded participants in order to collect high quality, unbiased data. Using international ethics guidance documents, this paper argues against placebo controls, given the existence of proven effective interventions, and against protracted blinding once safety and efficacy milestones have been met. Instead, it advocates for study designs that allow for direct comparison between approved and experimental vaccines, which facilitates both data collection and greater access to vaccines.

As research organisations around the world continue to develop a vaccine for COVID-19, George Winter considers the ethics of vaccination testing, examining what conditions must be met when conducting clinical trials

Covid-19-pandemin utgör ett globalt hot mot hälsa, ekonomiskt välbefinnande och politisk stabilitet. Enligt forskare är vacciner mot covid-19 en nyckel till att få ett slut på pandemin och återgå till en viss typ av normalitet. Problemet är att vaccinerna mot covid-19 har fördelats ojämnt mellan hög- och låginkomstländer. Denna studie är baserad på kvalitativa semistrukturerade intervjuer som undersöker hur experter ser på distributionen av vacciner mot covid-19 mellan hög- och låginkomstländer. Mer specifikt, vilka faktorer som de anser påverka fördelningen samt vilka åtgärder som behövs för att göra fördelningen mer rättvis. Studien är kopplad till ett teoretiskt ramverk om global rättvisa som används för att förklara varför vi människor har skyldigheter att hjälpa varandra. Denna studies resultat indikerar att majoriteten av experterna anser att fördelningen av vaccinerna har i hög grad varit ojämn eftersom höginkomstländer har anskaffat mer vacciner än låginkomstländerna. Enligt experterna kan en global ojämn fördelning av vacciner leda till konsekvenser som att det utvecklas mutationer av viruset som inte vaccinerna fungerar emot, och att pandemin således fortsätter. Den viktigaste faktorn som experterna belyste är att länder har agerat nationalistiskt och att det har varit ett högt tryck på politiska ledare att skaffa vacciner för deras befolkningar. Experterna var överens om att Covax initiativet var en bra åtgärd för att vaccinerna skulle fördelas mer rättvist även om de också påpekade utmaningar med Covax. Denna studie bidrar därför till förståelsen att det finns många faktorer som påverkar den globala fördelningen av vacciner mot covid-19, men också att det finns flera åtgärder för att göra fördelningen mer rättvis.
The COVID-19 pandemic poses a global threat to health, economic well-being and political sta- bility. According to researchers, COVID-19 vaccines are a key to ending the pandemic and return- ing to a certain type of normality. The issue is that the COVID-19 vaccines have been unevenly distributed between high- and low-income countries. This study is based on qualitative semi-struc- tured interviews exploring how experts view the distribution of the COVID-19 vaccines between high- and low-income countries. More specifically, what factors that they consider to affect the distribution and what measures are needed to make the distribution more equitable. The study connects to the theoretical framework of global justice which is used to clarify why humans have obligations to help each other. The result of the study indicates that the majority of experts con- clude that the distribution of the COVID-19 vaccines has been very uneven because high-income countries have obtained more vaccines than low-income countries. According to experts, an une- ven distribution of the vaccines can lead to several consequences such as the development of mu- tants which the vaccine does not work against, and thus to the pandemic continuing. The main factor pointed out by the experts is that countries have acted nationalistic and that there has been a lot of pressure on political leaders to procure vaccines for their populations. The experts agree that the Covax initiative was a good measure for the vaccines to be distributed more fairly, alt- hough they also highlighted challenges with Covax. This study therefore contributes to the under- standing that there are many factors that affect the global distribution of vaccines against COVID- 19, but also that there are several measures to make the distribution more equitable.

Inledning: Vaccinationstveksamhet är ett fenomen som är viktigt att studera eftersom bekämpningen mot covid-19 och andra sjukdomar är beroende av att befolkningen vaccinerar sig. Området Rinkeby-Tensta har tidigare haft låg vaccinationstäckning på grund av oro över biverkningar. Syftet är att ta reda på inställningen för vaccination mot covid-19 i Rinkeby-Tensta. Metod: En tvärsnittsstudie utfördes med bekvämlighetsurval. Resultat: Resultatet visar att 72 respondenter besvarade enkäten varav 78 procent av respondenterna svarade att de antingen inte vill eller inte vet om de vill vaccinera sig. Diskussion: Utbildningsnivå är inte associerat med vaccinationsviljan. Att senarelägga vaccinacceptansen uppfattas som en fördel. Bekymmer över vaccinets biverkningar är en faktor i vaccinationsbeslutet.
Introduction: Vaccine hesitancy is a phenomenon that is important to study when the fight against covid-19 and other diseases is dependent on the population being vaccinated. Rinkeby-Tensta previously had low vaccination coverage due to concerns about side effects. The aim is to measure the attitude toward vaccination against covid -19 in Rinkeby-Tensta Method: A cross-sectional study was performed with convenience sample. Results: Results show that 72 respondents answered the survey, of which 78 percent of the respondents answered that they either do not want or do not know if they want to get vaccinated. Discussion: Level of education is not associated with willingness to get vaccinated. To postpone vaccinations is perceived as a benefit. Concerns about the side effects of vaccine is a factor in the vaccination decision.

Introduktion: Coronavirus är RNA-virus med ett lipidhölje som är täckt utav karaktäristiska spikprotein. De mest kända coronavirusvarianterna är SARS-CoV-1 som var aktiv mellan 2002-2004, MERS-CoV som har varit aktiv sedan 2012 och SARS-CoV-2 som har varit aktiv sedan 2019–tillsvidare. SARS-CoV-2 infektionen betecknades januari 30 2020 som en pandemi. Flera läkemedelsföretag har forcerat ??? till att framställa vaccin riktad mot SARS-CoV-2, “The United States Food and Drug Administration” (FDA) och “European Medicines Agency” (EMA) har nödgats att ge ut “Emergency Use Authorization (EUA) i hopp om att få kontroll på dess spridining. Syfte och mål: Syftet med arbetet är att undersöka säkerheten och effektiviteten hos de EMA-godkända vaccinerna riktade mot SARS-CoV-2. Metod: Studierna för vardera vaccin hittades och valdes ut genom World Health Organizations (WHO) “Draft landscape and tracker of COVID-19 candidate vaccines”. Totalt inkluderades åtta studier baserade på tio kliniska prövningar som undersökte säkerheten och effektiviteten hos de fyra ledande vaccinerna från Pfizer BioNTech, Moderna, AstraZeneca och Johnson & Johnson. Resultat: De fyra undersökta vaccinerna visade en god säkerhet utan grövre biverkningar. De vanligaste biverkningarna hos samtliga vaccin var lokal smärta, trötthet och huvudverk. Dessa biverkningar varade mellan en till två dagar efter vaccination och var till större del milda. Större skillnader kunde ses hos de olika vaccinernas effektivitet, Pfizer BioNTech och Modernas mRNA-vacciner visade på effektiviteter runt 95% medan AstraZeneca och Johnson & Johnsons adenovirus-vektor-vacciner visade på effektiviteter runt 66-70%. Diskussion: Inga större skillnader i säkerhet kunde ses mellan de undersökta vaccinerna. AstraZeneca använde ett influensa vaccin istället för isoton vattenlösning till deras kontrollgrupper. Detta kan ha haft en påverkan på placebo och resultaten från deras prövningar. En tydlig skillnad i effektivitet kunde ses mellan de olika vaccintyperna, vilket har ett stort inflytande på hur lätt man kan inducera flockimmunitet hos en befolkning. Eftersom flockimmunitet har en stor roll i både att bromsa spridningen men även i att förebygga förekomsten av nya virus varianter så bör endast mRNA vacciner rekomenderas om möjligt.
Introduction: Coronaviruses are RNA viruses with a lipid envelope that is covered by characteristic spike protein. The most well-known coronaviruses are SARS-CoV-1 which were active between 2002-2004, MERS-CoV which is active since 2012 and SARS-CoV-2 which is active since 2019. SARS-CoV-2 was designated a pandemic January 30, 2020. Several pharmaceutical companies have been rushing to produce vaccines targeting SARS-CoV-2, The United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have had to issue Emergency Use Authorization (EUA) in the hope of gaining control of its spread. Objective: The purpose of this study is to investigate the safety and efficacy of the EMA-approved vaccines targeting SARS-CoV-2. Method: The studies for each vaccine were found and selected through the World Health Organizations' (WHO) "Draft landscape and tracker of COVID-19 candidate vaccines". A total of eight studies were included based on ten clinical trials examining the safety and efficacy of the four leading vaccines from Pfizer BioNTech, Moderna, AstraZeneca and Johnson & Johnson. Results: The four vaccines examined showed good safety without any serious side effects, the most common side effects with all vaccines were local pain, fatigue, and headache. These side effects lasted between one to two days after vaccination and were mostly mild. Larger differences could be seen in the efficacy of the different vaccines, with Pfizer BioNTech and Moderna's mRNA vaccines showing efficacies of around 95%. While AstraZeneca and Johnson & Johnson's adenovirus vector vaccines showed efficacies of around 66-70%. Discussion: No major differences in safety could be seen between the vaccines examined. AstraZeneca used an influenza vaccine instead of isotonic aqueous solution for their control groups, this may have had an impact on placebo and thus the results of their trials. A clear difference in efficacy could be seen between the different types of vaccines. This has a great influence on how easily one could induce herd immunity to a population. Herd immunity plays a major role in both slowing the spread but also in preventing the occurrence of new virus variants, therefore mRNA vaccines should be recommended if possible.

The purpose of this study was to investigate how domestic violence was presented in Swedish newspapers before and during the covid-19 pandemic. Based on the result, we discuss how a changed reporting can influence the involved parties (perpetrators and victims), and social work in a wider context.To answer the questions of the study, we have studied how newspapers presented the parties in domestic violence, the explanations for the violence, and the character of the violence. The focus of the study was to investigate if there were differences before and during the pandemic. 134 articles were studied in total, from the newspapers Aftonbladet, Expressen, Dagens Nyheter and Svenska Dagbladet. We found that the newspaper coverage on domestic violence has changed during the covid-19 pandemic, compared to before. During the pandemic, the newspapers reported the pandemic in itself as a reason for domestic violence, and hence excluded many other possible explanations. The reporting during the pandemic often focused on serious domestic violence, on cases where shelters for women were involved, and the pandemic as a reason for domestic violence. Consequently, other types of violence and other types of victims have gotten less coverage in the newspapers. There are fewer articles embracing the width of victims who suffer from domestic violence. In addition, we found that the reporting on the perpetrators committing the violence was more one-dimensional. Before the pandemic, it was clearer that the perpetrators could come from a wide range of age groups, social positions, genders, sexualities etc. During the pandemic, nearly all cases presented in the newspapers were about a hetrosexual man, who was often a father. In summary, we found that the reporting has become more linear and one-dimensional during the pandemic, but also more alarming. The changed newspaper coverage of domestic violence could certainly influence the general picture of the problem, both in the public and in social work.

The Covid-19 pandemic is an ongoing disaster on a scale no one living can recall. Since the end of 2019, it is causing not only countless deaths and physical debility, but also extraordinary social disruption, changing every aspect of people’s working and social lives. As a consequence, in the wake of the virus has come a second wave of psychiatric consequences, mostly prominently anxiety, depression, and posttraumatic stress. This flood of illness and distress will likely continue at least until an effective vaccine is found and distributed and, even then, will leave psychic scars. How best to treat the slew of psychiatric suffering from such tragedy or, indeed, from any ongoing disaster? Interpersonal psychotherapy (IPT) is an evidence-based, time-limited, affect- and life event–focused psychotherapy, repeatedly tested in more than forty years of treatment research and shown to help patients with mood, anxiety, and trauma disorders. With adaptation to the particular current conditions, IPT appears an excellent fit for the strong feelings and symptoms arising from these horrific life events. his manual by Dr. John Markowitz, a leading IPT expert, equips therapists to treat the most common psychiatric consequences of the pandemic.

Millions of lives throughout the globe are under threat due to the COVID-19 pandemic. COVID-19 causes severe respiratory tract infections. In most countries COVID-19 Infections and deaths continue to soar despite the various measures put in place by the World Health Organization. These measures include limited mobility through lock down and banning international travelers. Furthermore, social distancing, wearing masks, frequent hand washing with soap and sanitizing were undertaken to slow down the rate of the virus spread. Only few countries like South Korea have been able to contain the virus to date. Our only hope is in biotechnology which have been used to develop diagnostic kits and more recently approved vaccines: vaccines by Pfizer-BioNTech and Moderna; AstraZeneca and Oxford University vaccine; Sputnik V vaccine; Sinopharm and the Beijing Institute of Biological Products vaccine. However, the vaccines are yet to reach the majority of the world population. Hence, there is need for concerted effort among governments and non-governmental organizations in all nations to develop the necessary infrastructures to step up vaccine production, and procurement as well as vaccination programmes. There is need for continued effort in biotechnology, to develop COVID-19 therapeutic drugs.

Misinformation and disinformation, most often propagated on social media sites, became rampant during the pandemic, contributing to myths and conspiracy theories. Such falsehoods resulted in inappropriate treatments, such as happened with hydoxychloroquine, and has contributed to vaccine hesitancy. Disinformation and political interference in institutions such as the Centers for Disease Control (CDC) and the World Health Organization (WHO) caused confusion for the American public and contributed to the poor pandemic performance in the United States. Anti-vaccine disinformation has interfered with the COVID-19 vaccine rollout. Healthcare providers need to take an active role in combating medical misinformation.

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a dangerous virus named SARS-CoV-2. The most important symptoms are fever, cough, fatigue, and breathing problems. In the most serious forms of the disease, the appearance of an acute respiratory distress syndrome caused by the virus can be deadly, especially when people are fragile due to their age or in case of comorbidities. The exacerbated innate immune response could be another deadly complication. Different strategies of treatments are proposed for COVID-19 such as inhibition of virus entry by blocking ACE2 receptor used by COVID-19, inhibition of virus replication by using replication inhibitors, immunomodulatory agents to stimulate a strong immune response against COVID-19, and by using vaccines as an effective method for a long-term strategy for prevention of COVID-19.

Most experts would agree that recovery from the COVID-19 crisis will be slow (see Figure 6.2), in large part due to the impact that the crisis has had on the global travel and tourism industry (Romei, 2020). Until there is vaccine, the virus will influence nearly every sector of travel from transportation, destination and resorts, to the accommodations, attractions, events and restaurants. The first section of this chapter looks at the future for these different sectors, a future heavily influenced by technology and a heightened emphasis on health and safety. The second part of the chapter focuses on a theme that has been prevalent in this book – the need for adaptability or ‘COVID-aptability’. Consumer demands and behavior will be permanently altered by the pandemic, and all stakeholders in the travel industry will need to adapt. One part of adaptability is redesigning servicescapes – a necessity for many after the lockdown, and this is the subject of the penultimate section of the chapter. The conclusion looks at lessons learned from this crisis.

COVID-19 is a major pandemic disease exploited in this century in the whole world. COVID-19 was started om Wuhan, China in November 2019. The main reason for spreading this disease was that test kits were not available in huge amounts to diagnose the COVID-19, and no vaccine was available to cure this disease. Many researchers are trying to make a vaccine for the treatment of this disease. Prevention is better than cure. Therefore, prevention from this epidemic disease is diagnosis at early stages, and treatment should be given to the patient at an accurate time so that patient can escape death. Millions of people were infected by this disease, and most of them lost their lives after suffering from this disease. As we all know, this disease diagnosis test is complicated. Therefore, many smart apps like Siri, Cova App, Arogya Setu App, etc. and digital systems are used to detect and diagnose cases of infected people. These systems are embedded with artificial intelligence techniques. For diagnosis, the COVID-19 computer tomography is based on deep learning convolutional neural network.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCov-2) or COVID-19 is a pandemic that appeared in December 2019 in China and which is an RNA virus. It gave rise to a major health crisis at the start of 2020, with numerous hospitalizations. It was quickly important to understand the pathophysiology of this viral attack on the human body in order to be able to develop treatment. However, there is no vaccine or effective therapeutic agent against SARS-CoV-2. Most of the therapeutic strategies used to deal with this virus come from the work of previous epidemics of SARS, and other influenza viruses, such as antiviral therapies (chloroquine, hydroxychloroquine), adjuvant therapies by combining antivirals with drugs. Antibiotics or immunostimulants (vitamins C, Dm and Zinc, etc,) and several other therapies to be used depending on the region.

In the early twenty-first century, measles was completely eradicated in the United States of America (USA) and almost eliminated in Canada. This was greatly due to most of the population being vaccinated against the virus. In 2018 and 2019, the USA and Canada experienced a rapidly developing measles virus outbreak due to growing debates about vaccine efficacy and side effects. Therefore, some people refused to vaccinate their children against measles, as well as many other life-threatening preventable diseases. This led to a major measles outbreak and health concern in the USA, Canada, and globally. Some countries including the Democratic Republic of the Congo (DRC) reported a significant number of cases and casualties resulting from measles, mainly due to the lack of funding for vaccines, as well as inadequate vaccination coverage in certain socio-demographic areas. People traveling from these countries can easily transmit the disease, though there has been a steep decline in cases since the travel ban due to coronavirus disease-2019 (COVID-19). The number of unvaccinated children currently in the USA and Canada has quadrupled since 2001. Over the past couple of years, most of the measles cases have been diagnosed in those who either did not receive the measles vaccine or complete the recommended doses of the vaccine. This paper reviews the measles outbreak, in recent years, among unvaccinated individuals in the USA, Canada, and globally.

Recently, a newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic coronavirus disease (COVID-19). More than 10 million confirmed cases and 503,867 associated deaths of SARS-CoV-2 have been reported worldwide to WHO in the end of July 2020. According to WHO guidelines, there is no effective therapy available for treating devastating SARS-CoV-2. Consequently, lack of evidence for appropriate treatment and vaccines has led to the re-emergence of convalescent plasma (CP) immunotherapy. Herein, we discuss the historical perspectives of CP against SARS-CoV, MERS-CoV, H1N1 pandemic and mainly the clinical outcomes of COVID-19 patients with respect to neutralizing antibodies (nAbs). A brief possible clinical protocol for CP transfusion with its adverse effects and limitation were also highlighted. It is concluded that, CP transfusion with high neutralizing antibody titer administered in early course of disease significantly improved clinical outcomes in COVID-19 patients by reducing morbidity and mortality. Thus, CP immunotherapy is considered as noteworthy candidate to be further re-evaluated as a most suitable therapeutic option against SARS-CoV-2 pandemic.

In the 2020, COVID-19 pandemic disease created an havoc situation world widely and mainly caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). It has been challenging task for researchers, scientists and medico-pharmaceutical organisations to find out rapid and reliable diagnosis methods. Among the all testing services, a Reverse Transcription Polymerase Chain Reaction (RT-PCR) is the more accurate, rapid and authenticated molecular technique used for most of the diagnosis of major diseases. It has been a global priority to fix the rapid diagnosis method to combat against the pandemic COVID-19. Thus, the present chapter mainly focussing on the progress of RT-PCR method development though various processes of data collection on isolation of whole genome sequence, its primer and method designing. In this scenario, India suddenly become the global leader for vaccine development and hence the challenges and RT-PCR kit development in India and rest of the world has been be discussed. World wide many Government and private agencies and industries have taken an initiative for diagnosis of SARS-CoV-2 hence this chapter also summarised the scope of RT-PCR to combat pandemic situation in future.

Data science has been proven to be an important asset to support better decision making in a variety of settings, whether it is for a scientist to better predict climate change for a company to better predict sales or for a government to anticipate voting preferences. In this research, the authors leverage random forest (RF) as one of the most effective machine learning techniques using big data to predict vaccine intent in five European countries. The findings support the idea that outside of vaccine features, building adequate perception of the risk of contamination, and securing institutional and peer trust are key nudges to convert skeptics to get vaccinated against COVID-19. What machine learning techniques further add beyond traditional regression techniques is some extra granularity in factors affecting vaccine preferences (twice more factors than logistic regression). Other factors that emerge as predictors of vaccine intent are compliance appetite with non-pharmaceutical protective measures as well as perception of the crisis duration.

The recent worldwide epidemic of Covid-19 disease, for which there is no vaccine or medications to prevent or cure it, led to the adoption of public health measures by governments and populations in most of the aected countries to avoid the contagion and its spread. These measures are known as nonpharmaceutical interventions (NPIs) and their implementation clearly produces social unrest as well as aects the economy. Frequently, NPIs are implemented with an intensity quantied in an ad hoc manner. Control theory oers a worthwhile tool for determining the optimal intensity of the NPIs in order to avoid the collapse of the healthcare system while keeping them as low as possible, yielding in a policymakers concrete guidance. We propose here the use of a simple proportional controller that is robust to large parametric uncertainties in the model used.

The problematic relationship between communication technologies and information is among the essential discussion topics of the academy. Concepts such as information bombardment, disinformation, and misinformation refer to incorrect, distorted, and corrupt information disseminated by means of communication. Unhealthy information and knowledge are seen as the biggest obstacle to the formation of a healthy public opinion. In the Covid 19 epidemic, which affects the whole world, the relationship between communication tools and information has come to the fore again. An "infodemic," which can be defined as "false, distorted information epidemic/pandemic," describes the truly distant information flowing to the public about the Covid 19 pandemic through different communication tools. On the other hand, today, visual images have become the most crucial source in disseminating information and the production of meaning. With digitalization, our daily life is shaped by an image-filled culture surrounded by artificial visuals more than ever before. The curiosity of this work is "How is infodemic produced through visual images?" It is based on the question. For this purpose, Twitter has been chosen as the research universe of important social networking sites. The study showed how the infodemia spread about Covid 19 vaccine in Turkey was produced visually on Twitter and analyzed with content analysis. The critical visual literacy method proposed by Douglas Kellner was adopted for analysis. In line with the suggestion of Kellner, the political, ideological, religious, and so on semantic load has been tried to be interpreted.

Since December 2019, SARS-CoV-2 infections have altered many aspects of our societies. Citizens were faced with circumstances to which even experts and scientists did not yet know the answers and were applying the scientific method to make daily steps of progress towards better understanding the threat and how to contain it. Within a year, several vaccines were produced to protect individuals from the virus, thereby resolving the most important medical problem. However, not just medical issues call for the application of the scientific method. The management of epidemics also can, and in fact should, benefit significantly from a science-based approach. The novel complexity of the situation left us torn between permissive and authoritarian approaches of containment, and it is still subject to debate what works best and why. In our contribution, we model the emerging complexity of the epidemics and propose a scientific-based data driven approach that aims to aid the decision makers in their focus on the most relevant issues and thus helping them to make informed and consistent decisions. The resulting monitoring and control system, termed COVID-19 vigilance, helps with risk assessment and communication during regional COVID-19 outbreaks. The system is based on the Cynefin decision complexity framework and the universal process model, and it uses several mathematical models that describe epidemic spreading. Different future scenarios are used to predict the impact of realistic, optimistic, and pessimistic outcomes, in turn allowing for a more efficient communication of involved risk.

The corona epidemic spreads frighteningly and rapidly in all countries of the world, forcing humanity to an abnormal life. Failure to fully control the epidemic and to find adequate and effective vaccines endangers human life. Fighting against the epidemic becomes important, as all these measures could not be taken in the near future. For this reason, it is important to detect whether the person caught the virus expressed in thousands of people is covid or not and to take the necessary measures. For this purpose, an artificial intelligence-based study has been proposed that will speed up the diagnosis of the pandemic by saving labor and expense. In the study, X-Ray images were processed with the most up-to-date deep image processing techniques, and an objective decision support system was created, independent of the doctor's expertise. The proposed system can classify x-ray images as Normal, Covid -19 and Viral Pneumonia using pre-trained deep learning networks (AlexNet, GoogleNet, ResNet8 and ResNet50). The overall accuracies of the networks (AlexNet, GoogleNet, ResNet8 and ResNet50) were 95.7%, 94.5%, 95.4%, 97.4% respectively. It is easy to diagnose in the advanced stages of the disease. As with most diseases, early diagnosis is important in covid-19. With the proposed system based on deep learning, an especially useful tool has been created in combating the pandemic by determining the disease at an early stage. The proposed system can also be used in areas with shortage of health personnel such as rural and remote areas.

With the onset of the coronavirus pandemic in December 2019 in China, and the alarming rate at which it has spread across the world has unleashed not only fear, but has taken a toll on social, economic, health, and governing capabilities of the various countries infected with the virus. The pandemic is affecting all aspects of life, including industries such as the animal production industry all over the world. This includes plant, livestock and poultry production. Food security is accordingly impacted, as these industries are vital elements that are contributing to securing food to populations worldwide. In this review, light is shed on the origin of coronaviruses with special emphasis on COVID-19. It also includes introduction of symptoms, epidemiology and pathogenesis, etiology, and prevention. As the disease progresses, scientists are working around the clock in the hope of an effective vaccine, and they managed to introduce some to the worldwide populations. The world faces challenges on a day-to-day basis until most people are vaccinated.

The global pandemic of COVID-19 disease caused by infection with the SARS-CoV-2 Coronavirus, has produced an urgent requirement and search for improved treatments whilst effective vaccines are developed. A strategy for improved drug therapy is to increase levels of endogenous reactive metabolites for selective toxicity to SARS-CoV-2 by preferential damage to the viral proteome. Key reactive metabolites producing major quantitative damage to the proteome in physiological systems are: Reactive oxygen species (ROS) and the reactive glycating agent methylglyoxal (MG); cysteine residues and arginine residues are their most susceptible targets, respectively. From sequenced-based prediction of the SARS-CoV-2 proteome, we found 0.8-fold enrichment or depletion of cysteine residues in functional domains of the viral proteome; whereas there was a 4.6-fold enrichment of arginine residues, suggesting SARS-CoV-2 is resistant to oxidative agents and sensitive to MG. We examined activated arginine residues in functional domain with predicted low pKa by neighboring group interaction in the SARS-CoV-2. We found 25 such arginine residues, including 2 in the spike protein and 10 in the nucleoprotein. These sites were partially conserved in related coronaviridae: SARS-COV and MERS. We also screened and identified drugs, which increase cellular MG concentration to virucidal levels and found two antitumor drugs with historical antiviral activity, doxorubicin and paclitaxel were the best candidate for repurposing. Our findings provide evidence of potential vulnerability of SARS-CoV2 to inactivation by MG and a scientific rationale for repurposing of doxorubicin and paclitaxel for treatment of COVID-19 disease, providing efficacy and adequate therapeutic index may be established.

The COVID-19 pandemic has had a tremendous negative impact on economies of most countries around the world. COVID-19 has disrupted the ability of health systems to deliver on essential health services and has also exposed pre-existing vulnerabilities and inequities in public health systems. According to a key informant survey conducted by WHO, over one year into the COVID-19 pandemic, there still exist substantial disruptions to essential health services. This rapid review examines evidence on successful interventions that could enable adaptive approaches to help manage and respond future pandemics and mitigate the risk of collapse of the public health systems. Countries must use the opportunity provided by the deployment of COVID-19 vaccines to strengthen health services and health systems and find long-lasting solutions for similar future challenges. The review notes that there still exist gaps in preparedness and response to the Covid-19 pandemic. New variants of concern threaten the effectiveness of existing COVID-19 vaccines, vaccine hesitancy slowing rollout, including in Africa, and interrupted and limited supply of COVID-19 tools. More funding is required though to scale up adaptive measures which are working, accelerating new approaches and innovations to improve service delivery. This review also highlights briefly the plight of marginalised social groups, people living with disabilities, women and children during the pandemic. According to estimates by Global Fund, Gavi, Global Financing Facility, access to life-saving health interventions for women, children and adolescents in 36 of the world’s poorest countries has dropped by as much as 25% due to COVID-19. Countries must build on the momentum of health innovations during the COVID-19 crisis to build more resilient health systems that can withstand disruptions by future pandemics.

Until a vaccine is widely available, face masks and other nonpharmaceutical interventions (NPIs) will continue to be the frontline defense against Covid-19 in developing countries. But their effectiveness depends critically on compliance by young adults, who are most likely both to become infected and to infect others. We conducted a randomized controlled trial in Bogotá, Colombia, to assess the effectiveness of informational nudges on university students concern about Covid-19, recent compliance with NPI recommendations, and intended future compliance. Although nudges boosted concern, they had limited effects on either recent or intended future compliance. We attribute these null results to high baseline levels of information about and compliance with NPIs an informational diminishing returns scenario that is likely to be increasingly common globally. Nudges were more effective at boosting recent compliance among participants who were politically left-wing, were relatively poor, and lived with more people.

Key Message Ontario long-term care (LTC) home residents have experienced disproportionately high morbidity and mortality, both from COVID-19 and from the conditions associated with the COVID-19 pandemic. There are several measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes, if implemented. First, temporary staffing could be minimized by improving staff working conditions. Second, homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Third, the risk of SARS-CoV-2 infection in staff could be minimized by approaches that reduce the risk of transmission in communities with a high burden of COVID-19. Summary Background The Province of Ontario has 626 licensed LTC homes and 77,257 long-stay beds; 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal. LTC homes were strongly affected during Ontario’s first and second waves of the COVID-19 pandemic. Questions What do we know about the first and second waves of COVID-19 in Ontario LTC homes? Which risk factors are associated with COVID-19 outbreaks in Ontario LTC homes and the extent and death rates associated with outbreaks? What has been the impact of the COVID-19 pandemic on the general health and wellbeing of LTC residents? How has the existing Ontario evidence on COVID-19 in LTC settings been used to support public health interventions and policy changes in these settings? What are the further measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes? Findings As of January 14, 2021, a total of 3,211 Ontario LTC home residents have died of COVID-19, totaling 60.7% of all 5,289 COVID-19 deaths in Ontario to date. There have now been more cumulative LTC home outbreaks during the second wave as compared with the first wave. The infection and death rates among LTC residents have been lower during the second wave, as compared with the first wave, and a greater number of LTC outbreaks have involved only staff infections. The growth rate of SARS-CoV-2 infections among LTC residents was slower during the first two months of the second wave in September and October 2020, as compared with the first wave. However, the growth rate after the two-month mark is comparatively faster during the second wave. The majority of second wave infections and deaths in LTC homes have occurred between December 1, 2020, and January 14, 2021 (most recent date of data extraction prior to publication). This highlights the recent intensification of the COVID-19 pandemic in LTC homes that has mirrored the recent increase in community transmission of SARS-CoV-2 across Ontario. Evidence from Ontario demonstrates that the risk factors for SARS-CoV-2 outbreaks and subsequent deaths in LTC are distinct from the risk factors for outbreaks and deaths in the community (Figure 1). The most important risk factors for whether a LTC home will experience an outbreak is the daily incidence of SARS-CoV-2 infections in the communities surrounding the home and the occurrence of staff infections. The most important risk factors for the magnitude of an outbreak and the number of resulting resident deaths are older design, chain ownership, and crowding. Figure 1. Anatomy of Outbreaks and Spread of COVID-19 in LTC Homes and Among Residents Figure from Peter Hamilton, personal communication. Many Ontario LTC home residents have experienced severe and potentially irreversible physical, cognitive, psychological, and functional declines as a result of precautionary public health interventions imposed on homes, such as limiting access to general visitors and essential caregivers, resident absences, and group activities. There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents. The accumulating evidence on COVID-19 in Ontario’s LTC homes has been leveraged in several ways to support public health interventions and policy during the pandemic. Ontario evidence showed that SARS-CoV-2 infections among LTC staff was associated with subsequent COVID-19 deaths among LTC residents, which motivated a public order to restrict LTC staff from working in more than one LTC home in the first wave. Emerging Ontario evidence on risk factors for LTC home outbreaks and deaths has been incorporated into provincial pandemic surveillance tools. Public health directives now attempt to limit crowding in LTC homes by restricting occupancy to two residents per room. The LTC visitor policy was also revised to designate a maximum of two essential caregivers who can visit residents without time limits, including when a home is experiencing an outbreak. Several further measures could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes. First, temporary staffing could be minimized by improving staff working conditions. Second, the risk of SARS-CoV-2 infection in staff could be minimized by measures that reduce the risk of transmission in communities with a high burden of COVID-19. Third, LTC homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Other important issues include improved prevention and detection of SARS-CoV-2 infection in LTC staff, enhanced infection prevention and control (IPAC) capacity within the LTC homes, a more balanced and nuanced approach to public health measures and IPAC strategies in LTC homes, strategies to promote vaccine acceptance amongst residents and staff, and further improving data collection on LTC homes, residents, staff, visitors and essential caregivers for the duration of the COVID-19 pandemic. Interpretation Comparisons of the first and second waves of the COVID-19 pandemic in the LTC setting reveal improvement in some but not all epidemiological indicators. Despite this, the second wave is now intensifying within LTC homes and without action we will likely experience a substantial additional loss of life before the widespread administration and time-dependent maximal effectiveness of COVID-19 vaccines. The predictors of outbreaks, the spread of infection, and deaths in Ontario’s LTC homes are well documented and have remained unchanged between the first and the second wave. Some of the evidence on COVID-19 in Ontario’s LTC homes has been effectively leveraged to support public health interventions and policies. Several further measures, if implemented, have the potential to prevent additional LTC home COVID-19 outbreaks and deaths.

Countries around the world have endured over a year of extreme uncertainty in the context of the COVID-19 crisis, and economies in the Caribbean have suffered more than most. But with the increasing availability of vaccines and prospects for a resumption of international travel, light is emerging at the end of the Pandemic tunnel. With this in mind, The Inter-American Development Bank Caribbean1 Departments most recent Quarterly Bulletin reviews the latest available information regarding the crisis impacts on citizens, their economies, and key factors that will determine the speed and depth of recovery. As also discussed in previous editions, prospects for tourism-dependent economies will depend heavily on vaccine penetration and border normalization in source countries particularly the United States and Western Europe, while commodity-intensive economies could benefit from upward revisions to global demand growth estimates. All countries in the region can do much to support a rapid recovery through forward-looking policies aimed at ensuring they are well positioned to take advantage of post-Pandemic preferences with respect to travel and tourism, services trade, and investment. Our latest report considers these issues, what may lie ahead, and how counties can best position themselves for a recovery in 2021 and beyond.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.