COVID-19 and Vaccine Prevention

Project Report on Vaccine Hesitancy

• The project report is a systematic review of strategies for addressing vaccine hesitancy to identify effective strategies and evaluate their impact.
• The report is part of the MBA program at Dr. D.Y. Patil Vidyapeeth, Pune.

Objectives

• To identify published strategies related to vaccine hesitancy and hesitancy of other health technologies (reproductive health technologies).
• To map all evaluated strategies to the SAGE WG "Model of determinants of Vaccine Hesitancy".
• To evaluate relevant evaluated strategies relating to vaccine hesitancy using GRADE.
• To synthesise findings in a manner which aids the design of future interventions and further research.

Literature Review

• The review included a systematic literature review of peer-reviewed and grey literature on vaccine hesitancy.
• The review identified few evaluated interventions in the grey literature, with most studies focusing on high-income countries.
• The review also included a review of strategies used to address hesitancy around reproductive health technologies to seek relevant experiences outside of immunisation.

Results

• The review identified 15 PICO questions set out a priori by the SAGE WG, which were used to guide the evaluation of interventions.
• The results of the review are presented in a descriptive analysis of the findings, including the number of studies identified across the literature that acknowledged interventions relating to hesitancy (vaccines and RHTs), and whether these were evaluated or not.
• The review found that evaluated interventions were mainly from high-income countries, with few studies from low- and middle-income countries.

Literature Review on COVID-19 Pandemic

• The review identified several studies on the impact of the COVID-19 pandemic on education, including the effects on teaching and learning, and the need for alternative educational systems.
• The studies highlighted the importance of technology in education, particularly online learning, and the need for robust strategies to deal with the post-pandemic era.

Conclusion

• The project report provides a comprehensive review of strategies for addressing vaccine hesitancy and the impact of the COVID-19 pandemic on education.
• The review highlights the importance of evaluating interventions and identifying effective strategies to address vaccine hesitancy and improve education outcomes.### Research Methodology
• Methodology is the study of research methods, comprising theoretical analysis of methods and principles associated with a branch of knowledge.
• Methodology varies depending on historical development, creating a continuum of methodologies that stretch across competing understandings of knowledge and reality.
• Methodology can be visualized as a spectrum from a predominantly quantitative approach to a predominantly qualitative approach.

Search Methods

• Peer-reviewed literature search was conducted using Medline, Embase, PsychInfo, Cochrane, CINAHL Plus, Web of Science, IBSS, LILACS, and Africa Wide Info.
• Keywords used in the search included vaccine hesitancy, public trust, perceptions, concerns, confidence, attitudes, beliefs, and vaccination programmes.

Inclusion Criteria

• Articles that included research on vaccine hesitancy, public trust, perceptions, concerns, confidence, attitudes, and beliefs about vaccines and vaccination programmes.
• Keywords included in title or abstract, with focus on evaluating interventions addressing hesitancy.
• Location: Global, publication years: 2007-2013, vaccine: All vaccines, concerns: All concerns, populations: All, languages: All six UN languages.

Exclusion Criteria

• Not about vaccines, non-human vaccines, vaccines not currently available, non-peer reviewed papers.

BCG Vaccine

• The BCG vaccine is one of the most widely used vaccines worldwide, with a long history of use dating back to the early 20th century.
• Efficacy and effectiveness vary widely across different populations and settings, ranging from 0% to 80% protection against TB.
• Global vaccination coverage: around 90% among newborns, with disparities in coverage across regions and countries.
• The BCG vaccine has been credited with reducing childhood TB mortality and morbidity, preventing approximately 20% to 30% of TB cases in children.

DPT Vaccine

• The DPT vaccine is a combination vaccine that protects against diphtheria, pertussis, and tetanus.
• Vaccine components: diphtheria toxoid, tetanus toxoid, and killed Bordetella pertussis bacteria.
• Vaccine efficacy and effectiveness: highly effective in preventing diphtheria, pertussis, and tetanus when administered according to recommended schedules.
• Global vaccination coverage: 86% among infants, with disparities in coverage across regions and countries.

Pentavalent Vaccine

• The pentavalent vaccine is a combination vaccine that protects against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and hepatitis B.
• Vaccine components: diphtheria toxoid, tetanus toxoid, Bordetella pertussis, Haemophilus influenzae type b polysaccharide conjugated to a carrier protein, and hepatitis B surface antigen.
• Vaccine efficacy and effectiveness: highly effective in preventing diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and hepatitis B infections.
• Global vaccination coverage: 91% among infants, with high levels of vaccination coverage worldwide.

MR Vaccine

• The MR vaccine is a combination vaccine that protects against measles and rubella.
• Vaccine components: live attenuated viruses for measles and rubella.
• Vaccine efficacy and effectiveness: highly effective in preventing measles and rubella infections when administered according to recommended schedules.
• Global vaccination coverage: 86% with the first dose of the measles-containing vaccine, with efforts to increase vaccination coverage and eliminate measles and rubella.

Polio Vaccine

• The polio vaccine is a critical tool in the global effort to eradicate polio, a highly infectious viral disease that primarily affects young children.
• No further information provided on the polio vaccine.### Types of Polio Vaccine
• There are two main types of polio vaccines:
  • Inactivated Polio Vaccine (IPV): an injectable vaccine made from inactivated (killed) poliovirus strains, primarily used in countries where wild poliovirus transmission has been interrupted.
  • Oral Polio Vaccine (OPV): an oral vaccine containing live attenuated (weakened) poliovirus strains, used in routine immunization programs and polio eradication campaigns worldwide.

Polio Vaccine Components

• Both IPV and OPV protect against all three serotypes of poliovirus:
  • Poliovirus type 1 (PV1)
  • Poliovirus type 2 (PV2)
  • Poliovirus type 3 (PV3)

Administration of Polio Vaccines

• IPV is typically administered as a series of doses in infancy and childhood, with booster doses recommended in adolescence and adulthood.
• OPV is administered as part of routine childhood immunization schedules and supplemental immunization activities (SIAs) during polio eradication campaigns.

Global Polio Eradication Efforts

• The Global Polio Eradication Initiative (GPEI) was launched in 1988 as a public-private partnership aimed at eradicating polio worldwide.
• Since the launch of GPEI, global polio cases have declined by over 99%, from an estimated 350,000 cases in 1988 to just 33 reported cases in 2018.

Challenges and Strategies

• Challenges remain in achieving polio eradication, including:
  • Vaccine-derived poliovirus (VDPV) outbreaks
  • Gaps in vaccination coverage
  • Access issues in conflict-affected and hard-to-reach areas
• Strategies to address these challenges include:
  • Strengthening routine immunization programs
  • Conducting mass vaccination campaigns
  • Enhancing surveillance systems to detect and respond to polio outbreaks
  • Addressing community mistrust and vaccine hesitancy

Role of IPV and OPV

• Both IPV and OPV play complementary roles in polio eradication efforts:
  • IPV is used to maintain population immunity in countries where wild poliovirus transmission has been interrupted.
  • OPV is used for outbreak response and SIAs in high-risk areas.

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Sampling Methods

• Simple Random Sampling (SRS):
  • Each element of the population has an equal and independent chance of being included in the sample.
  • Merits: minimum knowledge of population required, free from subjectivity and personal error, provides appropriate data.
  • Demerits: cannot ensure representativeness, does not use knowledge about population.

Systematic Sampling

• An improvement over SRS.
• Merits: simple method, reduces field cost, inferential statistics may be used, sample may be comprehensive and representative.
• Demerits: not free from error, subjectivity in list creation, knowledge of population is essential.

Stratified Sampling

• Divides the population into strata based on some characteristics and draws a random sample from each stratum.
• Types: Disproportionate, Proportionate, Optimum Allocation.
• Merits: representative of the population, improvement over earlier methods, objective method.
• Demerits: difficult to decide on the relevant criterion, only one criterion can be used, costly and time-consuming.

Multi-Stage Sampling

• Selects primary sample units that are inclusive groups, and secondary units that are sub-groups within these units.
• Merits: comprehensive and representative of the population, improvement over earlier methods, objective procedure.
• Demerits: difficult and complex, errors in primary stages, subjective technique.

Cluster Sampling

• Selects intact groups as a whole, rather than individual members.
• Merits: easy method, economical, practicable, and highly applicable in education.
• Demerits: not free from errors, not comprehensive.

Non-Probability Sampling Methods

• Incidental or Accidental Sampling: selects samples because they are readily available.
  • Merits: easy, economical, frequently used.
  • Demerits: not representative, not free from errors, parametric statistics cannot be used.
• Judgment Sampling: selects samples based on available information.
  • Merits: uses knowledge of investigator, economical, better control of significant variables.
  • Demerits: reliability of criterion is questionable, knowledge of population is essential, errors in classifying sampling subjects.
• Purposive Sampling: selects samples based on judgment or assumption.
  • Merits: improvement over judgment sampling, easy sampling technique.
  • Demerits: not representative, not free from errors, influence of regional and social factors.
• Snowball Sampling: selects samples that go on increasing as the study proceeds.
  • Merit: can be converted into probabilistic sampling.
  • Demerit: sampling errors may creep in.

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Statement of Hypotheses

• A research hypothesis states what is expected to occur if various conditions are evoked or presumed.
• Should be presented in an affirmative form, rather than interrogative.
• Should be unambiguous, testable, and clearly defined.

Formulation of Testable and Significant Hypotheses

• Criteria:
  • Clearly stated in operational terms.
  • Specific and testable.
  • Research problems should be selected which are directly related to previous research or theoretical formulations.

Research Procedures

• Target Population: the universe of the study, should be thoroughly described.
• Sampling Plan: should specify the method of sampling, and ensure the sample is representative of the population.
• Research Design: should indicate how the research setting will be arranged to yield the desired data with minimum contamination/error.

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