CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
COVID-19 is a highly contagious illness characterized by its rapid transmission. The coronavirus disease 2019 (COVID-19) is caused by the viral pathogen known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The term "coronavirus" originates from the Latin word "corona," which means crown, referring to the distinctive appearance of the virus particles when viewed under an electron microscope. These particles resemble round structures with projections resembling the solar corona (Cascella et al., 2022; Dhar Chowdhury and Oommen, 2020).
First identified in Wuhan City, Hubei province, China on December 8, 2019, COVID-19 has had a devastating impact on global populations. It has resulted in over 6 million deaths worldwide and is considered the most significant global health crisis since the influenza pandemic of 1918 (Younes et al., 2020; Cascella et al., 2022).
The World Health Organization (WHO) was informed about COVID-19 on December 31, 2019. On January 30, 2020, the WHO declared the outbreak a global health emergency, and on March 11, 2020, it was officially designated as a global pandemic. This was the first time since 2009, when the H1N1 influenza was declared a pandemic, that such a classification had been made (Cennimo, 2023). Following its classification as a global pandemic by the WHO, the virus responsible for COVID-19, SARS-CoV-2, has spread to 223 countries. To date, there have been over 593 million reported cases and more than 6 million deaths worldwide.
Despite worldwide implementation of COVID-19 vaccination, there is currently no effective treatment for the disease. Vaccination is considered a crucial measure in preventing and controlling COVID-19, playing a significant role in managing the global epidemic. However, even with widespread vaccination efforts, SARS-CoV-2 continues to be prevalent. Similar to other vaccines, the protective efficacy of COVID-19 vaccines diminishes over time after completing the vaccination process.
According to a meta-analysis conducted by Feikin et al. (2022), the effectiveness of vaccines against SARS-CoV-2 infection decreases by 21% between one month and six months after initial vaccination. However, administering booster doses leads to higher antibody levels in the recipient's body, providing enhanced protection against the virus, as indicated by studies by Zeng et al. (2022) and Zhou et al. (2022). Consequently, many countries are currently administering booster doses to improve overall immunization rates among their populations.
The ongoing epidemic of COVID-19 is characterized by the continuous and rapid mutation of SARS-CoV-2. As of August 13, 2022, the World Health Organization (WHO) has identified five variants of concern (VOCs): Alpha (identified on December 18, 2020), Beta (identified on December 18, 2020), Gamma (identified on January 11, 2021), Delta (identified on May 11, 2021), and Omicron (identified on November 26, 2021) (WHO, 2022). Currently, the dominant strain driving the global outbreak has shifted from the Delta variant to the Omicron variant. Compared to the previously prevalent Delta variant, the Omicron variant exhibits a higher number of key mutations, with up to 32 mutations in the spike protein. Some of these mutations may be associated with immune evasion and increased infectivity.
However, overall, the Omicron variant is associated with milder symptoms and significantly fewer cases of severe hospitalization or death compared to previous variants. Recent studies have demonstrated the effectiveness of booster shots. Findings from both domestic and international research (Saban et al., 2022; Chemaitelly et al., 2022) indicate that COVID-19 vaccination significantly reduces the rate of infection, hospitalization, and mortality caused by SARS-CoV-2 variants. Vaccination plays a vital role in preventing and controlling outbreaks. The effectiveness of vaccines against symptomatic infections caused by the Omicron variant is approximately 50% during the first three months after receiving the second vaccine dose. However, vaccine effectiveness remains high for preventing hospitalization and death due to Omicron infection, with rates exceeding 70% after the second dose and over 90% after receiving the booster dose. Overall, current vaccinations continue to provide protection against the evolving variants (Zhu et al., 2022).
However, despite the strong evidence supporting the effectiveness of booster shots, there have been challenges in achieving high uptake rates for these additional doses. Ensuring a widespread acceptance and administration of booster shots has become crucial in controlling the pandemic. Pharmacists, as accessible healthcare professionals with expertise in medications, play a vital role in the healthcare system. Recognizing the significance of pharmacists, this study aims to investigate and examine their roles in promoting and facilitating the uptake of Covid-19 boosters.
1.2 Statement of the Problem
The primary objective to minimize hospitalizations and deaths due to COVID-19 is to achieve widespread vaccination coverage on a global scale. Over time, immunity acquired from primary vaccination diminishes, sometimes within a few months or even weeks. As a result, the implementation of booster vaccinations has become a routine approach to enhance the efficacy of vaccines, not only against infection but also in preventing severe illness. (Patalon et al., 2022; Barda et al., 2021).
As the Omicron variant continues to spread globally, various countries have initiated the administration of COVID-19 booster vaccines to the general adult population. This rollout began in the middle of 2021, with some countries like Australia, Israel, Chile, and the UK even announcing plans or already implementing a second booster dose. Despite being recommended in many countries, the uptake of booster vaccinations remains suboptimal. As of July 11, 2022, only 74% of fully vaccinated individuals (without boosters) in the European Union have received a booster dose. The percentages are notably lower in different regions worldwide. Specifically, Australia and South America have reported rates of 64%, while North America stands at 58%. In Asia, the percentage drops further to 41%, and the lowest rate is observed in Africa at just 11% (Mathieu et al., 2021).
The variation in booster vaccine uptake can be attributed to multiple factors, including limited vaccine supply and accessibility. limited vaccine supply and accessibility However, in addition to these challenges, there is a significant portion of previously vaccinated individuals who are hesitant or unwilling to receive the booster vaccination. This trend is observed even in countries where the initial uptake of COVID-19 vaccines was high (Jørgensen et al., 2022; Paul and Fancourt, 2022).
In order to enhance the acceptance of booster vaccines, numerous countries employ various strategies. Primarily, they educate individuals about the advantages of boosters. Additionally, some countries utilize interventions such as sending personalized reminders, offering incentives, implementing certain restrictions on individuals who have not received boosters (e.g., France, Germany), or even imposing mandates accompanied by financial penalties (e.g., Greece, Malaysia).
Moreover, non-governmental institutions and companies have also adopted diverse approaches to encourage their workforce to receive COVID-19 booster vaccines. These approaches include offering financial incentives and implementing mandates (Ivory et al., 2022). It is vital to address the obstacles and reluctance surrounding COVID-19 booster vaccinations for several reasons. Boosters play a critical role in maintaining and bolstering immunity against COVID-19, particularly in light of emerging variants. Attaining high uptake of booster vaccines is essential in reducing hospitalizations, severe illness, and mortality. Furthermore, promoting fair access to booster vaccines is crucial to safeguard vulnerable populations and mitigate health disparities.
Hence, it is of utmost importance to explore effective strategies for overcoming vaccine hesitancy. In this regard, the significance of pharmacists in promoting COVID-19 booster acceptance becomes apparent. Pharmacists, being accessible healthcare professionals with vaccination expertise, possess the potential to educate, provide guidance, and address concerns pertaining to booster vaccinations. Their involvement in promoting booster uptake can contribute significantly to achieving widespread coverage, reinforcing public health efforts, and curbing the transmission of COVID-19.
1.2 Aim of the Study
The aim of this study is to investigate and explore the role of pharmacists in encouraging COVID-19 booster uptake.
1.3 Objectives of the Study
The specific objectives of the study are as follows:
- To explore the role of pharmacists in promoting COVID-19 booster uptake among individuals.
- To assess the effectiveness of pharmacist-led interventions in increasing COVID-19 booster uptake.
- To identify best practices and provide recommendations for integrating the role of pharmacists in COVID-19 booster uptake campaigns at the community and national levels.
1.4 Research Questions
The study will address the following research questions:
- What are the roles of pharmacists in promoting COVID-19 booster uptake among individuals?
- What is the effectiveness of pharmacist-led interventions in increasing COVID-19 booster uptake?
- What are the best practices and recommendations for integrating the role of pharmacists in COVID-19 booster uptake campaigns at the community and national levels?
1.5 Research Hypothesis
H0: Pharmacists do not play significant roles in COVID-19 booster uptake
Ha: Pharmacists play significant roles in COVID-19 booster uptake
1.6 Justification of the Study
The study's significance lies in the urgent need to address the challenges and barriers to achieving high COVID-19 booster uptake rates globally. By focusing on the role of pharmacists, who are accessible healthcare providers with expertise in vaccination, the study aims to contribute valuable insights into strategies that can be implemented to increase booster uptake and address vaccine hesitancy. The findings of this study can inform policymakers, healthcare organizations, and pharmacy practice stakeholders in optimizing the involvement of pharmacists in vaccination efforts and ultimately contribute to controlling the spread of COVID-19.
1.7 Scope of the Study
The study will primarily focus on the role of pharmacists in encouraging COVID-19 booster uptake. The study will primarily draw on existing literature, research studies, and documented experiences of pharmacists involved in booster uptake campaigns. The scope will encompass the strategies employed by pharmacists, their impact on booster uptake, and recommendations for integrating pharmacists into booster vaccination programs.
