Vaccine hesitancy is an emerging term in the socio-medical literature which describes an approach to vaccine decision making. It recognizes that there is a continuum between full acceptance and outright refusal of some or all vaccines and challenges the previous understanding of individuals or groups, as being either anti-vaccine or pro-vaccine. The behaviours responsible for vaccine hesitancy can be related to confidence, convenience and complacency. The causes of vaccine hesitancy can be described by the epidemiological triad i.e. the complex interaction of environmental- (i.e. external), agent- (i.e. vaccine) and host (or parent)- specific factors. Vaccine hesitancy is a complex and dynamic issue; future vaccination programs need to reflect and address these context-specific factors in both their design and evaluation. Many experts are of the view that it is best to counter vaccine hesitancy at the population level. They believe that it can be done by introducing more transparency into policy decision-making before immunization programs, providing up-to-date information to the public and health providers about the rigorous procedures undertaken before introduction of new vaccines, and through diversified post-marketing surveillance of vaccine-related events.

Vaccine hesitancy is an important feature of every vaccination and COVID-19 vaccination is not an exception. During the COVID-19 pandemic, vaccine hesitancy has exhibited different phases and has shown both temporal and spatial variation in these phases. This has likely arisen due to varied socio-behavioural characteristics of humans and their response towards COVID 19 pandemic and its vaccination strategies. This commentary highlights that there are multiple phases of vaccine hesitancy: Vaccine Eagerness, Vaccine Ignorance, Vaccine Resistance, Vaccine Confidence, Vaccine Complacency and Vaccine Apathy. Though the phases seem to be sequential, they may co-exist at the same time in different regions and at different times in the same region. This may be attributed to several factors influencing the phases of vaccine hesitancy. The complexities of the societal reactions need to be understood in full to be addressed better. There is a dire need of different strategies of communication to deal with the various nuances of all of the phases. To address of vaccine hesitancy, an understanding of the societal reactions leading to various phases of vaccine hesitancy is of utmost importance.

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Background: Diabetes mellitus (DM) is associated with high morbidity and mortality. It has various complications. Risk factor control is effective way of prevention. Current study was conducted to know demographic profile including risk factors related to diabetes mellitus in patients attending a tertiary health care institute of Rajasthan.Methods: This cross-sectional study was conducted for the duration of six months. In the study 623 diabetes mellitus type 2 patients were included and subjected to evaluation of various demographic parameters and risk factors like age, sex, economic status, area of residence, obesity, hypertension (HTN), lack of exercise, smoking, dyslipidemia and positive family history.Results: Mean age of diabetic population was 62 years. Male-female, urban-rural ratios were nearly 1:1 and 3:2 respectively. Nearly 7 % patients were found to be below poverty line (BPL). On risk factor evaluation of 623 diabetic patients it was found that 598 (96%) patients had lack of exercise, 406 (65.2%) patients had age more than 60 years, 394 (63.2%) patients had dyslipidemia, 210 (33.7%) patients were smoker as per the mentioned criteria, 144 (23.1%) patients were obese, 118 (19%) patients had HTN before emergence of DM and 90 (14.4%) patients had positive family history.Conclusions: High prevalence of risk factors in Indian community is alarming. Health education, promotion of exercise, favourable life style, dietary modification, cessation of smoking, screening programmes for early detection of derange blood pressure, blood sugar, lipid profile can be effective prevention strategies.

Introduction: 'Out-of-pocket expenditure' (OOPE) is the expenditures at the point of receiving health care directly by households which affects the economic stability of the household. When the expenditure on immunization of under-five children results in OOPE, it affects the motivation of parents for vaccination inversely. Aim: This study was planned to evaluate the out-of-pocket expenditure and to assess predictors of OOPE on routine immunization practices. Settings and design: This was a cross-sectional community-based study conducted from May to August 2019 at one of the immunization sites at primary health centers under a tertiary care institute of southern Rajasthan. Material and methods: At the selected health facility, randomly 75% of beneficiaries of routine immunization were enrolled for the study. Data were collected using a pre-designed, pre-tested semistructured questionnaire about direct and indirect expenses during the process of immunization incurred by the parents of the vaccinee by interview technique. Results: In the study, 72.36% were infants, and 56.10% had first birth order. Mother accompanied nearly half of the vaccinee (49.6%) to the vaccination centre and the most used mode of transportation was the personal vehicle (63%). Mean loss of wages among parents/caretakers was 0.58 (±0.66) USD (median = 0.69; interquartile range (IQR) = 0.69; 95% confidence interval (CI) = 0.42-0.73) while average cost of transportation worn was 0.16 (±0.20) USD (median = 0.07; IQR = 0.21; 95% CI = 0.12-0.19) and mean duration of travelling to reach health facility was 11.87 (±7.53) minutes (median = 10; IQR = 10; 95% CI = 10.53-13.20). Vaccination at the centre was free of cost (zero USD) and no cost was incurred for drugs or registration. Average OPPE was 0.74 (±0.97) USD (median = 0.35; IQR = 0.62; 95% CI = 0.56-0.91) and regression analysis predicted significant contributors as age of vaccinee (p = 0.00; OR = 0.11; 95% CI = 0.04-0.34), religion (p = 0.04; OR = 0.34; 95% CI = 0.12-0.97) area of residence (p = 0.00; OR = 6.77; 95% CI = 2.37-19.32), birth order of vaccinee (p = 0.02; OR = 0.3; 95% CI = 0.11-0.85), longer waiting time (p = 0.03; OR = 0.16; 95% CI = 0.03-0.85), travelling time (p = 0.00; OR = 3.47; 95% CI = 1.49-8.09) and long distances (p = 0.00; OR = 10.40; 95% CI = 2.56-42.03) travelled to reach vaccination centre. Conclusion: The hidden cost of vaccination in the form of loss of wages and time, travel cost due to stretched distance traveled by family members to accompany vaccinee to immunization facility is experienced as OOPE by the families and could be one of the impediments in vaccination coverage. Amendments in the existing policies are required to reduce this invisible cost of vaccination.

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Background: The World Health Organization (WHO) had reported COVID-19 disease as a pandemic in March 2020, following which India witnessed more than 29,451 cases on 29th April. Correct knowledge about the disease, the right attitude, and response to infection control recommendations among people is of utmost importance to limit the contagion.Methods: A Cross-Sectional, web-based online study was conducted for five days. The responses (N= 1231) were collected across social networks using snowball sampling. The survey questionnaire assessed the knowledge, attitude, and practical aspects of participants for COVID-19. Knowledge items assessed the causative agent of COVID-19, it’s clinical symptoms, routes of transmission, preventive measures etc. Positive or negative attitudes towards mask usage and restriction compliance were assessed. Socio-demographic data and scores were de-identified and analyzed using appropriate statistical tests.Results: The mean age of participants (N=1231) was 32.3±13.7 years and 60.9% were males. High knowledge years and 60.9% participants were males. High knowledge accuracy rate of 84.5% and a mean score of 10.19±1.6 out of 12 was observed. Mean attitude and practice scores were 2.33±0.66 (3) and 1.97±0.16 (2) respectively. A significantly higher knowledge status was observed among females, medical workers, students, and homemakers. Similarly, better attitudes were noticed in males, adults (30-60 years), graduates, and those in job/service. As for practices, no such difference was noticed as more than 98% of participants were compliant to lockdown restrictions and practiced proper distancing and personal hygiene measures.Conclusions: Satisfactory awareness and response were observed owing to the public awareness campaign. Knowledge gaps, poor attitudes, and prevailing myths need to be addressed through targeted communication strategy.