Zeitschriftenartikel 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

Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.

To overcome pandemics, such as COVID-19, vaccines are urgently needed at very high volumes. Here we assess the techno-economic feasibility of producing RNA vaccines for the demand associated with a global vaccination campaign. Production process performance is assessed for three messenger RNA (mRNA) and one self-amplifying RNA (saRNA) vaccines, all currently under clinical development, as well as for a hypothetical next-generation saRNA vaccine. The impact of key process design and operation uncertainties on the performance of the production process was assessed. The RNA vaccine drug substance (DS) production rates, volumes and costs are mostly impacted by the RNA amount per vaccine dose and to a lesser extent by the scale and titre in the production process. The resources, production scale and speed required to meet global demand vary substantially in function of the RNA amount per dose. For lower dose saRNA vaccines, global demand can be met using a production process at a scale of below 10 L bioreactor working volume. Consequently, these small-scale processes require a low amount of resources to set up and operate. RNA DS production can be faster than fill-to-finish into multidose vials; hence the latter may constitute a bottleneck.

Background In the Arab countries, there has not been yet a specific validated Arabic questionnaire that can assess the psychological antecedents of COVID-19 vaccine among the general population. This study, therefore, aimed to translate, culturally adapt, and validate the 5C scale into the Arabic language. Methods The 5C scale was translated into Arabic by two independent bilingual co-authors, and then translated back into English. After reconciling translation disparities, the final Arabic questionnaire was disseminated into four randomly selected Arabic countries (Egypt, Libya, United Arab Emirates (UAE), and Saudi Arabia). Data from 350 Arabic speaking adults (aged ≥18 years) were included in the final analysis. Internal consistency was assessed by Cronbach’s alpha. Construct validity was determined by concurrent, convergent, discriminant, exploratory and confirmatory factor analyses. Results Age of participants ranged between 18 to 73 years; 57.14% were females, 37.43% from Egypt, 36.86%, from UAE, 30% were healthcare workers, and 42.8% had the intention to get COVID-19 vaccines. The 5 sub-scales of the questionnaire met the criterion of internal consistency (Cronbach’s alpha ≥0.7). The predictors of intention to get COVID-19 vaccines (concurrent validity) were young age and the 5C sub-scales. Convergent validity was identified by the significant inter-item and item-mean score of the sub-scale correlation (P<0.001). Discriminant validity was reported as inter-factor correlation matrix (<0.7). Kaiser-Meyer-Olkin sampling adequacy measure was 0.80 and Bartlett’s sphericity test was highly significant (P<0.001). Exploratory factor analysis indicated that the 15 items of the questionnaire could be summarized into five factors. Confirmatory factor analysis confirmed that the hypothesized five-factor model of the 15-item questionnaire was satisfied with adequate psychometric properties and fit with observed data (RMSEA = 0.060, GFI = 0.924, CFI = 0.957, TLI = 0.937, SRMR = 0.076 & NFI = 906). Conclusion The Arabic version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of COVID-19 vaccine among Arab population.

AbstractCOVID-19 still remains a severe global health threat. Despite the high-speed development of vaccines that efficiently prevent COVID-19, there are still no effective treatments of the disease once people are infected. MicroRNAs are powerful regulators of gene expression. They are intensely investigated as therapeutic targets up to the clinical stage. In addition, microRNAs can be detected in the circulation, and thus, represent promising diagnostic and prognostic biomarkers for (long)-COVID-19.

Background:Over 2 million deaths from the COVID-19 disease have been reported in the world. Since no antiviral treatment is available, the vaccination is the most important option to fight the SARS-CoV-2 infection. Patients living with rheumatoid arthritis (RA) affecting the immune system or under immunosuppressive agent will be considered as a high risk population and will start the vaccination shortly. But many patients could decline the vaccine for several reasons including safety concerns.Objectives:The aim of this study is to evaluate the proportion of patients with RA who are favourable to COVID-19 vaccination, to know the reasons to decline and to analyse the characteristics of these patients.Methods:We included patients with RA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria. A simple and standard questionnaire was distributed to patients who attended rheumatology out patient and day care clinic from 14 december 20 to 14 januari 21. All patient and RA characteristics (Age, gender, education, smoking habits, disease duration, ACPA, RF, DAS28-CRP, HAQ and therapies) were collected at the same time.Results:Data from 460 eligible RA patients were analyzed. The average age of the population is 58.21 years. 72% of the patients are women. 21% are smokers and 65% are positive for anti-citrullinated protein antibody (ACPA) with a mean DAS28-CRP of 2.39 and a mean HAQ of 0.821.281 patients (61%) indicated they would receive the vaccine as soon as it is available. For the 179 patients (39%) who decline, the reasons for not having vaccine were no trust in the vaccine at this time (53%), fear of side effects (28%), opposition to vaccine (4%), previous SARS-CoV-2 infection (2%) and unknown (5%),Interestingly, there were differences among RA patients not willing to receive the vaccine. Patient under the age of 50, women, low education grade, smokers, presence of RF/ACPA and treatment with a bioDMARD were less willing to receive the vaccine. No differences were observed for RA disease duration, HAQ and DAS28-CRP (see Table 1).Table 1.Characteristics of RA population and correlation between groups.TOTALn=460VACCIN-YESn=281 (61%)VACCIN-NOn=179 (39%)Age, mn58,21 +/-0,7160,37 ± 0,900454,82 ± 1,090p=0.0001*Group Age <30 yrs25 (5%)15 (5%)10 (6%)Group Age =31-50 yrs112 (24%)53 (19%)59 (33%)Group Age =51-70 yrs209 (45%)127 (45%)82 (46%)Group Age > 70 yrs114 (25%)86 (31%)28 (16%)p=0.0003**Gender, F/M, %-F332/128(F-72%)193/88(F-69%)139/40(F-78%)p=0.043**Educ0-163 (15%)27 (11%)36 (22%)Educ2-3349 (85%)222 (89%)127 (78%)p=0.003**RA Disease duration yrs, mn14,77 +/-0,5115,24 +/-0,6914,04 +/-0,73Smokers: YES/NO/Ex-Smokers, %-YES85/248/79 (21%)42/156/52 (17%)43/92/27 (27%)p=0.018**RF YES/NO, %243/137 (64%)133/94 (59%)110/43 (72%)p=0.009**ACPA YES/NO, %244/132 (65%)127/93 (58%)117/39 (75%)p=0.001**HAQ, mn0,814+/-0,0390,797+/-0,0510,838+/-0,061DAS28-CRP, mn2,39+/-0,052,35+/-0,072,44+/-0,09GC, YES/NO, %360/86 (19%)217/55 (20%)143/31 (18%)csDMARDs (MTX), YES/NO, %124/322 (72%)72/200 (74%)52/122 (70%)BioDMARDs, NO/YES, %151/295 (66%)107/165 (61%)44/130 (75%)p=0.003**(*) - Unpaired t Test; (**) - Fisher’s exact testConclusion:In our RA cohort, the rates of willingness to receive the vaccine are promising. Dedicated education and outreach efforts should be developed, especially in some RA subpopulation.Disclosure of Interests:None declared.

Pharmacists in health systems involved with immunizations have used their practice settings to become advocates for immunization and increase their responsibilities in the public health monarchy. Administering vaccines to patients and health care workers is enabling some health-system pharmacists to assume a prominent role in public health. Pharmacists have noticed that immunization needs were not being met and, through their advocacy, increased the numbers of patients and employees of health systems who have been vaccinated.

Introduction: In December 2019, China faced the COVID-19 outbreak. COVID-19 is a disease caused by the pathogen, SARS-CoV-2 which is a single stranded RNA virus that spreads person to person via direct contact or respiratory droplets. Since this disease has been found to be highly contagious, prevention from virus exposure seems to be a reasonable approach especially due to lack of an effective vaccination up till now. Our study is aimed at proposing the prophylactic strategies that can be implemented in Pakistan to help flatten the disease curve in order to provide more time for healthcare professionals to fight the disease better and to hopefully come up with an effective vaccination for long term disease control. Methods: We conducted a systematic literature review based on PRISMA guidelines. Only those articles were included which met the inclusion criteria. Results: The results gathered by the literature search suggested that due to the lack of any licensed vaccine or effective treatment, adopting personal and environmental protective measures, isolation and quarantine, and other community mitigation measures like temporary lockdown can help flatten the peak of the ongoing pandemic. Conclusion: Since there has not been any breakthrough in finding an effective vaccine, our review aims to devise an effective preventive strategy to curb this pandemic according to the present socio-economic conditions of Pakistan.

Introduction: SARS-CoV 2 firstly emerged in China on December 2019 and it was spreading rapidly across the world until now. At this time, there is no vaccine or medication approved by the FDA. However, there are some FDA approved medicines for treating other diseases that can be used for Covid-19 based on tests. This review focuses on therapy efficacy, work mechanism, pharmacokinetic profile, safety, and future perspective. Method: Article review related to therapy on Covid-19 patients, particularly antiviral therapy which was the combination of lopinavir and ritonavir, chloroquine, hydroxychloroquine, remdesivir, and favipiravir. The reviewed relevant articles were observational study, in vitro test, case report, and clinical test. Results: A total of 13 articles met the requirement, 9 articles discussed the result of therapy during the medication of COVID-19 patients, 2 reports of in vitro test, and 2 results of clinical trials. Conclusion: From several studies that had been conducted, remdesivir, combination of lopinavir and ritonavir, as well as favipiravir showed benefits in various clinical studies on Covid-19 patients. Meanwhile, chloroquine and hydroxychloroquine showed limited effects and did not affect the decrease of mortality.

Both the 1918 influenza pandemic and the 2019‒2021 COVID-19 pandemic are among the most disastrous infectious disease emergences of modern times. In addition to similarities in their clinical, pathological, and epidemiological features, the two pandemics, separated by more than a century, were each met with essentially the same, or very similar, public health responses, and elicited research efforts to control them with vaccines, therapeutics, and other medical approaches. Both pandemics had lasting, if at times invisible, psychosocial effects related to loss and hardship. In considering these two deadly pandemics, we ask: what lessons have we learned over the span of a century, and how are we applying those lessons to the challenges of COVID-19?

At times of crisis, access to information takes on special importance, and in the Internet age of constant connectedness, this is truer than ever. Over the course of the pandemic, the huge public demand for constantly updated health information has been met with a massive response from official and scientific sources, as well as from the mainstream media. However, it has also generated a vast stream of user-generated digital postings. Such phenomena are often regarded as unhelpful or even dangerous since they unwittingly spread misinformation or make it easier for potentially harmful disinformation to circulate. However, little is known about the dynamics of such forums or how scientific issues are represented there. To address this knowledge gap, this chapter uses a corpus-assisted discourse approach to examine how “expert” knowledge and other sources of authority are represented and contested in a corpus of 10,880 reader comments responding to Mail Online articles on the development of the COVID-19 vaccine in February–July 2020. The results show how “expert” knowledge is increasingly problematized and politicized, while other strategies are used to claim authority. The implications of these findings are discussed in the context of sociological theories, and some tentative solutions are proposed.

The current COVID-19 pandemic remains severe. There is no doubt that the COVID-19 pandemic is affecting every aspect of our lives. Currently, the spread of inaccurate information or fake news on the internet to the public is causing the community to panic. Thus, this study aims to obtain available information on food and nutrition related to the prevention and treatment of COVID-19 from various sources. A scoping review framework was used to chart the evidence on nutritional recommendations to prevent COVID-19 based on the preferred method in reporting systematic review and meta-analysis extension for scoping reviews (PRISMA-ScR). The articles were categorised into three main groups: i) general dietary recommendations; ii) supplementation with specific micronutrients and iii) their mixtures and supplementation with traditional herbs and miscellaneous foods. A total of 60 articles met the inclusion criteria and were used in the review. This scoping review demonstrates that there is no miracle cure, food or supplement that can cure or prevent COVID-19. Currently, there is no confirmed treatment or vaccine for the disease. Practicing healthy eating habits is the best nutritional recommendation during the pandemic. Hence, this review hopefully will provide evidence-based nutrition recommendations that are available for current COVID-19 treatment. We hope that the authorities can inform the public and media to stop the spread of nutrition pseudoscience in the wake of the COVID-19 pandemic.

Abstract Background Because of the increased risk for severe coronavirus disease 2019 (COVID-19), the Advisory Committee on Immunization Practices (ACIP) initially prioritized COVID-19 vaccination for persons in long-term care facilities (LTCF), persons aged ≥65 years, and persons aged 16–64 years with high-risk medical conditions when there is limited vaccine supply. We compared characteristics and severe outcomes of hospitalized patients with COVID-19 in the United States between early and later in the pandemic categorized by groups at higher risk of severe COVID-19. Methods Observational study of sampled patients aged ≥18 years who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and admitted to one of 14 academic hospitals in the United States during March–June and October–December 2020. Demographic and clinical information were gathered from electronic health record data. Results Among 647 patients, 91% met ≥1 of the following risk factors for severe COVID-19 [91% March-June (n = 434); 90% October–December (n = 213)]; 19% were LTCF residents, 45% were aged ≥65-years, and 84% had ≥1 high-risk condition. The proportion of patients who resided in a LTCF declined significantly (25% vs 6%) from early to later pandemic periods. Compared with patients at lower risk for severe COVID-19, in-hospital mortality was higher among patients at high risk for severe COVID-19 (20% vs 7%); these differences were consistently observed between March–June and October–December. Conclusions Most adults hospitalized with COVID-19 were those recommended to be prioritized for vaccination based on risk for developing severe COVID-19. These findings highlight the continued urgency to vaccinate patients at high risk for severe COVID-19 and monitor vaccination impact on hospitalizations and outcomes.

Objectives: This study investigated the predictors of risk perception and its effect on older adults’ preventive behavior and/or medical care avoidance during the COVID-19 pandemic. Methods: Older respondents (age >50 years) from the MIT COVID-19 Preventive Health Survey reported their social distancing, hand washing, mask wearing, and medical care avoidance between July and October 2020 ( n = 4395). Structural equation models were used. Results: Significant predictors of higher risk perception were female gender, older age, poorer health, city residency, personally knowing someone who had COVID-19, and correct knowledge of vaccine/treatment. Higher risk perception was subsequently associated with higher frequency/probability of practicing preventive behavior and/or avoiding medical care. Knowledge had the strongest path coefficient with risk perception. Discussion: Disseminating correct information to older adults could help them evaluate infection risk accurately. Educational programs on the precautions implemented at clinical settings to ensure patient safety may encourage older adults to seek timely medical care.

The emergence of the novel coronavirus pneumonia (COVID-19) pandemic at the end of 2019 led to worldwide chaos. However, the world breathed a sigh of relief when a few countries announced the development of a vaccine and gradually began to distribute it. Nevertheless, the emergence of another wave of this pandemic returned us to the starting point. At present, early detection of infected people is the paramount concern of both specialists and health researchers. This paper proposes a method to detect infected patients through chest x-ray images by using the large dataset available online for COVID-19 (COVIDx), which consists of 2128 X-ray images of COVID-19 cases, 8,066 normal cases, and 5,575 cases of pneumonia. A hybrid algorithm is applied to improve image quality before undertaking neural network training. This algorithm combines two different noise-reduction filters in the image, followed by a contrast enhancement algorithm. To detect COVID-19, we propose a novel convolution neural network (CNN) architecture called KL-MOB (COVID-19 detection network based on the MobileNet structure). The performance of KL-MOB is boosted by adding the Kullback–Leibler (KL) divergence loss function when trained from scratch. The KL divergence loss function is adopted for content-based image retrieval and fine-grained classification to improve the quality of image representation. The results are impressive: the overall benchmark accuracy, sensitivity, specificity, and precision are 98.7%, 98.32%, 98.82% and 98.37%, respectively. These promising results should help other researchers develop innovative methods to aid specialists. The tremendous potential of the method proposed herein can also be used to detect COVID-19 quickly and safely in patients throughout the world.

As the world reflects upon one year since the first cases of coronavirus disease 2019 (COVID-19) and prepare for and experience surges in cases, it is important to identify the most crucial ethical issues that might lie ahead so that countries are able to plan accordingly. Some ethical issues are rather obvious to predict, such as the ethical issues surrounding the use of immunity certificates, contact tracing, and the fair allocation of vaccines globally. Yet, the most significant ethical challenge that the world must address in the next year and beyond is to ensure that we learn the ethical lessons of the first year of this pandemic. Learning from our collective experiences thus far constitutes our greatest moral obligation. Appreciating that decision-making in the context of a pandemic is constrained by unprecedented complexity and uncertainty, beginning in June 2020, an international group of 17 experts in bioethics spanning 15 countries (including low-, middle-, and high-income countries) met virtually to identify what we considered to be the most significant ethical challenges and accompanying lessons faced thus far in the COVID-19 pandemic. Once collected, the group met over the course of several virtual meetings to identify challenges and lessons that are analytically distinct in order to identify common ethical themes under which different challenges and lessons could be grouped. The result, described in this paper, is what this expert group consider to be the top five ethical lessons from the initial experience with COVID-19 that must be learned.

Abstract Amentoflavone is one of the flavonoids that are known for their antiviral effects and many of them are predicted to have inhibitory effects against severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome Coronavirus (MERS-CoV) enzymes 3-chymotrypsin-like protease (3CLpro) and papain-like protease (PLpro). Amentoflavone is a biflavonoid found in the herbal extracts of St. John's wort (Hypericum perforatum), Gingko biloba, Selaginella tamariscina, Torreya nucifera, and many other plants. Its pharmacological actions have been listed as antiviral, antibacterial, antioxidant, anti-inflammatory, antidiabetic, antidepressant, and neuroprotective. Molecular docking studies have found that amentoflavone binds strongly to the active site of the main protease (Mpro) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As conventional antiviral medications are met with limited success against coronavirus disease-2019 (COVID-19) and vaccines are one of the only weapons against COVID-19 in the pharmaceutical armamentarium, traditional medicines are being considered for the forefront battle against COVID-19. Clinical studies with Hypericum and Gingko extract as additional or alternative drugs/supplements are registered. Here we review the potential of amentoflavone, an active agent in both Hypericum and Gingko extract as an adjunct therapy for COVID-19. Its anti-inflammatory, antioxidant, and sepsis preventive actions could provide protection against the “cytokine storm.” Compared with the herbal extracts, which induce cytochrome P450 (CYP) and uridine 5′-diphospho (UDP)-glucuronosyltransferases (UGT) activity producing a negative herb–drug interaction, amentoflavone is a potent inhibitor of CYP3A4, CYP2C9, and UGT. Further studies into the therapeutic potential of amentoflavone against the coronavirus infection are warranted.

Inequity in routine childhood vaccination coverage is well researched. Pandemics disrupt infrastructure and divert health resources from preventive care, including vaccination programmes, leading to increased vaccine preventable morbidity and mortality. COVID-19 control measures have resulted in coverage reductions. We conducted a rapid review of the impact of pandemics on existing inequities in routine vaccination coverage. PICO search framework: Population: children 0–18 years; Intervention/exposure: pandemic/epidemic; Comparison: inequality; Outcome: routine vaccination coverage. The review demonstrates a gap in the literature as none of the 29 papers selected for full-paper review from 1973 abstracts identified from searches met the inclusion criteria.

Abstract Purpose This report describes our process of 4 health systems coming together to agree on standard use criteria for remdesivir as a coronavirus disease 2019 (COVID-19) treatment for patients in Utah. We hope our process provides a framework for remdesivir use in other states and insights on future use of other therapeutic agents that may also be in short supply, such as vaccines and monoclonal antibodies. Summary Emergency use authorization (EUA) criteria for COVID-19 treatments often allow for broad use of a treatment relative to limited supplies. Without national criteria, each health system must develop further rationing criteria. Health systems in Utah worked together as part of the state’s crisis standards of care workgroup to develop a framework for how to limit the EUA criteria for remdesivir to match available supplies. The 4 largest health systems were represented by infectious diseases specialists, chief medical officers, and pharmacists. The group met several times online and communicated via email over a 9-day period to develop the criteria. The clinicians agreed to use this framework to develop criteria for future therapeutics such as monoclonal antibodies. Conclusion The unique collaboration of the 4 health systems in Utah led to statewide criteria for use of remdesivir for patients with COVID-19, ensuring similar access to this limited resource for all patients in Utah.

The development of rapid serological detection methods re urgently needed for determination of neutralizing antibodies in sera. In this study, four rapid methods (ACE2-RBD inhibition assay, S1-IgG detection, RBD-IgG detection, and N-IgG detection) were established and evaluated based on chemiluminescence technology. For the first time, a broadly neutralizing antibody with high affinity was used as a standard for the quantitative detection of SARS-CoV-2 specific neutralizing antibodies in human sera. Sera from COVID-19 convalescent patients (N = 119), vaccinated donors (N = 86), and healthy donors (N = 299) confirmed by microneutralization test (MNT) were used to evaluate the above methods. The result showed that the ACE2-RBD inhibition assay calculated with either ACE2-RBD binding inhibition percentage rate or ACE2-RBD inhibiting antibody concentration were strongly correlated with MNT (r ≥ 0.78, p < 0.0001) and also highly consistent with MNT (Kappa Value ≥ 0.94, p < 0.01). There was also a strong correlation between the two evaluation indices (r ≥ 0.99, p < 0.0001). Meanwhile, S1-IgG and RBD-IgG quantitative detection were also significantly correlated with MNT (r ≥ 0.73, p < 0.0001), and both methods were highly correlated with each other (r ≥ 0.95, p < 0.0001). However, the concentration of N-IgG antibodies showed a lower correlation with the MNT results (r < 0.49, p < 0.0001). The diagnostic assays presented here could be used for the evaluation of SARS-CoV-2 vaccine immunization effect and serological diagnosis of COVID-19 patients, and could also have guiding significance for establishing other rapid serological methods to surrogate neutralization tests for SARS-CoV-2.

There has been an increase in reporting clinical or radiological axillary lymphadenopathy after the coronavirus disease (COVID-19) vaccination. Cancer care is complex and multidisciplinary, which requires care events to be orchestrated promptly; radiology often serves a key role in diagnosis, post-diagnosis and is sometimes the patient’s first step in cancer care initiation, especially in breast cancer. Radiologists are also a key role in other Multidisciplinary Teams (MDT) dealing with different departments. Therefore, identifying unnecessary management within the health system can generally enhance the patient’s experience, reduce the pressure from providing extra health services, and reduce health costs. Based on personal observation and previous literature, the author concludes that patients having breast cancer or recent breast cancer diagnosis in the pre- or peri-treatment setting could benefit from receiving a vaccination, if possible, in the anterolateral thigh or contralateral arm regardless if this vaccine is for influenza, HPV, etc. Whether this is applicable for the COVID-19 vaccine remains unanswered. This approach will potentially reduce the patient anxiety from having a recurrence or failure of treatment and decrease the strain of the health care system both functionally and economically. In addition, this approach can potentially reduce or eliminate cancellations, delays, and rescheduling of relevant imaging modalities. Also, the author suggests adding a history of vaccinations to all the imaging request forms; countries with digital health services can reap the benefit of generating extensive epidemiological data of post-vaccination lymphadenopathy. Thus, creating new base-evidence guidelines for managing reactive post-vaccination lymphadenopathy, and potentially avoiding duplicating unnecessary imaging and patient over-treatment.

Covid-19 has brought about major changes for all people in various countries, for example creating vaccines, wearing masks and predicting the predictive state of death that will occur. In this paper, we will predict cases of covid-19 deaths using data taken from the worldometer website by taking data on daily covid-19 deaths worldwide in the period January 23rd- April 16th, 2020. Then the data is processed using the Poisson process that has been transformed using SPSS computer programming, namely the daily mortality rate in the period January 23rd - March 16th, 2020 using descriptive statistics, it was found that the death rate was 4 people in one day, then the Kolmogorov test followed the Poisson distribution, because it met the requirements for the P-value. value . Furthermore, it is calculated by using the death process, which is the chance of an event with the chance of death of all the corona suspects in the next 5 days, namely April 21 because the data has been transformed, so . the chance that no one will die within the next 45 days, namely April 30th, 2020 is close to. In the period of January 23rd - April 16th, 2020 using descriptive statistics, it was found that the death rate was 6 people in one day, then the Kolmogorov test was carried out with the results following the Poisson distribution, because it fulfilled the requirements for a P-value . Furthermore, it is calculated using the death process, which is the chance of an event with the chance of death of all the corona suspects in the next 5 days, namely April 21st, 2020 because the data has been transformed, so . The chance that no one will die within the next 45 days, namely May 31, is close to .

Covid-19 has brought about major changes for all people in various countries, for example creating vaccines, wearing masks and predicting the predictive state of death that will occur. In this paper, we will predict cases of covid-19 deaths using data taken from the worldometer website by taking data on daily covid-19 deaths worldwide in the period January 23rd- April 16th, 2020. Then the data is processed using the Poisson process that has been transformed using SPSS computer programming, namely the daily mortality rate in the period January 23rd - March 16th, 2020 using descriptive statistics, it was found that the death rate was 4 people in one day, then the Kolmogorov test followed the Poisson distribution, because it met the requirements for the P-value. value . Furthermore, it is calculated by using the death process, which is the chance of an event with the chance of death of all the corona suspects in the next 5 days, namely April 21 because the data has been transformed, so . the chance that no one will die within the next 45 days, namely April 30th, 2020 is close to. In the period of January 23rd - April 16th, 2020 using descriptive statistics, it was found that the death rate was 6 people in one day, then the Kolmogorov test was carried out with the results following the Poisson distribution, because it fulfilled the requirements for a P-value . Furthermore, it is calculated using the death process, which is the chance of an event with the chance of death of all the corona suspects in the next 5 days, namely April 21st, 2020 because the data has been transformed, so . The chance that no one will die within the next 45 days, namely May 31, is close to .

Det behövs sociologiska perspektiv för att belysa de många samhälleliga utmaningar som pandemin covid-19 har inneburit, såväl direkt som indirekt. Vi efterlyser därför aktuella och empiriskt grundade forskningsartiklar som utifrån sociologiska perspektiv kan öka vår förståelse av coronakrisen och pandemin covid-19. Relevanta frågor att belysa är till exempel expertkunskaper och relationen mellan vetenskap och politik, betydelsen av social ojämlikhet under pandemin samt dess sociala konsekvenser, samhällets organisering och styrning under kristider, de nya utmaningar som krishanteringsåtgärder skapar, hur människor agerar under kriser och hanterar ensamhet, isolering och permitteringar. Artiklarna kan handla om svenska förhållanden men även använda jämförande och internationella perspektiv för att förstå det som händer i Sverige i förhållande till andra länder. En världsomspännande hälsokris gör att vi alla behöver experter mer än någonsin, för att veta hur vi kan skydda oss mot viruset och för att ta fram vaccin eller andra effektiva behandlingar. Under pandemin covid-19 har vi sett att det finns en stor tilltro till vetenskap och teknik samtidigt som expertisen ständigt ifrågasätts. Expertkunskaper handlar aldrig enbart om faktaförhållanden utan även om hur problemen uppfattas och vem som har ansvar för att lösa dem. Sociologiska perspektiv på huruvida vetenskap uppfattas som är viktiga under kriser när experter dominerar debatten. Minst lika viktiga sociologiska teman är mellanmänskliga relationer, emotioner och människors drivkrafter. Vad är det som gör att vi agerar som vi gör i en kris? Vilken beredskap har människor och organisationer för att agera i en kris? Vi efterlyser också bidrag som uppmärksammar perspektiv som tenderat att falla bort i rapporteringen, till exempel frågor om ojämlikhet, konflikter, makt och ideologi. Det finns ett stort behov av empirisk forskning som undersöker hur coronakrisen och pandemin covid-19 har drabbat olika grupper och huruvida socioekonomiska skillnader, åldersskillnader och intressekonflikter har synliggjorts eller osynliggjorts under coronakrisen. Bidrag kan skrivas på svenska, engelska, danska och norska. Artiklar kan vara mellan 4 000 och 10 000 ord långa. I övrigt se tidskriftens riktlinjer på www.sociologiskforskning.se. Alla artiklar genomgår anonymiserad kollegial granskning (double blind peer review). Vid frågor, kontakta gärna någon av gästredaktörerna för temanumret. Deadline för manus är 15 oktober 2020 Gästredaktörer:Shai Mulinari, Lunds universitet: shai.mulinari@soc.lu.seLinda Soneryd, Göteborgs universitet: linda.soneryd@gu.seSusanna Öhman, Mittuniversitetet: susanna.ohman@miun.se

Background: The computer apparatus for electro-acupuncture diagnostics and medicated testing "IMEDIS-EXPERT" made in Russia was used for the purposes of this work to detect SARS-CoV-2 (COVID-19) or to prove its absence, and to select homoeopathic preparations, nosodes, and their relevant doses. The methods of the system-nosological approach (SNA) were used for the therapy of patients, which included recording and appliance of relevant control signals (C.S.) of homoeopathic preparations, both native and informational (electronic) copies. Aims: 1. Develop an algorithm to select preparations from the group of nosodes and homoeopathy to prevent the development of SARS-CoV-2 (COVID-19); 2. Evaluate the possibility of preventing treatment and therapy of coronavirus infection employing an "electronic vaccine" produced employing coronavirus C.S. Methodology: The electronic preventing "immunization" was made for patients as the preventing treatment of COVID-19, which was an adaptation to coronavirus C.S. conducted in accordance with a special algorithm. The three-block scheme of SNA therapy was used for the therapy of ill patients, which was composed of three preparations, which were used sequentially: 1. Control signal of coronavirus targeted on a patient's CMH; 2. Cerebral response (C.R.) with a patient's cumulative impact of: C.S. of coronavirus and the sum of target organs (blood-forming system, lymphatic systems, lungs, bronchus, gastrointestinal system) and test-indicators of immune regulation targeted on the second CMH marker amplification; 3. Drainages in the form of homeopathic preparations were used (after the impact of two previous preparations), which were: Arsenicum, Arsenicum iod, Carbo vegetabilis, Spongia, Drosera, Naya, Rhus Toxicodendron, and Ferrum met. The preparations were selected to compensate the third impact of CMH. Results: At present, 175 people have asked for help due to COVID-19, an electronic preventing vaccine ("immunization") made for 112 people on the SNA algorithm. According to the diagnostic testing results made for 63 ill patients and who asked for treatment: 47 people tested coronavirus infection, 16 people tested ARVI, and 12 people tested pneumonia caused by a virus. The coincidence of VRT tests (vegetative resonance tests) and PCR was found ranged from 68 to 75%. 4 people got ill by coronavirus among those who got preventing immunization (112 people) by "the electronic sensibilization method" (that was proved by VRT and PCR tests). The illness had the light form among 2 of them, and two people had moderate severity of illness without hospital admission. Conclusion: An algorithm is developed, which allows to select C.S. of therapeutic nosodes and homoeopathic preparations to prevent the development of SARS-CoV-2. The efficiency of applying the electronic immunization method according to the algorithms of SNA using coronavirus C.S. is 95%.

Accurate and rapid diagnostic tools are needed for management of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Antibody tests enable detection of individuals past the initial phase of infection and help examine vaccine responses. The major targets of human antibody response in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are the spike glycoprotein (SP) and nucleocapsid protein (NP). We have developed a rapid homogenous approach for antibody detection termed LFRET (protein L-based time-resolved Förster resonance energy transfer immunoassay). In LFRET, fluorophore-labeled protein L and antigen are brought to close proximity by antigen-specific patient immunoglobulins of any isotype, resulting in TR-FRET signal. We set up LFRET assays for antibodies against SP and NP and evaluated their diagnostic performance using a panel of 77 serum/plasma samples from 44 individuals with COVID-19 and 52 negative controls. Moreover, using a previously described SP and a novel NP construct, we set up enzyme linked immunosorbent assays (ELISAs) for antibodies against SARS-CoV-2 SP and NP. We then compared the LFRET assays with these ELISAs and with a SARS-CoV-2 microneutralization test (MNT). We found the LFRET assays to parallel ELISAs in sensitivity (90–95% vs. 90–100%) and specificity (100% vs. 94–100%). In identifying individuals with or without a detectable neutralizing antibody response, LFRET outperformed ELISA in specificity (91–96% vs. 82–87%), while demonstrating an equal sensitivity (98%). In conclusion, this study demonstrates the applicability of LFRET, a 10-min “mix and read” assay, to detection of SARS-CoV-2 antibodies.

BackgroundThe imperative for physical distancing (mostly referred to as social distancing) during COVID-19 pandemic may deteriorate physical and mental health. We aimed at summarising the strength of evidence in the published literature on the association of physical and mental health with social connection via social isolation, living alone and loneliness.MethodsWe conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social connection and any physical or mental health outcome. The findings were summarised in a narrative synthesis.ResultsTwenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. The results suggest that lack of social connection is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life and suicidal ideation.ConclusionsThe existing evidence clearly indicates that social connection is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures.

Abstract Background This research examines the equity implications of the geographic distribution of COVID-19 vaccine delivery locations in Aotearoa New Zealand under five potential scenarios: (1) stadium mega-clinics; (2) Community Based Assessment Centres; (3) GP clinics; (4) community pharmacies; and (5) schools. Methods We mapped the distribution of Aotearoa New Zealand’s population and the location of potential vaccine delivery facilities under each scenario. Geostatistical techniques identified population clusters for Māori, Pacific and people aged 65 years and over. We calculated travel times between all potential facilities and each Statistical Area 1 in the country. Descriptive statistics indicate the size and proportion of populations that could face significant travel barriers when accessing COVID-19 vaccinations. Results Several areas with significant travel times to potential vaccine delivery sites were also communities identified as having an elevated risk of COVID-19 disease and severity. All potential scenarios for vaccine delivery, with the exception of schools, resulted in travel barriers for a substantial proportion of the population. Overall, these travel time barriers disproportionately burden Māori, older communities and people living in areas of high socioeconomic deprivation. Conclusions The equitable delivery of COVID-19 vaccines is key to an elimination strategy. However, if current health services and facilities are used without well-designed and supported outreach services, then access to vaccination is likely to be inequitable. Key messages Organisations need to proactively plan for equity, including the delivery of COVID-19 vaccines. A social justice approach should be prioritised, and in Aotearoa Te Tiriti o Waitangi obligations must be met.

The rapid development of coronavirus disease 2019 (COVID-19) vaccines has not been met with the assurance of an effective and equitable global distribution mechanism. Low-income countries are especially at-risk, with the price of the vaccines and supply shortages limiting their ability to procure and distribute the vaccines. While the COVAX initiative is one of the solutions to these challenges, vaccine nationalism has resulted in the hoarding of vaccines and the signing of parallel bilateral deals, undermining this formerly promising initiative. Moreover, inequity in local distribution also remains a problem, with clear discrimination of minorities and lack of logistical preparation in some countries. As we continue to distribute the COVID-19 vaccines, pharmaceutical companies should share their technology to increase supply and reduce prices, governments should prioritize equitable distribution to the most at-risk in all nations and low-income countries should bolster their logistical capacity in preparation for mass vaccination campaigns.

Background: Mass coronavirus disease 2019 (COVID-19) vaccination to achieve herd immunity is an effective means to mitigate the current COVID-19 pandemic. Reports of COVID-19 vaccine-associated allergic reactions and lack of clear local guidance are contributing factors leading to a low vaccine acceptance rate in the community. A task force of experts from the Hong Kong Institute of Allergy (HKIA) has been formed to address current needs.Objective: To formulate a set of consensus statements (CS) on COVID-19 vaccine allergy safety (VAS) in Hong Kong.Methods: A nominated task force of experts managing patients with drug and vaccine allergies in Hong Kong formulated the CS by the Delphi method. An agreement was a priori defined as ≥80% consensus.Results: A total of 11 statements met the criteria for consensus with good overall agreement among task force members, including seven statements on pre-vaccination recommendations and four statements on vaccination and post-vaccination guidance. Individuals with a history of suspected allergic reaction to prior COVID-19 vaccination should not receive further COVID-19 vaccination, and other groups at risk of COVID-19 vaccine-associated allergic reactions have been identified. The importance of pre-vaccination and post-vaccination assessment by frontline healthcare workers and evaluation by allergists are highlighted.Conclusion: The CS provides pragmatic and timely guidance for local frontline healthcare providers on decisions regarding COVID-19 VAS.

Objective Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. Methods From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. Results Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. Conclusion Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.

Abstract To speed the development of vaccines against SARS-CoV-2, the United States federal government has funded multiple phase 3 trials of candidate vaccines. A single 11-member data and safety monitoring board (DSMB) monitors all government-funded trials to ensure coordinated oversight, promote harmonized designs, and allow shared insights related to safety across trials. DSMB reviews encompass 3 domains: 1) the conduct of trials, including overall and subgroup accrual and data quality and completeness; 2) safety, including individual events of concern and comparisons by randomized group; and 3) interim analyses of efficacy when event-driven milestones are met. Challenges have included the scale and pace of the trials, the frequency of safety events related to the combined enrollment of over 100,000 participants, many of whom are older adults or have comorbid conditions that place them at independent risk of serious health events, and the politicized environment in which the trials have taken place.

Antibody testing is vital in the study of the dangerousness, spread, identification of high-risk individuals and vaccine production against SARS-CoV-2. Viruses leave trails in the infected body and the immunologists turn out to be the detectives examining these viral footprints. There are two major types of tracks or memory responses that can be utilized by the body against reinfection: B cells which produce antibodies and T cells organising responses through cytotoxic cells and restricting viral replication. T cells’ memory of SARS-CoV-2 appears to last longer than antibodies and immunisation can activate T cells as well if it fails to induce long term antibody production. The immune history of SARS-CoV-2 is a huge jigsaw puzzle; several pieces are still missing. This viral research has met with a shortage of valuable foundational knowledge because of the sudden appearance of the virus and its spread. COVID-19 has posed an existential problem for the whole of human society.

Photo by Mufid Majnun on Unsplash INTRODUCTION In 2007, the Nuffield Council of Bioethics introduced the “Intervention ladder” as a guiding framework[1] to evaluate the impact on individual liberty of various public health measures. One criticism of the ladder is that it reflects a narrow view of liberty, yet other researchers adapted the intervention ladder to incorporate a more autonomy-based view. Recently, academics and public health officials have used intervention ladders as guides in framing policies, particularly COVID-19 pandemic policies.[2] Analyzing the Indian COVID-19 vaccination drive under these two ladders can illuminate the concepts of liberty underlying those ladders and help determine the best framework on a philosophical basis. ANALYSIS l. Case Study: The Indian COVID-19 Vaccination Drive On January 16, 2021, India attempted a public vaccination drive.[3] The drug regulatory body Central Drugs Standards Control Organization (CDSCO) approved two vaccines, Covishield and Covaxin, for emergency use.[4] The approval was granted despite a clear lack of phase 3 clinical trial data for both of these vaccines.[5] Covishield, produced by the Serum Institute of India, is the Indian variant of the Astra-Zeneca vaccine that has shown an average efficiency of 70.4 percent after trials in the UK.[6] Covaxin, manufactured by Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR) National Institute of Virology, was developed and manufactured in India. [7] Covishield relied on the safety and efficacy data from large trials conducted in Brazil, South Africa, and the UK with 24,000 participants and a small cohort for the Indian study. Covaxin was given approval based only on phase-1 trial data. [8] An article published in The Lancet called for further efficacy data from the Covaxin study.[9] The officials associated with Bharat Biotech, as well as the Indian Council of Medical Research, maintained that fast production of the vaccine does not indicate a compromise in safety, even though they had little data to produce.[10] However, transparency is key to vaccination policy, which requires public participation. The media reported that the Covaxin clinical trials compromised research integrity by providing a monetary incentive of around 7 euros, to research subjects. People’s University, a private medical college, and hospital, recruited survivors of the Bhopal Gas tragedy for the Covaxin study. The participants were told that they were being provided a vaccine against COVID-19 without clarifying that data was being collected for their clinical study. There was no record of informed consent from these participants for the Covaxin study.[11] The media reported the death of a 42-year-old individual who received his first dose on December 23, 2020. [12] Although it was reported that the cause of death was not linked to the vaccine, the death added to vaccine hesitancy. The vaccines were provided for free to the frontline healthcare workers with no choice on which vaccine the recipients would receive.[13] Similarly, in the US, some people do not have a choice between Pfizer or Moderna. In the UK and the US, data from phase 3 trials are known with a periodic follow-up after the administration of the second dose.[14] The WHO developed a tracking system for COVID-19 vaccine recipients which was updated on March 19, 2021, to reflect the results of Covaxin phase 3 trials.[15] India eliminated choice although the two vaccines approved for emergency use did not have the depth of research that those used elsewhere had. The intervention ladder, discussed below, which uses proportionality and the harm principle to justify the lack of choice between the vaccines in the UK and the US, should not be applied to India’s vaccination policy. ll. The Nuffield Intervention Ladder The foundational principle underlying the Nuffield Intervention Ladder is Mill’s conception of individual liberty from the prominent work, On Liberty.[16] However, the Council recognizes that the intervention ladder is conceived on a broader interpretation of Mill’s liberty, using the principle of proportionality as a tool for justification i.e., the desired effect from the intervention is proportional to the loss incurred in liberty.[17] As shown in Table 1, an ideal intervention that is least infringing would then be no intervention at all. An intervention that would be more difficult to justify would be one that significantly restricts individual liberty. Intuitively, eliminating occupies the topmost rung on the ladder. The metaphor of the ladder suggests that as one climbs up the rungs of the ladder, stronger justifications would be required. Table 1: Examples of interventions at each level of the intervention ladder adapted and improvised from the Nuffield Council of Bioethics Report, 2007. A voluntary vaccination policy is one public health intervention that is acceptable and justifiable in terms of the principle of proportionality as well as Mill’s Harm Principle, with emphasis on diminishing individual liberties when actions might result in harm to others.[18] Although a vaccination policy in the context of a global pandemic seems justifiable through the lens of the intervention ladder, the Indian modus operandi is unique because of inherent problems with the original conception of the intervention ladder. By pausing to elaborate and reflect on the Indian context as a case study, we can demonstrate that individual liberty should not be the sole variable in framing justifiability. lll. Critiquing the Nuffield Intervention Ladder & Adding a Precautionary Approach In his paper, ‘Snakes and Ladders: State Interventions and the Place of Liberty in Public Health Policy’, Angus Dawson criticizes the intervention ladder’s focus on individual liberty,.[19] and its inability to account for the different treatment of incentives and disincentives and the role of information. Public health institutions require public participation to restrict the infectious spread of COVID-19. The lack of transparency and minimal information surrounding the vaccines have been a major hurdle in increasing public participation. It is contradictory to think that the public does not require information about interventions and have the ability of self-determination to guide them, when in fact self-determination presupposes possession of relevant information. A voluntary vaccination policy can be seen as sitting on either the lowest rung (providing information) or the rung of enabling choice, as a vaccination campaign does both. However, in India, the precautionary principle should also be applied as providing the choice should not permit ‘harm’. The precautionary principle holds that anything that poses a risk to human health or the environment should be avoided or accompanied by precautionary measures. In India, because the clinical trials were smaller and there is less proof of safety and efficacy, a vaccination requirement, or a public health campaign to encourage vaccination violates the principle. The proportionality principle governing the intervention ladder only requires that the benefits of the intervention justify the restrictions on liberty. The intervention ladder should prevent requiring healthcare worker vaccination without a choice of vaccine because a free choice requires transparency and more information than is available from the small early-stage clinical trials. Actions surrounding the vaccines in India do not reflect proper precaution or a proportionate and thus acceptable restriction on liberty. If there is no ability to choose between the two possible vaccines, then they should not be mandatory for healthcare workers. The Indian government and its officials have urged healthcare worker compliance by invoking the seriousness of the pandemic and the alarming rates of mortality rather than providing transparent data pursuant to the regulatory mechanisms of the vaccine clinical trial. For a healthcare worker, the duty to provide service and a stronger obligation to do so in the time of a pandemic already imposes certain restrictions on their liberty. The lack of choice in opting for a preferred vaccine puts it on a higher rung on the intervention ladder and thus requires stronger justifications. This case study reveals how the same public health intervention falls on different rungs of the intervention ladder depending on the target group in consideration. Or to put this simply, choice is contextual. Table 2: The ethical values at stake when it comes to “choice” lV. An Autonomy-Based Intervention Ladder Liberty and autonomy differ slightly: liberty revolves around the constraints on the ability to act, whereas autonomy stresses on the independence and the authenticity of the willingness to act.[20] It is thus possible for an individual to be autonomous but unfree, as can be seen from the inability to opt for a preferred vaccine.[21] Figure 1 shows an adapted schematic of an autonomy-based intervention ladder as proposed by Griffiths et al. Figure 1: An adapted schematic of the autonomy-based intervention ladder proposed by Griffiths, P.E and West, C. In comparing the original intervention ladder with their proposal, we see that the autonomy-based model allows for a negative scale in terms of its effects on autonomy. Thus, on this ladder, actions can be autonomy-enhancing or autonomy-diminishing. Such a model challenges the one-directional view of the ladder and rearranges interventions on a scale that ranges from negative to positive. A few interventions that were shown to have restrictive effects on liberty now have reinforcing effects when viewed through the lens of autonomy. Thus, providing information and educating can be seen as positive reinforcements for autonomous choice rather than infringing on individual liberty. The autonomy-based intervention ladder requires the State to implement interventions and design policies in a manner that reinforces autonomy. Information and education allow individuals to be free and equal participants in public health discourses. As seen in the original intervention ladder restricting choice, as well as eliminating it, still fall in the negative, autonomy-infringing side of the ladder. Thus, requiring stronger justifications for their implementation. The only difference between the two is the manner in which the new model ensures the availability of a choice when the precautionary, as well as the proportionality principle, have not been met to a sufficient extent. Ensuring choice and exercising it becomes much more relevant in making people autonomous. The frontline worker thus can opt for a vaccine they prefer. Thereby, helping them navigate the moral conundrum of opting to get vaccinated, easing their moral burden. It also places strict vigilance over regulatory mechanisms that are involved in clinical trials since the burden of proof now involves providing information as a clear operational motive. This ameliorates public tendencies of hesitancy can be alleviated in this respect. An autonomy-based intervention ladder is not in conflict with Mill’s conception of liberty since Mill himself does not automatically assume a cost to liberty when the State seems to employ public education campaigns to inform the public.[22] CONCLUSION The original intervention ladder was conceived to remedy the hurdles that a traditional liberal landscape brings in implementing a public health intervention and to protect individual liberties. The intervention ladder assumes an inverse relationship between public health and freedom. Rethinking the intervention ladder from a different perspective allows a proper role of the dissemination of information, recognizing that consent relies on information. An autonomy ladder acts as a starting point for rethinking public health and how it can foster autonomy as well as impede it. By focusing on autonomy, the benefits that can be gained from educational and informational campaigns are viewed as reinforcing autonomy. Autonomy is vital to liberty. COVID-19 has brought a unique set of ethical issues that have questioned conventionally accepted frameworks and calls for a substantive, alternative approach to public health ethics. [1] Nuffield Council on Bioethics, “Public Health: Ethical Issues.” Nuffieldbioethics.org, Nov 13, 2007. www.nuffieldbioethics.org/publications/public-health. Accessed 9 May 2021. [2] Giubilini A, The Ethics of Vaccination [Internet]. Cham (CH): Palgrave Pivot; 2019. Chapter 3, “Vaccination Policies and the Principle of Least Restrictive Alternative: An Intervention Ladder.” 2018 Dec 29, 2018. www.ncbi.nlm.nih.gov/books/NBK538385/. [3] Dash, Sachinta. “India Begins Its COVID-19 Vaccination Drive — Here’s a Look at How the World’s Largest Vaccine Rollout Is Set to Take Place.” Business Insider India, January 16, 2021, www.businessinsider.in/india/news/india-will-begin-its-covid-19-vaccination-drive-tomorrow-heres-everything-you-need-to-know/articleshow/80281740.cms. Accessed 9 May 2021. ‌ [4] Special Correspondent, “Coronavirus | India Approves COVID-19 Vaccines Covishield and Covaxin for Emergency Use,” The Hindu, January 3, 2021, www.thehindu.com/news/national/drug-controller-general-approves-covishield-and-covaxin-in-india-for-emergency-use/article33485539.ece. Accessed 9 May 2021. ‌ [5] Thiagarajan, Kamala, “Covid-19: India Is at Centre of Global Vaccine Manufacturing, but Opacity Threatens Public Trust.” BMJ, January 28, 2021. www.bmj.com/content/372/bmj.n196, 10.1136/bmj.n196. [6] Thiagarajan, Kamala. [7] Bharat Biotech, “COVAXIN - India’s First Indigenous Covid-19 Vaccine | Bharat Biotech.” www.bharatbiotech.com/covaxin.html. [8] Prasad, R. “Coronavirus | Vaccine Dilemma — to Take or Not to Take Covaxin.” The Hindu, January 15, 2021, www.thehindu.com/sci-tech/health/vaccine-dilemma-to-take-or-not-to-take-covaxin/article33577223.ece. [9] Ella, Raches, et al. “Safety and Immunogenicity of an Inactivated SARS-CoV-2 Vaccine, BBV152: A Double-Blind, Randomised, Phase 1 Trial.” The Lancet Infectious Diseases, vol. 21, no. 5, January 21, 2021, pp. 637–646, www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30942-7/fulltext, 10.1016/S1473-3099(20)30942-7. [10] Thiagarajan, Kamala. [11] Thiagarajan, Kamala. ‌ [12] Nichenametla, Prasad. “Bhopal Volunteer’s Death Unrelated to Covaxin, Says Bharat Biotech.” Deccan Herald, 9 Jan. 2021, www.deccanherald.com/national/bhopal-volunteers-death-unrelated-to-covaxin-says-bharat-biotech-937199.html. [13] Thiagarajan, Kamala. ‌ [14] Thiagarajan, Kamala. ‌ [15] World Health Organization, “Draft Landscape of COVID-19 Candidate Vaccines.” www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines. Accessed 9 May 2021. ‌ [16] John Stuart Mill. On Liberty. 1859. S.L., Arcturus Publishing Ltd, 1859. [17] Nuffield. “Public Health: Ethical Issues.” [18] John Stuart Mill. On Liberty. p 13. [19] Dawson, Angus J. “Snakes and Ladders: State Interventions and the Place of Liberty in Public Health Policy.” Journal of Medical Ethics, vol. 42, no. 8, May 23, 2016, pp. 510–513, 10.1136/medethics-2016-103502. [20] Griffiths, P.E., and C. West. “A Balanced Intervention Ladder: Promoting Autonomy through Public Health Action.” Public Health, vol. 129, no. 8, August 2015, pp. 1092–1098, pubmed.ncbi.nlm.nih.gov/26330372/, 10.1016/j.puhe.2015.08.007 [21] Thaler, Richard H, and Cass R Sunstein. Nudge: Improving Decisions about Health, Wealth, and Happiness. London, Penguin Books, 2008. ‌ [22] Griffiths, P.E., and C. West.

Current perceptions of older adults are often met with prejudice and misconceptions that constitute what has been characterized as ‘ageism’. Rarely are older persons considered indispensable members of the population who deserve our respect and support. While it is unclear if and when this pandemic will end, what is clear is how COVID-19 has unveiled the prevalent ageist attitudes against older people, underscoring an unsettling discourse about age and human worth that has allowed us to easily question the value of older adults. In this commentary, we highlight specific recommendations that can be made to combat ageism during and after the COVID-19 pandemic, with exploration of vaccine administration and inequities across long-term care homes.

Abstract Background Animal models of COVID-19 have been rapidly reported after the start of the pandemic. We aimed to assess whether the newly created models reproduce the full spectrum of human COVID-19. Methods We searched the MEDLINE, as well as BioRxiv and MedRxiv preprint servers for original research published in English from January 1 to May 20, 2020. We used the search terms (COVID-19) OR (SARS-CoV-2) AND (animal models), (hamsters), (nonhuman primates), (macaques), (rodent), (mice), (rats), (ferrets), (rabbits), (cats), and (dogs). Inclusion criteria were the establishment of animal models of COVID-19 as an endpoint. Other inclusion criteria were assessment of prophylaxis, therapies, or vaccines, using animal models of COVID-19. Result Thirteen peer-reviewed studies and 14 preprints met the inclusion criteria. The animals used were nonhuman primates (n = 13), mice (n = 7), ferrets (n = 4), hamsters (n = 4), and cats (n = 1). All animals supported high viral replication in the upper and lower respiratory tract associated with mild clinical manifestations, lung pathology, and full recovery. Older animals displayed relatively more severe illness than the younger ones. No animal models developed hypoxemic respiratory failure, multiple organ dysfunction, culminating in death. All species elicited a specific IgG antibodies response to the spike proteins, which were protective against a second exposure. Transient systemic inflammation was observed occasionally in nonhuman primates, hamsters, and mice. Notably, none of the animals unveiled a cytokine storm or coagulopathy. Conclusions Most of the animal models of COVID-19 recapitulated mild pattern of human COVID-19 with full recovery phenotype. No severe illness associated with mortality was observed, suggesting a wide gap between COVID-19 in humans and animal models.

For the month of August 2021, APBN looks at some of the progress made in cancer research. In Features, we have Yie Hou Lee and Michael Birnbaum from the Singapore-MIT Alliance for Research and Technology Critical Analytics for Manufacturing Personalized-Medicine (SMART-CAMP) to share about the future of CAR T cell manufacturing. Next, a team of researchers from the National Neuroscience Institute, National University of Singapore, and the Duke-NUS Medical School enlightens us on the difficulty of treating glioblastoma brain tumours and how they plan to address its critical issues. Then we have Dr. Chi-Jui Liu and Hsiao Yun Lu to talk about hereditary cancers and how we may improve our odds in this game of roulette. In Columns, we have an analysis by Dr. Ping-Chung Leung on the integrative use of Traditional Chinese Medicine in managing treatment outcomes of COVID-19 patients and a reflection by Dr. Chris Nave on the lessons we can take away from the development of COVID-19 vaccines. Finally, in Spotlights, we share highlights from the Vaccines World Summit 2021 and an interview with Mr. Abel Ang, Group Chief Executive of Advanced MedTech on how their new venture AbAsia Biolabs can help meet Singapore’ need for increased COVID-19 test kits as we enter a new normal.

The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom. We encountered and overcame a number of challenges including differences in organisational structures, research facilities available, staff experience and skills, information technology and communications infrastructure, and research training and assessment procedures. We overcame these by setting up a project team that included key members from all three organisations that met at least daily by teleconference. This group together worked to identify the best practices and procedures and to harmonise and cascade these to the wider trial team. This enabled us to set up the trial within 25 days and to recruit and vaccinate the participants within a further 23 days. The lessons learned from our experiences could be used to inform the conduct of clinical trials during a future infectious disease pandemic or public health emergency.