Effectiveness of COVID-19 vaccine mandates in raising vaccination rates among the elderly and general population in Europe: Controlled interrupted time series analysis
Background: During the COVID-19 pandemic, three European countries (Austria, Greece, Italy) announced and/or implemented mandatory COVID-19 vaccination for high-risk groups in the general population. Besides the ethical justification for this policy, it is important to assess and quantify the effectiveness of the mandate in raising vaccination rates. Methods: Controlled interrupted time series analysis of first-dose vaccination rates in the targeted age groups (Greece: ≥60 years; Italy: ≥50 years) relative to a control group (Greece: 50–59 years; Italy: 25–49 years) between week 35/2021 and week 50/2022. For Austria an uncontrolled analysis was performed, as the vaccine mandate targeted all adults ≥18 years. Results: Announcement of mandatory vaccination substantially increased vaccination rates in the targeted age groups compared to control in both Greece (RR = 4.36, 95 % CI: 3.57–5.32) and Italy (RR = 2.90, 95 % CI: 2.37–3.56), an effect which persisted throughout the study period. There were 176,428 (95 % CI: 164,097–187,226) mandate-attributable first-dose vaccinations in Greece and 316,192 (95 % CI: 282,467–346,678) in Italy, most of which occurred before the mandate came into effect. In Austria no discernible increase in vaccination rates was observed after the announcement of mandatory vaccination. At the end of the study period, 9.5 % of ≥60 year-olds in Greece, 4.9 % of ≥50 year-olds in Italy and 13.8 % of ≥18 year-olds in Austria remained unvaccinated. Conclusions: In Greece and Italy – though not in Austria – simple announcement of a vaccine mandate rapidly increased COVID-19 vaccination rates in the targeted age groups, without fully closing the vaccination gap. Mandatory vaccination appears to effectively target complacency but not vaccine hesitancy, and its public health benefits need to be weighted against possible detrimental effects on confidence and trust.
Lack of association between vaccination rates and excess mortality in Cyprus during the COVID-19 pandemic
Background: It has been claimed that COVID-19 vaccination is associated with excess mortality during the COVID-19 pandemic, a claim that contributes to vaccine hesitancy. We examined whether all-cause mortality has actually increased in Cyprus during the first two pandemic years, and whether any increases are associated with vaccination rates. Methods: We calculated weekly excess mortality for Cyprus between January 2020 and June 2022, overall and by age group, using both a Distributed Lag Nonlinear Model (DLNM) adjusted for mean daily temperature, and the EuroMOMO algorithm. Excess deaths were regressed on the weekly number of confirmed COVID-19 deaths and on weekly first-dose vaccinations, also using a DLNM to explore the lag-response dimension. Results: 552 excess deaths were observed in Cyprus during the study period (95% CI: 508–597) as opposed to 1306 confirmed COVID-19 deaths. No association between excess deaths and vaccination rates was found overall and for any age group except 18–49 years, among whom 1.09 excess deaths (95% CI: 0.27–1.91) per 10,000 vaccinations were estimated during the first 8 weeks post-vaccination. However, detailed cause-of-death examination identified just two such deaths potentially linked to vaccination, therefore this association is spurious and attributable to random error. Conclusions: Excess mortality was moderately increased in Cyprus during the COVID-19 pandemic, primarily as a result of laboratory-confirmed COVID-19 deaths. No relationship was found between vaccination rates and all-cause mortality, demonstrating the excellent safety profile of COVID-19 vaccines.
Gaps in Knowledge About SARS-CoV-2 & COVID-19 Among University Students Are Associated With Negative Attitudes Toward People With COVID-19: A Cross-Sectional Study in Cyprus
University students represent a highly active group in terms of their social activity in the community and in the propagation of information on social media. We aimed to map the knowledge, attitudes, and perceptions of University students in Cyprus about severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19) to guide targeted future measures and information campaigns. We used a cross-sectional online survey targeting all students in conventional, not distance-learning, programs in five major universities in the Republic of Cyprus. Students were invited to participate through the respective Studies and Student Welfare Office of each institution. The survey was made available in English and Greek on REDCap. Participation was voluntary and anonymous. The questionnaire was developed based on a consensus to cover the main factual information directed by official channels toward the general public in Cyprus at the time of the survey. In addition to sociodemographic information (N = 8), the self-administered questionnaire consisted of 19 questions, assessing the knowledge regarding the characteristics of SARS-CoV-2 and COVID-19, infection prevention and control measures (N = 10), perceptions related to COVID-19, for instance, whether strict travel measures are necessary (N = 4), and attitudes toward a hypothetical person infected (N = 2). Furthermore, participants were asked to provide their own assessment of their knowledge about COVID-19 and specifically with regard to the main symptoms and ways of transmission (N = 3). The number of students who completed the survey was 3,641 (41% studying Health/Life Sciences). Amongst them, 68.8% responded correctly to at least 60% of knowledge-related questions. Misconceptions were identified in 30%. Only 29.1% expressed a positive attitude toward a hypothetical person with COVID-19 without projecting judgment (9.2%) or blame (38%). Odds of expressing a positive attitude increased by 18% (95% CI 13–24%; p < 0.001) per unit increase in knowledge. Postgraduate level education was predictive of better knowledge (odds ratio (OR) 1.81; 95% CI 1.34–2.46; p < 0.001 among doctoral students] and positive attitude [OR 1.35; 95% CI 1.01–1.80; p = 0.04). In this study, we show that specific knowledge gaps and misconceptions exist among University students about SARS-CoV-2 and COVID-19 and their prevalence is associated with negative attitudes toward people with COVID-19. Our findings highlight the integrated nature of knowledge and attitude and suggest that improvements to the former could contribute to improvements in the latter.