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The COVID-19 pandemic contributed to significant health services declines in South-East Asia including Indonesia, which experienced a decline in routine immunisation of children. This study investigated the influence of the pandemic on the beliefs and experiences of caregivers of children related to routine immunisation. This study involved a cross-sectional survey among 1399 caregivers of children aged 0-24 months in Central Java and West Nusa Tenggara provinces from March-April 2022. Data on beliefs and experiences of childhood immunizations were captured using core items from the WHO/UNICEF Behavioural and Social Drivers of Immunization (BeSD) survey. Bivariate and multivariate logistic regression analyses identified factors associated with uptake of routine immunisations. While nearly all caregivers (95.7%) reported wanting their child to receive all recommended routine immunisations, only 40.3% of children aged 2-24 months were up-to-date with all vaccines for age. Factors associated with up-to-date included higher parental education (aOR: 1.76, 95% CI 1.02-3.05), higher household income (aOR: 1.54, 95% CI 1.09-2.18), and caregivers who found it moderately or very easy to get immunisations (aOR: 2.26/2.22, 95% CI 1.06-4.83/1.06-4.69). Recovery efforts should prioritise responding to the factors associated with immunisation status (e.g., perceived ease of access) and on families experiencing disadvantage (e.g., caregivers with lower education and household income) to ensure protections against future outbreaks that are responsive to the context-specific needs and priorities of districts and communities.

BACKGROUND: In 2008/9, Fiji vaccinated >30,000 girls aged 9-12 years with the quadrivalent human papillomavirus (4vHPV) vaccine coverage for at least one dose was >60% (one dose only was 14%, two dose only was 13%, three doses was 35%). We calculated vaccine effectiveness (VE) of one, two and three doses of 4vHPV against oncogenic HPV genotypes 16/18, eight years following vaccination. METHODS: A retrospective cohort study was undertaken (2015-2019) in pregnant women ≤23 years old, eligible to receive 4vHPV in 2008/9, with confirmed vaccination status. The study was restricted to pregnant women due to the cultural sensitivity of asking about sexual behavior in Fiji. For each participant a clinician collected a questionnaire, vaginal swab and genital warts examination, a median eight (range 6-11) years post vaccination. HPV DNA was detected by molecular methods. Adjusted VE (aVE) against the detection of vaccine HPV genotypes (16/18), the comparison group of non-vaccine genotypes (31/33/35/39/45/51/52/56/58/59/66/68), and genital warts were calculated. Covariates included in the adjusted model were: age, ethnicity and smoking, according to univariate association with any HPV detection. FINDINGS: Among 822 participants the prevalence of HPV 16/18 in the unvaccinated, one, two and three-dose groups were 13.3% (50/376), 2.5% (4/158), 0% (0/99) and 1.6% (3/189), respectively; and for the non-vaccine high-risk genotypes, the detection rate was similar across dosage groups (33.2%-40.4%, p = 0.321). The aVE against HPV 16/18 for one, two and three doses were 81% (95% CI; 48-93%), 100% (95% CI; 100-100%), and 89% (95% CI; 64-96%), respectively. Prevalence of HPV 16/18 was lower among women with longer time since vaccination. INTERPRETATIONS: A single dose 4vHPV vaccine is highly effective against HPV genotypes 16 and 18 eight years following vaccination. Our results provide the longest duration of protection for reduced dose 4vHPV schedule in a low- or middle-income country

When poor mental health impairs a doctor's ability to safely practise medicine, poor patient outcomes can result. Medical regulators play a critical role in protecting the public from impaired doctors, by requiring monitoring and treatment. However, regulatory processes may paradoxically harm doctors, with potential adverse implications for the community. There is little prior research examining the experiences of doctors with prior mental health or substance use challenges who are subject to regulatory notifications and processes relating to their health. Therefore, we explored this issue through the thematic analysis of semi-structured qualitative interviews. Participants reported that mandated treatment improved aspects of their health, but that fear of regulatory processes delayed them seeking treatment. Participants recognised being significantly unwell at the time of regulatory notification. Participants told us that regulatory processes triggered psychological distress, symptom relapse, and adverse financial and vocational implications. They also told us that these processes eroded their trust in regulators and regulatory processes. To improve health outcomes for unwell doctors and to create safer healthcare for the community, we propose: 1) greater awareness and education of the medical profession about the thresholds and requirements for mandatory reporting of health impairment; 2) better integrating specialised doctors' health services into existing regulatory pathways; and 3) adoption of a more therapeutic approach to regulation by medical regulators.

Background: Healthcare workers experience burnout, psychological distress and suicide at higher rates than the general population. The stressors inherent to these professions have been magnified during the COVID-19 pandemic. In response, a group of doctors, nurses and allied health practitioners developed Hand-n-Hand Peer Support Inc. (Helping Australian and New Zealand Nurses and Doctors) in the early months of 2020. Objective(s): To provide peer support to colleagues in a pre-clinical setting and aims to reduce the rates of distress and improve the well-being of its participants. In addition, Hand-n-Hand aims to provide effective peer support training to facilitators to ensure healthcare workers are appropriately supported. Method(s): Hand-n-Hand was initially piloted on social media before being converted to a peer support model that connects facilitators with peers who had requested support, either in small groups or individually. Facilitators providing peer support may undertake training to become an accredited peer supporter through Hand-n-Hand. Finding(s): Uptake of peer support among healthcare workers has been consistent since Hand-n-Hand was piloted in March 2020. The initial social media launch gained more than 400 participants in the first 24 hours and Hand-n-Hand has continued to receive a steady influx of healthcare workers requesting peer support. Peer support was initially provided to healthcare workers in Australia and New Zealand. More recently, Hand-n-Hand has expanded to provide peer support training to healthcare workers in developing countries with a large COVID-19 burden. There are minimal sources of help for healthcare workers in these areas and the provision of peer-to-peer support is a cost-effective way to fill this gap. Feedback for Hand-n-Hand's work has been overwhelmingly positive, and there is large potential in the peer support space. Conclusion(s): There is a clear need and demand for peer support among healthcare workers both in re

Background: Healthcare workers experience burnout, psychological distress and suicide at higher rates than the general population. The stressors inherent to these professions have been magnified during the COVID-19 pandemic. In response, in early 2020, a group of doctors, nurses and allied health practitioners developed Handn- Hand Peer Support Inc. (Helping Australian and New Zealand Nurses and Doctors). Objective(s): This programme provides group or one-toone peer support to colleagues in a pre-clinical setting and aims to reduce the rates of distress and improve the wellbeing of its participants. In addition, Hand-n-Hand aims to provide effective peer support training to facilitators to ensure healthcare workers are appropriately supported. Method(s): Data have been collected using quantitative and qualitative means since Hand-n-Hand's inception to monitor the uptake of peer support over time and impact on healthcare worker well-being. Social media and website traffic statistics have been monitored and compared to national lockdowns, COVID-19 outbreaks and referrals to Hand-n-Hand. Baseline confidential data has also been collected from each participant and facilitator who signs up for peer support. Finally, a mixed-methods survey has been provided to all participants for quality assessment purposes in addition to targeted interviews with volunteer group facilitators. Finding(s): There has been consistent uptake of Hand-n- Hand's peer support programme across various platforms. Hand-n-Hand has a strong social media presence and the Facebook peer support group continues to grow. More than 200 healthcare workers have referred themselves for small group or one-to-one peer support since March 2020. More than 90 healthcare workers have taken part in peer support training delivered by the team at Handn- Hand. Participants and group facilitators alike have found involvement with Hand-n-Hand beneficial for their well-being and personally rewarding. Based on the initial f

BACKGROUND: In 2012, Fiji introduced the 10-valent pneumococcal conjugate vaccine (PCV10). We assessed the impact of PCV10 on invasive pneumococcal disease (IPD), probable bacterial or pneumococcal meningitis (PBPM), meningitis and sepsis 3-5 years post-introduction. METHODS: Laboratory-confirmed IPD and PBPM cases were extracted from national laboratory records. ICD-10-AM coded all-cause meningitis and sepsis cases were extracted from national hospitalisation records. Incidence rate ratios were used to compare outcomes pre/post-PCV10, stratified by age groups: 1-23m, 2-4y, 5-9y, 10-19y, 20-54y, ≥55y. To account for different detection and serotyping methods in the pre-and post-PCV10 period, a Bayesian inference model estimated serotype-specific changes in IPD, using pneumococcal carriage and surveillance data. FINDINGS: There were 423 IPD, 1,029 PBPM, 1,391 all-cause meningitis and 7,611 all-cause sepsis cases. Five years post-PCV10 introduction, IPD declined by 60% (95%CI: 37%, 76%) in children 1-23m months old, and in age groups 2-4y, 5-9y, 10-19y although confidence intervals spanned zero. PBPM declined by 36% (95%CI: 21%, 48%) among children 1-23 months old, and in all other age groups, although some confidence intervals spanned zero. Among children <5y of age, PCV10-type IPD declined by 83% (95%CI; 70%, 90%) and with no evidence of change in non-PCV10-type IPD (9%, 95%CI; -69, 43%). There was no change in all-cause meningitis or sepsis. Post-PCV10, the most common serotypes in vaccine age-eligible and non-age eligible people were serotypes 8 and 23B, and 3 and 7F, respectively. INTERPRETATIONS: Our study demonstrates the effectiveness of PCV10 against IPD in a country in the Asia-Pacific of which there is a paucity of data. FUNDING: This study was support by the Department of Foreign Affairs and Trade of the Australian Government and Fiji Health Sector Support Program (FHSSP). FHSSP is implemented by Abt JTA on behalf of the Australian Government.

Strong community engagement has been critical to support COVID-19 vaccine uptake in Australia and elsewhere. Community engagement builds trust, enables tailored information dissemination and shapes social norms. Engagement is particularly important in communities with greater vaccine hesitancy, lower health literacy and mistrust in authorities. Early in 2021, as a team of vaccine social scientists and clinicians, we developed a program to train and empower community, faith, industry and healthcare leaders to advocate for COVID-19 vaccines as “vaccine champions”. We partnered with the Victorian Department of Health to deliver 91 online Vaccine Champions sessions from March 2021 to June 2022. Over 80 people who received this training were supported by the Department of Health to become formal vaccine champions, independently delivering over 100 locally tailored information sessions. Our survey evaluation of 20 sessions delivered in 2022 found most participants (94%, 118/125) felt more confident to discuss safety and effectiveness of COVID-19 vaccines and find relevant information after attending a session. We also recorded >90% participant satisfaction with training content, format and presentation. Qualitative feedback from two group interviews highlighted the value of vaccine communication role plays and opportunities for discussion. In this brief report, we present an overview of the Vaccine Champions program, evaluation and next steps.