Amy Booth, MPH
Research Project Manager, Global HPV Control

Claire Lenouvel, MD, CCFP
Family Physician

In mid December 2020, after months of restrictions and closures, changing public health measures and general uncertainty, people across British Columbia were relieved and excited to hear news of an approved COVID-19 vaccine that would soon be available. However, some British Columbians were uncertain about this new development in the control of the COVID-19 pandemic. While many people booked vaccination appointments with urgency, others were more hesitant, and took their time deciding whether to receive the vaccine.  

In recent years, vaccine hesitancy has been a growing concern in British Columbia, across Canada, and around the world, with the World Health Organization naming vaccine hesitancy as one of the top 10 threats to human health. “Vaccine hesitancy” is a complex concept made up of attitudes, beliefs, and behaviours toward vaccination, but ultimately refers to a delay in acceptance or the refusal of a vaccine, despite the vaccine being readily available.  

Through an online research survey, and with the support of the BCCDC Foundation, Principal Investigators Dr Claire Lenouvel and Dr Gina Ogilvie sought to investigate rates of vaccination among employees of the Northern Health Authority (NHA), and more specifically, sought to better understand vaccine confidence and vaccine hesitancy in individuals working in healthcare settings in Northern BC. With an understanding of the factors that contribute to vaccine hesitancy, public health leaders and Medical Health Officers are able to more effectively address concerns and communicate with the public on issues around vaccines, and strengthen public health programs for future vaccination campaigns.

In this study, individuals working in healthcare settings were of interest for two reasons: 1) they are regularly in close contact with the most medically vulnerable in our society, and therefore, can potentially transmit infection to them, and 2) they are at an elevated risk for infection themselves, due to workplace exposures from sick individuals. The Principal Investigators chose the NHA as the focus region because, at the time, there was concern about COVID-19 vaccination uptake rates from several communities located in the Northern Health Authority. As well, Dr Lenouvel is a resident physician in Northern BC and was especially interested in the topic!

With support from the Medical Health Officers and NHA, Dr Lenouvel was able to collect over 1,700 responses to the online survey from Northern Health employees from July to November 2021. The survey asked individuals about their COVID-19 vaccination history, intentions to receive future COVID-19 vaccines, and their attitudes toward COVID-19 vaccines in general.

Out of 1,700 survey responders, 92% reported that they had received one dose of a COVID-19 vaccine, and 88% had received a second dose. Overall, respondents had positive attitudes toward COVID-19 vaccines, with 89% believing COVID-19 vaccines were beneficial. This was encouraging news; however, the rates of vaccination were not the same across all places of employment, and across all professions.

Among all survey responders who had received two doses of a COVID-19 vaccine, their reasons for getting vaccinated included: concerns about others’ safety, the threat of losing employment, wanting the pandemic to end, and working in public and not wanting to get sick.

Employees in long-term care homes and assisted living facilities had lower rates of COVID-19 vaccinations, which was concerning given the high COVID-19 infection and mortality rates observed in both these settings throughout the pandemic. Licensed Practical Nurses (LPNs) and Care Aides (CAs) also had lower rates of vaccine uptake compared to other healthcare sector groups, like physicians and registered nurses.

Among LPNs and CAs, reasons for remaining unvaccinated included: not believing that COVID-19 vaccines are safe, not believing that COVID-19 vaccines are beneficial, and not believing that COVID-19 vaccines would reduce risk at work.

The investigators also wanted to know how Northern Health employees felt about required vaccines. They found that 76% of respondents felt that COVID-19 vaccines should be required for healthcare professionals, and 74% felt that COVID-19 vaccines should be required for high-risk settings, while only 59% of respondents believed that COVID-19 vaccines should be required for everyone.

Finally, vaccinated respondents were asked if they would receive seasonal COVID-19 vaccine boosters if offered and available, and 83% said they would be likely to receive a seasonal booster.

With funding from the BCCDC Foundation, this local research helped to uncover important findings about vaccine hesitancy and vaccine confidence among NHA employees during the COVID-19 pandemic. The findings from the research were shared with Medical Health Officers in the region and are helping to shape future workplace vaccine campaigns to support the health of employees and the community. 

The post Researchers Examine Vaccine Confidence and Hesitancy in Healthcare Settings in Northern BC appeared first on Pacific Public Health Foundation.

The post Newsletter #35: April 2022 appeared first on Pacific Public Health Foundation.

The introduction of vaccination for COVID-19 was a game-changing moment in our pandemic, and equally important was the immediate launch of research to study the new vaccine technologies, and to monitor the effectiveness of SARS-CoV-2 vaccines in the real world and in real time.

Through one of the most critical COVID-19 projects we are funding, Dr Danuta Skowronski, Epidemiology Lead, Influenza & Emerging Respiratory Pathogens at the BC Centre for Disease Control (BCCDC), is leading this novel and real-time vaccine effectiveness research. Vaccine effectiveness (VE) looks at strength, durability, and interchangeability (protection offered when mixing vaccines), among other factors, and allows researchers and public health experts to learn about vaccines in real-world populations (this is different from efficacy, which is based on clinical trial data).

VE monitoring is critical in guiding vaccine policies and programs (e.g., target populations, intervals between doses, number of booster doses), and it is this monitoring that informs changes to vaccine programming and evidence-based decision-making, especially in relation to variations in pandemic waves and variants of concern (VOC).

Early work included reporting of the strength and duration of SARS-CoV-2 vaccine protection against infection, including emerging VOC and serious outcomes. This included:

• Single-dose effectiveness in healthcare workers and long-term care facility residents;
• Comparing mRNA vaccines versus AstraZeneca effectiveness in younger adults;
• The strength, durability, and interchangeability of two-dose VE including mixing different types of vaccines and extended intervals between doses.

Early findings demonstrated:

• The mRNA formulations gave higher protection against infection compared to AstraZeneca, but both provided excellent protection against severe outcomes.
• An AstraZeneca dose, plus a single dose of an mRNA vaccine in a mixed two-dose schedule, is as effective as two mRNA doses.
• Protection was better with a longer interval between first and second doses, and that the decision to extend the interval between first and second doses in BC not only brought first dose protection to more people more rapidly, but it also may have resulted in better responses to one’s second dose.

Recent findings are demonstrating that:

• Two-doses of vaccine provided protection against the Delta variant in both teens and adults.
• As we transitioned from Delta to Omicron, VE against infection decreased, but against hospitalization it remained comparable.
• With the rise of Omicron in December 2021, two-dose protection against severe outcomes was also well-maintained in adults.
• A third vaccine dose boosted protection from Omicron for adults, but less so than for Delta, and offered comparative protection against hospitalization.
• The incremental value of booster doses during times of low incidence (not in a ‘wave’) needs further study.

Perhaps you’ve learned about some of these findings in Dr Henry’s modelling updates, demonstrating why research like this is vital to the progression of the COVID-19 pandemic, to our understanding of vaccination, for decision-making around vaccine programming, and to care for our population as we experience differing waves or periods of high incidence versus low incidence.

Both early and recent findings, as well as continued findings as this work progresses, have been, and will continue to be, used to guide decisions for vaccination in BC. With the loosening of public health restrictions, and the transition to weighing one’s own personal risk and self-management (going at your own pace), vaccination will continue to be critical in our ability to protect ourselves and others from COVID-19.

For vaccination to continue to offer this protection, we have to understand how the evolution of SARS-CoV-2 impacts vaccines and how well they work—across all age groups, in all settings, and against new VOC. Ongoing monitoring of VE is critical to assess: potential waning of vaccine protection; impact of booster doses; protection in children; and with continued evolution of VOC, evaluating the strength, durability, and interchangeability of vaccines is an ongoing need for all target groups.

For this reason, we are partnering with the BC Ministry of Health, the BCCDC, and private donors to ensure this research can continue to provide critical evidence, for as long as our pandemic continues to impact BC, and the world. It is research like this that has been shaping our pandemic response in BC, and saving lives; and it is research like this that will ensure we keep everyone protected as we look ahead and learn to live with COVID-19 as safely as we can.

Vaccination remains our strongest tool in our toolkit, and we need to understand vaccine effectiveness in real-time and continue monitoring and providing evidence for decision-making. Findings from this research have already had substantial impacts on public policy provincially, nationally, and internationally. If you’d like to support this work, you can donate via our Emergency Response Fund.

The post Monitoring the Effectiveness of SARS-CoV-2 Vaccines in British Columbia appeared first on Pacific Public Health Foundation.