[Frontiers in Digital Health, 28 June 2023]

Background: The use of social media data provides an opportunity to complement traditional influenza and COVID-19 surveillance methods for the detection and control of outbreaks and informing public health interventions.

Objective: The first aim of this study is to investigate the degree to which Twitter users disclose health experiences related to influenza and COVID-19 that could be indicative of recent plausible influenza cases or symptomatic COVID-19 infections. Second, we seek to use the Twitter datasets to train and evaluate the classification performance of Bidirectional Encoder Representations from Transformers (BERT) and variant language models in the context of influenza and COVID-19 infection detection.

Methods: We constructed two Twitter datasets using a keyword-based filtering approach on English-language tweets collected from December 2016 to December 2022 in Saskatchewan, Canada. The influenza-related dataset comprised tweets filtered with influenza-related keywords from December 13, 2016, to March 17, 2018, while the COVID-19 dataset comprised tweets filtered with COVID-19 symptom-related keywords from January 1, 2020, to June 22, 2021. The Twitter datasets were cleaned, and each tweet was annotated by at least two annotators as to whether it suggested recent plausible influenza cases or symptomatic COVID-19 cases. We then assessed the classification performance of pre-trained transformer-based language models, including BERT-base, BERT-large, RoBERTa-base, RoBERT-large, BERTweet-base, BERTweet-covid-base, BERTweet-large, and COVID-Twitter-BERT (CT-BERT) models, on each dataset. To address the notable class imbalance, we experimented with both oversampling and undersampling methods.

Results: The influenza dataset had 1129 out of 6444 (17.5%) tweets annotated as suggesting recent plausible influenza cases. The COVID-19 dataset had 924 out of 11939 (7.7%) tweets annotated as inferring recent plausible COVID-19 cases. When compared against other language models on the COVID-19 dataset, CT-BERT performed the best, supporting the highest scores for recall (94.8%), F1(94.4%), and accuracy (94.6%). For the influenza dataset, BERTweet models exhibited better performance. Our results also showed that applying data balancing techniques such as oversampling or undersampling method did not lead to improved model performance.

Conclusions: Utilizing domain-specific language models for monitoring users’ health experiences related to influenza and COVID-19 on social media shows improved classification performance and has the potential to supplement real-time disease surveillance.

[Science Advances, 3 November 2023]

The seasonal influenza (flu) vaccine is designed to protect against those influenza viruses predicted to circulate during the upcoming flu season, but identifying which viruses are likely to circulate is challenging. We use features from phylogenetic trees reconstructed from hemagglutinin (HA) and neuraminidase (NA) sequences, together with a support vector machine, to predict future circulation. We obtain accuracies of 0.75 to 0.89 (AUC 0.83 to 0.91) over 2016–2020. We explore ways to select potential candidates for a seasonal vaccine and find that the machine learning model has a moderate ability to select strains that are close to future populations. However, consensus sequences among the most recent 3 years also do well at this task. We identify similar candidate strains to those proposed by the World Health Organization, suggesting that this approach can help inform vaccine strain selection.

[SSRN, 3 September 2021]

Background: After the start of the COVID-19 pandemic and its spread across the world, countries have adopted containment measures to stop its transmission, limit fatalities and relieve hospitals from strain and overwhelming imposed by the virus. Many countries implemented social distancing and lockdown strategies that negatively impacted their economies and the psychological wellbeing of their citizens, even though they contributed to saving lives. Recently approved and available, COVID-19 vaccines can provide a really viable and sustainable option for controlling the pandemic. However, their uptake represents a global challenge, due to vaccine hesitancy logistic-organizational hurdles that have made its distribution stagnant in several developed countries despite several appeal by the media, policy- and decision-makers, and community leaders. Vaccine distribution is a concern also in developing countries, where there is scarcity of doses.

Objective: To set up a metric to assess vaccination uptake and identify national socio-economic factors influencing this indicator.

Methods: We conducted a cross-country study. We first estimated the vaccination uptake rate across countries by fitting a logistic model to reported daily case numbers. Using the uptake rate, we estimated the vaccine roll-out index. Next, we used Random Forest, an “off-the-shelf” machine learning algorithm, to study the association between vaccination uptake rate and socio-economic factors.

Results: We found that the mean vaccine roll-out index is 0.016 (standard deviation 0.016), with a range between 0.0001 (Haiti) and 0.0829 (Mongolia). The top four factors associated with vaccine roll-out index are the median per capita income, human development index, percentage of individuals who have used the internet in the last three months, and health expenditure per capita.

Conclusion: The still ongoing COVID-19 pandemic has shed light on the chronic inequality in global health systems. The disparity in vaccine adoption across low- and high-income countries is a global public health challenge. We must pave the way for a universal access to vaccines and other approved treatments, regardless of demographic structures and underlying health conditions. Income disparity remains, instead, an important cause of vaccine inequity, and the tendency toward "vaccine nationalism" and “vaccine apartheid” restricts the functioning of the global vaccine allocation framework and, thus, the ending of the pandemic. Stronger mechanisms are needed to foster countries' political willingness to promote vaccine and drug access equity in a globalized society, where future pandemics and other global health rises can be anticipated.