The findings come amid documented inequities in routine vaccination among Native Hawaiian and Pacific Islander communities in the United States, a group that also faces a higher risk of death from HPV-related cervical cancer than other populations. The researchers said broad category labels can obscure cultural, social and linguistic differences within those communities, including the experiences of Tongans.

The researchers conducted three focus group discussions in February and March 2024 with Tongan adults aged 18 and older who lived in Utah. Groups were conducted in English and Tongan. The study used the Socioecological Model and Social Cognitive Theory to examine behavioral, social and cultural influences on general vaccine attitudes and HPV literacy, experience and access.

Participants showed a generational pattern in where they preferred to obtain vaccine information. Those younger than 55 relied mainly on social media, whereas participants aged 56 to 65 and older expressed greater confidence in healthcare providers. The older group emphasized the importance of trust between patients and physicians, identifying that relationship as central to confidence in vaccination decisions.

Within families and households, participants described conformity with traditional gender expectations as a major influence. Tongan women were viewed as the primary caregivers and health decision-makers, with much of the responsibility for household health decisions, including vaccination, assigned to them. The study therefore identified gender and family roles as important parts of the environment in which vaccine acceptance and refusal were considered.

Vaccine hesitancy within close social circles was strongly influenced by misinformation, according to the participants. Their accounts also highlighted the strong reliance on traditional medicine and religious leaders in Tongan communities. At the same time, participants said discussions of sexual health and sexually transmitted diseases are constrained by social stigma. The findings indicate that misinformation and culturally influential sources operate alongside limited discussion of subjects directly relevant to HPV vaccination.

At the societal level, participants identified several structural barriers: inadequate insurance coverage for preventive and therapeutic services, limited access to health information in culturally and linguistically appropriate forms, and under-representation of Tongans among healthcare providers and staff. These gaps were described not only as problems of individual knowledge but also as conditions affecting whether useful information and services could be reached and trusted.

As a qualitative pilot study, the research was designed to explore experiences and perceptions rather than estimate vaccination rates or test an intervention. Its sample was small and geographically limited to Tongan adults in Utah, and the findings arose from three facilitated discussions conducted in two languages. The authors said the results underscore the need for culturally specific and culturally humble vaccine messaging and strategies at multiple social-ecological levels, particularly to address misinformation and barriers affecting HPV vaccine awareness and acceptance.

Subject of Research: Tongan adults’ vaccine attitudes, HPV awareness and access barriers in Utah

Article Title: Navigating vaccine beliefs: a qualitative pilot study of general vaccine attitudes and HPV awareness among Tongan adults

Article References: Obray, A. M., Skyles, T. J., Poole, B. D., Bashford, T. M., Hoelzer, H., Davis, S. C., Petersen, L. G., Fox, D., Sloan, D. S., Vergara, M. A. C., & Novilla, M. L. B. (2026). Navigating vaccine beliefs: a qualitative pilot study of general vaccine attitudes and HPV awareness among Tongan adults. BMC Public Health. https://doi.org/10.1186/s12889-026-29627-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29627-9

Keywords: Tongan adults, HPV vaccine, vaccine hesitancy, cervical cancer, health disparities, Utah, cultural competence, health misinformation, focus groups, public health, Navigating, vaccine

Review author Ibrahim Npochinto Moumeni describes the work as a narrative review prepared with recommendations from SANRA, using purposive searches of PubMed, Scopus and Google Scholar. The initial search covered January 2019 to December 2022 and was updated to December 2025 to capture later publications reporting data collected during 2020 and 2021. Sources included systematic reviews, large multicentre studies, official agency reports and selected French research. The 49-source evidence base was selected thematically rather than through a systematic screening process, and individual studies did not receive formal quality appraisal. First-person observations from the author’s postgraduate training in two French university hospitals were kept separate from the literature and were not used to support quantitative claims.

Health-worker mortality was one of the review’s central subjects. WHO estimated that between January 2020 and May 2021, 80,000 to 180,000 health and care workers died from COVID-19, with a central estimate of 115,500. Over the same period, 6,643 health-worker deaths had been reported through surveillance, less than 6% of the central estimate. Early systematic-review data through 8 May 2020 identified 152,888 infections and 1,413 deaths among health workers. Infections were concentrated among women, who represented 71.6% of cases, and nurses, who accounted for 38.6%; deaths were concentrated among men, who represented 70.8% of fatalities, and physicians, who accounted for 51.4%. In the United Kingdom and United States, front-line workers had an adjusted 3.4-fold higher risk of a positive test than the general community, with risk increasing further where protective equipment was inadequate or reused.

Although the United States did not produce an official national count, an investigative journalism database documented more than 3,600 health-worker deaths during the first pandemic year and found that lower-paid staff, including nurses and support workers, were disproportionately represented. The review also reports psychological distress among health workers, citing a meta-analysis with pooled prevalences of 23.2% for anxiety, 22.8% for depression and 38.9% for insomnia. From the synthesis and the author’s clinical observations, the paper proposes Frontline Abandonment Syndrome as a possible description of temporary or prolonged withdrawal from high-risk duties and its consequences for continuity of care. This is a hypothesis rather than a diagnosis or validated syndrome; it differs from burnout, moral injury and compassion fatigue by focusing on observable withdrawal and organisational conditions such as protective-equipment availability and communication.

Vaccine hesitancy was another major focus. Defined in the review as delay in accepting or refusing vaccination despite its availability, hesitancy was reported in 37% of 4,630 health workers surveyed across 91 countries between February and April 2021. A separate review involving 76,471 workers estimated hesitancy at 22.5%, while a scoping review of 41,098 nurses in 36 countries found a pooled refusal prevalence of 20.7%. The nurse review found refusal prevalence was higher in 2020 than in 2021. Reported reasons included safety concerns, side effects, doubts about efficacy, misinformation and mistrust of authorities or pharmaceutical companies. The figures cannot be compared directly because the studies used different populations, periods and definitions, and the review notes this limitation explicitly.

French data showed an occupational gradient at the beginning of the vaccination campaign. In a February 2021 survey of 1,965 workers at a tertiary centre, 73.1% favoured vaccination, 23.1% were hesitant and 3.9% opposed it. Fewer than 60% of auxiliary nurses and technicians intended to be vaccinated, compared with 60% to 79% of nurses and support staff and more than 80% of medical personnel. Controversy surrounding AstraZeneca tolerability was independently associated with lower vaccination intention. The review also discusses the temporary European pause involving France in March 2021 and the legal requirement introduced in France on 5 August 2021. From these observations, the author proposes the Vaccination Refusal Cascade, a hypothesis in which a salient institutional or media event triggers successive refusals across professional networks. The French association is consistent with that idea but does not demonstrate that such a cascade occurred.

Physiotherapy guidance developed during the pandemic addressed respiratory management, patient positioning, early mobilisation and exercise prescription under strict infection-control conditions. A Stanford Hall consensus described post-discharge rehabilitation, including a graded return to activity, while a rapid living systematic review documented the emerging evidence on patients’ rehabilitation needs. A WHO pulse survey also recorded widespread disruption of essential health services, including rehabilitation, in 2020. The author’s clinical observations from home-based physiotherapy during the first French lockdown described programmes adapted to minimal equipment, greater family involvement and the integration of psychosocial support. These observations illustrate practical adaptations but do not constitute evaluated outcomes, and they come from a single practitioner in a high-resource setting.

For patients with persistent symptoms, the review distinguishes physiological recovery from functional recovery. WHO defines post-COVID-19 condition as symptoms that usually arise three months after probable or confirmed infection, continue for at least two months and cannot be explained by another diagnosis; fatigue, post-exertional symptom exacerbation, cognitive dysfunction and dysautonomia are frequent. The proposed Post-COVID Functional Decoupling describes a pattern in which measures such as oxygenation, imaging and inflammatory markers normalise while functional capacity lags by weeks or months. It is not presented as a diagnosis, but as a rehabilitation-oriented pattern within post-COVID-19 condition and post-intensive care syndrome. The stated practical implication is that functional measures may guide rehabilitation and discharge decisions, while exercise progression must be individualised because post-exertional symptom exacerbation can occur.

The shift to remote rehabilitation produced both promising evidence and limited routine uptake. A rapid overview found telerehabilitation generally comparable to in-person physical therapy for several conditions. A Cochrane review of 15 studies involving 1,904 participants, mostly patients with chronic obstructive pulmonary disease, found pulmonary telerehabilitation achieved outcomes similar to centre-based rehabilitation without reported safety issues, although certainty of evidence was limited. A retrospective study of 164 patients found telerehabilitation non-inferior to in-person rehabilitation 12 weeks after total knee arthroplasty, and a prospective observational study of 23 patients found mixed in-person and remote delivery feasible in cancer rehabilitation. Yet a US database containing 222,680 outpatient physiotherapy episodes recorded telerehabilitation in only 6% of cases, declining from 10% to 5% between the second and third quarters of 2020. The proposed Telerehabilitation Emergency Pivot describes the rapid, improvised system-level transition to remote care and the subsequent persistence of hybrid models.

The review’s four constructs collectively shift attention toward service-level processes: from psychological distress to observable workforce withdrawal, from generic hesitancy to possible network diffusion, from digital transition to rehabilitation-specific constraints, and from physiological normalisation to delayed functional recovery. Proposed tests include linking staffing and deployment data with protective-equipment availability and validated distress measures; interrupted time-series analyses around vaccine safety alerts; adoption and safety comparisons across in-person, remote and hybrid rehabilitation; and cohort studies comparing physiological recovery with functional measures such as the six-minute walk test and activities-of-daily-living scales. These ideas remain hypotheses. The evidence base is non-exhaustive and exposed to selection and publication bias, clinical observations are vulnerable to recall bias, rehabilitation data from sub-Saharan Africa are scarce, and the review focuses mainly on 2020 and 2021. Formal concept analysis and empirical testing are therefore required before the proposed terms should be used beyond research settings.

Subject of Research: Narrative review of health-worker mortality, vaccine hesitancy, physiotherapy and telerehabilitation during COVID-19

Article Title: Rehabilitation professionals at the COVID-19 frontline: a testimony-informed narrative review of health-worker mortality, vaccine hesitancy, physiotherapy and telerehabilitation

Article References: Npochinto Moumeni, I. (2026). Rehabilitation professionals at the COVID-19 frontline: a testimony-informed narrative review of health-worker mortality, vaccine hesitancy, physiotherapy and telerehabilitation. Frontiers in Rehabilitation Sciences, 7, Article 1921614. https://doi.org/10.3389/fresc.2026.1921614

Image Credits: AI Generated

DOI: 10.3389/fresc.2026.1921614

Keywords: COVID-19, health workers, mortality, vaccine hesitancy, physiotherapy, telerehabilitation, post-COVID condition, rehabilitation services, narrative review, pandemic preparedness, Rehabilitation, professionals

The survey assessed participants’ knowledge, experiences and attitudes toward vaccine communication. Among respondents, 58.6% described themselves as only slightly prepared to address vaccine hesitancy, 79% said they did not have enough training, and 82% regarded addressing hesitancy as important. Another 60.9% reported encountering vaccine hesitancy monthly or more often. The abstract does not specify the survey participants’ subgroup composition, limiting interpretation of how these percentages relate specifically to practising doctors, medical students or other groups.

Five focus groups included 13 practising doctors—10 general practitioners and three hospital doctors—and five groups included 33 final-year medical students. The researchers used inductive thematic analysis to explore participants’ views of responsibility and communication. Focus-group participants were ambivalent about whether addressing vaccine hesitancy was part of the doctor’s role. Their approaches generally concentrated on giving information, understanding patients or persuading them, but rarely combined all three elements. Participants also expressed frustration when communication was ineffective. The authors said an overly biomedical approach and frustration with unsuccessful communication may be replicated through teaching and learning as the next generation of doctors is trained.

The authors concluded that clearer role definition, better training and systemic support are needed to help doctors undertake opportunistic vaccine conversations. The reported survey and focus-group findings describe confidence, attitudes and perceived roles; they do not establish that any particular educational or communication approach changes vaccination uptake. As the source available here is the abstract, the survey recruitment methods, detailed subgroup composition, statistical analyses and wider representativeness of the focus-group findings cannot be assessed. Accordingly, the qualitative themes characterize the participating doctors and students rather than demonstrating how common those views are across the wider workforce or student population.

Subject of Research: Mixed-methods research on doctors’ and medical students’ preparedness and perceived roles in addressing vaccine hesitancy.

Article Title: “Is it worth our time?” Understanding the educational culture of medical students and educators in addressing vaccine hesitancy

Article References: White, P., Alberti, H., Rowlands, G., Tang, E., & Dubé, È. (2026). “Is it worth our time?” Understanding the educational culture of medical students and educators in addressing vaccine hesitancy. BMC Medical Education. https://doi.org/10.1186/s12909-026-10424-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10424-2

Keywords: vaccine hesitancy, medical education, doctor training, vaccine communication, practising doctors, medical students, survey research, focus groups, public health, worth, time, Understanding

The research team, led by Xin Su and Qilin Wu of the Guangzhou Center for Disease Control and Prevention and colleagues at district-level CDCs across the city, surveyed parents of children aged five years or younger at ten community health centers. Using stratified multi-stage sampling designed to capture a representative slice of Guangzhou’s diverse urban population, the investigators measured parental knowledge, attitudes and practices related to the EV-A71 vaccine, along with physician recommendation behavior. The headline finding is sobering: 28.95 percent of parents surveyed exhibited vaccine hesitancy toward the EV-A71 shot—a voluntary, self-paid vaccine in China’s immunization landscape, which makes parental decision-making particularly consequential.

The demographic patterns the team uncovered through logistic regression with cluster-robust standard errors reveal who is most likely to balk. Mothers were markedly less hesitant than fathers, with an odds ratio of 0.46, suggesting that the primary caregivers most often managing children’s health decisions hold more favorable views of the vaccine. Parents holding a college or associate degree were also less hesitant (odds ratio 0.53), consistent with the broader observation that educational attainment often correlates with greater vaccine acceptance. On the other side of the ledger, parents who were not healthcare workers were more than twice as hesitant (odds ratio 2.38), and—perhaps most tellingly—parents whose children had no history of HFMD were over three times as hesitant (odds ratio 3.45). That last finding hints at a paradox of prevention: families spared direct experience of the disease may perceive less need for a vaccine against it.

To move beyond simple associations, the researchers employed structural equation modeling (SEM), a statistical framework that allows latent psychological variables—constructs that cannot be directly observed but are inferred from multiple survey items—to be tested in a network of direct and indirect causal pathways. Exploratory factor analysis, preceded by principal component assessment and Kaiser-Meyer-Olkin sampling adequacy checks, first identified the underlying latent dimensions in the data. The SEM then revealed three psychological constructs exerting significant negative direct effects on hesitancy: vaccine confidence (standardized coefficient -0.39), trust in vaccination services (-0.17), and perceived risk of the disease (-0.17). In plain terms, parents who trusted the vaccine’s safety and effectiveness, trusted the health system delivering it, and felt the disease posed a real threat to their child were substantially less likely to hesitate.

One of the study’s most technically interesting results concerns knowledge. Parental knowledge about EV-A71 and the vaccine showed no direct effect on hesitancy at all. Yet its total indirect effect, transmitted through the three mediating constructs, was substantial (standardized coefficient -0.45)—actually larger than any single direct effect in the model. This dissociation between direct and indirect pathways carries a crucial message for public health practice: simply handing parents facts does not by itself reduce hesitancy. Facts work only when they reshape confidence, trust and risk perception. A parent who learns that EV-A71 remains capable of causing severe neurological complications may update their risk assessment; a parent who learns how the inactivated vaccine was tested may grow in confidence. Knowledge is the raw material, but attitude change is the mechanism.

The team also examined how physician recommendation interacts with parental psychology, using a cross-level interaction term in the regression framework that specifically tested whether the enthusiasm of healthcare providers’ recommendations modifies the effect of parental vaccine confidence. The interaction was marginally significant (coefficient 2.10, P = 0.08), a result the authors interpret cautiously but which suggests that provider communication style may amplify or buffer the effects of confidence on hesitancy. In the context of a voluntary, self-paid vaccine, where no school-entry mandate or national program force exists to drive uptake, the enthusiasm with which a community health center physician recommends the shot may matter considerably—particularly for parents whose confidence is already wavering.

The epidemiological backdrop gives these findings their urgency. Before the vaccine era, EV-A71 was the pathogen most feared in HFMD outbreaks, capable of causing brainstem encephalitis, acute flaccid paralysis and death in small children. Large vaccination campaigns in China demonstrably reduced severe EV-A71 disease. But enterovirus ecology is competitive: with EV-A71 suppressed, other serotypes expanded, and the HFMD pathogen spectrum shifted. This shift is a textbook example of how successful vaccines can alter pathogen dynamics in ways that complicate continued vaccine acceptance. Parents who cannot distinguish between HFMD caused by EV-A71 and HFMD caused by coxsackieviruses see only that their vaccinated child still developed blisters, fever and mouth ulcers—fueling the perception that the vaccine does not work.

The Guangzhou study’s methodological rigor strengthens its conclusions. The stratified multi-stage sampling design captured parents across ten community health centers, and the combination of factor analysis, SEM and cluster-robust logistic regression allowed the team to disentangle demographic risk factors from psychological pathways. The ethics protocol was approved by the Guangzhou CDC ethics committee, and written informed consent was obtained from all participants. The work was supported by a self-financed research project with funding from Sinovac Biotech, the manufacturer of one of the inactivated EV-A71 vaccines, though the funder had no role in study design, data collection, analysis or publication decisions—an arrangement the authors disclose transparently.

What does the study recommend? The authors argue that communication and counseling strategies targeting the three mediating constructs—confidence, service trust and risk perception—are more likely to support informed parental decisions than knowledge campaigns alone. For a voluntary vaccine, where uptake depends entirely on parental willingness, the psychological pathway is the practical pathway. Health providers in Guangzhou and beyond may need to move beyond fact sheets and toward conversations that address the specific doubts the pathogen shift has created: explaining that the vaccine targets the most dangerous HFMD pathogen, that breakthrough HFMD caused by other enteroviruses is typically milder, and that EV-A71 remains a threat capable of re-emergence.

The broader lesson extends past HFMD. Vaccine hesitancy is not a static phenomenon; it evolves with epidemiological reality. As pathogens shift, so do parental perceptions of relevance, and public health systems must adapt their communication accordingly. The Guangzhou findings offer a quantitative template for understanding how knowledge, confidence, trust and risk perception interact in the minds of parents weighing a voluntary vaccine against a disease whose face has changed. With nearly 29 percent of parents hesitant, the stakes of getting that communication right are considerable—not only for EV-A71 vaccination in southern China, but for every voluntary vaccine program navigating the shifting terrain of post-vaccine pathogen ecology.

Subject of Research: Parental vaccine hesitancy toward the EV-A71 vaccine amid shifting hand, foot and mouth disease pathogens in Guangzhou

Article Title: Parental EV-A71 vaccine hesitancy amid shifting HFMD pathogens: a cross-sectional study in Guangzhou

Article References: Su, X., Gao, Z., Zhong, J., Bai, C., Xie, R., Luo, L., & Wu, Q. (2026). Parental EV-A71 vaccine hesitancy amid shifting HFMD pathogens: a cross-sectional study in Guangzhou. BMC Public Health. https://doi.org/10.1186/s12889-026-29951-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29951-0

Keywords: EV-A71, hand foot and mouth disease, vaccine hesitancy, structural equation modeling, Guangzhou, enterovirus, parental confidence, vaccine confidence, HFMD pathogens, BMC Public Health, physician recommendation, public health

Senior author Dr. Chadi Saad-Roy, an assistant professor in UBC’s Department of Mathematics and Department of Microbiology and Immunology, said the models indicate that even modest post-infection costs can tip the scales and make the case for vaccine-driven elimination. The central insight of the work is that most existing frameworks for evaluating infectious disease management strategies focus almost exclusively on the acute phase of infection, quantifying hospitalizations, deaths, and transmission during the active illness while treating recovery as the end of the story. When a substantial fraction of recovered individuals go on to experience lingering sequelae, that accounting error can fundamentally distort the cost-benefit calculus that determines how aggressively a population should be vaccinated.

To address this gap, the team developed a system of mathematical equations designed to examine the interactions between interventions and post-infection effects. From the perspective of society, Dr. Saad-Roy explained, there is some cost to producing vaccines, and there is a large benefit to reducing infections and their downstream consequences, so the essential question is where the optimum lies. For a genuinely benign virus, it may not be worth vaccinating at all. For other infections, it may be best to vaccinate enough people to eliminate the disease entirely. In many realistic cases, the ideal point falls somewhere between those extremes, and the new modelling framework is intended to help answer precisely those questions in a principled way.

The researchers began with an epidemiological model of the classic susceptible-infectious-recovered type, which tracks the fraction of a population in each disease state over time. This compartmental structure allowed them to evaluate non-pharmaceutical interventions that reduce transmission, such as masking, social distancing, and air filtration, as complements to vaccination rather than substitutes for it. On long timescales, the team found that these non-pharmaceutical measures substantially decreased the portion of people who became infected and then recovered, and who were therefore vulnerable to post-infection effects. That result suggests that transmission-reducing measures can meaningfully reduce the long-term disease burden even when their most visible impact is on acute case counts.

The next step was to couple the epidemiological model to an economic one, allowing the researchers to assess how the costs associated with post-recovery syndromes alter the optimal level of vaccine coverage. To build a tool capable of pinpointing that sweet spot, they wrote equations that account for the societal cost of both acute and long-term infection, including expenses such as hospitalization and the loss of labor force productivity, alongside the cost of vaccination in terms of development, production, distribution, and recruitment. This dual accounting makes explicit what has often been implicit in immunization policy debates: the true price of an infection extends well beyond the acute episode, and the true cost of a vaccine campaign depends on how easily coverage can be expanded.

A key innovation of the study lies in how it treats vaccine costs. The team examined three different scenarios describing how the marginal cost of vaccination changes as the number of doses administered increases. In the accelerating scenario, there is a first wave of easy-to-reach vaccine adopters, and it becomes progressively harder to vaccinate additional people because of hesitancy or logistical barriers. In the decelerating scenario, initial resistance to vaccination gives way to peer influence that makes each additional individual easier to reach. The third scenario alternates between acceleration and deceleration, capturing settings where uptake dynamics shift back and forth as campaigns mature.

Across all three cost scenarios, the researchers found that the ideal amount of vaccine coverage was highly sensitive to post-acute effects. Even small post-infection costs were sufficient to shift the optimal coverage to higher rates, and in some cases to push the optimum all the way to elimination levels. This sensitivity means that diseases once considered marginal candidates for elimination campaigns, on the basis of acute severity alone, may become clear candidates once the cumulative burden of post-infection morbidity is factored in. Conversely, the result underscores how fragile optimal policy can be when the long-term consequences of infection are dismissed or left unmeasured.

Dr. Saad-Roy emphasized that the phenomenon needs to be tackled rigorously rather than dismissing individuals’ experiences as anecdotal. To more systematically monitor and document post-infection effects, he suggested that researchers conduct large, long-term cohort studies that survey participants on a broad constellation of symptoms. Such studies would supply the empirical cost estimates that models like these require, replacing scattered clinical impressions with population-level data on incidence, duration, and severity of post-acute conditions. Because these interventions reduce acute infection, he noted, they in turn mitigate post-acute burden and ultimately lead to a healthier world.

The practical implications extend to how vaccination campaigns are designed and communicated. It is critical, the authors argue, to understand which vaccine cost scenario, accelerating or decelerating, is actually at play in a specific setting in order to determine the optimal coverage level. That determination will require socioeconomic studies exploring vaccine decision-making dynamics in a given time and place, which may themselves be shaped by outreach efforts. Prakhar Jaiswal, a graduate student in the UBC Department of Mathematics and first author of the study, observed that educating people about the benefits of vaccination and reducing hesitancy can lower the cost of vaccination and tip the balance in favor of vaccinating to eliminate the disease. In other words, public engagement is not merely a soft complement to immunization programs but a direct lever on the economics that determine whether elimination is the rational target.

The interdisciplinary team behind the study includes co-authors Daniel Coombs of UBC Mathematics, Caroline Wagner of McGill Bioengineering, and Troy Day of Queen’s Mathematics and Statistics. The research was supported by the Natural Sciences and Engineering Research Council of Canada and the Canadian Institutes of Health Research. As health systems worldwide continue to grapple with the legacy of long COVID and prepare for future viral threats, the study offers a quantitative argument that the era of evaluating vaccines by acute outcomes alone is drawing to a close, and that the arithmetic of elimination looks far more favorable once the full lifetime cost of infection is on the table.

Subject of Research: Mathematical modelling of how post-infection morbidity costs influence optimal vaccine coverage levels

Article Title: Even modest post-infection complications can make expanded vaccine coverage cost effective: New modelling

Article References: Even modest post-infection complications can make expanded vaccine coverage cost effective: New modelling. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: vaccine coverage, post-infection complications, long COVID, mathematical modelling, cost-effectiveness, epidemiology, non-pharmaceutical interventions, vaccine hesitancy, disease elimination, public health, University of British Columbia, PNAS

The study focused on Rulindo, Kayonza, Nyanza, Rusizi, Rubavu, and Nyaruguru districts, selected to represent Rwanda’s geographic and socioeconomic diversity. Data collection took place in October 2025, using six in-depth interviews per district and two focus group discussions per district. Participants were drawn from different socioeconomic classes and occupations, rotated across districts to ensure inclusivity. In total, 143 people participated in the focus group discussions, the majority of whom were male (n=82, 57.34%) and aged between 31 and 40 years. The most common occupation among focus group participants was animal health personnel (n=19, 13.29%). Among the 36 in-depth interview participants, nearly half (n=15, 41.7%) were aged 31-40, and the most frequently reported occupation was health personnel (n=12, 33.32%).

The researchers anchored their analysis in two established behavioral frameworks: the Health Belief Model and the Social Ecological Model. The Health Belief Model posits that health-seeking behavior is shaped by perceived susceptibility to a disease, perceived severity of its consequences, perceived benefits of taking action, and perceived barriers to action, modulated by cues to action and self-efficacy. The Social Ecological Model extends this logic outward, situating individual behavior within nested layers of interpersonal relationships, community norms, institutional structures, and policy environments. Together, these models allowed the team to trace how personal perceptions interact with systemic constraints to produce the health-seeking patterns observed in the field.

Data were coded using Dedoose software, and the team conducted weekly debriefing meetings to familiarize themselves with the material as it accumulated. Using the joint display method to compare findings from in-depth interviews and focus group discussions, the researchers identified points of convergence across several themes. These included factors influencing healthcare-seeking behavior, economic constraints and the deprioritization of health interventions, perceived importance of One Health alongside weak intersectoral collaboration, community health information dissemination through multiple communication channels, myths and misinformation leading to vaccine rejection, and the persistent challenge of maintaining proper handwashing practices.

Economic constraints emerged as a dominant barrier to healthcare-seeking. Participants described how the cost of transport to health facilities, consultation fees, and the opportunity cost of missed workdays forced families to deprioritize health interventions, particularly preventive ones. When resources are scarce, immediate economic needs take precedence over future health security, a dynamic that the Health Belief Model would interpret as a perceived barrier outweighing perceived benefits. This deprioritization extends beyond individual choices to community-level resource allocation, where limited engagement of community members in planning continues to promote health insecurity, according to the study’s conclusions.

Participants recognized the conceptual importance of One Health, understanding that human health cannot be separated from animal health and environmental conditions. Yet this recognition coexisted with reports of weak intersectoral collaboration. District-level coordination between health, agriculture, and environment sectors remained fragmented, with limited accountability mechanisms. The study found that bottleneck challenges on resources and insufficient community engagement perpetuated these gaps. Community health workers and community animal health workers, who serve as frontline connectors between households and formal health systems, were identified as critical assets that require better training to listen to and engage community members effectively.

Health information reached communities through multiple channels, including radio, community meetings, and household visits by community health workers. However, the study documented how myths and misinformation circulating through these same networks led to vaccine rejection. This finding underscores a central tension in risk communication: the channels that disseminate accurate information also transmit falsehoods, and without targeted counter-messaging, misinformation can undermine even well-designed immunization campaigns. The researchers noted that training community health workers to actively listen and engage community members would enhance the effectiveness of risk communication and community engagement strategies.

Handwashing, a cornerstone of infection prevention, presented its own set of challenges. Participants reported difficulty maintaining consistent handwashing practices, citing water scarcity, lack of soap, and competing daily demands. This finding connects individual behavior to environmental determinants, illustrating precisely the kind of human-environment interface that the One Health approach is designed to address. When water infrastructure fails, infection prevention breaks down at the household level, regardless of how well people understand the science of disease transmission.

The study received ethical approval from the Rwanda National Ethics Committee and was funded by UNICEF-Rwanda through the Pandemic Fund award. The research team included investigators from Rinda Ubuzima, Rwanda Biomedical Centre, and UNICEF in Kigali. The authors conclude that their findings provide a critical foundation for identifying behavioral and systemic gaps and facilitators toward the One Health approach in Rwanda. They recommend district-level coordination and accountability, alongside enhanced training of community health workers, as priority interventions for strengthening the country’s One Health sector.

As Rwanda confronts emerging health threats, including the Marburg virus outbreaks that have highlighted the urgency of integrated surveillance and response, this study offers actionable evidence for policymakers. The convergence of behavioral insights and systemic analysis demonstrates that pandemic preparedness cannot be achieved through infrastructure alone. It requires communities that trust health systems, understand disease risks, and can act on that understanding without economic penalty. The study’s findings suggest that Rwanda’s next phase of One Health implementation must move beyond sectoral coordination to genuine community partnership, where local knowledge shapes national strategy and where the barriers that families face daily are treated as central to health security rather than peripheral to it.

Subject of Research: Community barriers, perceptions, and health-seeking behaviors within the One Health approach in Rwanda

Article Title: Community barriers, perceptions, and health-seeking behaviors within the one health approach in six priority districts of Rwanda: a descriptive qualitative study

Article References: Umulisa, M.-M., Ishema, L., Rwagasore, E., Muhirwa, P. K., Mugwaneza, O., Desie, S., Ilibagiza, D., Birungi, A., Umutoni, G., & Dine, R. D. (2026). Community barriers, perceptions, and health-seeking behaviors within the one health approach in six priority districts of Rwanda: a descriptive qualitative study. BMC Public Health. https://doi.org/10.1186/s12889-026-29896-4

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29896-4

Keywords: One Health, Rwanda, outbreak preparedness, community engagement, risk communication, vaccine hesitancy, public health, qualitative research, Community, barriers, perceptions, health-seeking

Immuniser Lyon was conceived as a coordinated, locally tailored effort to promote vaccination across the French city and its surrounding department, the Rhône. Rather than imposing a single top-down message, the initiative wove together actions adapted to local contexts: outreach in neighborhoods, engagement with pharmacies and general practitioners, and targeted communication aimed at groups with historically low coverage. The program’s architects bet on a simple premise—that proximity and local trust can accomplish what broad national messaging sometimes cannot. The new study set out to test whether that bet paid off in measurable terms.

The research team took a comparative approach, tracking two very different vaccines over two very different time horizons. For human papillomavirus (HPV) vaccination, which primarily targets adolescents, they analyzed coverage trends in the Rhône area from 2010 through 2022. For influenza vaccination, which is recommended annually for adults aged 65 and older, they examined the period from 2016 to 2020. Both analyses compared the Rhône against the rest of the neighboring Auvergne-Rhône-Alpes (ARA) region, using binomial log-linear models to quantify differences in uptake over time.

The HPV results tell a story of national dynamics dominating the picture. Vaccine coverage in the Rhône and the wider ARA region followed strikingly similar trajectories: after a nationwide decline that began in the mid-2010s—a period marked by public controversy over the HPV vaccine in France—uptake began climbing again from 2015 onward, and both areas rose in parallel through 2022. The researchers found no evidence that Immuniser Lyon had accelerated HPV uptake beyond what broader national trends would predict. This is not necessarily a failure of the local program; HPV vaccination in France is largely driven by national policy shifts, including the gradual extension of school-based vaccination recommendations and growing public confidence in the vaccine’s safety.

The influenza findings, however, paint a different picture. Among adults aged 65 and older—the group for whom seasonal flu poses the greatest risk of severe complications and death—vaccine coverage in Lyon in 2020 reached 64.5 percent, significantly higher than the 59.2 percent observed in the rest of the ARA region. The difference corresponds to an odds ratio of 1.25, with a 95 percent confidence interval of 1.24 to 1.26 and a p-value below 0.001, indicating that the gap is statistically robust rather than a product of random variation. In practical terms, roughly one in twenty additional older adults in Lyon was vaccinated compared with their counterparts elsewhere in the region.

What makes this gap notable is its timing and persistence. Influenza vaccination campaigns in France are largely standardized nationally, with the same vaccines, the same recommendations, and the same eligibility criteria applying across regions. If the difference in Lyon were driven by demographics alone—say, an older or wealthier population—the gap would likely be smaller or inconsistent over time. Instead, the researchers observed a pattern consistent with a potential contribution from Immuniser Lyon’s sustained local actions, which included pharmacist-led outreach, targeted reminders, and community-level engagement with older residents. The study’s authors are careful to frame this as a consistency check rather than proof of causation; the observational design cannot rule out confounding factors. But the alignment between the program’s activities and the observed uptake pattern is difficult to dismiss.

The contrast between the two vaccine outcomes offers a nuanced lesson for public health planners. HPV vaccination in France operates within a highly centralized policy framework, where national decisions about school-based programs and recommendation schedules shape coverage far more than local initiatives can. In that context, Immuniser Lyon’s HPV results simply mirror national trends—hardly surprising. Influenza vaccination, by contrast, depends heavily on individual annual decisions, repeated year after year, and on the accessibility of vaccination points within communities. This is precisely the terrain where local, sustained, relationship-based interventions can make a difference. Pharmacists, general practitioners, and community health workers in Lyon were able to reach older adults in ways that a national letter or television campaign might not.

The study also highlights the value of long-term evaluation. Eight years of data allowed the researchers to distinguish between short-term fluctuations and durable trends, and to compare the Rhône against a demographically similar neighboring region rather than against an abstract national average. This kind of longitudinal, geographically grounded analysis is rare in vaccination research, where programs are often evaluated over one or two seasons and where comparison regions are difficult to define. The binomial log-linear modeling approach, while statistically conventional, was applied with enough granularity to detect modest but meaningful differences in coverage—differences that would be invisible in coarser analyses.

For policymakers, the implications are cautiously optimistic. Local initiatives like Immuniser Lyon are not a substitute for national immunization strategy, but they appear capable of complementing it in specific, measurable ways—particularly for vaccines that require repeated, individual-level engagement. The findings suggest that cities and regions with the resources and political will to sustain multi-year vaccination programs may achieve incremental gains in coverage among hard-to-reach or hesitant populations. As France and other countries continue to grapple with vaccine hesitancy and uneven coverage, the Lyon experience offers a template: invest locally, measure rigorously, and be patient with the timeline. Eight years is a long commitment, but the data suggest it may be exactly the kind of commitment that moves the needle.

Subject of Research: Evaluation of the Immuniser Lyon local vaccination initiative and its association with HPV and influenza vaccine coverage trends in the Rhône area of France

Article Title: Assessing a local vaccination initiative: Eight years of “Immuniser Lyon” in France

Article References: Dessemon, J., Saux, R., Elias, C., Ronnaux-Baron, A.-S., Malachane, A. S., Pamies-Jeantet, S., Soubeyrand, B., Roy, P., & Vanhems, P. (2026). Assessing a local vaccination initiative: Eight years of “Immuniser Lyon” in France. PLOS Global Public Health, 6(10), e0007468. https://doi.org/10.1371/journal.pgph.0007468

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007468

Keywords: Immuniser Lyon, vaccination, HPV vaccine, influenza vaccine, vaccine coverage, France, public health, Auvergne-Rhône-Alpes, older adults, vaccine hesitancy, local health initiatives, PLOS Global Public Health

The study’s timing is significant. Kazakhstan first piloted HPV vaccination in four regions during 2013 and 2014, but the effort collapsed amid low uptake, widespread parental refusal, negative media coverage, and persistent safety narratives. The national programme was relaunched in September 2024 for eleven-year-old girls, with catch-up vaccination for those aged twelve to thirteen and parental informed consent required. In May 2026, voluntary vaccination was extended to girls aged fourteen to seventeen. The researchers designed their survey to capture public sentiment in this renewed context, drawing on a validated bilingual questionnaire originally developed in France and previously adapted for Kazakh populations.

Participants completed an electronic questionnaire between 17 January and 28 February 2026, recruited through QR codes displayed in fourteen gynaecology offices at the City Center for Primary Health Care in Astana. The sample skewed young and educated: the largest age groups were eighteen to twenty-four (26.7 percent) and thirty-five to forty-four (25.3 percent), 73.3 percent held higher education, and 40.7 percent were healthcare workers. Nearly all participants (95.0 percent) had heard of the HPV vaccine, and 85.1 percent had actively searched for information about it. Despite this high engagement, factual knowledge remained strikingly low.

On a twelve-item knowledge test, the mean score was just 4.95 out of 12, with a standard deviation of 3.84. ‘Don’t know’ responses exceeded 40 percent for ten of the twelve items, indicating widespread uncertainty rather than confidently held false beliefs. Only 19.9 percent correctly recognised that cervical cancer can still occur after HPV vaccination, and just 29.9 percent knew the vaccine protects against genital warts. Even the highest-scoring item, recognition that HPV infection may remain unnoticed for years, was answered correctly by only 64.7 percent of respondents. These gaps matter because HPV is a necessary cause of nearly all cervical cancers, which accounted for approximately 660,000 new cases and 350,000 deaths worldwide in 2022.

Trust in information sources varied dramatically. Scientific researchers earned the highest mean trust score (3.47 on a five-point scale), followed by healthcare workers (3.29). Alternative media and social networks scored lowest at 2.36, with traditional media close behind at 2.48. This hierarchy suggests that clinicians and researchers remain the most credible voices in the Kazakh information environment, even as digital platforms dominate actual information-seeking behaviour.

To move beyond simple attitude measurement, the researchers applied exploratory psychometric analysis to sixteen perception items. Using polychoric correlations, parallel analysis, and principal-axis factor analysis with oblimin rotation, they identified a two-factor structure. One factor captured perceived effectiveness alongside social endorsement and service facilitation; the other reflected safety- and age-related concern. From this structure, the team derived two preliminary composite measures: a five-item safety concern scale (mean 2.34, Cronbach’s alpha 0.868, McDonald’s omega 0.901) and a three-item perceived effectiveness scale (mean 3.20, alpha 0.922, omega 0.948). Critically, the two scores correlated only weakly (Spearman’s rho 0.129, p = 0.055), confirming that believing in a vaccine’s benefit does not preclude harbouring safety fears.

Knowledge and trust shaped these dimensions in distinct ways. Higher HPV knowledge was inversely associated with safety concern (rho = -0.284, p < 0.001) and positively associated with perceived effectiveness (rho = 0.393, p < 0.001). In multivariable robust regression, each additional correct knowledge answer predicted a 0.061-point increase in perceived effectiveness (95% CI 0.010 to 0.111). But the strongest independent correlate of perceived effectiveness was professional and scientific trust: each one-point increase was associated with a 0.297-point higher effectiveness score (95% CI 0.114 to 0.480). Institutional trust, media trust, and anecdotal experience showed no independent association with effectiveness.

Safety concern told a different story. In a model accounting for 44.6 percent of outcome variance, three contextual beliefs emerged as significant predictors: spillover from COVID-19 vaccine controversies (B = 0.190, 95% CI 0.043 to 0.337), distrust attributed to Kazakhstan’s earlier HPV vaccination programme (B = 0.197, 95% CI 0.047 to 0.347), and preference for natural immunity (B = 0.137, 95% CI 0.040 to 0.234). Healthcare workers reported modestly lower adjusted concern than other participants (B = -0.225, 95% CI -0.449 to -0.001). Notably, the association between knowledge and safety concern was attenuated after contextual beliefs were included (B = -0.023, p = 0.269), suggesting that safety fears are driven more by narrative and historical context than by factual gaps alone.

The most striking finding came from a secondary exploratory analysis. Forty-nine participants (22.2 percent) reported refusal or intention to refuse HPV vaccination for a daughter. The strongest predictor of this response was knowing someone believed to have become seriously ill after vaccination, which raised the odds more than sevenfold (adjusted odds ratio 7.42, 95% CI 2.60 to 21.16). Having children was also associated with higher odds (aOR 3.71, 95% CI 1.40 to 9.81). The researchers caution that this outcome combines actual refusal among women with daughters and prospective intention among those without, so it cannot be interpreted as verified historical refusal prevalence. Nevertheless, the magnitude of the anecdotal-narrative effect underscores how personal stories, even when causally unverified, can override statistical safety data in vaccination decisions.

The findings carry clear programme-level implications. First, communication materials should address effectiveness and safety separately, since belief in benefit does not eliminate concern. Second, healthcare workers require standardised communication training and rapid access to evidence-based answers, because professional-scientific trust is a key asset and recent meta-analytic evidence shows that clinician communication training improves HPV vaccination uptake. Third, the history of the earlier national programme should be acknowledged directly through transparent safety surveillance rather than dismissed. Fourth, preference for natural immunity deserves targeted counter-messaging that contrasts the predictable protection of vaccination with the uncertain and potentially carcinogenic consequences of natural HPV infection. Finally, programme evaluation should measure actual first-dose and series-completion outcomes rather than attitudes alone. The study’s limitations, including convenience sampling at a single centre, a cross-sectional design that cannot establish causality, and preliminary psychometric measures requiring external validation, temper these conclusions. Yet the core message is unambiguous: in a post-COVID information environment marked by cross-vaccine narrative spillover, rebuilding confidence in HPV vaccination demands not just more facts, but a fundamentally different kind of conversation between clinicians, scientists, and the communities they serve.

Subject of Research: HPV vaccine knowledge, trust, and multidimensional perceptions among women attending primary care in Astana, Kazakhstan

Article Title: Knowledge, trust, and multidimensional perceptions of human papillomavirus vaccination among women attending a single primary care centre in Astana, Kazakhstan: a cross-sectional study

Article References: Umbetzhanova, A., Kusniyeva, A., Derbissalina, G., Abduldayeva, A., Safonov, N., & Koikov, V. (2026). Knowledge, trust, and multidimensional perceptions of human papillomavirus vaccination among women attending a single primary care centre in Astana, Kazakhstan: a cross-sectional study. Frontiers in Global Women's Health, 7, Article 1960252. https://doi.org/10.3389/fgwh.2026.1960252

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1960252

Keywords: HPV vaccination, vaccine hesitancy, Kazakhstan, vaccine safety, vaccine confidence, cervical cancer, COVID-19 spillover, health communication, primary care, psychometrics, women's health, public trust

The research, published in BMC Medical Education, was led by Zixin Wang and Aiping He, co-first authors based in the Department of Health Services Management at Anhui Medical University in Hefei, China, with a team spanning the university’s Institute of Medical Education, a Hefei hospital, and the Johns Hopkins Bloomberg School of Public Health. The investigators set out to answer a deceptively simple question: how much vaccine science do undergraduate health professions students actually encounter in their formal coursework, and what do they think about it?

To find out, the team used a two-phase explanatory sequential mixed-methods design with triangulation. In the first phase, conducted between March and May 2025, they collected 708 curriculum guidelines from the medical university in Anhui province. After screening and systematic content extraction, they descriptively analyzed the distribution, proportion, and topical coverage of vaccine-related material across the documented curriculum. In the second phase, from June to July 2025, they conducted semi-structured interviews with 23 senior students who had completed their undergraduate coursework and had either finished or were finishing their required graduation internships under those same guidelines.

The quantitative findings are stark. Across the 30 guidelines that did mention vaccines, the median length of the teaching-related sections was 7,894 Chinese characters, with an interquartile range of 5,505 to 10,989 and a full range of 1,482 to 24,080 characters. The median length of vaccine-related content within those sections, by contrast, was just 49 Chinese characters — an interquartile range of 17 to 89 and a range of 10 to 146. In other words, where a course guideline devoted nearly 8,000 characters to teaching, the portion addressing vaccines amounted to a sentence or two.

The proportions tell the same story from a different angle. The median proportion of vaccine-related content across the 30 guidelines was 0.7 percent, with an interquartile range of 0.2 to 0.9 percent and a range stretching from 0.1 to 10.0 percent. In 24 of the 30 guidelines — 80.0 percent — vaccine-related content accounted for less than 1 percent of the teaching-related character count. The study site’s formal curriculum, as documented, explicitly recorded limited vaccine-related material and relatively narrow teaching approaches.

The interview phase added texture that character counts alone cannot capture. From the 23 conversations with senior students, the researchers identified four themes: vaccine cognition and risk perception; assessment of vaccine education; professional role identity and learning expectations; and acquisition and identification of vaccine information. The themes suggest that students were not indifferent to the subject — they were navigating confusion about vaccines, forming views on how the topic had been taught, weighing their future professional responsibilities, and figuring out where to get and how to judge vaccine information on their own.

Interview data further indicated that some students perceived gaps in practical preparation and vaccine-related learning support. This matters because the study’s premise rests on a well-established observation: healthcare professionals’ recommendations can influence public vaccination decisions, yet insufficient vaccine-related literacy and hesitancy among healthcare professionals themselves remain persistent challenges. If the professionals of tomorrow are left to assemble their vaccine knowledge from fragments, the risk is not merely academic — it is that hesitant or under-informed clinicians may pass that uncertainty along to patients.

The timing is significant. Vaccine hesitancy has been flagged by global health authorities as a threat to hard-won immunization gains, and the COVID-19 pandemic demonstrated both the power of vaccines and the fragility of public trust. China’s research in this specific field — examining how vaccine education is embedded in undergraduate health-related curricula — remains limited, which is precisely the gap the Anhui team sought to address. Their study is among the first to combine a systematic audit of curriculum guidelines with student perspectives at a Chinese medical university.

The methodological choices deserve attention. The explanatory sequential design means the quantitative audit came first and shaped the qualitative follow-up, allowing the interviews to probe and explain what the document analysis revealed. Triangulation — comparing the documented curriculum against student experiences — strengthens the conclusions, because a gap that appears in both the official guidelines and the students’ own accounts is harder to dismiss. The study received ethical approval from the Biomedical Ethics Committee of Anhui Medical University, and oral informed consent was obtained from all interview participants before recording began.

The authors’ conclusions point toward concrete remedies. Educational institutions, they suggest, could consider strengthening vaccine education by making learning objectives and core content more explicit in curriculum guidelines, broadening vaccine-related topics, diversifying teaching approaches, and enhancing practical competency development. The findings help clarify potential directions for further optimizing the documented curriculum. Whether other Chinese medical universities — and programs elsewhere — show similar patterns is an open question, but the study offers a template for finding out: audit the guidelines, count the characters, and then ask the students what they were never taught.

Subject of Research: Vaccine education in undergraduate health-related curricula at a Chinese medical university

Article Title: Vaccine education in undergraduate health-related curricula: a mixed-methods study based on curriculum guidelines and student perspectives from a Chinese medical university

Article References: Wang, Z., He, A., Yang, Y., Zhang, X., Yao, L., Wang, Y., Zhou, R., Wang, L., Chen, R., & Zhang, X. (2026). Vaccine education in undergraduate health-related curricula: a mixed-methods study based on curriculum guidelines and student perspectives from a Chinese medical university. BMC Medical Education. https://doi.org/10.1186/s12909-026-10642-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10642-8

Keywords: vaccine education, medical curriculum, vaccine hesitancy, health professions students, mixed-methods study, medical education, Vaccine, education, undergraduate, health-related, curricula, mixed-methods

The study, conducted by Kerem Yıldırım of Bilkent University and colleagues at Koç University, the University of Queensland, and the National University of Singapore, set out to disentangle two forces that usually travel together in the real world: the regime type of the country where a vaccine is made, and the transparency of the vaccine’s development and production process. Democracies tend to be more open about scientific data, so a vaccine from a democratic country is usually also a vaccine with a visible production trail. By randomly assigning experimental participants to read descriptions that varied these two attributes independently, the team could isolate which factor actually drives hesitancy.

Turkey offered an ideal laboratory. By early 2021 the country had approved four COVID-19 vaccines from very different political systems: Sinovac’s CoronaVac from China, Russia’s Gamaleya Sputnik V, the Pfizer-BioNTech mRNA vaccine developed in the United States and Germany, and the domestically produced Turkovac. Vaccination was voluntary, and people could choose among these options. Public debate over their relative merits was intense and politically polarized, sharpened by a media environment in which pro-government outlets dominated and by controversies such as the government’s late-2020 admission that asymptomatic cases had been excluded from official daily case counts.

The experiment itself was elegantly simple. Between October 12 and 27, 2021, 761 participants recruited through quota sampling to mirror the Turkish population in age, education, and sex read one of four short vignettes, each between 59 and 63 words. The vignettes described a COVID-19 vaccine produced in either a democratic or an autocratic country — defined strictly by whether fundamental decisions are made by popularly elected representatives — and developed through either a transparent or an opaque process. Crucially, no real country was named, which prevented pre-existing geopolitical loyalties or animosities from contaminating the results. After reading, participants rated the vaccine’s safety and effectiveness on 11-point scales, stated their willingness to be vaccinated on a 5-point scale, and contributed to an overall support index with strong internal consistency (Cronbach’s alpha of 0.89).

The results were unambiguous. Vaccines described as coming from democratic countries were rated significantly more safe, more effective, and more acceptable than identical vaccines attributed to autocratic countries. Vaccines described as transparently produced outperformed those with opaque production histories on every measure. When the two factors were compared head to head, transparency emerged as the heavier weight: respondents consistently preferred a transparently produced vaccine from an authoritarian country over an opaquely produced vaccine from a democracy. In statistical terms, when production remained opaque, shifting the country of origin from democratic to autocratic produced its weakest effect on willingness to vaccinate, with a standardized difference of about −0.28, while transparency manipulations produced larger drops across all outcome measures.

These effects survived a battery of controls. The researchers accounted for respondents’ age, sex, and education, their COVID-19 risk perception, their vaccination status, their trust in the World Health Organization, doctors, and pharmaceutical companies, and their support for each of Turkey’s five major political parties. Even after all of this, the experimental effects of regime type and production transparency remained robust across all four dependent variables. The findings also align with a striking macro-level pattern the authors document: among countries using vaccines from both democratic and authoritarian producers, vaccination rates run roughly 12 percentage points lower than in countries relying exclusively on vaccines from one type of regime, suggesting that a mixed vaccine menu may itself breed doubt.

The most theoretically interesting result concerns who responds to political information at all. The team measured each participant’s democratic attitudes using a ten-item index capturing both intrinsic support for democratic procedures and instrumental appreciation of democratic outcomes such as accountability. When this index was interacted with the experimental treatments, a clear moderation pattern appeared. Respondents with strong democratic attitudes were highly sensitive to both regime type and production transparency, distinctly favoring vaccines made openly in democracies. Respondents with weak democratic attitudes, by contrast, were essentially unmoved by either manipulation — neither the political character of the producing country nor the openness of the production process shifted their evaluations.

This asymmetry carries a subtle implication for theories of democratic support. Citizens who value democracy for its own sake anchored their vaccine judgments in the regime itself, treating democratic origin as an encompassing signal of legitimacy. Citizens who value democracy instrumentally — for the accountability and openness it delivers — responded primarily to the transparency cue, which is precisely the output-level quality they prize. The fact that transparency, rather than regime type, dominated overall suggests that for most people the procedural honesty of vaccine development is the more proximate and persuasive signal, even though it is conceptually embedded in the democratic ideal.

The authors are careful about the limits of their design. Social desirability pressure could have inflated reported support for democratic and transparent conditions in a pandemic that was intensely moralized, but the use of anonymized vignettes and random assignment protects the comparative causal claims even if absolute levels are somewhat inflated. Manipulation checks also revealed that some participants inferred a country’s democratic character from the transparency of its vaccine development — itself evidence that citizens see openness as part of what democracy means. The team notes a further wrinkle: because traditional and mRNA vaccines happen to be produced in different countries, stated country preferences may partly proxy for vaccine technology preferences.

For public health officials, the practical message is direct. Overcoming hesitancy is not only a matter of asserting scientific efficacy; it requires demonstrable openness about how vaccines are made, tested, and monitored. In polarized settings where domestic institutions are distrusted, the transparency credentials of foreign producers become powerful heuristics that citizens actually use. As the world prepares for future pandemics, the Turkish evidence suggests that investing in open, accountable production processes — and communicating them clearly — may do more to build public confidence than any appeal to numbers alone.

Subject of Research: Survey experiment on how vaccine country-of-origin regime type and production transparency shape COVID-19 vaccine preferences in Turkey

Article Title: Does country of origin matter in COVID-19 vaccine preferences? The role of vaccine transparency and regime type

Article References: Yıldırım, K., Çarkoğlu, A., Baruh, L., Kuru, O., & Cemalcılar, Z. (2026). Does country of origin matter in COVID-19 vaccine preferences? The role of vaccine transparency and regime type. SN Social Sciences, 6(10), Article 551. https://doi.org/10.1007/s43545-026-01857-z

Image Credits: AI Generated

DOI: 10.1007/s43545-026-01857-z

Keywords: vaccine hesitancy, COVID-19, country of origin, regime type, transparency, survey experiment, Turkey, democratic attitudes, public health, vaccine preferences, political polarization, Sinovac