Controversies and Challenges of Mass Vaccination against SARS-CoV-2 in Italy: Medico-Legal Perspectives and Considerations

During the COVID-19 pandemic, forensic sciences, on the one hand, contributed to gaining knowledge about different aspects of the pandemic, while on the other hand, forensic professionals were called on to quickly adapt their activities to respond adequately to the changes imposed by the pandemic. This review aims to clarify the state of the art in forensic medicine at the time of COVID-19, discussing the following: the influence of external factors on forensic activities, the impact of autopsy practice on COVID-19 and vice-versa, the persistence of SARS-CoV-2 RNA in post-mortem samples, forensic personnel activities during the SARS-CoV-2 pandemic, the global vaccination program and forensic sciences, forensic undergraduate education during and after the imposed COVID-19 lockdown, and the medico-legal implications in medical malpractice claims during the COVID-19 pandemic. The COVID-19 pandemic has greatly influenced different aspects of human life, and, accordingly, the practical activities of forensic sciences that are defined as multidisciplinary, involving different expertise. Indeed, the activities are very different, including crime scene investigation (CSI), external examination, autopsy, and genetic and toxicological examinations of tissues and/or biological fluids. At the same time, forensic professionals may have direct contact with subjects in life, such as in the case of abuse victims (in some cases involving children), collecting biological samples from suspects, or visiting subjects in the case of physical examinations. In this scenario, forensic professionals are called on to implement methods to prevent the SARS-CoV-2 infection risk, wearing adequate PPE, and working in environments with a reduced risk of infection. Consequently, in the pandemic era, the costs involved for forensic sciences were substantially increased.

Background To date, coronavirus disease 2019 (COVID-19) becomes increasingly fierce due to the emergence of variants. Rapid herd immunity through vaccination is needed to block the mutation and prevent the emergence of variants that can completely escape the immune surveillance. We aimed to systematically evaluate the effectiveness and safety of COVID-19 vaccines in the real world and to establish a reliable evidence-based basis for the actual protective effect of the COVID-19 vaccines, especially in the ensuing waves of infections dominated by variants. Methods We searched PubMed, Embase and Web of Science from inception to July 22, 2021. Observational studies that examined the effectiveness and safety of SARS-CoV-2 vaccines among people vaccinated were included. Random-effects or fixed-effects models were used to estimate the pooled vaccine effectiveness (VE) and incidence rate of adverse events after vaccination, and their 95% confidence intervals (CI). Results A total of 58 studies (32 studies for vaccine effectiveness and 26 studies for vaccine safety) were included. A single dose of vaccines was 41% (95% CI: 28–54%) effective at preventing SARS-CoV-2 infections, 52% (31–73%) for symptomatic COVID-19, 66% (50–81%) for hospitalization, 45% (42–49%) for Intensive Care Unit (ICU) admissions, and 53% (15–91%) for COVID-19-related death; and two doses were 85% (81–89%) effective at preventing SARS-CoV-2 infections, 97% (97–98%) for symptomatic COVID-19, 93% (89–96%) for hospitalization, 96% (93–98%) for ICU admissions, and 95% (92–98%) effective for COVID-19-related death, respectively. The pooled VE was 85% (80–91%) for the prevention of Alpha variant of SARS-CoV-2 infections, 75% (71–79%) for the Beta variant, 54% (35–74%) for the Gamma variant, and 74% (62–85%) for the Delta variant. The overall pooled incidence rate was 1.5% (1.4–1.6%) for adverse events, 0.4 (0.2–0.5) per 10 000 for severe adverse events, and 0.1 (0.1–0.2) per 10 000 for death after vaccination. Conclusions SARS-CoV-2 vaccines have reassuring safety and could effectively reduce the death, severe cases, symptomatic cases, and infections resulting from SARS-CoV-2 across the world. In the context of global pandemic and the continuous emergence of SARS-CoV-2 variants, accelerating vaccination and improving vaccination coverage is still the most important and urgent matter, and it is also the final means to end the pandemic. Graphical Abstract

Background: Amid the coronavirus disease of 2019 (COVID-19) pandemic, China's vaccination campaign is progressing in an orderly manner. In the process of vaccination, the vaccination rates in different parts of China are different, and the factors affecting people's vaccination are also different, which may be caused by some reasons affecting people's willingness to vaccinate or complex sociodemographic characteristics factors.We found that inconsistent findings on factors associated with willingness to get COVID-19 vaccination in available studies. Therefore, we conducted a meta-analysis of current factors influencing people's willingness to receive COVID-19 vaccination to assess the associated factors influencing people's COVID-19 vaccination. Methods: The databases of CNKI, Chinese Biomedical Literature (CBM), Wanfang, VIP, PubMed, Web of Science, and Cochrane Library were searched by computer to collect the relevant literature on the factors affecting the willingness of Chinese community residents to undergo COVID-19 vaccination. After extracting the data, RevMan 5.3 and R software were used for statistical analysis. Population included in the study were Chinese community residents; outcome indicators were associated factors of willingness to get COVID-19 vaccination; COVID-19, odds ratio (OR), confidence interval (CI). Study designs were Crosssectional study. Egger's tests was used to check potential publication bias. Results:The willingness to get COVID-19 vaccination of community residents who think COVID-19 vaccine is effective is 4.10 times that of community residents who think COVID-19 vaccine is ineffective (OR =4.10, 95% CI: 3.08-5.46), and community residents who think COVID-19 vaccine is safe are 1.82 times more willing to receive COVID-19 vaccine than those who think COVID-19 vaccine is unsafe (OR =1.82, 95% CI:1.42-2.33); the willingness to get COVID-19 vaccination of community residents who think COVID-19 infection risk is high was 1.53 times that of community residents who think COVID-19 infection risk is low (OR =1.53, 95% CI: 1.43-1.64); the willingness of male community residents to vaccinate COVID-19 is 1.48 times higher than that of female community residents (OR =1.48, 95% CI: 1.23-1.76). Conclusions:The finding means that vaccination strategies need to be formulated according to the gender of community residents, propaganda of vaccination information, and dissemination of epidemic information to achieve higher levels of COVID-19 vaccination.