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Introduction: School-based immunization programs offer an accessible route to routine vaccines for students. During the COVID-19 pandemic, school closures to comply with public health measures had a drastic effect on school-based immunization program delivery and associated vaccine uptake. We sought to integrate findings from a mixed methods study to co-develop evidence-based and theory-informed recommendations with a diverse group of stakeholders (i.e., decision makers, healthcare providers, school staff, parents and adolescent students) to address barriers to new and existing school-based immunization programs. Methods: Findings from a mixed methods study were integrated using a joint display and narrative summary. These findings were mapped through the Behaviour Change Wheel, a series of tools designed to facilitate the development of behaviour change interventions. Draft recommendations were provided to previous mixed methods study participants who consented to participating in future phases of the research study (n = 26). Feedback was captured using a Likert-scale survey of acceptability, practicality, effectiveness, affordability, safety and equity (APEASE) criteria, with feedback and additional insights captured using open-ended textboxes. Data was used to revise and finalize recommendations. Results: Applying the Behaviour Change Wheel, we drafted 26 evidence-based, theory-informed recommendations to address barriers to school-based immunization programs. Participants (n = 16) provided feedback, with half of the recommendations scoring 80% or higher across all six APEASE criteria. The remaining 13 recommendations received a moderate score across one or more criteria. Stakeholders identified a high level of interest in expanding the use of e-consent forms, expanding programming to offer a meningitis B vaccine, and recommendations to ease student anxiety. Conclusion: We co-developed a range of recommendations to improve school-based immunization programs with stakeholders using data generated from a mixed methods study. Implementation of any single or combination of recommendations will need to be tailored to local clinic procedures, school system and health system resources. [ABSTRACT FROM AUTHOR]

Influenza is a serious, vaccine-preventable illness. The current vaccination rates in Canada are below target rates, highlighting the potential need for more convenient ways to receive vaccinations. Wait times to be seen in Canadian emergency departments are escalating, and using the time spent waiting to offer and administer an influenza vaccine could potentially improve ease of access to immunization for some Canadians. The aim of this cross-sectional study was to gauge public interest and identify perceived barriers and facilitators to influenza vaccine availability in a Canadian emergency and trauma center. Anonymous questionnaires were completed by a convenience sample of adult patients classified as low acuity (n = 151) as 1 arm of a 2-arm study. Of the unvaccinated patients, 34.6% expressed willingness to be vaccinated in the emergency department. The patients who had received a vaccine in the previous year were significantly more willing to accept the vaccine in the emergency department (χ2 [1] = 23.78, P < 0.001). The 3 top factors associated with having received vaccination in the previous year include trust in vaccine information (χ2 [2] = 27.34, P < 0.001), immunity preferences (χ2 [2] = 32.25, P < 0.001), and beliefs about efficacy (χ2 [2] = 44.90, P < 0.001). Patients classified as low acuity were supportive of ED influenza vaccination. In addition, some of the unvaccinated participants had unmet education needs (ie, regarding trustworthy sources of vaccine information, immunity, and vaccine efficacy) that would require addressing before they would likely consider receiving influenza vaccination in future during their ED visit. [ABSTRACT FROM AUTHOR]

Influenza is a burdensome and vaccine-preventable infectious disease. Lack of time was reported as a common barrier by Canadians who did not receive their influenza vaccine. Increasing convenient access to vaccination increases uptake, and a potential setting for vaccine administration is the emergency department, where long wait times are common. A cross-sectional survey to gauge health care provider support and perceived barriers and facilitators to delivering influenza vaccine was conducted at 1 emergency and trauma center in Halifax, Nova Scotia. Anonymous questionnaires were completed by a convenience sample of emergency nurses, physicians, and paramedics (n = 82). In total, 86% (n = 68) of health care providers supported vaccination in the emergency department when sufficient staffing and resources were available. When asked to consider implementation of influenza vaccination in the emergency department based on current staffing and resources, only 59% (n = 48) supported making vaccination available. Most surveyed health care providers preferred screening for vaccination at triage (57%) and supported a nurse-initiated protocol for vaccine administration (74%). After Bonferroni correction, there was no significant association between preference for when to vaccinate and being a nurse or physician (χ2(2) = 6.208, P = 0.05). The highest risk patient groups with the lowest provider endorsement of vaccination were people involved in poultry culling (77%) and pregnant women (83%). Surveyed health care providers were supportive of ED influenza vaccination. However, this study revealed additional barriers that need to be addressed to effectively launch such a program. [ABSTRACT FROM AUTHOR]

Background Nova Scotia has the highest rate of cervical cancer in Canada, and most of these cases are attributed to the Human Papillomavirus (HPV). In 2007, Gardasil® was approved and implemented in a successful school-based HPV immunization program. Little is known, however, which strategies (if any) used within a school-based program help to improve vaccine uptake. Methods A retrospective, exploratory correlation study was conducted to examine the relationship between school-based strategies and uptake of HPV vaccine. Data was analyzed through Logistic regression, using PASW Statistics 17 (formerly SPSS 17). Results HPV vaccine initiation was significantly associated with Public Health Nurses providing reminder calls for: consent return (p = 0.017) and missed school clinic (p = 0.004); HPV education to teachers (p < 0.001), and a thank-you note to teachers (p < 0.001). Completion of the HPV series was associated with vaccine consents being returned to the students' teacher (p = 0.003), and a Public Health Nurse being assigned to a school (p = 0.025). Conclusions These findings can be used to help guide school-based immunization programs for optimal uptake of the HPV vaccine among the student population. [ABSTRACT FROM AUTHOR]

• Mainstream media, such as newspapers, play a critical role during a public health crisis by shaping public perceptions and behaviors. • Analyzing editorial cartoons is useful to rapidly gather information on public opinion. • We analyzed editorial cartoons on COVID-19 vaccines over 32 months of the pandemic. • There was a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment. • Recent editorial cartoons illustrate vaccine fatigue, which can be a challenge to maintaining confidence and high vaccination rates. In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2 172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better understand barriers and enabling conditions for HPV vaccination in school-based vaccination programs in Canada. Semi-structured interviews were conducted by telephone or in person with parents, nurses, and school staff (n = 50) in three Canadian provinces. Interviews explored views on HPV and HPV vaccination, strengths and weaknesses of the school-based HPV vaccination programs and proposed interventions to increase uptake. Interview transcripts were coded and analyzed thematically using the socio-ecological model. Participants had positive views towards HPV vaccination and school-based offer. They identified barriers and enabling conditions at the individual and interpersonal level (e.g., knowledge, attitudes, behaviours of – and relationships between – parents, nurses, and school personnel), at the organizational level (e.g., allocated resources, information provision, process to ensure informed consent, vaccination setting and environment) and at the community and policy level (e.g., social group values and norms, media coverage around the HPV vaccine). Participants also suggested strategies to reduce identified barriers (e.g., communication interventions, simpler inform consent process). Different layers of barriers and enabling conditions of HPV vaccination in school settings were identified. Tailored interventions remain key to enhance vaccine acceptance and uptake. • Different barriers and facilitators of HPV vaccination in school settings were identified by using the socio-ecological model. • Strategies to improve HPV vaccination include communication interventions and simplification of the information and consent process. • Enhanced collaboration between public health nurses and school personnel are key in achieving greater vaccine acceptance and uptake. [ABSTRACT FROM AUTHOR]

Highlights • Globally, many countries have enacted, strengthened or contemplated mandatory infant and/or childhood immunization. • No standard approach to mandatory immunization; varies from soft/flexible to rigid/hard. • Varies in terms of vaccines included, age groups covered, penalties, degree of enforcement, and if AEFI compensation. • There are ethical, legal and public health implications. • Meager evidence on benefits of hard mandatory; may have unintended consequences. • Mandatory immunization does not guarantee improved vaccine uptake rate. Abstract Globally, infant and childhood vaccine uptake rates are not high enough to control vaccine preventable diseases, with outbreaks occurring even in high-income countries. This has led a number of high-, middle-and low income countries to enact, strengthen or contemplate mandatory infant and/or childhood immunization to try to address the gap. Mandatory immunization that reduces or eliminates individual choice is often controversial. There is no standard approach to mandatory immunization. What vaccines are included, age groups covered, program flexibility and rigidity e.g. opportunities for opting out, penalties or incentives, degree of enforcement, and whether a compensation program for causally associated serious adverse events following immunization exists vary widely. We present an overview of mandatory immunization with examples in two high- and one low-income countries to illustrate variations, summarize limited outcome data related to mandatory immunization, and suggest key elements to consider when contemplating mandatory infant and/or child immunization. Before moving forward with mandatory immunization, governments need to assure financial sustainability, uninterrupted supply and equitable access to all the population. Other interventions may be more effective and less intrusive than mandatory. If mandatory is implemented, this needs to be tailored to fit the context and the country’s culture. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic represents not only the spread of a highly contagious and potentially fatal virus, but also an outbreak of theories, rumors, discourses and representations trying to make sense of a crisis. In this article, we explore the issue of blame and stigma in the context of the COVID-19 pandemic in Canada. We do so by studying editorial cartoons published about COVID-19 in ten mainstream Canadian newspapers between January 2020 and March 2021. We identified 203 editorial cartoons that highlight common discourses which blame or stigmatize specific groups of people for the origin or transmission of COVID-19, or for their behavior during the pandemic. The cartoons focused on four groups: 1) people of Chinese origin or descent and of other national/geographic provenance (Americans, Canadians from specific provinces, urban residents); 2) international travelers; 3) people who do not respect the preventive measures to contain the pandemic; and 4) people who question or criticize the scientific discourses about COVID-19. Our analysis revealed an "othering process" common in times of pandemic. Our analysis of editorial cartoons in Canada also uncovered a moralization around the respect of the counter measures against COVID-19. These editorial cartoons largely divide the population into two groups: 1) "virtuous" people who are "selfless" and "smart" and who respect the public health preventive measures; 2) those who are "immoral", "self-centered", "silly" and even "stupid", who do not respect the recommended measures to prevent the transmission of COVID-19. While negatively portraying these individuals may help promote adherence to the recommended measures, it also can exacerbate polarization. Analyzing editorial cartoons can be a useful approach to rapidly gather information on attitudes and feelings in the public at a specific time and place. • The search for scapegoats in times of pandemic is common. • Blaming reflects pre-existing conceptions of health, contagion and what a good citizen does. • Analyzing editorial cartoons is useful to rapidly gather information on public opinion. • Findings showed that foreigners, travelers, and city dwellers were held responsible for COVID-19. • Blame attribution shifted later to people who did not follow recommended measures. [ABSTRACT FROM AUTHOR]