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BackgroundThe COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure’s political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation. ObjectiveWe aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework. MethodsWe first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals. ResultsThis study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users. ConclusionsWe conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts.

L’Organisation mondiale de la Santé (OMS) reconnaît que la vaccination est l’une des interventions en matière de santé publique les plus efficaces pour sauver des vies. Lors de l’élaboration d’une feuille de route permettant d’établir un ordre de priorité relatif à l’utilisation des vaccins contre la maladie à coronavirus 2019 (COVID-19) dans un contexte d’approvisionnement limité, l’OMS a souligné l’importance d’un cadre de valeurs (principes éthiques). La vaccination doit faire l’objet d’un examen éthique indépendant des données de recherche sur les vaccins, des pratiques de fabrication, de l’assurance juridique et éthique du consentement éclairé, ainsi que des questions de justice sociale concernant l’équité des programmes, y compris le droit d’accès. Un examen déontologique du programme de vaccination de l’Australie a été rapporté en 2012. Ce dossier CANVax (Centre canadien de ressources et d’échange sur les données probantes en vaccination) propose un examen déontologique de la vaccination au Canada en utilisant les critères utilisés pour l’Australie.

The World Health Organization (WHO) recognizes immunization as one of the most successful and effective public health interventions for saving lives. In developing a roadmap for prioritizing use of the coronavirus disease 2019 (COVID-19) vaccines in the context of limited supply, WHO highlighted the importance of a values (ethical principles) framework. Immunization does need to be subject to independent ethical scrutiny of vaccine research data, manufacturing practices, the legal and ethical assurance of informed consent, and also social justice issues with respect to program equity, including right to access. An ethics review of Australia’s immunization program was reported in 2012. This CANVax (Canadian Vaccination Evidence Resource and Exchange Centre) Brief offers an ethics review of immunization in Canada using the criteria utilized for Australia.

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Our framework considers four domains: (1) behavioural psychology, (2) politics and law, (3) socioeconomics, and (4) the integrity of science and public health. While current vaccines appear to have had a significant impact on decreasing COVID-19-related morbidity and mortality burdens, we argue that current mandatory vaccine policies are scientifically questionable and are likely to cause more societal harm than good. Restricting people’s access to work, education, public transport and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarisation, and adversely affects health and well-being. Current policies may lead to a widening of health and economic inequalities, detrimental long-term impacts on trust in government and scientific institutions, and reduce the uptake of future public health measures, including COVID-19 vaccines as well as routine immunisations. Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in institutions. We argue that current COVID-19 vaccine policies should be re-evaluated in light of the negative consequences that we outline. Leveraging empowering strategies based on trust and public consultation, and improving healthcare services and infrastructure, represent a more sustainable approach to optimising COVID-19 vaccination programmes and, more broadly, the health and well-being of the public.

BackgroundThe COVID-19 pandemic exacerbated existing health disparities and disproportionately affected vulnerable individuals and communities (e.g., low-income, precariously housed or in institutional settings, racialized, migrant, refugee, 2SLBGTQ+). Despite their higher risk of infection and sub-optimal access to healthcare, Canada's COVID-19 vaccination strategy focused primarily on age, as well as medical and occupational risk factors.MethodsWe conducted a mixed-methods constant comparative qualitative analysis of epidemiological data from a national database of COVID-19 cases and vaccine coverage in four Canadian jurisdictions. Jurisdictional policies, policy updates, and associated press releases were collected from government websites, and qualitative data were collected through 34 semi-structured interviews of key informants from nine Canadian jurisdictions. Interviews were coded and analyzed for themes and patterns.ResultsCOVID-19 vaccines were rolled out in Canada in three phases, each accompanied by specific challenges. Vaccine delivery systems typically featured large-venue mass immunization sites that presented a variety of barriers for those from vulnerable communities. The engagement and targeted outreach that featured in the later phases were driven predominantly by the efforts of community organizations and primary care providers, with limited support from provincial governments.ConclusionsWhile COVID-19 vaccine rollout in Canada is largely considered a success, such an interpretation is shaped by the metrics chosen. Vaccine delivery systems across Canada need substantial improvements to ensure optimal uptake and equitable access for all. Our findings suggest a more equitable model for vaccine delivery featuring early establishment of local barrier-free clinics, culturally safe and representative environment, as well as multi-lingual assistance, among other vulnerability-sensitive elements.

Vaccine hesitancy-the reluctance to receive recommended vaccination because of concerns and doubts about vaccines-is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (CAM) use and vaccine hesitancy and/or refusal has been frequently reported in the literature. To date, significant gaps persist in our understanding of contemporary Canadian CAM providers' beliefs regarding vaccination and how socio-professional influences may shape their vaccine-related attitudes and behaviours. To address the latter gap, the current study aims to explore the content of professional guidelines, recommendations and other discourses among CAM providers as they concern vaccination by analyzing both academic, peer-reviewed literature and Canadian organizational webpages prepared by and/or for practicing chiropractors, naturopaths and homeopaths. In the academic literature, we identified a number of complex and diverging views on vaccination that spanned topics of effectiveness; safety; theoretical, empirical, and ethical soundness; political justifiability; and compatibility with CAM philosophy and professional boundaries. However, in its current state the CAM literature cannot be described in broad strokes as being either pro- or anti-vaccination without considering finer areas of disagreement. Compared to the academic literature, which focuses more on the conceptual and evidentiary basis of vaccination, a greater proportion of vaccine-related content on Canadian CAM organizations' webpages seems to be dedicated to offering specific directives and prescriptions to providers. Guidelines and standards of practice address a number of issues, including vaccine administration, counsel, education and marketing. As CAM organizations further evolve in Canada and elsewhere as part of a broader "professionalization" initiative, greater attention will need to be directed at their role in shaping providers' beliefs and practices that both support and undermine vaccine promotion efforts.

Trust is an essential component of successful cooperative endeavours. The global health response to the 2014–2016 West Africa Ebola outbreak confronted historically tenuous regional relationships of trust. Challenging sociopolitical contexts and initially inappropriate communication strategies impeded trustworthy relationships between communities and responders during the epidemic. Social scientists affiliated with the Ebola 100-Institut Pasteur project interviewed approximately 160 local, national and international responders holding a wide variety of roles during the epidemic. Focusing on responder’s experiences of communities’ trust during the epidemic, this qualitative study identifies and explores social techniques for effective emergency response. The response required individuals with diverse knowledges and experiences. Responders’ included on-the-ground social mobilisers, health workers and clinicians, government officials, ambulance drivers, contact tracers and many more. We find that trust was fostered through open, transparent and reflexive communication that was adaptive and accountable to community-led response efforts and to real-time priorities. We expand on these findings to identify ‘technologies of trust’ that can be used to promote actively legitimate trustworthy relationships. Responders engaged the social technologies of openness (a willingness and genuine effort to incorporate multiple perspectives), reflexivity (flexibly responsive to context and ongoing dialogue) and accountability (taking responsibility for local contexts and consequences) to facilitate relations of trust. Technologies of trust contribute to the development of a framework of practical techniques to improve the acceptance and effectiveness of future emergency response strategies

Objective: Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers’ knowledge, attitudes, and practices around vaccination in pregnancy. Methods: Qualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes. Results: Participants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile. Conclusion: Provider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers’ knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling.

Background Analysing the Canadian government’s efforts to support the development of COVID-19 “medical countermeasures” (MCMs), this article seeks insights into political economy as a driver of pandemic response. We explore whether Canadian public funding policy during the pandemic involved departures from established practices of financialisation in biopharmaceutical research and development (R&D), including the dominance of private sector involvement in an intellectual property (IP) intensive approach to innovation underscoring profit, and governance opacity.Methods We interrogate public funding for MCMs by analyzing how much the Government of Canada (GoC) spent, how those funds were allocated, on what terms, and to whom. We identify the funding institutions, and the funds awarded between February 10, 2020, and March 31, 2021, to support the research, development, and manufacturing of MCMs, including diagnostics, vaccines, therapeutics, and information about clinical management and virus transmission. To collect these data, we conducted searches on the Internet, public data repositories, and filed several requests under the Access to Information Act (1985). Subsequently, we carried out a document-based analysis of electronically accessible research contracts, proposals, grant calls, and policy announcements.Results The GoC announced CAD$ 1.4 billion for research, development and manufacturing of COVID-19 MCMs. Fully 68 (CAD$ 959 million) of the announced public funding was channelled to investment in private sector firms. Canadian public funding showed a consistent focus on early and late stage development of COVID-19 MCMs and the expansion of biopharmaceutical manufacturing capacity. Assessing whether Canada’s investments into developing COVID-19 MCMs safeguard affordable and transparent access to the products of publicly funded research, we found that access policies on IP management, sharing of clinical data, affordability and availability were not systematic, consistent, or transparent, and few, if any, mechanisms ensured long-term sustainability.Conclusion Beyond incremental change in policy goals, such as public investment in domestic biomanufacturing, the features of Canadian public policies endorsing financialization in the biopharmaceutical sector remained largely unchanged during the pandemic.

Canadians and Quebecers increasingly consult complementary and alternative medicine (CAM) practitioners in parallel with biomedical providers. The close relationship between vaccine hesitancy and CAM use remains under explored in Western countries. We present the results of a qualitative study conducted among one of Quebec's most used CAM approaches: naturopathy. Using Boholm and Corvellec's relational theory of risk to illustrate naturopaths' construction of vaccination as an “object of risk”, we describe how the health representations of 30 Quebec naturopath interviewees are associated with the ways they perceived the risks of infectious diseases and vaccination. Our findings illustrate how Quebec naturopaths' view the body as “at risk” from the possible harmful effects of vaccines. For these naturopaths, the body is a site, a “terrain”, where homeostasis must continually be preserved, and needs to be protected from risks such as vaccines—which were seen as far riskier than infectious diseases—through natural means. Such views are often perceived as unscientific or even irrational by public health researchers. Our study highlights that naturopaths' attitudes towards vaccination are perfectly aligned with the epistemological tenets of their risk representations and conceptions of health.

Abstract Background Little is known about volunteers from Northern research settings who participate in vaccine trials of highly infectious diseases with no approved treatments. This article explores the motivations of HIV immunocompromised study participants in Canada who volunteered in a Phase II clinical trial that evaluated the safety and immunogenicity of an Ebola vaccine candidate. Methods Observation at the clinical study site and semi-structured interviews employing situational and discursive analysis were conducted with clinical trial participants and staff over one year. Interviews were recorded, transcribed and analysed using critical qualitative interpretivist thematic analytical techniques. Patterns were identified, clustered and sorted to generate distinct and comprehensive themes. We then reassembled events and contexts from the study participants’ stories to develop two ideal portraits based on "composite characters" based on study participants features. These provide ethnographically rich details of participants’ meaningful social worlds while protecting individual identities. Results Ten of the 14 clinical trial participants, and 3 study staff were interviewed. Participant demographics and socio-economic profiles expressed limited contextual diversity. Half were men who have sex with men, half were former injection drug users experiencing homelessness, one was female, none were racialized minorities and there were no people from HIV endemic countries. Fully 90% had previous involvement in other clinical studies. Their stories point to particular socio-economic situations that motivated their participation as clinical labor through trial participation. Conclusions Our findings support Fisher’s argument of “structural coercion” in clinical trial recruitment of vulnerable individuals experiencing precarious living conditions. Clinical trials should provide more detail of the structural socio-economic conditions and healthcare needs which lie “under consent” of study participants. Going well beyond an overly convenient narrative of altruism, ethical deliberation frameworks need to sufficiently address the structural conditions of clinical trials. We offer concrete possibilities for this and acknowledge that further research and clinical data should be made available underlying study participant contexts with regards to recruitment and participation in resource poor settings, in both the South and the North.

An amendment to this paper has been published and can be accessed via the original article.