=Paper=
{{Paper
|id=Vol-3156/paper19
|storemode=property
|title=Covid'19 Vaccination Decision-Making Method and Subsystem Based on Civil Law
|pdfUrl=https://ceur-ws.org/Vol-3156/paper19.pdf
|volume=Vol-3156
|authors=Yelyzaveta Hnatchuk,Alla Herts,Andrii Misiats,Tetiana Hovorushchenko,Krishna Kant Singh
|dblpUrl=https://dblp.org/rec/conf/intelitsis/HnatchukHMHS22
}}
==Covid'19 Vaccination Decision-Making Method and Subsystem Based on Civil Law==
https://ceur-ws.org/Vol-3156/paper19.pdf
Covid’19 Vaccination Decision-Making Method and Subsystem
Based on Civil Law
Yelyzaveta Hnatchuka, Alla Hertsb, Andrii Misiatsa, Tetiana Hovorushchenkoa and Krishna
Kant Singhc
a
Khmelnytskyi National University, Institutska str., 11, Khmelnytskyi, 29016, Ukraine
b
Ivan Franko National University of Lviv, Universytetska str., 1, Lviv, 79000, Ukraine
c
Faculty of Engineering & Technology, Jain (Deemed-to-be University), Bengaluru, India.
Abstract
The conducted analysis of civil law grounds on the need and possibility of vaccination
against Covid’19 in Ukraine made it possible to determine the categories of workers subject
to compulsory vaccination, as well as a list of medical contraindications and warnings to
vaccination against Covid’19. Developed Covid’19 vaccination decision-making method
based on civil law provides: a conclusion on the mandatory or optional depending on the
profession and place of work of the patient (but desirability) vaccination from Covid’19;
conclusion on the possibility or contraindications to vaccination from Covid’19 - depending
on the existing diseases and the current state of health of the patient; conclusion on the type
of contraindication and its duration - in the case of a conclusion on contraindications to
vaccination from Covid’19. Developed Covid’19 vaccination decision-making subsystem
based on civil law provides a conclusion on whether or not vaccination from Covid’19 is
mandatory or optional from the point of view of profession and place of work (but
desirability); conclusion on the possibility or contraindications to vaccination from Covid’19;
conclusion on the type of contraindication and its duration. So the subsystem will be useful
for patients who, truthfully answering questions from the subsystem, will receive a
conclusion on the need and possibility of vaccination from Covid'19 them or their relatives,
as well as for family physicians, which will reduce the burden during patient counselling and
make it easier to answer questions about the need and possibility of vaccination, as they will
no longer need to know all the current legislation and civil law.
Keywords 1
Covid’19 vaccination, decision-making, Covid’19 vaccination decision-making method
based on civil law, Covid’19 vaccination decision-making subsystem based on civil law.
1. Introduction
The information society in Ukraine is currently actively developing, which is characterized by the
introduction of information technology in all spheres of human life to automate routine work, reduce
physical load and eliminate or reduce the human factor [1-3]. Today, the decision-making process in
the field of medicine (health care) remains difficult and ambiguous for both patients and physicians
[4]. Decision support systems can facilitate the decision-making process in the field of medicine
(health) and at the same time increase the productivity of doctors, are effective tools in the age of
evidence-based medicine and can provide doctors with the necessary information, for example, about
the latest medical resources or about civil law grounds relating to a decision [4].
IntelITSIS’2022: 3rd International Workshop on Intelligent Information Technologies and Systems of Information Security, March 23–25,
2022, Khmelnytskyi, Ukraine
EMAIL: liza_veta@ukr.net (Ye. Hnatchuk); agerc@ukr.net (A. Herts); misiatc@khnu.km.ua (A. Misisatc); tat_yana@ukr.net (T.
Hovorushchenko); krishnaiitr2011@gmail.com (K. K. Singh)
ORCID: 0000-0003-2989-3183 (Ye. Hnatchuk); 0000-0002-3310-3159 (A. Herts); 0000-0002-0003-6340 (A. Misiats); 0000-0002-7942-
1857 (T. Hovorushchenko); 0000-0002-6510-6768 (K. K. Singh)
©️ 2022 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
At present, medicine around the world is facing a serious challenge in the form of the Covid’19
pandemic. The pandemic Covid’19 is continued to the massive burden of morbidity and mortality
while disrupting economies and societies all over the world. Given the rapid spread of the pandemic
of Acute Respiratory Infection of SARS-CoV-2 coronavirus, Covid’19 vaccination is a critical tool to
contain the pandemic, combined with effective testing and precautions.
Now 61.9% of the world population has received at least one dose of a Covid’19 vaccine. Only
10.6% of people in low-income countries have received at least one dose. Share of people who
received at least one dose of Covid’19 vaccine on February 14, 2022 is represented on Figure 1 [5].
Figure 2: Share of people who received at least one dose of Covid’19 vaccine on February 14, 2022
[5]
At present, a person has many questions when deciding whether or not to be vaccinated against
Covid'19: whether he or she is subject to compulsory vaccination (due to his or her occupation and
place of work), whether he or she can be vaccinated (given existing diseases and current health
status). Of course, in order to do this, a person needs to study the civil law grounds for vaccination
used in his country. A person can study all the legislation related to vaccination against Covid'19
himself, but most often people ask their family doctors, who are already overwhelmed during a
pandemic and also do not always know civil grounds for the need or possibility of vaccination. This
problem could be solved by the Covid'19 vaccination decision-making subsystem based on civil law,
implemented as part of intelligent information technology for supporting medical decision-making
taking into account the legal basis [6] in the form of a web-based application, which will be available
24/7, without any registration. Such a subsystem will be useful for patients who, truthfully answering
the questions of the subsystem, will receive a conclusion on the need and possibility of vaccination
from Covid'19 for them or their relatives, given the existing civil law, which will facilitate further
independent decision-making (without consulting with family physicians). In addition, such a
subsystem will be useful for family physicians, for them the burden of patient counselling on the need
and possibility of vaccination will reduce, and they will find it easier to answer vaccination questions
to those patients who still need a family physician (e. g. older people, who do not know how to use
the Internet and web-based applications), because doctors will no longer need to know all the laws
and civil law, but will need to answer the subsystem questions from the patient's words, considering
his anamnesis and get the conclusions about the need and possibility of vaccination from Covid'19. Of
course, the proposed subsystem is designed for true answers from users.
Thus, currently, the motivation of patients to himself make their own decisions about Covid'19
vaccination and facilitation of the work of family physicians to advise on Covid'19 vaccination by
developing the Covid'19 vaccination decision-making method and subsystem based on civil law is an
actual problem in Ukraine and in the world.
2. Literature Review
Let’s review the known solutions on Covid’19 vaccination decision-making based on civil law.
Informing the general practitioners and other vaccinators provides patients with clear and reliable
information to support a shared decision. These professionals are the defence against vaccine
hesitation in the population, but only in the case if they have solid arguments to answer the questions
of patients. The obtained findings can support policymakers, clinicians, and other stakeholders in
prioritizing research and development to support operationalization of artificial intelligence for future
pandemics [7, 8].
The study [9] was aimed to analyse the Covid'19 vaccination willingness level of the general
public on the basis of the multi-criteria decision-making method known. The significant determinants
of Covid'19 vaccination willingness were: cues to action, perceived benefits, positive attitude,
government recommendation, and perceived stress. Determinants of willingness to uptake the
COVID-19 vaccine were: individual decision, vaccine origin, adapting to change, perceived barriers
to vaccinating.
Paper [10] aimed to development of the digital platform for communication between scientists and
the general population and to use this digital platform for a pilot study on factors associated with the
Covid'19 vaccination readiness. Multiple logistic regression models adjusted for personal covariates,
factors affecting the motivation to vaccinate, and risk of infection/severe disease were built to
investigate a vaccination readiness. Digital platform can help creating the data-driven dialogue on
vaccination readiness, opening the evidence-based scientific discussion between state authorities and
the population.
The paper [11] offers information about decision-making related to Covid’19 vaccine uptake,
considering the importance of vaccine literacy, trust, and social responsibility in this process.
In the paper [12] the decision-making supporting system is proposed as an epidemiological
prediction tool considering Covid'19 trends in several countries and regions, the big data clouds for
important geophysical and socio-ecological characteristics and the expected potentials of the medical
service, including vaccination and restrictions on population migration both within the country and
international traffic. The numerical simulations of Covid'19 transition and results are mainly based on
the deterministic approach and the algorithm for processing statistical data based on the instability
indicator. The developed decision-making supporting system helps predict the effects of Covid’19
depending on the protection strategies against Covid’19 including vaccination.
Paper [13] proposes a behavioural economics-based framework to model vaccination choices. The
model is constantly calibrated using up-to-date surveys on people attitudes toward vaccination as well
as estimates of Covid’19 infection and mortality rates and vaccine efficacy for the UK population.
The paper [14] shows that pharmacists and other health care professionals may use motivational
interviewing to enable individuals making informed decisions with regards to the Covid'19 vaccines
with the purpose of the reduce Covid'19 vaccine hesitancy.
The paper [15] reviews the underlying mechanisms and predictions about Covid'19 vaccination
risky decision-making offered by expectancy-value and dual-process theories. In addition, the authors
of [15] highlight how fuzzy-trace theory builds on these approaches and provides further insight into
how knowledge, emotions, values, and metacognitive inhibition influence risky decision-making.
The main goal of the study [16] was to synthesize a data-driven model for the predictors of
Covid'19 vaccine willingness among students using decision tree and regression analyses. The
proposed conceptual model was developed and tested through a machine learning approach to elicit
factors related to students' willingness to get the Covid'19 vaccine. Machine learning analysis shows
five important predictors of Covid'19 vaccination willingness: the economic level of the country, the
individual's trust of the pharmaceutical industry, the individual's misconception of natural immunity,
the individual's belief of vaccines risk-benefit-ratio, and the individual's attitudes toward novel
vaccines.
The paper [17] presents a model to study individuals' decision about stay-at-home during Covid'19
making based on decision and prospect theory, and conducts sensitivity analysis to study the
fluctuations in optimal strategies when there are changes made to the model's parameters. This
research can help support decision making regarding control measures and policy development when
public health emergencies appear in the future.
The goal of the study [18] is determining the variables affecting the likelihood of refusal and
indecision toward a vaccine against Covid’19 and to determine the acceptance of the vaccine for
different scenarios of effectiveness and side effects. A multinomial logistic regression method based
on the Health Belief Model is used to estimate. The conducted analysis of hypothetical vaccine
scenarios revealed that individuals preferred less risky vaccines in terms of fewer side effects, rather
than effectiveness.
The aim of [19] is: to provide an overview of shared decision making and the use of patient
decision aids and to determine the effect of shared decision making interventions on Covid’19 vaccine
uptake. The authors of [19] examined the impact on vaccine hesitancy by searching for randomized
controlled trials of shared decision making interventions, conducted a meta-analysis and calculated a
pooled odds ratio.
The CAPACITI decision support tool [20] has been developed to structure and document an
evidence-based, context-specific process for prioritizing or selecting among multiple Covid'19
vaccination products, services, or strategies. The CAPACITI decision-support tool is based on multi-
criteria decision analysis, as a structured way to incorporate multiple sources of evidence and
stakeholder perspectives.
The conducted review of the known decisions on Covid'19 vaccination decision-making based on
civil law showed that with a large number of different solutions proposed in 2021-2022, Covid'19
vaccination decision-making method and subsystem based on civil law are not proposed today, and
existing solutions cannot be used as a subsystem of intelligent information technology for supporting
medical decision-making taking into account the legal basis [6] to obtain a conclusion on the need and
possibility of vaccination from Covid'19. Thus, the aim of this study is to develop the Covid’19
vaccination decision-making method and subsystem based on civil law. Such a subsystem, like any
classical decision support system, should consist of basic elements (based on the analysis of the
subject area analysis), rules, and methods used to process information. Then, for developing a
Covid'19 vaccination decision-making method and subsystem based on civil law, it is necessary to
analyze the subject area to identify civil law grounds for the need and possibility of vaccination from
Covid'19 and to develop rules for deciding on the need and possibility of vaccination from Covid'19.
3. Civil Law Grounds for the Necessity and Possibility of Vaccination from
Covid’19 in Ukraine
Pursuant to paragraph 3 of Resolution 2361 (2021), the Parliamentary Assembly of the Council of
Europe calls on and recommends that citizens be informed that vaccination is not compulsory and that
no one may be subject to political, social, or other pressure to be vaccinated, and ensure that no one
was not discriminated against for not being vaccinated. In the case of vaccines, individuals present
with unique circumstances that may differ substantially from those of another and might be foreseen a
priori. This means that an analysis must be performed individually before vaccination is imposed [21-
23].
The first country to make vaccination from Covid’19 coronavirus disease mandatory for health
professionals was Italy [24, 25].
In France, the Covid’19 coronavirus vaccination is also mandatory for physicians, nursing home
staff, social workers, and volunteers working in health or care facilities [24, 25].
Let's consider the peculiarities of civil law regulation on the need and possibility of vaccination
from Covid’19 in Ukraine, as the subsystem will be developed currently taking into account only
Ukrainian legislation.
According to Article 284 of the Civil Code of Ukraine, the provision of medical care to an
individual who has reached the age of fourteen is carried out with his consent. An adult able-bodied
individual who is aware of the significance of his actions and can manage them has the right to refuse
treatment.
The Law of Ukraine "Fundamentals of the Legislation of Ukraine on Health Care", in particular,
Article 10, provides for the responsibilities of citizens in the field of health care, namely:
1. take care of their own health and the health of children, do not harm the health of other
citizens
2. in cases provided by law to undergo preventive medical examinations and vaccinations
3. take measures provided by the Law of Ukraine "On Emergency Medical Care" to ensure the
provision of emergency medical care to other persons in an urgent state (sudden deterioration
of physical or mental health, which poses a direct and imminent threat to human life and
health or people around her and occurs due to illness, injury, poisoning or other internal or
external causes)
4. perform other duties provided by the legislation on health care
Considerable attention in the current legislation is paid to the patient's consent to medical
intervention.
Patient consent is required for the use of methods of diagnosis, prevention, and treatment. In the
case of a patient under the age of 14 (a minor patient), as well as a patient who has been declared
incapable in accordance with the procedure established by law, medical intervention is carried out
with the consent of their legal representatives.
Of course, there are cases when the consent of the patient or his legal representative for medical
intervention is not required, namely in the presence of signs of the direct threat to the patient's life if it
is impossible for objective reasons to consent to such intervention from the patient or his legal
representatives.
If the lack of consent can lead to serious consequences for the patient, the doctor must explain it to him.
If the patient still refuses treatment, the doctor has the right to take written confirmation from him, and if it
is impossible to obtain it - to certify the refusal by appropriate action in the presence of witnesses.
A patient who has acquired full civil capacity and is aware of the significance of his actions and
can manage them has the right to refuse treatment.
Analysing other legislative acts, it should be noted that the Law of Ukraine "On Protection of the
Population from Infectious Diseases" and the Law of Ukraine "On Ensuring Sanitary and Epidemic
Welfare of the Population" [5] provide for preventive vaccinations against diphtheria, pertussis,
measles, polio, tetanus, tuberculosis, which are mandatory and included in the vaccination schedule.
Persons who refuse or evade mandatory vaccination and preventive medical examinations are
suspended from work, and minors, pupils, and students - from visiting the relevant institutions. The
Law of Ukraine “On Protection of the Population from Infectious Diseases” and the Law of Ukraine
“On Ensuring Sanitary and Epidemic Welfare of the Population” establish a list of mandatory
vaccinations, but these Laws do not establish mandatory Covid’19 vaccination.
However, according to the same Laws of Ukraine "On Protection of the Population from Infectious
Diseases" and "On Ensuring Sanitary and Epidemic Welfare of the Population", certain categories of
workers are subject to mandatory preventive vaccination to prevent the spread of other infectious
diseases in connection with the peculiarities of production or work performed by them. Population
groups and categories of workers subject to preventive vaccinations, including mandatory, as well as
the procedure and timing of their implementation are determined by the central executive body, which
ensures the formation of state policy in the field of health care.
The analysis of case law shows that courts take into account the case-law of the Supreme Court
and the European Court of Human Rights.
In a decision of April 17, 2019 (case №682/1692/17) the Supreme Court concluded that the
requirement for mandatory vaccination of the population against particularly dangerous diseases in
view of the need to protect public health and the health of interested persons is justified. The principle
of the importance of public interests prevails over the personal rights of the individual, but only when
such interference has objective grounds and is justified.
The European Court of Human Rights has concluded that vaccination is one of the most successful
and effective measures in the field of health care, which aims to protect the health of individuals and
society as a whole from infectious diseases. Thus, the mandatory vaccination of a certain category of
citizens from COVID-19 to prevent its spread among the population is justified and does not violate
Article 8 of the Convention for the Protection of Human Rights and Fundamental Freedoms.
Thus, the Ministry of Health of Ukraine by its order of 04.10.2021 №2153, registered with the
Ministry of Justice on 16.12.2021 on №1624/37246, expanded the list of organizations whose
representatives are subject to mandatory preventive vaccinations from Covid’19.
So, the following categories of employees subject to mandatory prophylactic vaccination against acute
respiratory disease Covid'19 caused by coronavirus SARS-CoV-2, for the period of quarantine established
by the Cabinet of Ministers of Ukraine to prevent the spread of Covid'19 acute respiratory disease:
1. employees of central executive bodies and their territorial bodies
2. employees of local state administrations and their structural subdivisions
3. employees of institutions of higher, postgraduate, professional higher, professional
(vocational), general secondary, including special, preschool, extracurricular education,
specialized education, and research institutions, regardless of type and form of ownership
4. employees of local governments
5. employees of state and municipal health care institutions
6. employees of utilities, institutions, and organizations
The list of medical contraindications and warnings for which contraindications to vaccination
against Covid’19 are provided, established by the relevant Orders of the Ministry of Health of
Ukraine:
1. acute illness with a fever over 38.0 °C - temporary contraindications (up to 2 weeks from the
onset of the disease)
2. history of Covid’19 (0 doses in the history) - temporary contraindications (up to 3 months
from the time of Covid’19)
3. history of Covid’19 (1 dose in the history) - temporary contraindications (up to 3 months from
the time of Covid’19)
4. treatment with monoclonal antibodies or convalescent plasma - temporary contraindications
(3 months)
5. pregnancy - temporary contraindications (during pregnancy) and only for vaccines that
indicate pregnancy as a contraindication (contraindicated live vaccines, CoronaVac/Sinovac
Biotech vaccines)
6. lactation - temporary contraindications (during lactation) and only for vaccines that indicate
lactation as a contraindication (contraindicated CoronaVac/Sinovac Biotech vaccine))
7. vaccination against other infectious diseases - temporary contraindications (14 days)
8. test with tuberculin or blood test for the release of interferon-γ (IGRA) - temporary
contraindications (until the evaluation of the test/IGRA)
9. comorbidities (for example, chronic (stable and controlled) infection with human
immunodeficiency virus (HIV), hepatitis C virus, and hepatitis B virus) - temporary
contraindications (based on the level of immunosuppression)
10. thrombosis and/or thrombocytopenia - permanent contraindications for vector-based vaccines
(AstraZeneca)
11. myocarditis and/or pericarditis - permanent contraindications for vaccine mRNA
(Pfizer/BioNTech)
12. oncopathology - vaccination with caution (in case of allogeneic or autogenic transplantation
or cell therapy - not earlier than 3 months after such procedures; the course of intensive
cytotoxic chemotherapy - postpone vaccination until the recovery of absolute neutrophils; in
the otherwise cases - vaccination is possible in any times)
13. persons with an immunodeficiency - vaccination with caution (contraindication to the
introduction of live vaccines)
14. history of an allergic reaction (anaphylactic reaction to the previous dose of vaccine,
anaphylactic reaction to the components of the vaccine) - constant contraindications (for such
vaccines)
15. autoimmune conditions - vaccination with caution
4. Covid’19 Vaccination Decision-Making Method and Subsystem Based on
Civil Law
Taking into account the above civil law grounds on the need (category of employees) and the
possibility (existing medical contraindications and warnings) of vaccination from Covid’19, let's
develop rules for deciding on the need and possibility of vaccination from Covid’19.
Rules for deciding on the need of vaccination from Covid’19:
1. if the person is the employee of central executive bodies and their territorial bodies, then
n[1]=1, else n[1]=0
2. if the person is the employee of local state administrations and their structural subdivisions,
then n[2]=1, else n[2]=0
3. if the person is the employee of institutions of higher, postgraduate, professional higher,
professional (vocational), general secondary, including special, preschool, extracurricular
education, specialized education, and research institutions, regardless of type and form of
ownership, then n[3]=1, else n[3]=0
4. if the person is an employee of local governments, then n[4]=1, else n[4]=0
5. if the person is an employee of state and municipal health care institutions, then n[5]=1, else
n[5]=0
6. if the person is the employee of utilities, institutions, and organizations, then n[6]=1, else
n[6]=0
Rules for deciding on the possibility of vaccination from Covid’19:
1. if the person has now acute illness with a fever over 38.0 °C, then p[1,1]=1, else p[1,1]=0
2. if the person has a history of Covid’19, then p[2,1]=1, else p[2,1]=0
3. if the person passes or has passed treatment with monoclonal antibodies or convalescent
plasma, then p[3,1]=1, else p[3,1]=0
4. if the person is pregnant, then p[4,1]=1, else p[4,1]=0
5. if the person is in lactation, then p[5,1]=1, else p[5,1]=0
6. if the person has been vaccinated against other infectious diseases, then p[6,1]=1, else
p[6,1]=0
7. if the person has been tested with tuberculin or blood tested for the release of interferon-γ
(IGRA), then p[7,1]=1, else p[7,1]=0
8. if the person has human immunodeficiency virus (HIV), or the person has hepatitis C virus, or
the person has hepatitis B virus, then p[8,1]=1, else p[8,1]=0
9. if the person has thrombosis and/or thrombocytopenia, then p[9,1]=1, else p[9,1]=0
10. if the person has myocarditis and/or pericarditis, then p[10,1]=1, else p[10,1]=0
11. if the person has oncopathology and passes or has passed allogeneic or autogenic
transplantation or cell therapy, then p[11,1]=1, else p[11,1]=0
12. if the person has oncopathology and passes or has passed the course of intensive cytotoxic
chemotherapy, then p[12,1]=1, else p[12,1]=0
13. if the person has an immunodeficiency, then p[13,1]=1, else p[13,1]=0
14. if the person has a history of an allergic reaction (anaphylactic reaction to the previous dose of
vaccine, anaphylactic reaction to the components of the vaccine), then p[14,1]=1, else
p[14,1]=0
15. if the person has the autoimmune conditions, then p[15,1]=1, else p[15,1]=0
Given the developed rules, Covid’19 vaccination decision-making method based on civil law
consists of the following steps:
1. compilation of questionnaires for determining the need for vaccination and the possibility of
vaccination from Covid’19, based on the above civil law on the need (category of employees)
and the possibility (existing medical contraindications and warnings) of vaccination from
Covid’19
2. filling the second column of the matrix p in order to further form a conclusion about the type
of contraindication and its duration: p[1,2] = “temporary contraindications (up to 2 weeks
from the onset of the disease)”; p[2,2] = “temporary contraindications (up to 3 months from
the time of Covid’19)”; p[3,2] = “temporary contraindications (3 months from completion of
treatment)”; p[4,2] = “temporary contraindications (until the end of pregnancy is
contraindicated the live vaccines, CoronaVac/Sinovac Biotech vaccines)”; p[5,2] =
“temporary contraindications (until the end of lactation is contraindicated the
CoronaVac/Sinovac Biotech vaccine)”; p[6,2] = “temporary contraindications (14 days since
the another vaccination)”; p[7,2] = “temporary contraindications (until the evaluation of the
test/IGRA)”; p[8,2] = “temporary contraindications (based on the level of
immunosuppression)”; p[9,2] = “permanent contraindications for vector-based vaccines
(AstraZeneca)”; p[10,2] = “permanent contraindications for vaccine mRNA
(Pfizer/BioNTech)”; p[11,2] = “vaccination with caution (not earlier than 3 months after such
procedures) ”; p[12,2] = “vaccination with caution (postpone vaccination until the recovery of
absolute neutrophils)”; p[13,2] = “vaccination with caution (contraindication to the
introduction of live vaccines)”; p[14,2] = “constant contraindications (for specific vaccines to
which or to components of which an allergic/anaphylactic reaction was noticed)”; p[15,2] =
“vaccination with caution”
3. conducting a survey (using the developed questionnaires) of a patient who plans to vaccinate,
on his profession and place of work for determining the need for vaccination, as well as to
identify existing patient diseases and current health, which may be contraindications for
vaccination, in order for determining the possibility of vaccination from Covid'19
4. analysis of the answers provided by the patient and filling the array n using each of the
developed rules for deciding on the need for vaccination from Covid’19
5. if n[i]=1 (i=1..6), the patient is issued a conclusion on the necessity of his vaccination from
Covid'19, else, if all elements of the array n are 0, the patient is issued a conclusion on the
optional Covid'19 vaccination from the point of view of profession and place of work (but
desirability)
6. analysis of the patient's answers and filling the first column of the matrix p using each of the
developed rules for deciding on the possibility of vaccination from Covid’19
7. if p[j,1]=1 (j=1..15), the patient is given a conclusion on contraindications to his vaccination
from Covid'19, else, if all elements of the first column of the matrix p are 0, the patient is
given a conclusion on the possibility of his vaccination from Covid'19
8. if p[j,1]=1 (j=1..15), the patient is also given a conclusion on the type of contraindication and
its duration - the element p[j,2] (j=1..15) of the matrix p
Developed Covid’19 vaccination decision-making method based on civil law provides: a
conclusion on the mandatory or optional (but desirability) vaccination from Covid’19 - depending on
the profession and place of work of the patient; conclusion on the possibility or contraindications to
vaccination from Covid’19 - depending on the existing diseases and the current state of health of the
patient; conclusion on the type of contraindication and its duration - in the case of a conclusion on
contraindications to vaccination from Covid’19.
The developed method is the basis for the Covid'19 vaccination decision-making subsystem based
on civil law, which is part of the intelligent information technology for supporting medical decision-
making taking into account the legal basis [6], and will be further implemented as a web-based
application, which will be available 24/7, without any registration. This subsystem provides a
conclusion on whether or not vaccination from Covid’19 is mandatory or optional (but desirability) in
terms of profession and place of work; conclusion on the possibility or contraindications to
vaccination from Covid’19; conclusion on the type of contraindication and its duration.
So the subsystem is useful for patients who, truthfully answering questions from the subsystem, will
receive a conclusion on the need and possibility of vaccination from Covid'19 them or their relatives. In
addition, such a subsystem is useful for family physicians, for them the burden of patient counselling on
the need and possibility of vaccination will reduce, and they will find it easier to answer vaccination
questions to those patients who still need a family physician (e. g. older people, who do not know how
to use the Internet and web-based applications), because doctors will no longer need to know all the
laws, but will need to answer the subsystem questions from the patient's words, considering his
anamnesis and get the conclusions about the need and possibility of vaccination from Covid'19.
The structure of the Covid’19 vaccination decision-making subsystem based on civil law is
represented in Figure 2.
Currently, Covid'19 vaccination decision-making subsystem based on civil law helps to decide on
the need and possibility of vaccination only on the basis of the current legislation of Ukraine, but it
can be adapted to the legislation of any country and changes in Ukrainian legislation (e. g. expanding
the categories of employees for whom vaccination is mandatory) - this requires an analysis of civil
law grounds for the need and possibility of vaccination against Covid'19 in a particular country;
supplementing or amending the rules for deciding on the need for vaccination against Covid’19, as
well as the rules for deciding on the possibility of vaccination against Covid’19, taking into account
the analysis of the civil law grounds of a particular country.
Figure 2: The structure of the Covid’19 vaccination decision-making subsystem based on civil law
5. Results & Discussion
Let's consider the functioning of the Covid’19 vaccination decision-making method and subsystem
based on civil law.
On the basis of the above civil law grounds on the need (category of employees) and the
possibility (existing medical contraindications and warnings) of vaccination from Covid’19,
questionnaires for determining the need for vaccination and the possibility of vaccination from
Covid’19 were compiled. The second column of the matrix p is completed in order to further draw a
conclusion about the type of contraindication and its duration in accordance with step 2 of the
developed Covid’19 vaccination decision-making method based on civil law. A patient who plans to
be vaccinated against David’19 was interviewed about his profession and place of work and about the
patient’s existing diseases and current health status in order to determine the need and possibility of
vaccination.
The patient provided answers, based on which the completion of array n using each of the
developed rules for deciding on the need of vaccination from Covid’19. The patient is a doctor, so the
array n = [0 0 0 0 1 0]. Since n [5] = 1, the patient is issued a conclusion on the necessity of his
vaccination from Covid’19.
Based on the analysis of the answers provided by the patient, the first column of the matrix p was
filled using each of the developed rules for deciding on the possibility of vaccination from Covid’19.
The patient has thrombosis and thrombocytopenia, in which case the matrix p has the form - Table 1.
Table 1
Matrix p, which contains signs of presence/absence of contraindications against vaccination from
Covid’19 (for this example), as well as the type of contraindication and its duration
І column ІІ column
0 temporary contraindications (up to 2 weeks from the onset of the disease)
0 temporary contraindications (up to 3 months from the time of Covid’19)
0 temporary contraindications (3 months from completion of treatment)
0 temporary contraindications (until the end of pregnancy is contraindicated the live
vaccines, CoronaVac/Sinovac Biotech vaccines)
0 temporary contraindications (until the end of lactation is contraindicated the
CoronaVac/Sinovac Biotech vaccine)
0 temporary contraindications (14 days since the another vaccination)
0 temporary contraindications (until the evaluation of the test/IGRA)
0 temporary contraindications (based on the level of immunosuppression)
1 permanent contraindications for vector-based vaccines (AstraZeneca)
0 permanent contraindications for vaccine mRNA (Pfizer/BioNTech)
0 vaccination with caution (not earlier than 3 months after such procedures)
0 vaccination with caution (postpone vaccination until the recovery of absolute
neutrophils)
0 vaccination with caution (contraindication to the introduction of live vaccines)
0 constant contraindications (for specific vaccines to which or to components of which
an allergic/anaphylactic reaction was noticed)
0 vaccination with caution
Since p[9,1]=1, the patient is given a conclusion on the contraindications to his vaccination from
Covid’19, as well as a conclusion on the type of contraindication and its duration - "permanent
contraindications for vector-based vaccines (AstraZeneca)". Therefore, the patient has contraindicated
vaccination with a vector-based vaccine (AstraZeneca), but he may be vaccinated with a different
type of vaccine. After analysing the findings, the patient decided to be vaccinated with a non-vector
vaccine, received two doses of Pfizer/BioNTech, which he successfully tolerated. The coagulogram
did not show significant abnormalities after vaccination, so the vaccine did not exacerbate his
thrombosis and thrombocytopenia.
6. Conclusions
The conducted review of the known decisions on Covid'19 vaccination decision-making based on
civil law showed that with a large number of different solutions proposed in 2021-2022, Covid'19
vaccination decision-making method and subsystem based on civil law are not proposed today.
The conducted analysis of civil law grounds on the need and possibility of vaccination from
Covid’19 in Ukraine made it possible to determine the categories of employees subject to compulsory
vaccination, as well as a list of medical contraindications and warnings for contraindications to
vaccination from Covid’19.
The developed Covid’19 vaccination decision-making method based on civil law provides: a
conclusion on the mandatory or optional (but desirability) vaccination from Covid’19 - depending on
the profession and place of work of the patient; conclusion on the possibility or contraindications to
vaccination from Covid’19 - depending on the existing diseases and the current state of health of the
patient; conclusion on the type of contraindication and its duration - in the case of a conclusion on
contraindications to vaccination from Covid’19.
The developed Covid’19 vaccination decision-making subsystem based on civil law is a part of the
intelligent information technology for supporting medical decision-making taking into account the
legal basis and will be further implemented as a web-based application, which will be available 24/7,
without any registration. This subsystem provides a conclusion on whether or not vaccination from
Covid’19 is mandatory or optional from the point of view of profession and place of work (but
desirability); conclusion on the possibility or contraindications to vaccination from Covid’19;
conclusion on the type of contraindication and its duration. So the subsystem will be useful for
patients, who truthfully answering questions from the subsystem, will receive a conclusion on the
need and possibility of vaccination from Covid'19 them or their relatives, and for family physicians,
which will reduce the burden during patient counselling and make it easier to answer questions about
the need and possibility of vaccination, as they will no longer need to know all the current legislation.
Currently, Covid'19 vaccination decision-making subsystem based on civil law helps to decide on
the need and possibility of vaccination only on the basis of the current legislation of Ukraine, but it
can be adapted to the legislation of any country and changes in Ukrainian legislation - this requires an
analysis of civil law grounds for the need and possibility of vaccination against Covid'19 in a
particular country; supplementing or amending the rules for deciding on the need for vaccination
against Covid’19, as well as the rules for deciding on the possibility of vaccination against Covid’19,
taking into account the analysis of the civil law grounds of a particular country.
7. Acknowledgments
The Ukrainian authors would like to thank the Armed Forces of Ukraine for providing security to
perform this work. This work has become possible only because of the resilience and courage of the
Ukrainian Army.
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