Table of contents Covid-19 vaccination strategy 5 Ethical considerations and acceptance issues Implementation in the cantons and the role of the Confederation voluntary vaccination Social and health impacts of the pandemic LiteratureReferences required vaccine properties 6 Legal Basis and Liability 21 3 3 4 5 7 8 9 1 Introduction 14 Vaccination against Covid-19 10 10 8 Annex 2: Definition of the target groups and estimated number of people 23 Introductory remarks on the updated version (autumn 2022) Overall objectives 3 International conformity of the national vaccination strategy Ethical considerations 15 10 Appendix 4: More detailed information on the legal basis and liability 2 Strategic considerations 4 Implementation of the vaccination strategy Epidemiological starting point acceptance issues 7 Annex 1: Objective, assigned target groups with specific vaccination goals and associated 5 10 11 Implementation monitoring Coverage of the cost of the Covid-19 vaccination 17 10 objectives 11 12 14 14 9 Annex 3: Possible vaccine allocation in case of limited availability (priority groups) based on the strategy at the beginning of the vaccine availability in the late 2020 pandemic 3 Approach to achieve vaccination goals 26 Federal Commission for Vaccination questions EKIF Federal Office of Public Health Federal Department of Home Affairs FDHA Federal Office of Public Health (BAG) and Federal Commission for Vaccination (EKIF) As of 11/29/2022 Machine Translated by Google Federal Department of Home Affairs FDHA Vaccination questions EKIF Federal Office of Public Health Federal Commission for Table 1: Approved Covid-19 vaccines in Switzerland (as of November 2022). page 8 Prioritization strategy over time List of Tables Figure 1: Survey of the population about vaccination and page 13 Vaccination goals and associated required vaccine properties List of Figures Table 2: Vaccination strategy, assigned target groups with specific page 9 2 Machine Translated by Google 1 Introduction National strategies for the prevention and control of certain infectious diseases serve to define and achieve disease- specific goals at national level. They align the activities of the partners involved at national, cantonal and local level with the common strategic goals. In the case of vaccine- preventable diseases, vaccination is often a central, but not the only measure that is used. Taking into account the conditions in Switzerland, the Covid-19 vaccination strategy is based as far as possible on common international goals and measures to contain Covid-19. With the progressive development of the pandemic, the changing properties of SARS- Corona Virus 2 (SARS- CoV-2), the immunological situation in the population and the growing knowledge and further developments, especially of the mRNA vaccines, the Covid-19 vaccination strategy continuously supplemented and adjusted. The present version replaces the version from 05.07.2022 and addresses the procedure that has been used since the vaccines were first available, as well as the procedures during ongoing pandemic- epidemic conditions and the transition to an endemic situation in Switzerland. The strategy should now not only define the procedures for the current epidemiological situation and their vaccination recommendations, but also serve as a superordinate document for all conceivable scenarios. The first version of this Covid-19 vaccination strategy was created at the end of 2020, shortly before the first Covid-19 vaccines became available. Their orientation, objectives and prioritization corresponded to the state of knowledge at the time about the Covid-19 pandemic, its consequences for individual and public health and the knowledge about the properties of the vaccines at the time of their approval. Vaccination against Covid-19 is a key element in combating the health, economic and social consequences of the Covid-19 pandemic. The vaccination strategy determines at a higher level which goals are to be pursued with the vaccination against Covid 19 in the different epidemiological phases (pandemic, endemic) and defines the measures how these are to be achieved. It also describes which responsibilities and aspects must be taken into account during implementation. The actual vaccination recommendations are derived from this, which take into account the respective epidemiological situation (disease burden, current virus variants) and also the properties of the available vaccines (effectiveness, safety, etc.). The vaccination recommendations must be checked and adapted in accordance with the current state of knowledge and the epidemiological situation. The vaccination strategy as an overarching document covers various scenarios over a longer period of time. Federal Department of Home Affairs FDHA Federal Commission for Vaccination questions EKIF Federal Office of Public Health Overarching Objectives Introductory remarks on the updated version (fall 2022) 3 Machine Translated by Google 4 Federal Department of Home Affairs FDHA Federal Commission for Federal Office of Public Health The Covid-19 pandemic has had a major impact on individual and public health, as well as other areas. Covid-19 contributes significantly to morbidity, especially in certain population groups and is associated with a significant excess mortality in the population over 65 years of age (Federal Statistical Office BFS). Vaccination questions EKIF Epidemiological starting point 3. Reduction of the negative direct and indirect health, psychological, social and economic effects during a Covid 19 pandemic. Detailed information on the burden of disease caused by Covid-19 can be found in the regularly updated document "Covid-19 burden of disease". accessible. Some key aspects are outlined below. In accordance with international recommendations, the vaccination strategy pursues three goals in descending order of relevance (see Chapter 2.1): Infections with SARS- CoV-2 have affected all age groups since the beginning of the pandemic, but to different extents depending on the phase of the pandemic and population group. Due to the high vaccination coverage of people ÿ 65 years of age, the incidence of infection (incidence of infections) shifted continuously over the course of the pandemic from the oldest to younger age groups. Since the beginning of the pandemic, SARS- CoV-2 has mutated several times and the resulting variants and subvariants (e.g. delta and omicron) have led to several outbreak waves that have shaped the course of the pandemic. The various virus variants differ in terms of their transmissibility and virulence, as well as their ability for immune evasion (immune escape). In addition to older people, people ÿ 16 years of age with defined chronic diseases [1], as well as people with trisomy 21 [2, 3] and pregnant women [4– 8] have an increased risk of a severe course or hospitalization as a result of a SARS- CoV-2 infection . 2. Ensuring health care. While a Covid-19 disease in young people usually shows a mild course, the risk of a severe disease increases significantly with age. The incidence of hospitalizations was by far the highest among the ÿ 65- year- olds compared to all other age groups. Throughout the period (also in the delta and omicron waves), unvaccinated individuals and ÿ 65- year- old individuals recorded a significantly higher incidence of hospitalizations than vaccinated or < 65- year- old individuals. The incidence of hospitalizations of vaccinated ÿ 65- year- olds was many times lower than that of unvaccinated individuals of the same age. Unvaccinated people and people ÿ 65 years of age also show a significantly increased incidence of deaths as a result of Covid-19. The incidences of deaths in people over 65 years of age who had completed primary immunization were many times lower than A high number of severe Covid-19 diseases and in particular diseases that require intensive medical treatment can lead to an overload of the health system. ongoing Covid-19 cases. They are therefore also counted among the particularly endangered persons (BGP) according to the BAG category list . 1. Reducing the burden of disease, particularly severe and fatal Machine Translated by Google 2 Strategic considerations Federal Commission for Federal Department of Home Affairs FDHA Federal Office of Public Health Vaccination questions EKIF Social and health impacts of the pandemic 5 The Covid-19 pandemic has made it clear that not all people are equally affected by an illness and the restrictions on the preventive measures taken, and that not all people have the same access to healthcare services. In particular, people with a low socio- economic status are more likely to suffer from a severe course of Covid-19 and are more likely to die from the disease [10, 11]. A new version for 2023 and beyond is in the works. of unvaccinated people of the same age and again significantly lower in people with basic immunization and booster vaccination. The vaccination strategy is based on the properties of the available vaccines in relation to the prevalent and assumed properties of future virus variants and the disease risks of specific population groups. It not only takes into account the individual risk- benefit assessment, but also the overall social impact of the Covid-19 pandemic. The vaccination should not only reduce human suffering in terms of morbidity and mortality, but also help to ensure the relevant social supply functions, minimize the negative effects on social and cultural life and education and protect the economy from major damage . The Swiss vaccination strategy is closely based on the vaccination strategy of the WHO Global Covid-19 Vaccination Strategy in a Changing World at. The WHO vaccination strategy dates from July 2022. Studies on seroprevalence in Switzerland show that in June 2022 > 97% of the population had antibodies against SARS- CoV-2 (corona- immunitas.ch). These can be the result of an infection or a vaccination, or a combination of both. According to available evidence, the protection against (re)infections in the newer variants (e.g. Omikron) decreases relatively quickly after vaccination. Protection against severe Covid-19 courses lasts longer, but also decreases over time, especially in older and particularly vulnerable people. Therefore, depending on the epidemiological situation and the risk profile of population groups, a booster vaccination is recommended. The measures to combat the pandemic with school closures and other restrictions have shown that, in addition to school operations, the health and well- being of children and young people are also significantly affected (unesco: school closures). These measures have led to increased mental stress, especially among the young population. This was reported by between 30-45% of young adults during the pandemic (Mental Health OBSAN). After a SARS- CoV-2 infection, long- lasting, sometimes limiting symptoms can occur (post- Covid-19 disease / Long Covid). These have been observed predominantly in adults, but may also occur in children and adolescents, although less frequently. The symptoms can last for several weeks and sometimes for months. In general, the probability and severity of post- Covid-19 disease increases with the severity of the Covid-19 disease that has gone through. Initial studies show that vaccinated adults who have had a SARS- CoV-2 infection have a lower probability than unvaccinated people of developing a post- Covid-19 disease (UKHSA Evidence Briefing, [9]). Machine Translated by Google Federal Commission for Federal Department of Home Affairs FDHA Federal Office of Public Health Vaccination questions EKIF In the following, the Swiss vaccination strategy defines the overarching goals for the Covid 19 vaccination, as well as the individual strategies for each target group and their possible prioritization. Experts worldwide expect SARS- CoV-2 to become endemic in the long term. transition phase and during the period in which Covid-19 has established itself as an endemic disease in Switzerland, differ from those of pandemic crisis management. These goals are to be achieved primarily by reducing the burden of disease associated with the Covid-19 pandemic. Depending on the characteristics of the pathogen and the properties of the available vaccines, possible vaccination goals are basically herd protection, elimination of the pathogen or a high vaccination rate for individual protection. In the Covid-19 pandemic, the first two vaccination goals cannot be achieved with the vaccines available to date. On the other hand, aiming for a high vaccination coverage makes sense. Because the higher the vaccination coverage, especially in the risk groups, the less the health system is burdened by severe Covid 19 cases. In addition, the WHO describes as a further goal to accelerate the development and availability of improved vaccines, which ensure immunity and possible protection against transmission or. should improve. The measures to protect public health will be reflected in the Test strategies and case management must be adapted to the endemic situation. The vaccination recommendation derived from the vaccination strategy defines vaccination schemes for the individual population groups. It is based on the currently predominant virus variants, the effectiveness and duration of protection of the vaccines in the individual target groups and on the immunity observed in the population. The illness of people with potentially severe courses of Covid-19 should be recognized and treated at an early stage. In addition, low- threshold access to treatment should be possible. The transition to an endemic situation is expected in the foreseeable future. For the time being, however, the focus of considerations is how to deal with further epidemic SARS- CoV-2 waves caused by newly emerging variants of the virus and how to combat them with the vaccines that are currently and will be available in the future. Vaccination as a preventive measure will also play a central role in the long- term management of SARS- Cov-2, with public access and understanding of the preventive measures being important. The epidemiological situation, international recommendations and framework conditions [12, 13] as well as the special features of the Covid-19 situation in Switzerland and the Swiss healthcare system must be taken into account. Accordingly, the virus will not disappear again, but will continue to lead to infections in the population. Most people have already acquired at least some immunity through vaccination and/ or infection. As a result, it can be expected that Covid-19 will permanently not pose an immediate public health threat as it did during the pandemic phase. However, individual population groups will continue to be at high risk. As an endemic disease, Covid-19 will also be able to cause severe courses and post- Covid 19 diseases, especially in vulnerable people. To protect public health or specific target groups, measures including the repeated recommendation of vaccination will continue to be necessary, as is the case with other vaccine- preventable diseases. 6 Machine Translated by Google 7 Vaccination questions EKIF Federal Office of Public Health Federal Commission for Federal Department of Home Affairs FDHA 2. Ensuring health care. 2. Ensuring health care is the second overarching vaccination goal. On the one hand, the healthcare system must be able to cope with the burden of disease caused by Covid-19 and, on the other hand, it must continue to be available to the Swiss population for all diseases and health problems not caused by Covid-19. Basically, the vaccination offers good individual protection against severe courses. Depending on the epidemiological situation, however, vaccination does not offer any protection against infection and transmission. Therefore, without effective non- pharmaceutical measures, the disease burden of Covid-19 can lead to an overload of the health system in certain phases. This overload is caused by a high number of Covid-19 patients in inpatient and, in particular, intensive care treatment. Depending on the epidemiological situation, it may therefore be necessary to take non- pharmaceutical measures in addition to vaccination. Securing health care is achieved by reducing the burden of disease from Covid-19 (see goal 1) and by employing health workers. This requires optimal protection of the health of staff to reduce staff absence due to Covid-19. In order to maintain the overall performance of the healthcare system, the utilization of the intensive care/ intermediate care units by Covid-19 patients must not exceed a tolerable level. The postponement of non- urgent treatments in the hospitals should only be considered in the short term. People who are particularly at risk bear the main burden of disease and have a significantly increased risk of hospitalization and death [1– 4]. Vaccination is the most important measure for protection against serious illnesses, especially in the case of people who are particularly at risk. ongoing Covid-19 cases. 1. Reducing the burden of disease, especially severe and fatal Covid-19 cases, is the priority vaccination goal, since the Covid-19 pandemic led to excess mortality and clear additional morbidity in the population (see Chapter 1.3). However, non- pharmaceutical measures to control the pandemic can lead to major economic problems with declining sales and existential threats (plant closures, bankruptcies, short- time work, etc.). They also severely restrict social and cultural life as well as education. From the resulting negative 3. Reducing the negative direct and indirect health, psychological, social and economic effects of the Covid-19 pandemic is the third overriding vaccination goal. The achievement of Goal 3 is supported by the achievement of Goals 1 and 2 and, if necessary, by non- pharmaceutical measures, especially in certain settings and population groups. Depending on the effect of the available vaccines on the prevailing virus variants, this vaccination goal cannot be achieved or can only be achieved to a small extent. 1. Reducing the burden of disease, particularly severe and fatal 3. Reduction of the negative direct and indirect health, psychological, social and economic effects during a Covid 19 pandemic. In line with international recommendations [13], the vaccination strategy pursues three goals in descending order of importance. Primary goals of vaccination: objectives Machine Translated by Google Federal Commission for Federal Department of Home Affairs FDHA Federal Office of Public Health Vaccination questions EKIF Vaccination against Covid-19 8th Consequences on mental health and well- being (www.coronastress.ch) Adolescents and young adults are particularly affected (see Chapter 1.4). Nevertheless, non- pharmaceutical measures may be deemed necessary due to the burden of the disease and may therefore be recommended or ordered. (moderna) Vaccine Comirnaty® (Novavax) based (Pfizer/ BioNTech) Technology mRNA vaccine, monovalent In Switzerland, the vaccines based on the new mRNA technology were primarily used and were also the first to be approved. The later approved vector and protein vaccines were initially recommended as alternatives for people who could not be given mRNA vaccines for medical reasons or Vaccines approved in Switzerland (as of November 2022): Six vaccines with three different vaccine technologies for the prevention of Covid-19 are approved, recommended and available in Switzerland and Liechtenstein. The vaccines from Moderna (Spikevax® and Spikevax Bivalent Original / Omicron® BA.1) and Pfizer/ BioNTech (Comirnaty® and Comirnaty® Bivalent Original / Omicron BA.1) are so- called mRNA vaccines. Johnson & Johnson vaccine (Covid-19 Vaccine Janssen®) is an adenoviral vector vaccine. Novavax's Nuvaxovid® is a protein- based vaccine. All vaccines are based on the presentation of the spike protein (Wuhan variant and, in the case of bivalents, also the Omicron variant). The exact dosages and detailed information on effectiveness, safety and duration of protection can be found in the vaccination recommendation be removed. (Johnson & Johnson) spike protein Table 1: Approved Covid-19 vaccines in Switzerland (as of November 2022). Nuvaxovid® Vaccine, monovalent mRNA vaccine, bivalent Spikevax® Bivalent Original / Omicron BA.1 (Moderna) Adenoviral vector vaccine, monovalent Vaccination is of great importance as a primary preventive measure to reduce health and other consequences of Covid-19. Vaccination with the available vaccines enables large parts of the population to develop good protection against severe Covid-19 courses (hospitalization and death). This protection decreases over time, especially for BGP. In the first waves (origin variant), the vaccination also protected against infection and transmission to a certain extent, while the effectiveness of the vaccination during later waves (omicron variants) was limited in particular to protection against severe courses. Vaccination against the omicron variants, on the other hand, can hardly offer any protection against symptomatic infections and has only negligible protection against transmission. The need for newly developed vaccines and their effectiveness against new variants will become apparent in the future. Covid-19 Vaccine Janssen® Comirnaty® Bivalent Original / Omicron BA.1 (Pfizer/ BioNTech) mRNA vaccine, bivalent adjuvant Spikevax® mRNA vaccine, monovalent Machine Translated by Google The order of target groups presented in Table 2 is based on the disease burden per target group and the estimated contribution of vaccination to the overall immunization goals. This against the background of the current epidemiological situation and immunity in the Swiss population. Table 2: Objective, assigned target groups with specific vaccination goals and associated required vaccine properties. because these mRNA vaccines refused. Since autumn 2022, the approved protein vaccine has been generally recommended for booster vaccinations. In addition to these target groups, the vaccination recommendation can enable other groups of people to have access to a vaccination. The initial definition of the target groups and the estimated number of people per group in 2020 can be found in Appendix 2. In order to achieve the overarching vaccination goals 1-3, a target group- oriented vaccination strategy is being pursued. The original version of this table (see Appendix 1) also took into account the situation that the vaccines are highly effective in reducing all symptomatic SARS- CoV-2 infections (not just severe courses) and transmission and includes seven target groups. Under circumstances, such as those in autumn 2022, in which the effectiveness of reducing infections and/ or transmission is no longer available or only very low, certain target groups can be combined or excluded from a current vaccination recommendation. In autumn 2022, the focus will therefore only be on two target groups. The structure should also show a prioritization, for example in the case of a vaccine shortage or with regard to the time of administration of the vaccination for the best possible protection during a wave of infection. The mRNA vaccines offer the possibility of being adapted relatively quickly to new or several virus variants and being produced in large quantities. This can be an advantage with regard to the appearance of new variants. Vaccines (such as Nuvaxovid) can also be used, the effectiveness of which is less dependent on the virus variant and can therefore offer broader protection. gradients health 1) Particularly vulnerable people Illnesses and other conditions (see category list) Protection of BGPs heavy and care and Direct protection of group (reduction/ prevention of before Maintaining the BGP 9 prevention of serious illness. deaths) deaths; Target groups (hierarchical order) Per Persons 16-64 years with certain chronic maintenance objective (BGP): more individual Care, Vaccinated against severe Adults ÿ 65 Specific Goals gradients Years Necessary vaccine properties Effective in the elderly and those with comorbidities. hospitalization and 1 Federal Department of Home Affairs FDHA Vaccination questions EKIF Federal Office of Public Health Federal Commission for Approach to achieve vaccination goals 1 Definition of target groups and number of people per group, see Appendix 2. Machine Translated by Google 1 The Confederation supports the cantons in the implementation at various levels. The procurement of the vaccines against Covid-19 and the logistical rough distribution to the cantons has been carried out by the federal government since the beginning of the pandemic. In the longer term, however, procurement and logistics are to be transferred to the standard structures of the healthcare system. This includes giving priority to giving particularly vulnerable and older people access to vaccination and then extending it to other population groups. The implementation of the vaccination recommendations for Covid-19 vaccination is tracked and analyzed with specific monitoring. Based on the Epidemics Act (Art. 24 Para. 2 EpG and Art. 36 EpV and Art. 40 EpV), the FOPH, after consultation with the cantons, sets the In particular, the cantons are responsible for ensuring an appropriate range of vaccinations in order to be able to meet the demand for Covid-19 vaccinations in a low- threshold, efficient and timely manner. Demand promotion is also the responsibility of the cantons. The vaccination strategy, the overarching vaccination goals and the prioritization of the target groups in Switzerland conform to the recommendations of the WHO [12, 13]. The cantons are responsible for implementing the vaccination strategy and vaccination recommendations. The Confederation also supports the cantons by providing information material on Covid-19 vaccination for the general public and professionals. The federal government is also developing information campaigns on Covid-19 vaccination to raise awareness and stimulate demand among the population. Switzerland recognizes (complete) vaccination series with vaccines recognized by the WHO (WHO Emergency Use Listing). Recommendations for completing a vaccination series in order to ensure the best possible vaccination protection from a medical point of view are described in the vaccination recommendation. Federal Department of Home Affairs FDHA Federal Commission for Federal Office of Public Health Vaccination questions EKIF Necessary vaccine properties Efficacy to reduce serious illness and thus hospitalization due to Covid-19. 2) BGP support staff Healthcare workers who come into contact with patients Specific Goals and group b) Ensuring health care (reduction of care and work loss due to Covid-19 diseases) 10 At least a small reduction in symptomatic infections (reduction in lost work time) objective Target groups (hierarchical order) Per a) Direct protection of Vaccinated from rarely severe courses 3 International conformity of the national vaccination strategy 4 Implementation of the vaccination strategy Implementation monitoring Implementation in the cantons and the role of the Confederation Machine Translated by Google On the one hand, necessary prioritizations (e.g. at the beginning of a pandemic when only a limited amount of vaccine is available) must be ethically justified; on the other hand, high vaccination acceptance is necessary for an effective target group vaccination strategy (see Chapter 2.3). The fact that vaccination is voluntary (see Chapter 5.3) is an important principle and contributes to good acceptance of vaccination. The same applies to the assumption of costs by the federal government (see Chapter 5.4). For the situation of a shortage of vaccine or vaccination options, as was expected when the vaccine became available in the pandemic at the end of 2020, but can also occur again depending on the development, prioritization must be provided. Appendix 3 lists the intended prioritization and the underlying ethical principles. data to be collected (minimum data set) and the methodology for documentation and monitoring. Based on aggregated data from the documentation of the Covid-19 vaccinations carried out, the development of vaccination activity and the acceptance of the vaccination in the various target groups is electronically processed closely and promptly. The aim of the monitoring is to monitor the current burden of disease and the vaccination process in order to be able to derive the resulting measures. It is particularly important to integrate national real- time data (including IPS and hospitals) in order to be able to take appropriate measures in good time, especially in times of crisis. It should be noted at this point that there is a socio- psychological perspective as well as an ethical perspective on questions of prioritization under conditions of scarcity, which are essentially questions of justice. While the ethical perspective sees itself as setting standards (e.g. “what should a fair distribution look like”), perspective aims at observing the perception of justice (e.g. “what does a distribution that the population perceives as fair look like”). Ideally, ethical arguments coincide with the perception of justice. However, this is not always the case [12] and can lead to problems with the acceptance of certain prioritizations. the As part of the pandemic planning with a focus on influenza, a literature analysis was prepared in 2018 as part of a prioritization list and for calculating quotas on behalf of the BAG [15]. In this study, the ethical and justice- theoretical discourse was processed. A total of 17 ethical criteria could be derived as to how medical services can be distributed fairly under conditions of scarcity. These can be divided into five classes: (1) equality principle, (2) favoring the worst off (need principle), (3) maximizing total utility (utilitarianism principle), (4) promoting social utility, and (5) combination of criteria. Empirical preference studies on the allocation of scarce medical services in the event of a pandemic indicate that the population adheres to the principle of "the sickest first". Ethical aspects (see Chapter 5.1) and vaccination acceptance (see Chapter 5.2) are of great importance in the Covid-19 vaccination strategy and the achievement of the overarching vaccination goals. The strategic considerations presented in Chapter 2 follow WHO recommendations for vaccine assignment and prioritization. These recommendations are in turn based on the arguments of recognized ethics experts [14]. on social- psychological Relevant indicators for vaccination in Switzerland are on the FOPH dashboard public. Ethical considerations Federal Commission for Vaccination questions EKIF Federal Office of Public Health Federal Department of Home Affairs FDHA 5 Ethical considerations and acceptance issues 11 Machine Translated by Google In order to achieve a high level of acceptance of the Covid-19 vaccination in the population, it is important that c) all persons for whom the vaccination is recommended and who want to be vaccinated have easy and low- threshold access to the vaccination (see Chapter 5.4). expression of the needs principle [14] attaches very high importance to fairness [16, 17] (see Chapter 5.2). Vaccination readiness and assessment of vaccination prioritization Surveys by the ETH- ZHAW- IQVIA team on behalf of the FOPH show that the willingness to vaccinate2 has increased steadily over time since the start of the vaccination campaign at the end of 20203 and peaked at around 75% in summer 2022. At the same time, the number of undetermined people has steadily decreased; most recently it was around 5% of those surveyed. Other studies (e.g. by Sotomo) came to comparable results. b) vaccination is voluntary for all target groups (see Chapter 5.3); The acceptance of a vaccination depends on many factors (e.g. perception of the individual risk, expected benefit of the vaccination, fear of side effects, skepticism about the state and Covid-19 policy, etc.) and varies over time [18]. Explanation of the new vaccine technologies, undesirable vaccination symptoms) as well as the vaccination strategy and recommendation (including explanation of vaccine allocation and priority groups; approval processes and EKIF evaluations); The willingness to vaccinate can be significantly reduced in later campaigns (such as the booster vaccination in autumn 2022). These survey results were confirmed by the number of those actually vaccinated. For example, the proportion of those vaccinated with at least one vaccination in the 16-64 age group is 77.2% (covid19.admin.ch, as of November 14, 2022). a) all stakeholders involved, the addressed target groups and the general population receive open, transparent, addressee- oriented and purposeful information. This in particular via the Covid-19 vaccination (e.g. Covid-19 is expected to become an endemic disease in the longer term. Covid-19 will be constantly present with fluctuating incidence, possibly also with epidemic outbreaks. The question that arises from an ethical point of view is the following: Will there be scarcity again and thus also distribution and prioritization issues? According to the current state of knowledge, this case cannot be ruled out, especially when new variants appear that lead to severe courses and for which neither the existing vaccinations nor therapies are sufficiently effective. Shortages may arise until adapted vaccines and therapies are developed and available in sufficient quantities. The considerations mentioned above also apply in such a case. However, the prioritization may have to be adjusted, depending on which group of people is most affected. 3 A total of 5 surveys were carried out. The surveys were conducted via an online panel. The first survey took place in the second half of December 2020, the fifth in the last 2 People aged 18-75 were interviewed. 1'472-1'416. Population- representative quotas for gender and age were set for the five samples. December week 2021. In the first survey, 3,058 from French (33%) and German- speaking Switzerland (67%) were involved. The other surveys included adjusted samples between Federal Office of Public Health Federal Commission for Federal Department of Home Affairs FDHA Vaccination questions EKIF acceptance issues 12 Machine Translated by Google (Hospital employees to prioritize) between the first and second survey, a significant increase in the fairness values from 59% to 76%. So after the first saturation of the vaccination rate of the particularly vulnerable people became apparent, in the eyes of the respondents, it was the turn of the health workers. Eight different prioritization principles were queried in the surveys. The hierarchical order of prioritization of specific groups (simplified according to the EKIF vaccination strategy), (1) risk groups and older people ÿ65, followed by (2) Overall, the vaccine distribution preferred by the respondents correlates with the prioritization provided in the present vaccination strategy in the event of a vaccine shortage. Health workers with close contacts to (1), then (3) the other health workers and essential services (e.g. police, fire brigade, etc.), finally (4) the other people) are perceived as very fair. Approximately 80% of those surveyed judge this principle to be fairly or very fair. The prioritization principle of favoring people who are particularly at risk is felt to be just as fair as the one mentioned above. On the other side of the spectrum, the principle of randomly distributing the vaccine doses to the people asking is judged by 85% of those surveyed to be somewhat or very unfair. The response pattern remains stable over time, deviations can be explained by the dynamics of the course of the pandemic. For example, with regard to the prioritization principle «social function» With reference to the previous chapter 5.1, it is of particular interest which possible vaccination strategies are perceived as fair by the population. As shown, there are a number of prioritization principles that can be ethically justified. 13 Federal Department of Home Affairs FDHA Federal Commission for Federal Office of Public Health Vaccination questions EKIF Figure 1: Public survey on vaccination and prioritization strategy over time4. The prioritization questions were only asked in the first 4 of a total of 5 surveys. points: mean values; vertical bars: confidence intervals. 4 A total of 5 surveys were carried out. The surveys were conducted via an online panel. The first survey took place in the second half of December 2020, the fifth in the last December week 2021. In the first survey, 3,058 from French (33%) and German- speaking Switzerland (67%) were involved. The other surveys included adjusted samples between 1'472-1'416. Population- representative quotas for gender and age were set for the five samples. Machine Translated by Google voluntary vaccination Coverage of the cost of the Covid-19 vaccination 5 Article 6 paragraph 2 letter d and Article 22 EpidA 14 Federal Commission for Federal Department of Home Affairs FDHA Federal Office of Public Health Vaccination questions EKIF A general vaccination requirement for the population is legally excluded in Switzerland. A vaccination recommended to fight the epidemic in Switzerland is free for the population. Covid vaccinations for other reasons are accessible for a fee. For more information, see the Funding of Covid-19 Vaccinations factsheet be removed. The federal government also relies on information and awareness- raising for the Covid-19 vaccination. The Swiss population should be informed in an understandable and transparent manner. Everyone should be able to make a well- informed, personal vaccination decision. However, the Epidemics Act provides that, under certain conditions, the Confederation and the cantons can make vaccinations compulsory for at- risk groups of the population, for people who are particularly exposed and for people who carry out certain activities (“mandatory vaccination” or “mandatory vaccination”).5 But no one can be forced to be vaccinated (no «vaccination obligation»). The present Covid-19 vaccination strategy is based on the competence and obligation of the FOPH to publish vaccination recommendations and guidelines for combating communicable diseases (Art. 20 para. 1 and 9 para. 3 Epidemics Act [EpG; SR 818.101]). More detailed information on legal issues and questions of liability in the event of vaccination damage can be found in Appendix 4. 6 Legal Basis and Liability Machine Translated by Google LiteratureReferences 9 Al- Aly Z, Bowe B, Xie Y. Long COVID after breakthrough SARS- CoV-2 infection. Natural medicine 5 Chinn J, Sedighim S, Kirby KA, Hohmann S, Hameed AB, Jolley J et al. Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic. JAMA network open 2021;4(8):e2120456. 10.1001/ jamanetworkopen.2021.20456. 12 World Health Organization. WHO SAGE ROADMAP FOR PRIORITIZING USES OF COVID-19 VACCINES IN THE CONTEXT OF LIMITED SUPPLY: An approach to inform planning and subsequent recommendations based upon epidemiologic setting and vaccine supply scenarios. 15 6 Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta- analysis. BMJ (Clinical research ed.) 2020;370:m3320. 10.1136/ bmj.m3320. 13 World Health Organization. WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination, 14 September 2020. 3 Clift AK, Coupland CAC, Keogh RH, Hemingway H, Hippisley- Cox J. COVID-1