In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.

In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance—a key path to ensure a rapid way out of the current pandemic emergency.

The epidemic of coronavirus disease 2019 (COVID-19) broke out in Wuhan, China, in December 2019 and rapidly spread across the world. In order to counter this epidemic, several countries put in place different restrictive measures, such as the school's closure and a total lockdown. However, as the knowledge on the disease progresses, clinical evidence showed that children mainly have asymptomatic or mild disease and it has been suggested that they are also less likely to spread the virus. Moreover, the lockdown and the school closure could have negative consequences on children, affecting their social life, their education and their mental health. As many countries have already entered or are planning a phase of gradual lifting of the containment measures of social distancing, it seems plausible that the reopening of nursery schools and primary schools could be considered a policy to be implemented at an early stage of recovery efforts, putting in place measures to do it safely, such as the maintenance of social distance, the reorganisation of classes into smaller groups, the provision of adequate sanitization of spaces, furniture and toys, the prompt identification of cases in the school environment and their tracing. Therefore, policy makers have the task of balancing pros and cons of the school reopening strategy, taking into account psychological, educational and social consequences for children and their families. Another issue to be considered is represented by socioeconomic disparities and inequalities which could be amplified by school's closure.

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During the SARS-CoV-2 pandemic, a surge in overall deaths has been recorded in many countries, most of them likely attributable to COVID-19. However, COVID-19 confirmed mortality (CCM) is considered an unreliable indicator of COVID-19 deaths because of national health care systems' different capacities to correctly identify people who actually died of the disease. 1,2 Excess mortality (EM) is a more comprehensive and robust indicator because it relies on all-cause mortality instead of specific causes of death. 3 We analyzed the gap between the EM and CCM in 67 countries to determine the extent to which official data on COVID-19 deaths might be considered reliable. MethodsIn this cross-sectional study, we retrieved aggregated country-level data on population and COVID-19 overall confirmed cases, deaths, and testing as of December 31, 2020, from Our World in Data. Data on countries' overall deaths from 2015 to 2020 were obtained from the World Mortality Data set (eAppendix in the Supplement). This research was based on public use datasets that do not include identifiable personal information and, per the Common Rule, was exempt from Institutional Review Board review and approval. For the same reason, no informed consent was required. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Negative binomial regression models were used to estimate projected deaths in 2020 using mortality data from 2015 to 2019. Two-sided 95% CIs for country-specific projected deaths were calculated applying the normal approximation to the Poisson distribution. EM in the pandemic period (ie, February 26 to December 31, 2020) was estimated as the difference between cumulative observed deaths and projected deaths. Countries' testing capacity was assessed with their cumulative test-to-case ratio (eAppendix in the Supplement). The association between countryspecific cumulative CCM and EM per 100 000 population of 2020 was displayed using a scatterplot, in which the identity line discriminates countries with EM exceeding CCM from those with EM lower than CCM. A color was assigned to countries based on their decile of testing capacity. All analyses were performed using R version 4.0.4 (R Project for Statistical Computing). Details on the analytic approach are available in the eAppendix in the Supplement. ResultsMost of the 67 countries experienced an increase in mortality during 2020 (Table ). Among countries with increased mortality (ie, those located above 0 on the y-axis in the Figure ), a small number appeared under the identity line, showing lower-than-expected mortality after subtracting COVID-19 deaths. Countries located above the identity line can be visually classified into 2 groups: 1 with several Latin American and East European countries, which exhibit a large gap between EM and CCM (eg, Mexico, 212 excess deaths vs 96 COVID-19 deaths per 100 000 population); the other, more heterogeneous group showed a moderate EM beyond CCM (eg, Greece, 57 excess deaths vs 45 CO...