Background: National Immunisation Technical Advisory Groups (NITAGs) play a critical role in providing evidence-based and locally tailored recommendations to achieve the maximum public health benefit from vaccines. The Vietnamese Ministry of Health plans to introduce pneumococcal and human papillomavirus vaccines to their Expanded Programme on Immunisation (EPI), and our prior collaboration identified an opportunity to provide technical support on these vaccines and to strengthen the operations and decision-making processes of their NITAG.

Aims: This project aims to strengthen the capacity of Vietnam’s NITAG through developing and implementing Standard Operating Procedures (SOPs), strengthening research capacity, facilitating twinning with other NITAGs and providing technical support for new vaccine introductions.

Method: A needs assessment survey, key informant interviews and baseline NITAG Maturity Assessment Tool were conducted. A program of activities was co-designed during a NITAG secretariat visit to Australia. Three workshops were delivered in 2024 with themes including evidence-based decision-making for vaccine policy; sharing lessons learnt between various NITAGs; identifying research needs, and global & regional support for NITAGs. All partners collaborated in developing SOPs, including an adapted Evidence-to-Recommendation Framework. Evaluation surveys were completed following each workshop and NITAG members reported increased knowledge and confidence. Partnership enabled sharing of key tailored data to inform upcoming policy decisions. An external evaluation is planned in 2025.

Results: Through the workshops we conducted several case studies on policy questions, identified relevant national data and evidence gaps. The SOPs has since been used within NITAG’s evidence-based decision-making process to give recommendations towards the integrating vaccination programmes within EPI, e.g., the application of HPV/PCV vaccinations, thereby improving coordination, service quality, and timely vaccine distribution. This has reduced vaccine-preventable diseases and strengthened healthcare workers' preparedness.

Conclusion: This collaboration has created a sustainable immunisation model that can be adapted to other countries in the region.

Context and aim: This study investigates the introduction and removal of COVID-19 vaccination requirements for healthcare workers (HCWs) in Australia and France, focusing on governance processes to explain similarities and differences.

Methods and analysis/research findings: We analysed policy documents to ascertain start and end dates of mandates. We conducted in-depth qualitative interviews with key informants in Australia and France, including Ministers and senior bureaucrats, to gather insights into the rationales and processes. Data was collected and analysed inductively via the interdisciplinary "MandEval" project. Australia’s COVID-19 vaccine requirements were influenced by policies for other infectious diseases but arose through a federal process. The rapid spread of COVID-19 overseas heightened concerns about hospital capacity and staff shortages, motivating strict policies to protect healthcare workers and vulnerable patients. Mandates were framed as ensuring a functioning healthcare system. A complementary occupational health and safety framing emerged subsequently. As states and territories enacted their own policies, there were variations in execution and removal. The unitary policy of France, by contrast, was informed by the input of various expert groups. There were similarities and differences with Australia. Both jurisdictions used executive orders and offered limited exemptions (medical only). Consequences for non-compliance ranged from redeployment to dismissal. Perceptions of the pandemic’s severity and vaccine effectiveness played a role in mandate removals. However, in France, the removal decision arose through a broader examination of the appropriateness of HCW vaccine mandates for multiple diseases.

Translational outcomes: This study highlights the processes of introducing and removing vaccine mandates within unitary and federal systems to offer lessons for the next pandemic.

Future actions: The team is conducting further analysis on mandate policymaking in Italy and the United Kingdom.

Context:
This presentation addresses the crucial role of public health units in improving immunisation practice and coverage through face-to-face education for general practice providers.

Aim and process:
Boorloo (Perth) Public Health Unit has conducted tailored training sessions, in collaboration with the WA Primary Health Network, to support general practice immunisation nurses. These sessions aim to empower nurses through targeted face-to-face education, addressing their concerns and knowledge gaps. The presentation will describe effective strategies that enhance the capabilities of general practice providers in managing vaccine catch-up, overcoming vaccine hesitancy, understanding, and adhering to complex immunisation guidelines.

Analysis:
Education sessions have identified an apparent recent increase in new graduate nurses working in general practice in Perth. Challenges faced by frontline staff include managing patient catch-up schedules and rules, interpreting overseas records, opportunistic immunisation, and recall, tackling vaccine hesitancy, managing cold chain and navigating complex immunisation guidelines. Ongoing support mechanisms, like regular check-ins with practice nurses, provide ongoing support and guidance. Additionally, clear, user-friendly materials that simplify complex immunisation guidelines make it easier for practice nurses understand and prepare immunisation plans.

Outcome:
Based on observations and interactions with healthcare providers during education sessions, public health should develop and advocate for user-friendly resources, such as easy-to-follow guides for catch-up planning and the use of AIR. Face-to-face practice nurse support will continue with locally developed resources to address knowledge gaps.

Policy and clinical practice guidelines are dependent on high quality evidence when making vaccine recommendations. A review of the quality of the evidence used to inform vaccine clinical practice guidelines could help guide researchers on how to improve the design of their clinical studies to produce evidence of greater value to decision-makers. In Australia, the Australian Technical Advisory Group on Immunisation (ATAGI) develops evidence-based vaccine clinical practice recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a transparent, systematic and methodical framework for developing and presenting summaries of evidence and its certainty.

We summarised the publicly available Australian GRADE assessments for the use of vaccines for prevention of cholera, diphtheria, tetanus and pertussis, human papillomavirus, influenza, meningococcal, pneumococcal, rabies and varicella zoster virus, including the certainty of evidence for each outcome (e.g., effectiveness, immunological or safety outcomes) and overall, in addition to the reasons for downgrade or upgrade of the certainty assessments. Across 25 research questions, 189 separate outcomes were assessed; of these 43 (23%), 38 (20%), 68 (36%) and 40 (21%) were classified as informed by very low, low, moderate and high certainty of evidence, respectively. Overall, 4 (16%), 10 (40%), 9 (36%) and 2 (8%) research questions across the disease areas had their overall certainty of evidence classified as very low, low, moderate and high, respectively. Certainty of evidence was downgraded for confounding, uncertainty in the effect estimation, and differences between the research questions asked by ATAGI and those answered in the studies.

There is an unmet need to improve the quality of evidence available to vaccine policy-makers. This could be achieved by improvements in the design of vaccine trials, particularly focusing on improving the precision of statistical estimates, inclusion of relevant subpopulations and ensuring trial endpoints are better aligned with the needs of policy-makers.

Nevio Sarmento1,2, Manuel Mausiri3, Celia G. Santos4, Mariano da Silva Marques1, Helio S. F. Guterres1, Solange A. Fernandes1, Joshua R. Francis2, Sarah L Sheridan5, Kristine Macartney5, Nicholas S. S. Fancourt2

1. National Immunisation Technical Advisory Group, Timor-Leste (NITAG-TL), Dili, Timor-Leste
2. Menzies School of Health Research, Charles Darwin University, NT, Australia
3. Expanded Program of Immunisation, Ministry of Health, Timor-Leste
4. Hospital Nacional Guido Valadares (HNGV), Dili, Timor-Leste
5. National Centre for Immunisation Research and Surveillance, NSW, Australia


Background
Timor-Leste introduced Pneumosil, a low-cost pneumococcal conjugate vaccine (PCV) manufactured by the Serum Institute of India, in 2023. This was the first occasion Pneumosil was used in a PCV-naïve setting. This case study analyses the evidence to recommendation pathway that led to this vaccine policy decision.
examines the decision-making process behind its introduction, including key stakeholders, evidence-based considerations, and implementation challenges.

Methods
A structured assessment of the decision-making framework was conducted, including a review of national immunization policies, epidemiological data, cost-effectiveness analyses, and stakeholder involvement.

Results
Local disease burden, cost considerations, and global recommendations provided strong support for the decision to introduce Pneumosil. Timor-Leste’s National Immunization Technical Advisory Group (NITAG) played a central role in evaluating clinical evidence, comparative assessments, financial sustainability, and logistical feasibility. Stakeholder engagement with government bodies, technical advisory groups, and international health organizations informed suitability and acceptability. Strategic partnerships with global health agencies facilitated procurement and technical support, ensuring a smooth implementation process.

Conclusion
The introduction of Pneumosil in Timor-Leste underscores the importance of a structured decision-making approach in vaccine policy. Evidence-driven recommendations, stakeholder collaboration, and financial sustainability assessments were crucial in selecting a preferred vaccine. This approach can assist other low resource settings and ongoing reviews of PCV immunisation strategies in Timor-Leste.

Keywords: Pneumosil, PCV-10, pneumococcal vaccine, decision-making, immunization policy, Timor-Leste.

Low HPV vaccination rates among young Aboriginal and Torres Strait Islander (Aboriginal) people can result in an increased risk of HPV-related cancers. Health promotion empowers individuals to control their health, and social media offers a key platform to reach youth. Our approach co-creates health messages with young Aboriginal people, disseminated by local "micro-influencers" on social media.

This presentation aims to (i) present young people’s thoughts on HPV and the vaccination and (ii) the process of developing the social media campaign for young Aboriginal people called ‘Our Business’.

To create the "Our Business" brand, we partnered with a marketing agency specialising in Generation Z's social media habits (DeeBlanche), who was guided by the HPV Aboriginal Advisory Group and Aboriginal Content and Strategy Advisor, Nooky. Extensive interviews with 60 Aboriginal young people and 22 families provided invaluable insights into their HPV knowledge, understanding of the vaccine, and social media use. This data directly informed the brand's identity, key health messages, and the selection of appropriate micro-influencers. We collaborated with 15 Aboriginal and Torres Strait micro-influencers who created content for the campaign.

The "Our Business" campaign launched in 2024, coinciding with the HPV vaccination schedule in Perth schools, Western Australia. Our influencers released 22 videos across Instagram and TikTok, achieving impressive initial reach. As of June 2024, 18 TikTok posts from 10 influencers received just under 250,000 views and nearly 14,000 likes.

We will evaluate the campaign's effectiveness using a controlled interrupted time series analysis to examine changes in HPV vaccination rates in Perth. These promising early results will inform the campaign's evolution for 2025 and beyond.

This project prioritises Aboriginal leadership and community engagement. Developed with Aboriginal youth, it features health messages created by youth and families. The project is guided by a Aboriginal Reference Group including ECU's Elder in Residence, Dr Roma Winmar. Aboriginal influencers and Nooky, ensure cultural relevance. Community leadership is embedded throughout, with project data recently presented at IMICH 2025 (Canada) by one of our Reference Group members. We have permission to present these research findings.

The Department of Health launched a nationwide school-based immunization (SBI) campaign from October 7, 2024, to January 15, 2025, to address immunization gaps from the COVID-19 pandemic. The campaign administered Measles-Rubella, Tetanus toxoid, and Human Papilloma Virus vaccines, ensuring vaccine safety through an Adverse Event Following Immunization (AEFI) surveillance system. This investigation aims to analyze AEFI cases, identify serious cases and clusters, and recommend improvements to the surveillance system.

This descriptive study analyzed data on AEFI cases gathered through VigiFlow, a passive surveillance information system, and analyzed using Google BigQuery. AEFI cases were categorized as serious, non-serious, or clusters. Serious cases are assessed for causality by the Regional AEFI Committee (RAEFIC), using available information and expert review, and classified as consistent, inconsistent, or indeterminate.

The campaign administered 2,089,615 MR, 2,082,495 Td, and 526,272 HPV vaccines. Of the vaccinated individuals, 291 reported AEFI cases, 96.22% of which were non-serious, with symptoms such as pyrexia, dizziness, rash, headache, and pain. These were classified as very rare and within WHO-established rates. A peak in cases was observed during morbidity week 45 (November 3-9, 2024). Region IV-A had the highest number of cases (61.86%), with several non-serious clusters. Of 11 identified clusters, only one was investigated, revealing chickenpox as the cause. RAEFIC classified the two suspected death cases and two others as "Coincidental." One case was excluded due to a confirmed dengue diagnosis, and six cases remain unassessed.

The SBI campaign has successfully increased vaccine coverage among school-aged children, protecting them against vaccine-preventable diseases. Surveillance data confirms that most AEFI cases were non-serious, and the causality assessment found that the reported deaths were coincidental, not vaccine-related. Strengthening surveillance and reporting will ensure continued vaccine safety and uphold public trust in the immunization program.

Background: The COVID-19 pandemic urged various interventions to increase vaccine uptake, including the implementation of vaccine mandates. These mandates have varied widely in terms of their design and timing across different jurisdictions, impacting different sub-populations and sectors. This study explores the effects of vaccine mandate announcements and removals on vaccine uptake across Australia, France, Italy, and the US (California).

Methods: We employed an Interrupted Time Series (ITS) analysis to assess the impact of COVID-19 vaccine mandate announcements and removals on vaccine uptake. The study utilized aggregated data from various sources, including Our World in Data and local health databases. The primary outcome was the natural logarithm of first doses and booster doses per hundred thousand people. Policy impact was evaluated through changes in vaccine uptake trends before and after policy announcements and removals.

Findings: Vaccine mandates was associated with an increase in vaccine uptake in all studied countries. Initial mandates appeared to have been associated with an increase in the first dose uptake by 113% (95% CI, 63% - 178%) in Italy, 195% (95% CI, 113% - 308%) in France (though goes away when cases and deaths are controlled for) and 32% (95% CI, 16% - 51%) in California, demonstrating robust responses to policy interventions. The effects varied by the type of mandate, with employment mandates or mandates announced later having different/lower impacts compared to public space mandates or the first mandate, for instance in Italy. However, the removal of mandates generally resulted in decreased vaccine uptake, highlighting the mandates' role in sustaining high vaccination rates. Updates on the results for Australia will be provided in due course.

Conclusion: Vaccine mandates increased COVID-19 vaccine uptake during critical periods of the pandemic. The removal of these mandates often associated with a reduction in uptake, suggesting that the continuity of such policies may be crucial in maintaining high vaccination rates. These findings underscore the importance of carefully timed and targeted public health interventions to manage vaccine coverage during pandemics. Future policies should consider the diverse impacts of mandate types and the potential benefits of maintaining mandates during ongoing public health crises.

Many countries around the world implemented vaccine mandates to increase COVID-19 vaccine uptake during the pandemic. Malaysia officially stated that its COVID-19 National Immunisation Programme was voluntary but has been identified as having implemented various types of vaccine mandates across its population. No studies have examined why the Malaysian government acted as it did regarding vaccination policy during the COVID-19 pandemic. This study aims to understand the rationale behind the Malaysian government’s mandate decision-making during the pandemic by employing a qualitative research methodology. Data were collected through semi-structured interviews with purposively identified policymakers, including health and security agencies of the Malaysian government. The data was analysed using inductive coding and categorised according to four key themes that underpinned the government’s decision-making: (1) ensuring national stability, (2) minimising public health risks and mortality, (3) balancing personal choice, collective responsibilities, and compliance strategies, and (4) legal and constitutional constraints on government actions. The results indicate that the Malaysian government’s decision-making during the COVID-19 pandemic was not arbitrary but rather influenced by a complex interplay of factors and resembles a principled approach. This study concludes that Malaysia’s COVID-19 National Immunisation Programme was formally a voluntary policy due to legal and constitutional constraints. However, the goals of ensuring national stability, minimising public health risks and mortality, and balancing personal choice, collective responsibilities, and compliance strategies led to the implementation of vaccine mandates in Malaysia. Thus, this study provides valuable insights for future policymaking in the context of pandemic crises, particularly in a Southeast Asian context.

Background: The COVID-19 pandemic necessitated unprecedented public health measures to achieve herd immunity, reduce virus transmission, and mitigate socio-economic and behavioural impacts. Governments employed vaccine mandates, enforced through incentives and penalties, to enhance vaccination uptake and facilitate economic recovery. While effective in minimizing virus spread, these mandates raised public concerns regarding personal freedoms, social equity, and trust in health authorities.

Methods: Adhering to PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Web of Science, Embase, and Scopus, and supplemented by Google Scholar. The search focused on studies published between 2020 and 2024 that examined attitudes toward vaccine mandates, influencing factors, and consequential impacts. The SPIDER framework guided the search strategies, targeting adults aged 16 and above without excluding any study designs.

Findings: From 955 records, 31 studies were included, encompassing various countries and population groups, and employing qualitative, quantitative, and mixed methods. Findings indicate mandates fostered social cohesion and collective responsibility but sometimes exacerbated distrust in government and scientific institutions among certain groups. Economically, mandates reduced the burden on healthcare systems and supported business continuity but could lead to workforce shortages and operational disruptions. Behaviorally, mandates created a sense of urgency, increasing vaccine uptake, yet also led to resistance among individuals with low trust in vaccines or health authorities.

Conclusion: COVID-19 vaccine mandates have been instrumental in increasing vaccine uptake and controlling the transmission of the virus. However, trust deficits, misinformation, and equity issues remain critical barriers to widespread acceptance. Future research should focus on longitudinal data and diverse populations to better understand the long-term impacts of vaccine mandates and inform more effective public health policies.

"COVID-19 vaccines played a crucial role in mitigating the impact of the pandemic, and understanding factors influencing vaccine access is essential for effective public health strategies. This scoping review explored access to COVID-19 vaccines among the Indonesian population using Levesque's framework of access to healthcare. A systematic search was conducted across five databases using the PRISMA guidelines for publications from January 1, 2019, to May 5, 2023. This yielded 89 studies that met the inclusion criteria and were analysed using NVivo-14 software. More than half of the studies were published by 2022 (n=58), with most studies using data collected in 2021 (n=55). The majority of the identified studies employed a quantitative approach (n=74) and utilised online survey methods (n=50). A focus on user factors predominated over those on health system issues. Several personal factors, such as trust, beliefs, and perceptions, emerged as the primary determinants of vaccine acceptance. The halal status of vaccines and information from social media played crucial roles in shaping perceptions. Sociodemographic factors such as age, gender, education, marital status, and occupation were identified as important variables, along with COVID-19-specific factors such as comorbidity and prior infection history. Notably, financial aspects received less attention in the existing literature. The study also uncovered gaps in research regarding health system factors, particularly concerning vaccine availability and distribution logistics. These findings underscore the importance of addressing user perceptions, leveraging social media for information dissemination, ensuring equitable access, and considering religious and cultural factors in vaccine-distribution strategies. By integrating community perspectives with health system approaches, policymakers can enhance vaccine acceptance and reduce hesitancy, ultimately contributing to more effective pandemic preparedness and responses in Indonesia."