Tag: vaccine hesitancy

Should Unvaccinated-by-choice COVID Patients Get Less Priority?

Credit: ATS

A new opinion piece provides an exhaustive examination of the ethics of using hospital resources on unvaccinated-by-choice COVID patients with pneumonia, versus patients with other serious but slower illnesses.

In his article published online in the Annals of the American Thoracic Society, William F. Parker, MD, PhD, looked at cases in which hospitals delayed time-sensitive and medically necessary procedures for vaccinated adults when they were overwhelmed with unvaccinated patients who had severe, life-threatening COVID pneumonia and suggested an ethical framework for triaging these patients.

“These vaccinated patients are directly harmed when hospitals use all their resources to care for the many unvaccinated patients with COVID,” he wrote.  “For example, delaying breast cancer surgery by just four weeks increases the relative risk of death from the disease by 8%.”

Dr Parker argues for a contingency care standard prioritising emergency life-support, regardless of vaccination status, in order to save the most lives.  “Simply rejecting the use of vaccination in prioritisation of medical resources without analysis ignores the very real tradeoffs at play during a pandemic.  The pain and suffering of the vaccinated from deferred medical care require a deeper defense of caring for the unvaccinated.”

Eliminating double standards
He stated: “Even though the vast majority of patients who develop life-threatening COVID pneumonia are unvaccinated, hospitals still have ethical obligations to expand capacity and focus operations on caring for them—even if it means making vaccinated patients wait for important but less urgent care like cancer and heart surgeries.”

“If tertiary care centers turn inward and stop taking transfers of COVID patients from overwhelmed community hospitals, this will result in de facto triage in favor of lower benefit care and cause systematic harm to both the vaccinated and unvaccinated in vulnerable communities,” he adds.  “Hospitals must justify their nonprofit status by accepting transfers and prioritizing life-saving care during a pandemic surge.”

He cited the example of a surge in Los Angeles, when the public health department had to issue an order forcing elite hospitals to stop doing financially lucrative elective procedures and accept patient transfers from community hospitals with ICUs overwhelmed by COVID.

Reciprocity and proportionality
The principle of reciprocity supports a possible tiebreaker role for vaccination status when two patients have equivalent survival benefit from a scarce health care resource. However, a universal exclusion of the unvaccinated from life support during a pandemic surge fails the test of proportionality for reciprocity, according to Dr Parker.

Reciprocity is rewarding one positive action with another. One example of this principle is giving vaccinated people access to sporting or entertainment events that are off limits to the unvaccinated (even if negative for COVID). Proportionality is the principle that ‘payback’ should be proportional to the magnitude of the act.  For example, living kidney donors get moved way up the waitlist- the equivalent of four years of waiting time on dialysis.  This satisfies the proportionality principle.

Dr Parker points out that while the increased relative risk of death of 8% from deferring breast cancer surgery is awful, the absolute increase in risk is only one per 100, and perhaps only one per 200 for a two-week deferral.
“After the surge is over, the hospital can catch up on deferred elective surgeries,” he wrote. “The harm from a coronary artery bypass or cancer surgery delayed two weeks is real, but tiny in comparison to certain death from denying life support for respiratory failure.”

He concluded that: “There is a defensible role for vaccination status in triage as a limited tiebreaker, not as a categorical exclusion, but only in the context of a well-defined and transparent triage algorithm.  Despite the enormous financial pressure to do otherwise, elite academic centres are obligated to prioritise life support for emergency conditions to save as many lives as possible during COVID surges.”    

Source: EurekAlert!

South Africa Faces Vaccine Glut as Uptake Slows

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South Africa has asked Johnson & Johnson and Pfizer to delay delivery of COVID vaccines as it has too much stock now, health ministry officials said, as vaccine hesitancy continues to slow the immunisation campaign.

About 35% of South Africans are fully vaccinated, still only half the government’s target of 70% by year end. In the past 15 days, an average of 106 000 doses a day have been administered. At the beginning of the year, the programme had been beset by a lack of doses for a wide range of reasons, from AstraZeneca’s ineffectiveness against the Beta variant to overseas production delays. 

Deputy director-general of the Health Department, Nicholas Crisp, told Reuters that South Africa had 16.8 million doses in stock and said that deliveries had been deferred.

A spokesman for the Health Ministry said: “We have 158 days’ stock in the country at current use. We have deferred some deliveries.”

Stavros Nicolaou, chief executive of Aspen Pharmacare, which is packaging 25 million doses a month of J&J vaccines in South Africa, said most of the vaccines bound for South Africa would now be diverted to the rest of Africa, and deliveries would likely be deferred until the first quarter of next year.

A Pfizer spokesperson said: “We remain adaptable to individual country’s vaccine requirements whilst continuing to meet our quarterly commitments as per the South Africa supply agreement.”

The government has been trying to boost the rate of daily administered doses, such as with R100 ‘Vooma vouchers’ for registering to vaccinate, but even these have failed to sufficiently stoke uptake.

“There is a fair amount of apathy and hesitancy,” said Wits University’s Professor Shabir Madhi.

On Twitter, he further suggested using the excess stock for booster shots, which would “provide all single dose JJ adult recipients a JJ or Pfizer boost, and  those > 65 or immunosuppressive conditions an additional Pfizer dose if received 2 doses > 5 months ago.” 

Source: U.S. News

Vaccine Hesitancy Among Caregivers of Childhood Cancer Survivors

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In a study published in Pediatric Blood & Cancerresearchers reported that caregivers of childhood cancer survivors expressed high rates of vaccine hesitancy, especially if they lacked confidence in governmental COVID response.

The researchers conducted a survey of 130 caregivers of childhood cancer survivors, 21% of caregivers expressed hesitancy to vaccinate themselves and 29% expressed hesitancy to vaccinate their children who had survived cancer.  

Caregivers who expressed confidence in the US government’s response to COVID were six times more likely to express willingness to self-vaccinate and were three times more likely to express willingness to vaccinate their children.  

Caregivers who reported that they were hesitant to vaccinate cited concerns about the speed of COVID vaccine development and a lack of safety and efficacy data in children, particularly children with cancer.

“Results suggest that COVID vaccination outreach to hesitant caregivers might be more effective when delivered by non-governmental organisations, including paediatric oncology care teams,” said senior author Kyle Walsh, PhD, of the Duke Cancer Institute. “Such providers are well-positioned to discuss potential risks and benefits of vaccination and to update families as longer-term outcomes data emerge from vaccine trials and registries.”

Source: Wiley

Feeling of Invulnerability against COVID Leads to Vaccine Refusal

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An international survey has found that people who do not believe that being infected with COVID could seriously threaten their health are both less likely to believe in the importance of preventing spread of the disease and less willing to get vaccinated. 

To contain COVID, it may be critical for individuals to feel concern about taking action to prevent transmission within their community. However  such concerns and actions could be impacted by a number of both individual and cultural factors. Leonhardt and colleagues hypothesised that one factor influencing pandemic concerns could be people’s perceived invincibility to COVID. The findings were presented in PLOS ONE.

To test this idea, the researchers analysed responses from over 200 000 people across 51 countries from an ongoing online survey. The survey included a question about how serious it would be to get infected with COVID, as well as questions about willingness to get vaccinated and taking action to reduce spread in one’s community. The researchers also accounted for participants’ overall health, age, sex, and level of education.

Respondents who reported feeling more  invincibile to COVID were less willing to get vaccinated, the researchers found, and also less likely to believe in the importance of individual actions to reduce transmission.

The strength of this link varied between countries. Individuals with high perceived invincibility living in countries with a greater emphasis on individual freedoms and autonomy, such as the US, were less willing to get vaccinated and less willing to take action than individuals with high perceived invincibility living in cultures with greater emphasis on collective action.

The authors say their findings highlight the importance of considering both individual and cultural factors when addressing pandemics. They suggest that suppression efforts employ messaging underscoring the importance of collective action, especially in individualistic cultures. Meanwhile, future research could further explore the impact of cultural factors on health beliefs and behaviours.

The authors added: “While feeling invincible may be beneficial in overcoming economic hardships or during periods of war, the results of our study suggest that it threatens the likelihood that people get vaccinated against COVID, and this is especially the case in individualistic countries, such as the USA, where people tend to focus on their own health rather than the collective health of their community.”

Source: EurekaAlert!

6 Tips For Communicating With the Vaccine-hesitant

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Bhekisisa writes that although there are a great number of people who are hesitant but not completely unwilling to take vaccines, there are a number of proven methods to help convince them to get their vaccinations. They offer six helpful tips to improve communication.

Early on during COVID vaccine trials, surveys showed that more than two thirds of adults globally said they would be willing to get on board when a vaccine became available. This was promising, but willingness to get vaccinated doesn’t necessarily translate into actual uptake.

In South Africa at least one poll showed similar results, yet so far just over 32% have actually followed through with getting at least one vaccine dose. There is some good news, though, as there is evidence showing that many people simply need the right approach.

Here are six things to take into account when encouraging hesitant people to get vaccinated.

1. Know the audience
To persuade people to get vaccinated, messages have to be tailored for the intended audience. For example, UK study showed that people seeking to be vaccinated may be receptive to messages public health benefits of vaccination, while those who are vaccine hesitant appear to be more interested about benefits for themselves.

2. Get the word out ASAP
A study in Nature found that the right timing of vaccine messages can increase appointments and subsequent vaccinations. Participants in the US received a text message inviting them to make a vaccination appointment either one day after becoming eligible or eight days after. The earlier text got 1.5 times as many people to make appointments than the later one.

In addition, making the booking also increased uptake, as almost 90% of participants who made a booking after receiving the text kept their appointments – and nearly everyone receiving their first dose got the second.

3. Allay people’s fears
The speed of the COVID vaccine rollout led some to question its safety. Studies from around the world show that fears about ingredients, safety and what many perceive as rushed approval processes deter people from getting vaccinated. This can be compounded by a lack of transparency around vaccine trials and ‘big pharma’ procurement deals can compound doubt and hesitancy.

Though vaccines have abundant evidence on their safety and efficacy, acknowledging that people’s fears are valid is important, as is showing empathy to make hesitant people more open to balanced, evidenced-based messages. At the same time, it is best to be honest about minor side effects, and contextualise how rare the severe side effects are.

The media scare over blood clots in the J&J and AstraZeneca vaccine generated the impression that they were far more frequent than they truly were: which were only one in a million for J&J and 4 to 6 million for AstraZeneca.

4. Name-dropping
Socially influential people can greatly increase vaccine uptake when they encourage others to do so and get one themselves. In 1956, during low uptake of the polio vaccine, Elvis Presley was shown getting his polio shot on TV. This spurred US teenagers to recruit their friends, resulting in a surge of vaccinations. Studies show that even encouragement within peer groups can motivate members to get vaccinated.

5. Ignore holdouts and focus on fence-sitters
A small percentage of people will not take the vaccine under any circumstances, and research shows that it’s virtually impossible to change their minds. About one in eight people are holdouts, while in South Africa the rate is roughly one in 15. While those who are merely hesitant may be persuaded over time, changing the minds of stubbornly resistant individuals is simply a waste of time and money.

6. Understand people’s realities
Historically, vaccination campaigns focused on busting myths and providing evidence-based information about vaccine safety and benefits. Yet opposition to COVID-19 vaccines (and also non-pharmaceutical interventions such as wearing masks and social distancing) seems more strongly rooted in people’s lack of institutional trust, and even a mistrust of government in general when faced with a large-scale epidemic.

There is also a distrust of vaccine arising from historical injustice, such as racism and government experimentation on unknowing individuals. A more recent example is American intelligence services using a vaccination in Pakistan to track down Osama bin Laden, which became something the Taliban used to discredit subsequent vaccination drives.

Source: Bhekisisa

The Complex Web of South African Vaccine Hesitancy

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A review of surveys towards COVID vaccines in South Africa has revealed that there are multiple factors at work, with an underlying scepticism towards vaccines in general that appears to be growing in the very face of the pandemic.

The findings, published in Expert Review of Vaccines, highlight the multi-faceted and unique aspects of vaccine hesitancy in South Africa, such as men being more likely to reject a vaccine.

Vaccine hesitancy is not new; two years before the emergency of COVID the World Health Organization identified it as a top ten threat to health, underscored by outbreaks of preventable diseases such as measles.

A previous review of 126 surveys in 2020 found a global decline of COVID vaccine acceptance from 70% in March to 50% by October. Vaccine hesitancy has been an obstacle in South Africa for a long time: it was a factor in various measles outbreaks from 2003 to 2011, and it became more apparent during the nation-wide school HPV vaccination programme begun in 2014.

The researchers searched for surveys on COVID vaccine hesitancy in South Africa up until 15 March 2021, with sample sizes ranging from 403 to 75 518.

Unlike elsewhere, men are more hesitant
In a survey by Ask Africa, men were more likely to distrust vaccines (39%) than women (26%). Of the women who would refuse, there was a higher percentage who would  However, women were more likely to take the vaccine even if they thought it was unsafe. The authors cautioned that this result should be interpreted with caution; however, Department of Health deputy director Dr Nicholas Crisp also recently pointed this out, suggesting that more recent survey data helped inform his opinion.
Curiously, this is in contrast to other COVID studies and other vaccine studies in general, which indicate that women are more hesitant than men when it comes to vaccines in general. 

Age, race, education, geographical location
Three of the studies found that age may be important, with older adults having less concerns and/or being more accepting of COVID vaccination. 

The COVID-19 Democracy survey found that people 55 or older were more likely to take the vaccine (74%) compared to those 18 to 24 years old (63%).
The same survey found that white adults were the least likely racial group to accept vaccination, with only 56% willing to be vaccinated compared to 69% of black African adults. Education was another factor, with just 59% of tertiary educated people willing to be vaccinated compared to 72% of this who did not complete high school.

Council for Medical Schemes (CMS) survey found that vaccine acceptance was higher (83%) in urban suburban settings compared to other settings (73% and 78%).

Doubts about safety significant
Three rounds of Ipsos survey data showed a huge drop in acceptance from 64% in July/August and 68% in October to 53% in December. Of those not accepting, concern about side effects as a reason rose from 30% in October to 65% in December.

The Ask Afrika survey indicated that stopping the roll-out of the AstraZeneca vaccine early this year reduced both levels of trust in vaccine safety and confidence in the process. 

Of particular concern were several surveys indicating South African antipathy to all vaccines; in the Ipsos surveys, about a quarter refusing COVID vaccines were also opposed to vaccines in general. Thus, this hesitancy to COVID vaccines, the authors suggest, is just the tip of the iceberg of South African vaccine hesitancy.  Indeed, the Africa CDC survey indicated that at least one in five South Africans were less likely to get vaccinated in general than before the pandemic.

More research and targeted messaging needed
Overall, the authors found about a third of the adult South African public is hesitant towards COVID vaccines. Age, race, education, geographic locations and possibly gender all influence the social nature of vaccine acceptance in South Africa.

The authors conclude that responding to vaccine hesitancy, including COVID vaccine hesitancy, requires a better understanding of the often complex and multi-layered issues influencing vaccination views and practices, and tailoring interventions accordingly. Individualistic, decontextualised, and ‘one-size-fits-all’ approaches are unlikely to have great success.

Source: Expert Review of Vaccines