Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

Background: The World Health Organization has recommended that individual governments identify vaccine hesitancy areas. It is proposed that the governments, with the aid of local organizations, educate and implement social insights on the vaccination so that high population levels are covered with this safe immune program. Methods: A longitudinal online survey covered 3000 adults from India. We examined the demography, behavioral (socio-economic) attitude, vaccine hesitancy, vaccine resistance for the COVID-19 vaccine. The specific reasons for the COVID-19 vaccine decline were also evaluated. Results: Our survey revealed 59% definite response, 29% low-level response, and 7% high-level response for vaccine hesitancy, while 6% had resistant views on the COVID-19 vaccine. Individuals who had higher income levels, lived in a society, maintained social distancing, had downloaded the COVID-19 update app, showed a positive attitude towards their government, and more confidence in their healthcare system were more inclined towards the vaccination. On the contrary, individuals who had overstated the risks of COVID-19 and had a religious and populistic attitude towards vaccination were more hesitant/resistant to vaccination. The respondents who declined vaccine administration were further evaluated for their specific reason for their response. The most common reasons for declining the COVID-19 vaccine were post-vaccine scare of adverse health effects and accepting the information spread by social media. Conclusions: The results in our study show that by identifying population “hot spots” that have negative or unclear information on the COVID-19 vaccination, these “hot spots” can be addressed by involving friendly organizations that can clear their strong disbeliefs and increase the percentage of vaccine-definite people within the population. The role of government-induced COVID-19 vaccine policy measures can always be beneficial to cause this shift from disbelief to confidence within the population.

Background: During the ongoing COVID-19 pandemic, trust within a community in the projected schemes or strategies to combat COVID-19 depends on the confidence generated and launched by the government and medical employees toward the public. The “vaccination intention” within a community is determined by a range of factors, which include sociodemographic features, personal beliefs, and attitude toward vaccination. Methods: A nationwide survey was conducted involving 2000 people using a Tencent questionnaire platform. One-way ANOVA was conducted for age, education, and occupation with vaccination intention for the COVID-19 vaccine. Correlation analysis was conducted between sources, trust, and vaccination intention indicating both types of sources (official and unofficial sources) and both types of trust (trust in the social environment and in vaccines). Results: The reception of the sources of information on the COVID-19 vaccine was significantly higher from official sources (M = 5.54, SD = 1.37) and government officials (M = 5.68, SD = 1.499) compared with that from experts in medicine (M = 5.39, SD = 1.511). Among the unofficial sources, “chatting and communicating with family and friends” scored the highest (M = 4.84, SD = 1.649). In the statistics on people’s trust in all aspects involved in vaccines, the level of trust in the social environment was significantly higher and more concentrated than in vaccines (M = 5.67, SD = 1.129). The level of trust in government (M = 5.80, SD = 1.256) was slightly higher than in medical personnel (M = 5.53, SD = 1.199). People’s willingness to be vaccinated was generally high (M = 78.15, SD = 22.354). The demographic factors were not influential in vaccination intention. Both sources (official and unofficial sources) and trust (trust in the social environment and in vaccines) are significantly and positively correlated with vaccination intention. Information receptions from official and unofficial sources were significant positive predictors of trust in the social environment, but they were not significant predictors of trust in vaccines. The mediating effect of trust in vaccines on the relationship between receiving information from official and unofficial sources and vaccination intention was insignificant. Conclusions: This study revealed that trust in the environment is an important channel linking people’s information reception and vaccination intention, explores a new path for health information communication, and attempts to provide new ideas for health information dissemination and promotion.

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Background: Consumers&#039; perception and satisfaction with the vaccination services is a critical and commonly used indicator to evaluate the quality of services provided by the concerned authorities. The present survey assessed social perception, satisfaction, hesitancy, and associated factors of COVID-19 vaccination provided at the primary health centers (PHC) of South India. Methods: We collected a validated data using data collection tool. The associated factors for the low and high satisfaction with the vaccination services were evaluated by logistic regression analysis. We performed Spearman&#039;s correlation test to identify the correlation between perception and satisfaction scores. Results: Of the 675 participants, 87.4% were satisfied with the vaccination services provided at the PHCs. The participants&#039; satisfaction was significantly associated with the age group [Adjusted OR (AOR) = 1.89, 95% CI = 1.39 – 2.89, P = 0.037] and occupation status [AOR = 1.42, 95% CI = 1.17 – 1.74, P = 0.024]. We found a significant positive correlation (Spearman&#039;s rho = 0.207, p &lt; 0.001) between perception and satisfaction scores. Furthermore, 20.7% of participants were hesitant (too much and somewhat) to give recommended COVID-19 vaccines. Conclusion: We recommend targeted health education programs for social population to improve their perceptions and the importance of all recommended COVID-19 vaccines. Next, we suggest continuing social satisfaction assessment to enhance and maintain the quality of vaccination services.