As this week’s Queensland COVID-19 outbreak and snap lockdown shine a spotlight on glitches and failures in Australia’s vaccine rollout, the latest COVID-19 Wrap has an important focus on Israel’s success and its use of penalties as well as incentives for vaccine uptake.
Public health researcher Alison Barrett also reviews other new research, including PTSD and other mental illness in patients who experienced severe COVID-19 and the importance of early identification and management of delirium in COVID-19 patients.
She also includes useful resources for vaccine communications.
COVID-19 in Israel: incentives for vaccine, and promising findings
Publication: Incentivizing vaccination uptake: the “green pass” proposal in Israel by Wilf-Miron, R, Myers, V, Saban, M, on 15 March 2021, in JAMA Network
As of 27 March 2021, Israel had fully vaccinated 54.4 percent of its population with two doses of the Pfizer-BioNTech vaccine and administered at least one dose to 60.3 percent of the population.
This is the highest proportion of any country’s population to be vaccinated against COVID-19, and is a result of many factors including, but not limited to, Israel’s relatively small population of 9.3 million people, its centralised national government that has primary responsibility for the vaccine rollout plan and implementation, and a strong health system with experience in responding to emergency health situations.
Israel also has an agreement with Pfizer where it will provide Pfizer with anonymous epidemiological data from Israel’s vaccine program, and Pfizer will maintain sufficient delivery of the vaccine to achieve herd immunity.
According to the authors, Israel aims to achieve a 95 percent immunisation rate. To achieve this, the Israeli government has considered various models of incentive or enforcement, such as making vaccination compulsory.
However, amid concerns that compulsory vaccination infringes on human rights, the Israeli Government implemented a “green pass”, an incentive model that allows people to have access to gyms, hotels, restaurants, social, cultural and sporting events if they are immune to COVID-19 (by vaccination or being previously infected with the virus).
The “green pass” can be downloaded from the Israeli Ministry of Health website or app, or as a printed document with a QR code. It is valid for 6 months and also exempts people from having to quarantine if they are returning from international travel or been in contact with someone who has COVID-19.
Outlining details in in JAMA Network, the authors wrote, “as opposed to traditional incentives, the green pass allows entry to certain places for individuals who have been vaccinated while penalising those who have not.”
Concerns have been raised about this type of incentive, also being discussed in the UK, that it discriminates against those who won’t or can’t get vaccinated for religious, health, limited access or other reasons.
While off to a great start, the vaccination campaign has slowed down in recent weeks. As the “green pass” only came into effect on 21 February 2021, it is too early to tell if it will have an impact on vaccination rates.
The authors acknowledge that while the “green pass” incentive may motivate some to get vaccinated, systemic barriers, such as access, appropriate and reliable information and health literacy, need to be addressed.
Due to the large proportion of people vaccinated in Israel, sufficient data has been collected to assess the effectiveness of the Pfizer vaccine in the population.
Results have recently been published in the New England Journal of Medicine and highlight that the Pfizer vaccine is 94 percent effective at preventing symptomatic COVID-19 and 92 percent effective against severe disease, similar to findings from the Phase III clinical trial, and consistent across all age groups above 16 years.
These results provide promising evidence for the effectiveness of Pfizer COVID-19 vaccine.
PTSD and other mental illness in patients who experienced severe COVID-19
Publication: Posttraumatic stress disorder in patients after severe COVID-19 infection, by Janiri, D, Carfi, A, Kotzalidis, G, on 18 February 2021, in JAMA Psychiatry
A COVID-19 post-recovery health check in Rome has found that one-third of patients who had recovered from COVID-19 had post-traumatic stress disorder (PTSD).
The health checks were part of a post-acute care service established at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS hospital in Rome in April 2020.
In trying to understand more about post-acute symptoms and care needs of COVID-19 survivors, patients in the post-acute care service underwent a variety of medical and psychiatric assessments, including a PTSD screening.
In addition to PTSD, patients experienced depression (17.3 percent of patients), generalised anxiety (7 percent of patients) and hypomania (0.1 percent).
Patients with PTSD were more commonly women and who reported higher rates of history of mental health issues and agitation or delirium during the acute phase of illness.
While representing a small sample size and participants from a single centre, the results from 381 assessments reported in this research letter highlight the mental health impact of COVID-19, and the need for appropriate post-COVID-19 care.
Prevention and management of delirium in older adults
Publication: The importance of delirium and delirium prevention in older adults during lockdowns, by Inouye, S, on 15 March 2021, in JAMA Insights
While only comprising 9 percent of the global population, people 65 years and older have accounted for 30 to 40 percent of all COVID-19 cases, and are at a higher risk of experiencing severe disease, admission to hospital and intensive care, and death from the virus.
Studies published in 2020 found that delirium, also known as acute brain failure, occurred in 25 to 37 percent of older adults hospitalised with severe COVID-19 and more than 65 percent of older adults who were admitted to intensive care.
Delirium is one of the most common symptoms in older adults presenting with COVID-19 at emergency departments, and in one-third of patients occurs without the presence of usual COVID-19 symptoms, such as fever and cough.
Because of the association between delirium and increased mortality, it is important for delirium to be identified early in patients and managed appropriately.
However, effective prevention and management approaches include regular exercise and mobilisation, communication with family and other social connection and engagement, all of which are challenging to implement with the necessary infection control measures in hospitals and intensive care units.
Inouye outlined some interventions that could be implemented whilst adhering to infection control measures:
- Remote visits, communication and activities with family multiple times each day on tablet computers.
- Therapeutic activities such as crosswords and games.
- Enhancing sleep with provision of ear plugs, eye mask and relaxation techniques.
- Encouraging exercise and mobility to be undertaken in the hospital room.
She concluded: “Families should be involved as part of the caregiving team to enhance both short-term and long-term outcomes of delirium for this vulnerable population.”
Evidence-based approaches to promoting physical distancing measures
Health Evidence Network synthesis report: What are relevant, feasible and effective approaches to promoting acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control? By Ryan, R et al., World Health Organization Europe, 2021
A rapid review was conducted to determine the current evidence about approaches to promoting the acceptance, uptake and adherence to physical distancing measures to prevent COVID-19.
Key findings from the review:
- Public communication about physical distancing measures is critical, and should be clear, consistent, actionable and tailored appropriately to the audience.
- Practical support, such as access to financial support and essential services is important in promoting acceptance and adherence to the measures.
- Public trust in authorities needs to be built and maintained by being consistent, acknowledging uncertainties and considering inequalities in populations that may influence acceptance and adherence to physical distancing.
- Local stakeholders should be engaged in the planning and communication of responses to outbreaks.
The full report can be read here.
Resources for vaccine communication
Guide for talking to friends and family who are feeling unsure about COVID-19 vaccines, by Willis, O, with illustrations by Seselja, E on 29 March 2020, ABC News
ABC Health Reporter, Olivia Willis, consulted three experts in the area of vaccine uptake, Dr Katie Attwell, Dr Jessica Kaufman, and Professor Julie Leask, and developed this guide for tackling conversations with friends and family who are hesitant about the COVID-19 vaccine.
Recommendations for developing COVID-19 vaccine communication materials, National Centre for Immunisation Research and Surveillance Australia, 25 March 2021.
Australia’s National Centre for Immunisation Research and Surveillance published an evidence-based guideline for developing COVID-19 vaccine communication materials.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
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