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COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country...
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COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "COVID-19 Vaccines and Vaccination".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 10963

Special Issue Editors

Dr. Dimitris Papamichail

E-Mail Website
Guest Editor
Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
Interests: public health; vulnerable groups; vaccination coverage; public health surveillance; epidemiology; outbreak investigation; migrant health; Roma population
Dr. Pietro Ferrara

E-Mail Website
Guest Editor
Center for Public Health Research, University of Milan-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
Interests: epidemiology; public health; preventive medicine; vaccinology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are announcing this Special Issue “COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities”. This Special Issue focuses on under-researched populations and aims to introduce new insights regarding vaccine inequalities during the COVID-19 response. The research areas include the impact of COVID-19 vaccination, public health surveillance of disparities in COVID-19 vaccination coverage, global and within-country inequalities in access to vaccines, vaccine confidence, and coping strategies aimed at bridging the gap of health injustice observed during the pandemic. We welcome original research articles, reviews, and perspectives.

We will provide you with a fast peer-review process to ensure the quick of your research. We look forward to receiving your contributions.

Dr. Dimitris Papamichail
Dr. Pietro Ferrara
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19 vaccine
  • population impact of COVID-19 vaccination
  • public health surveillance
  • health inequalities
  • access

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Published Papers (7 papers)

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Research

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10 pages, 1235 KiB  
Article
The Impact of Limited Vaccine Access on COVID-19 Mortality—Descriptive Study of COVID-19 Vaccination and Mortality Due to COVID-19 in Montenegro, July 2020–February 2022
by Aleksandar Obradović, Marija Raičević and Milko Joksimović
Vaccines 2025, 13(3), 278; https://doi.org/10.3390/vaccines13030278 - 6 Mar 2025
Viewed by 568
Abstract
Introduction: The Delta variant of SARS-CoV-2 dominated Montenegro from July 2020 until early 2022, when Omicron took over. COVID-19 vaccination began on 20 February 2021, two months later than in the EU. The study aimed to investigate the impact of vaccination on [...] Read more.
Introduction: The Delta variant of SARS-CoV-2 dominated Montenegro from July 2020 until early 2022, when Omicron took over. COVID-19 vaccination began on 20 February 2021, two months later than in the EU. The study aimed to investigate the impact of vaccination on mortality rates in Montenegro during Delta’s predominance. Methods: A descriptive study was conducted using data from the Montenegrin Institute of Public Health COVID-19 database, the Population Electronic Immunization Register, which provides data for all administrated COVID-19 vaccines in Montenegro, and EUROSTAT mortality data. Results: COVID-19 accounted for 17.8% of total deaths in Montenegro during the period of study. Crude mortality rate among unvaccinated was almost four times higher compared to those who received at least one vaccine dose. Inactivated vaccines were predominantly administered to those aged 60 and over, while RNA vaccines were mainly given to those under 60. The median interval between the last vaccine dose and death was significantly higher for vector vaccines compared to inactivated vaccines. Discussion: The delayed start of vaccination and limited vaccine choices in Montenegro likely contributed to prolonged high mortality due to COVID-19. Our findings reveal disparities in vaccine distribution and effectiveness, highlighting the need for timely and equitable access to effective vaccines, especially for vulnerable populations. Conclusions: The study underscores the importance of prompt vaccine distribution and the option to choose vaccine types in building public trust and reducing mortality rates. It emphasizes the need for strengthening global mechanisms COVAX and continuing educational activities to address vaccine hesitancy and ensure equitable access to effective vaccines. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)
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14 pages, 728 KiB  
Article
The Real-World Effectiveness of Inactivated COVID-19 Vaccines in Zimbabwe During the Omicron Variant Dominance: A Test-Negative Case–Control Study
by Azure Tariro Makadzange, Patricia Gundidza, Kimberly Cheryl Chido Konono, Margaret Gurumani and Chiratidzo Ndhlovu
Vaccines 2024, 12(12), 1303; https://doi.org/10.3390/vaccines12121303 - 22 Nov 2024
Viewed by 930
Abstract
Background/Objectives: The COVID-19 pandemic has significantly impacted global health, with varying vaccine effectiveness (VE) across different regions and vaccine platforms. In Africa, where vaccination rates are relatively low, inactivated vaccines like BBIP-CorV (Sinopharm) and Coronovac (Sinovac) have been widely used. This study evaluated [...] Read more.
Background/Objectives: The COVID-19 pandemic has significantly impacted global health, with varying vaccine effectiveness (VE) across different regions and vaccine platforms. In Africa, where vaccination rates are relatively low, inactivated vaccines like BBIP-CorV (Sinopharm) and Coronovac (Sinovac) have been widely used. This study evaluated the real-world effectiveness of licensed inactivated COVID-19 vaccines in Zimbabwe during a period dominated by Omicron variants. Methods: We conducted a prospective, test-negative, case–control study among symptomatic adults across six Zimbabwean provinces from November 2022 to October 2023. Participants were categorized based on vaccination status, and nasopharyngeal swabs were collected for SARS-CoV-2 PCR testing. Vaccine effectiveness was assessed using conditional logistic regression, adjusting for various covariates such as age, sex, and comorbidities. Results: Among 5175 participants, 701 tested positive for SARS-CoV-2 and 4474 tested negative. The overall adjusted VE against symptomatic COVID-19 was 31% (95% CI: 5.3–49.7%) among verified vaccinated individuals. Boosted individuals demonstrated a higher VE of 59.8% (95% CI: 40.3–72.9%). VE decreased significantly to 24% (95% CI: −4.1–44.8%) in individuals vaccinated over a year prior. Similar VE was observed for BBIP-CorV (36.8%, 95% CI: 11.4–54.9%) and Coronovac (38.1%, 95% CI: 16.3–54.2%). Conclusions: This study indicates modest protection from inactivated COVID-19 vaccines against symptomatic Omicron infection, with significant enhancement following booster doses. These findings highlight the need for continued vaccine evaluation, particularly in resource-limited settings, to inform public health strategies and optimize vaccination programs. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)
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14 pages, 423 KiB  
Article
Impact of Immunosuppressants and Vaccination on COVID-19 Outcomes in Autoimmune Patients and Solid Organ Transplant Recipients: A Nationwide Propensity Score-Matched Study
by Mindong Sung, Young-Sam Kim, Changjin Cho, Yongeun Son, Dong-Wook Kim and Su-Hwan Lee
Vaccines 2024, 12(10), 1190; https://doi.org/10.3390/vaccines12101190 - 18 Oct 2024
Viewed by 1391
Abstract
Purpose: This study investigates the impact of varying degrees of immunosuppression on the clinical outcomes of immunocompromised individuals, particularly those with autoimmune diseases or post-solid organ transplant statuses, in the context of COVID-19. By focusing on these highly vulnerable populations, the study underscores [...] Read more.
Purpose: This study investigates the impact of varying degrees of immunosuppression on the clinical outcomes of immunocompromised individuals, particularly those with autoimmune diseases or post-solid organ transplant statuses, in the context of COVID-19. By focusing on these highly vulnerable populations, the study underscores the significant health inequalities faced by immunocompromised patients, who experience disproportionately worse outcomes in comparison to the general population. Methods: A retrospective cohort analysis of the K-COV-N dataset was conducted, comparing the effects of immunosuppression in autoimmune and transplant groups with matched control groups. Propensity score matching was employed to minimize inequalities in baseline characteristics, ensuring a more equitable comparison between immunocompromised and non-immunocompromised individuals. Outcomes included COVID-19-related in-hospital mortality, 28-day mortality, ICU admissions, and the need for respiratory support among 323,890 adults in the Republic of Korea. Patients with cancer or other immunosuppressive conditions, such as HIV, were excluded. Subgroup analyses assessed the influence of specific immunosuppressive medications and vaccination extent. Results: Significantly elevated in-hospital mortality was found for patients with autoimmune diseases (adjusted Odds Ratio [aOR] 2.749) and transplant recipients (aOR 7.567), with similar patterns in other outcomes. High-dose steroid use and a greater number of immunosuppressant medications markedly increased the risk of poor outcomes. Vaccination emerged as a protective factor, with a single dose substantially improving outcomes for autoimmune patients and at least two doses necessary for transplant recipients. Conclusions: Immunocompromised patients, particularly those with autoimmune diseases and transplant recipients, are highly vulnerable to severe COVID-19 outcomes. High-dose steroid use and multiple immunosuppressants further increase risks. Vaccination significantly improves outcomes, with at least one dose benefiting autoimmune patients and two doses necessary for transplant recipients. Personalized vaccination schedules based on immunosuppression levels are essential to mitigate healthcare inequalities and improve outcomes, particularly in underserved populations, informing both clinical and public health strategies. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)
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20 pages, 3549 KiB  
Article
Dynamic Vaccine Allocation for Control of Human-Transmissible Disease
by Mingdong Lyu, Chang Chang, Kuofu Liu and Randolph Hall
Vaccines 2024, 12(9), 1034; https://doi.org/10.3390/vaccines12091034 - 9 Sep 2024
Viewed by 1181
Abstract
During pandemics, such as COVID-19, supplies of vaccines can be insufficient for meeting all needs, particularly when vaccines first become available. Our study develops a dynamic methodology for vaccine allocation, segmented by region, age, and timeframe, using a time-sensitive, age-structured compartmental model. Based [...] Read more.
During pandemics, such as COVID-19, supplies of vaccines can be insufficient for meeting all needs, particularly when vaccines first become available. Our study develops a dynamic methodology for vaccine allocation, segmented by region, age, and timeframe, using a time-sensitive, age-structured compartmental model. Based on the objective of minimizing a weighted sum of deaths and cases, we used the Sequential Least Squares Quadratic Programming method to search for a locally optimal COVID-19 vaccine allocation for the United States, for the period from 16 December 2020 to 30 June 2021, where regions corresponded to the 50 states in the United States (U.S.). We also compared our solution to actual allocations of vaccines. From our model, we estimate that approximately 1.8 million cases and 9 thousand deaths could have been averted in the U.S. with an improved allocation. When case reduction is prioritized over death reduction, we found that young people (17 and younger) should receive priority over old people due to their potential to expose others. However, if death reduction is prioritized over case reduction, we found that more vaccines should be allocated to older people, due to their propensity for severe disease. While we have applied our methodology to COVID-19, our approach generalizes to other human-transmissible diseases, with potential application to future epidemics. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)
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14 pages, 840 KiB  
Article
Predictors of Hospitalization in Breakthrough COVID-19 among Fully Vaccinated Individuals with Immune-Mediated Rheumatic Diseases: Data from SAFER-Study
by Débora Cerqueira Calderaro, Valéria Valim, Gilda Aparecida Ferreira, Ketty Lysie Libardi Lira Machado, Priscila Dias Cardoso Ribeiro, Sandra Lúcia Euzébio Ribeiro, Natalia Sarzi Sartori, Rodrigo Poubel Vieira de Rezende, Ana Karla Guedes de Melo, Vitor Alves Cruz, Adah Sophia Rodrigues Vieira, Adriana Maria Kakehasi, Aline Teixeira de Landa, Ana Paula Neves Burian, Flávia Maria Matos Melo Campos Peixoto, Camila Maria Paiva França Telles, Rafaela Cavalheiro do Espírito Santo, Katia Lino Baptista, Yasmin Gurtler Pinheiro de Oliveira, Vanessa de Oliveira Magalhães, Raquel Lima de Lima, Erika Biegelmeyer, Pietra Zava Lorencini, Andréa Teixeira-Carvalho, Edgard Torres dos Reis-Neto, Emília Inoue Sato, Marcelo de Medeiros Pinheiro, Odirlei André Monticielo, Viviane Angelina de Souza, Ricardo Machado Xavier and Gecilmara Salviato Pileggiadd Show full author list remove Hide full author list
Vaccines 2024, 12(9), 1031; https://doi.org/10.3390/vaccines12091031 - 9 Sep 2024
Cited by 1 | Viewed by 1716
Abstract
Breakthrough COVID-19 (occurring in fully vaccinated people) has been described. Data on its characteristics among immune-mediated rheumatic disease (IMRD) patients are scarce. This study describes breakthrough COVID-19 occurring in IMRD patients participating in the SAFER-study, a Brazilian multicentric cohort evaluating the safety, effectiveness, [...] Read more.
Breakthrough COVID-19 (occurring in fully vaccinated people) has been described. Data on its characteristics among immune-mediated rheumatic disease (IMRD) patients are scarce. This study describes breakthrough COVID-19 occurring in IMRD patients participating in the SAFER-study, a Brazilian multicentric cohort evaluating the safety, effectiveness, and immunogenicity of SARS-CoV-2 vaccines in patients with autoimmune diseases. A descriptive analysis of the population and a binary logistic regression model were performed to evaluate the predictors of COVID-19-related hospitalization. A p-value < 0.05 was significant. The included 160 patients were predominantly females (83.1%), with a mean (SD) age of 40.23 (13.19) years. The patients received two (19%), three (70%), or four (11%) vaccine doses. The initial two-dose series was mainly with ChAdOx1 (Oxford/AstraZeneca) (58%) or BBIBP-CorV (Sinopharm-Beijing) (34%). The first booster (n = 150) was with BNT162b2 (BioNtech/Fosun Pharma/Pfizer) (63%) or ChAdOx1 (29%). The second booster (n = 112) was with BNT162b2 (40%) or ChAdOx1 (26%). The COVID-19 hospitalization rate was 17.5%. IMRD moderate/high activity (OR: 5.84; CI: 1.9–18.5; p = 0.002) and treatment with corticosteroids (OR: 2.94; CI: 1.02–8.49; p = 0.0043) were associated with higher odds of hospitalization, while increasing the number of vaccine doses was protective (OR: 0.37; CI: 0.15–0.9; p = 0.032). These findings, along with previous reassuring results about the safety of the COVID-19 vaccines, argue in favor of booster vaccination in IMRD patients. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)
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Review

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16 pages, 314 KiB  
Review
COVID-19 Vaccination and Public Health: Addressing Global, Regional, and Within-Country Inequalities
by Omar Enzo Santangelo, Sandro Provenzano, Giuseppe Di Martino and Pietro Ferrara
Vaccines 2024, 12(8), 885; https://doi.org/10.3390/vaccines12080885 - 4 Aug 2024
Cited by 3 | Viewed by 2345
Abstract
The COVID-19 pandemic, with over 775 million cases and 7 million deaths by May 2024, has drastically impacted global public health and exacerbated existing healthcare inequalities. The swift development and distribution of COVID-19 vaccines have been critical in combating the virus, yet disparities [...] Read more.
The COVID-19 pandemic, with over 775 million cases and 7 million deaths by May 2024, has drastically impacted global public health and exacerbated existing healthcare inequalities. The swift development and distribution of COVID-19 vaccines have been critical in combating the virus, yet disparities in access to and administration of the vaccine have highlighted deep-seated inequities at global, regional, and national levels. Wealthier nations have benefited from early access to vaccines, while low- and middle-income countries (LMICs) have faced persistent shortages. Initiatives such as COVAX aimed to address these disparities, but challenges persist. Socioeconomic factors, education, ethnic identity, and the healthcare infrastructure play crucial roles in vaccine equity. For example, lower-income individuals often face barriers such as poor access to healthcare, misinformation, and logistical challenges, particularly in rural areas. Addressing these inequities requires a multifaceted approach, integrating national policies with local strategies to enhance vaccines’ accessibility, counter misinformation, and ensure equitable distribution. Collaborative efforts at all levels are essential to promote vaccine equity and effectively control the pandemic, ensuring that all populations have fair access to life-saving vaccines. This review explores these complex issues, offering insights into the barriers and facilitators of vaccine equity and providing recommendations to promote more equitable and effective vaccination programs. With a focus on the different levels at which vaccination policies are planned and implemented, the text provides guidelines to steer vaccination strategies, emphasizing the role of international cooperation and local policy frameworks as keys to achieving equitable vaccination coverage. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)

Other

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11 pages, 1745 KiB  
Systematic Review
Assessing the Vulnerability of Splenectomized Patients to Severe COVID-19 Outcomes: A Systematic Review and Meta-Analysis
by Francesco Paolo Bianchi, Massimo Giotta, Andrea Martinelli, Maria Grazia Giurgola, Giulia Del Matto, Elita Mastrovito, Maria Tina Fedele, Giuseppe Manca, Salvatore Minniti, Maurizio De Nuccio, Vincenzo Gigantelli, Silvio Tafuri and Stefano Termite
Vaccines 2025, 13(2), 203; https://doi.org/10.3390/vaccines13020203 - 18 Feb 2025
Viewed by 1233
Abstract
Background: Splenectomized/asplenic individuals are at a heightened risk for severe infections due to compromised immune function. However, the impact of splenectomy/asplenia on COVID-19 outcomes remains underexplored. This study aims to systematically review and meta-analyze the association between splenectomy/asplenia and severe COVID-19 outcomes. Methods: [...] Read more.
Background: Splenectomized/asplenic individuals are at a heightened risk for severe infections due to compromised immune function. However, the impact of splenectomy/asplenia on COVID-19 outcomes remains underexplored. This study aims to systematically review and meta-analyze the association between splenectomy/asplenia and severe COVID-19 outcomes. Methods: Following the PRISMA guidelines, databases including Scopus, MEDLINE/PubMed, and Web of Knowledge were searched for relevant articles published between January 2020 and June 2024. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for severe COVID-19 outcomes, with a random-effects model being used to account for heterogeneity. Out of 749 identified studies, 4 met the inclusion criteria. Results: The meta-analysis revealed a significant association between splenectomy/asplenia and overall severe COVID-19 outcomes (OR = 1.92; 95% CI = 1.06–3.47). Specifically, splenectomy/asplenia was significantly associated with increased COVID-19-related hospitalization (OR = 2.06; 95% CI = 1.21–3.49), while the association with COVID-19-related death was not statistically significant (OR = 1.52; 95% CI = 0.78–2.99). COVID-19 vaccination is strongly recommended for these patients. Conclusions: Splenectomy/asplenia significantly increases the risk of severe COVID-19 outcomes, particularly hospitalization. The findings underscore the need for vigilant clinical management and targeted interventions for this vulnerable population. Further research is warranted to fully understand the risks and to develop effective guidelines for the protection of splenectomized individuals against COVID-19. Full article
(This article belongs to the Special Issue COVID-19 Vaccination and Public Health: Addressing Global, Regional and Within-Country Inequalities)
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