Ana Rita Sequeira (she/her)

Objective
This study investigates the extent to which individual characteristics and preferences towards vaccine attributes and societal restrictions influence vaccination behaviour in a representative Brazilian population.

Method
We conducted a discrete choice experiment (DCE) involving 3,001 Brazilian respondents from July to September 2022 through an online panel. The DCE involved five vaccine features and two social restriction features. Participants were presented to a sequence of binary choices of hypothetical vaccination programs, with an option to opt-out. We performed multiple regression models to investigate the predictors of vaccination and opt-out decisions. We also performed a latent class logit model to estimate trade-offs between vaccination attributes and societal restrictions across groups.

Results
Our regression results identified that gender, religiosity, income, political orientation and trust in public health institutions were important predictors of vaccination decisions in Brazil. Our latent class models indicated significant heterogeneity and detected four main classes: (i) left-leaning, pro restrictions, who showed strong preferences for vaccine features such as its effectiveness (62.4%); (ii) left-leaning, pro mandates, who showed strong support for societal restrictions (19.5%); (iii) centrists, pragmatics, who were opposed to restrictions but supportive of vaccine features (11.4%); (iv) right-leaning, vaccine refusers, who showed a willingness to opt-out from vaccination programmes and did not show any preferences for vaccine features (6.7%).

Conclusions
Our findings suggest that the Brazilian population had overall high willingness to accept vaccines and displayed high trust in public health authorities. Nonetheless, the presence of a non-negligible proportion of cautious and hesitant groups may prevent the effectiveness of vaccination campaigns in the future.

Context: In recent decades, many countries experienced a reduction in the quality and functioning of democratic institutions and norms, accompanied by rising social distrust and opposing political views. The decline in vaccine confidence might be linked to these trends. This study explores the political factors influencing individual attitudes towards vaccination across 22 upper-middle-income and high-income countries, examining the interaction between political orientation, trust in public health authorities, and levels of democracy.

Methods: Using the VaxPref database, encompassing demographically representative data from 50,242 respondents collected between July 2022 and June 2023, our analysis operates on three levels: pooled sample, democracy groups, and country-specific analyses.

Results: We found that higher democracy scores generally correlated with lower levels of vaccine scepticism. People at the centre and on the right of the political spectrum expressed more scepticism towards vaccines overall. However, trust in public health authorities emerged as the determinant which explains the largest variation in vaccine attitudes.

Conclusions: Our findings suggest a greater effectiveness of democratic systems in fostering vaccine confidence, and the need to depoliticise vaccination efforts. Building and maintaining trust in scientific information and technical expertise is critical. Blunt measures like vaccination mandates may not sustain long-term confidence, particularly in democratic contexts. Effective interventions should prioritise comprehensive school-based education to promote preventive health behaviours, coupled with trust-enhancing targeted communication strategies

In vaccination decisions, individuals must weigh the benefits against the risks of remaining unvaccinated and potentially facing social restrictions. Previous studies have focused on individual preferences for vaccine characteristics and societal restrictions separately. This study aims to quantify public preferences and the potential trade-offs between vaccine characteristics and societal restrictions, including lockdowns and vaccine mandates, in the event of a future pandemic. We conducted a discrete choice experiment (DCE) involving 47,114 respondents from 21 countries between July 2022 and June 2023 through an online panel. Participants were presented with choices between two hypothetical vaccination programs and an option to opt out. A latent class logit model was used to estimate trade-offs among attributes. Despite some level of preference heterogeneity across countries and respondents’ profiles, we consistently identified three classes of respondents: vaccine refusers, vaccine-hesitant, and pro-vaccine individuals. Vaccine attributes were generally deemed more important than societal restriction attributes. We detected strong preferences for highest levels of vaccine effectiveness and domestically produced vaccines across most countries. Being fully vaccinated against COVID-19 was the strongest predictor of pro-vaccine class preferences. Women and younger people were more likely to be vaccine refusers compared to men and older individuals. Lower socioeconomic status was associated with vaccine hesitancy and refusal in some countries, while higher-educated and wealthier individuals were more likely to exhibit hesitancy in others. Our findings emphasize the need for tailored vaccination programs that consider local contexts and demographics. Building trust in national regulatory authorities and international organizations through targeted communication, along with investing in domestic production facilities, can improve vaccine uptake and enhance public health responses in the future.

Objective
Despite widespread perceptions that SARS-CoV-2 (COVID-19) is no longer a significant threat, the virus continues to loom, and new variants may require renewed efforts to control its spread. Understanding how individual preferences and attitudes influence vaccination behaviour and policy compliance in light of the endemic phase is crucial in preparation for this scenario.

Method
This paper presents descriptive data from a global stated choice survey conducted in 22 countries across 6 different continents between July 2022 and August 2023, and reports the methodological work developed to address the need for comparable data.

Results
This study included 50,242 respondents. Findings indicated significant heterogeneity across countries in terms of vaccination status and willingness to accept boosters. Vaccine hesitancy and refusal were driven by lower trust in public health bodies, younger age, and lower educational levels. Refusers and hesitant people reported lower willingness to take risks compared to those fully vaccinated (p<0.05). Lower mental health levels were found for the hesitant cohort (p<0.05).

Conclusions
Insights from this database can help public health authorities to gain a new understanding of the vaccine hesitancy phenomenon, support them in managing the transition from the pandemic to the endemic phase, and favour a new stream of research to maximise behavioural response to vaccination programs in preparation of future pandemics.

Background
Countries have adopted different COVID-19 policies to contain the transmission of the disease and to prepare for vaccination rollout. Countries’ political context, vaccine policy history, and health systems’ responses impacted COVID-19 health outcomes.

Objective
This study focused on synthesizing and examining COVID-19 non-pharmaceutical interventions in Brazil and Portugal, understanding the enablers and barriers to COVID-19 vaccination access and distribution, and health and non-health outcomes across three time-points: before vaccination, during mass vaccination, and after the declaration of endemicity.

Methods
Extensive qualitative document analysis of secondary sources published in Portuguese and English over the past three years, and examination of primary publicly available epidemiological data since the beginning of the pandemic.

Results
In the first year of the pandemic, the COVID-19 government response between the two countries was dissimilar; effective coordination, trust in the government response and political alignment in Portugal contrasted the political denial of the pandemic, lack of coordination between the various levels of government, at the same time the Brazilian population engaged in protective behaviours and distrusted the government. The COVID-19 vaccination had a good response from the public, associated with a primary care level network of distribution, low vaccine hesitancy, and strong childhood immunization programs before the pandemic in both countries. Vaccine manufacturing in Brazil and the strong support from the European Union to Portugal on vaccine acquisition have also aided these countries in achieving high COVID-19 vaccination coverage.

Conclusion
Future policies to promote a well-functioning and resilient health system should consider medical and nursing workforce sustainability, equity in all policies, building public trust, strengthening health system governance, and improving preparedness and surveillance.

Scholarship on feedback format tends to demonstrate that students prefer video feedback; however, the characteristics of study participants are often absent. This study builds on the scholarship of feedback practice mediated by technology and feedback literacy in intercultural contexts. A mixed methods approach examined international postgraduate students' experience of, preferences for and attitudes towards three feedback formats: text, audio and video. Eighty-four participants in an Australian university completed a survey, and twelve participated in semi-structured phone interviews. The participants were mainly women from India, aged between 25 and 34 years old and declared English as a second language. Participants scored their experience with video, audio and written feedback. Written feedback was ranked first, followed by video and audio feedback. Participants reported that written feedback allows students to easily locate areas that need improvement. The role of the disciplinary traditions and respondents' educational background is discussed to make sense of the results.

Objective Lack of medical and scientific knowledge on rare diseases (RD) often translates into limited research on them and a subsequent lack of understanding of their economic impact. This meta-analysis aims to fill this gap by evaluating the economic impact of RDs and exploring potential factors associated with the societal burden of RD. Methods Studies published between January 2010 and February 2017 were identified by searches in the PubMed platform. Thirty eligible studies were identified for inclusion, and nineteen studies were included in the meta-analysis and outcomes were explored. The cost categories include direct healthcare costs, direct non-healthcare formal costs, and direct non-healthcare informal costs. The patients’ health-related quality of life (QoL) dimensions examined include EQ-5D scores, VAS scores and Barthel index, and the carers’ utility outcomes include EQ-5d scores, VAS scores and Zarit scale. Random effects meta-regression models were used for modelling the impact of study and societal characteristics on cost. Results Across all RDs, mean direct healthcare (DH) costs ($16,513) account for the majority of direct costs (mainly driven by drug costs), followed by mean direct healthcare informal (€15,557) and mean direct healthcare formal (€4,579) costs. Body system affected by the RD, Gross Domestic Product (GDP) per capita and public health expenditure in country of study were the most significant determinants in predicting cost. In regards to QoL outcomes, patients with musculoskeletal diseases seem to have the lowest quality of life across EQ-5D scores, VAS scores and Barthel index. The burden on caregivers seemed to be associated with Autoimmune, followed by Musculoskeletal and Respiratory conditions. Conclusions This meta-analysis highlights the significant burden of RDs on the health care system and explicitly provides evidence for the magnitude of this impact. Such estimates are necessary to further the debate on priority setting around RDs and their comparison with other chronic diseases. Nevertheless, the large degree of cost variability across RDs might suggest that the use of umbrella terms to raise awareness around RDs’ societal impact might not be warranted.

Background COVID-19 reached Latin-American countries slightly later than European countries, around February/March, allowing some emergency preparedness response in countries characterized by low health system capacities and socioeconomic disparities. Objective This paper focuses on the first months of the pandemic in five Latin American countries: Brazil, Chile, Colombia, Ecuador and Peru. It analyses how the pre-pandemic context, and the government's responses to contain and mitigate the spread together with economic measures have affected the COVID-19 health outcomes. Methods Extensive qualitative document analysis was conducted focused on publicly-available epidemiological data and federal and state/regional policy documents since the beginning of the pandemic. Results The countries were quick to implement stringent COVID-19 measures and incrementally scaled up their health systems capacity, although tracing and tracking have been poor. All five countries have experienced a large number of cases and deaths due to COVID-19. The analysis on the excess deaths also shows that the impact in deaths is far higher than the official numbers reported to date for some countries. Conclusion Despite the introduction of stringent measures of containment and mitigation, and the scale up of health system capacities, pre-pandemic conditions that characterize these countries (high informal employment, and social inequalities) have undermined the effectiveness of the countries’ responses to the pandemic. The economic support measures put in place were found to be too timid for some countries and introduced too late in most of them. Additionally, the lack of a comprehensive strategy for testing and tracking has also contributed to the failure to contain the spread of the virus.

We use data collected as part of a baseline survey in 2012 and a survey 5 months post-intervention in 2014 to assess the short-term outcomes of a water supply intervention in Ribáuè, Mozambique. This intervention included the rehabilitation and expansion of a piped water system, revitalization of water committees, and creation of and capacity building for small-scale private water enterprises. Quantitative results suggest that the intervention led to an immediate significant increase in the use of piped water supply at the expense of unprotected wells and other non-revenue generating forms of unimproved water supply with more than a 2.5-fold increase in the usage of yard taps and water kiosks/standpipes and a two-fold decrease in the use of unprotected wells. Family water consumption also increased by approximately 40 L/d, and the point-of-use treatment of water nearly tripled. Economic opportunities were generated for business and small enterprise owners due to the new water supply infrastructure, and piped water infrastructure had additional positive effects for both public and private sanitation facilities.

Background

The trade-off between efficiency and equity has been largely studied in the health economics literature and for countries with different types of health systems. Even if efficiency and equity are desired, it is not always feasible to attain both simultaneously. In Spain, the National Health System has historically been recognized for its universal access and free of charge provision, with good health outcomes. However, the recent increase in health expenditures together with the economic cycle has turned the orientation of health policy implementation towards efficiency, threatening universality and equity in the access to healthcare.

Methods

A Discrete Choice Experiment was carried out to weigh priorities of policy-makers from different regions in Spain. A total of 69 valid questionnaires were collected and the preferences towards equity and/or efficiency criteria were evaluated. Composite League Tables (CLTs) were used to rank hypothetical health interventions based on their attributes.

Results

The Spanish health policy-makers, managers and other stakeholder displayed a stronger preference for severity of disease, high individual benefits, a large number of beneficiaries and proven cost-effectiveness criteria in decision making. The priority interventions targeted severe mental disorders, i.e. major depressive disorders and suicides (or suicidal attempts), especially for young and middle age categories across the three regions under study.

Conclusion

In times of economic crisis, health policy-makers, managers and other stakeholder value, in moderation, efficiency over equity. The impact of austerity measures on populations’ socio-economic wellbeing seems correlated with the preference for mental health interventions.