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Assoc. Prof Samantha Vanderslott, Kate Joynes-Burgess, Dr Seilesh Kadambari and Prof. Tushna Vandrevala

Abstract

The COVID-19 pandemic has highlighted how ethnic minority groups are disproportionally affected by health crises and also the need for community engagement to provide equitable public health information and services. Community engagement has been presented by policymakers, practitioners, and academics as a way to improve access and uptake of health services, including vaccination. We examine the role of leaders in different communities across the UK through the form of ‘community vaccine champions’, who have been acting as advocates, promoting community engagement among ethnic minority groups and vaccination during the pandemic. Our research explored how champions experienced and confronted the challenges brought on by the pandemic. From April 2021 until May 2022, we conducted 12 semi-structured interviews lasting 45-60 minutes via video call. The interviews were inductively coded and analysed following a discourse approach to health communication, where the focus is on drawing out underlying messages and talking points.

The activities and interventions to improve COVID-19 vaccine uptake should be viewed against two key contextual issues: the backdrop of falling vaccination rates – in 2019, the UK lost its measles-free status – and calls for greater consideration of issues affecting ethnic minority groups (for example, the ‘Black Lives Matter’ movement). Our findings highlighted the striking role and influence of media and social media misinformation on vaccine decision-making, especially on ethnic minority groups. This rise of false and misleading information during the pandemic has been labelled an ‘infodemic’ by international health institutions and was made evident in community settings through our interviews. However, our informants cautioned about making simplistic assumptions about how misinformation negatively affects vaccine uptake amongst their communities. We conclude by setting out the need for ongoing community support for health issues and how data collection, particularly concerning ethnic minority groups classifications matter in a pandemic setting.

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Vaccine hesitancy is often portrayed as a major global problem, addressed by researchers and policy-makers alike. This incredibly complex phenomenon (McDonald 2015) encompasses a plethora of attitudes (from mild doubt to outright refusal) and (in)actions towards vaccines (from vaccinating despite uncertainty, to delaying, to refusing), which need to be addressed. Otherwise, vaccine hesitancy can lead to escalation of fears and radicalisation of attitudes, especially when questions unaddressed in mainstream discourses (also scientific) find their easily digestible answers (online and offline). The media shapes vaccination discourses by disciplining and polarising discussions. In those polarised mainstream and social media, vaccine hesitancy becomes invisible. Additionally, it is sidelined in everyday immunisation practices, with

healthcare professionals only marginally addressing concerns about vaccines. These existing questions and fears (mainly about side effects) were amplified and fuelled (with fears of the unknown and the new) by the pandemic and rapid introduction of Covid-19 vaccines.

Given these complementary tendencies, we suggest that vaccine hesitancy may increasingly evolve into distrust of vaccines and vaccination, but also of science, so eagerly deployed in polarising discourses and, for many, embodied by vaccines. This could lead to a decline in vaccine uptake, a trend already observed in recent years.

The findings are based on extensive qualitative and quantitative research conducted in Poland before and after the pandemic. It included mainstream and social media analysis, interviews with healthcare professionals and hesitant parents, and ethnographic research. More general conclusions are drawn about possible future scenarios for vaccine hesitancy and vaccine mistrust.

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This presentation delves into the intricacies of pharmacovigilance, specifically within the realm of vaccines, commonly referred to as vaccinovigilance. Defined as the comprehensive science and activities surrounding the detection, assessment, understanding, prevention, and communication of events following immunization, pharmacovigilance is a crucial component of ensuring consumer and patient safety. This contribution provides a concise historical overview of pharmacovigilance, illustrating how its evolution has been shaped by diverse actors with varying interests, needs, and resources.

In recent decades, the neoliberalization of drug regulation has heightened the significance of pharmacovigilance activities and evidence in influencing drug access and safety. This presentation highlights the intricate flow of pharmacovigilance data across global, national, and regional levels, offering an analysis of the "power geometry" between countries in the Global North and Global South.

With a primary focus on the methodological cornerstone of pharmacovigilance—the spontaneous reporting system—the presentation explores the nature of evidence generated through this form of passive surveillance. By scrutinizing what this system validates and magnifies, as well as what it diminishes and excludes, the analysis sheds light on the methodological intricacies that shape our understanding of vaccine safety and efficacy. This exploration aims to contribute to current debates about critical databasing, epistemic justice and decolonial global health.

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During the Covid-19 pandemic, cooperation between states gave way to a global competition for protective equipment and in the production and distribution of vaccines. Governments of some wealthy countries signed privileged deals with manufacturers, leaving the populations of less wealthy states vulnerable to the virus and thus prolonging the pandemic. Although much attention has been devoted to vaccination-related inequity and inequalities, little attention has been paid to competition between states in the control of post-vaccination adverse reactions. This paper is concerned with the inability of weak states to control the efficacy and safety of vaccines administered to their populations. Instead, responsibility has been transferred to other levels, either the supra-national (global bodies such as WHO, or EMA and ECDC in the European Union), or the private (i.e., pharmaceutical companies producing vaccines). The case of post-socialist states supports the ‘hyperglobalist’ thesis. Weak states have ceded some of their prerogatives to supranational institutions or to large private companies. In doing so, they have given up a significant part of the autonomy and the sovereignty they previously had. The paper argues that, because of these processes of transformation and transition, the Romanian state has failed to position itself as a trustworthy and credible institutional actor whose first concern is the protection of its population during a pandemic. The paper examines the mechanisms by which Romania has lost, not only control over domestic vaccine production and distribution, but also its strategic oversight of vaccine efficacy, safety, and quality.

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From the early 1900´s, public vaccine manufacturing laboratories in several Latin American and Caribbean countries produced the vaccines their national vaccination programs required. From the 1970’s, the development of more complex vaccines meant that public vaccine laboratories needed to undergo dramatic changes. With this in mind, in the early 1990s, the PAHO led the initiative to create a Regional System for Vaccines in Latin America and the Caribbean. The planned network of member institutions would implement a comprehensive approach covering all stages of vaccine development, production, quality control, and evaluation. However, lack of funding impacted on the initial motivations of collaboration. Only in Brazil, and Mexico, were the necessary political and financial commitments made. The PAHO and WHO considered supporting both public and private vaccine development and production institutions, but, at that time, state vaccine production was being abandoned, so, eventually private industry prevailed and SIREVA disappeared. The COVID-19 pandemic highlighted the region’s limited vaccine production capacity and demonstrated the weaknesses of its health systems. With the aim of reducing dependence on the outside world in the health sector, in 2021 the 33 members of the Community of Latin America and Caribbean states approved the guidelines of a health self-sufficiency plan for the region. The aim is that the countries in the region achieve greater coordination to end the pandemic and, building on the experiences of Cuba, Argentina, Brazil, and Mexico, (which have developed their own vaccines), strengthen the region’s capacities to develop and produce its own pandemic vaccines.

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In this presentation I analyze the models of vaccine development for Covid-19 and other emerging infectious diseases in Brazil and India. The two countries have become relevant actors in health biotechnology, and both have similarities and differences to explore in their R&D ecosystems. Brazil relies upon state production organizations to supply its national immunization program. In the last decades, the government has strengthened the public producers through the “health industrial complex” policy to nationalize the high-cost technologies employed at the Brazilian public healthcare system. India has a more extensive set of vaccine producers (21 organizations). The government has mainly invested in the private sector industries instead of public producers and has been implementing a strategy to overcome gaps in the Indian innovation ecosystem and favor indigenous vaccines.

The interviews conducted during fieldwork in Brazil (August-September 2022, and July 2023) and India (April-May 2022) enable us to define and compare the ways these two countries organize vaccine innovation. This presentation analyses how Brazilian and Indian actors produce vaccines through the negotiation of technology and knowhow transfer from other companies. It also investigates their engagement in locally developed technologies through investments in human resources training and the construction of new R&D and manufacturing infrastructure. Furthermore, considering the growing role of emerging nations like India and Brazil in addressing global immunization demands from other countries, vaccine development enterprises in the Global South resonates a new geopolitics of health industries and its implications for changes in global health norms and policies.

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The COVID-19 pandemic has had a significant impact on Latin America's health and socioeconomic conditions. The high inequity, the weakness of health systems, and the disparities between countries in producing their vaccines have been identified as sources of concern. In Colombia, despite the academic community's and civil society's calls to

produce vaccines, the national government was reluctant to promote local vaccine production at the beginning of the pandemic. However, there followed a change in the government’s position. One reason for this was the country’s critical technological dependence. Also relevant was the privileged place Colombian officials occupied on the executive boards at WHO and PAHO. Officials were soon aware that the governments of many other countries acknowledged the need to rebuild vaccine manufacturing capacity. The recent presidential elections in Colombia also help explain this change of position. Indeed, one of the local vaccine manufacturing projects is a private initiative funded by Colombia's largest health insurance company, based in Medellín, and which enjoyed the support of the previous right-wing government. The other project is a state initiative, based in Bogota, led by the center-left mayor and now supported by the new leftist president. Keeping in mind the developmental trajectories of these projects, there are regional and global political and regulatory barriers which have to be overcome. These include clinical trial coordination, intellectual property, post-authorization monitoring, or portfolio coordination. The ultimate objective is strategic independence rather than dominant competitive nationalism in Latin America´s vaccine production system.

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The paper delves into the social history of epidemics, particularly focusing on vaccine hesitancy in Brazil within two epidemic contexts: the 'Revolta da Vacina' (Vaccine Riot) of 1904 and the anti-vaccine movement led by 'Médicos pela Vida' (Doctors for Life) during and post the COVID-19 pandemic. While the Vaccine Riot marked a transformative period in Brazilian society, showcasing urbanization and bourgeois trends, the COVID-19 pandemic illuminated unresolved issues, sparking controversies between science, institutions, and society.

The 'Doctors for Life' association, active during the health crisis, vehemently opposed vaccination and advocated for alternative treatments, prompting inquiries into the conditions facilitating their influence on medical practice and society. Pandemic uncertainties, spanning scientific challenges, knowledge production, information dissemination, and institutional responses, significantly contribute to shaping the anti-vaccination landscape.

Groups like 'Doctors for Life' strategically exploit these uncertainties to influence social behaviors, emphasizing the manipulation potential within a sanitary crisis. Analysis of historical and contemporary contexts draws from the literature on the Vaccine Riot, the WHO's concept of 'vaccine hesitancy,' and empirical research on Doctors for Life in Brazil since 2020. This comprehensive exploration underscores the intricate interplay between intentional actors and societal responses to vaccination, providing valuable insights for understanding and addressing vaccine hesitancy in the ongoing battle against infectious diseases.

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The recent pandemic has exposed the effect of deep-rooted inequalities in access to health care. Low- and middle-income countries received significantly fewer doses of vaccines than their high-income counterparts. Typically, policy makers attribute the problem of vaccine inequality to matters of distribution, isolating it from linked processes of creation, production, and regulation. The proposed paper is an attempt to address this problem by examining the socio-technological relationships underlying vaccine innovation. The underlying hypothesis is that technological gaps between countries create distribution inequality, and this gap is largely a function of economic, legal, and political processes in a given space and time. Historically, technological progress in various fields is associated with a simultaneous fading out of ‘old’ technologies. Popular discourses explain these interrelated phenomena as a function of scientific advancement and technological determinism. The proposed paper problematizes such historically linear, technologically deterministic explanations and attempts to provide a critical understanding of technological progress and the concomitant obsoleteness. This approach examines the questions of why and how certain technologies become relevant in a given space and time by attending not only to the technological features which shape their interactions with the world but also to the underlying social conditions which determine their form and function.