Communications medicine最新文献

{"title":"Simulation-based inference at the theoretical limit for fast, robust microstructural MRI with minimal diffusion data.","authors":"Maximilian F Eggl, Silvia De Santis","doi":"10.1038/s43856-026-01614-6","DOIUrl":"10.1038/s43856-026-01614-6","url":null,"abstract":"<p><strong>Background: </strong>Diffusion-weighted magnetic resonance imaging provides a non-invasive way to probe brain tissue microstructure and is widely used in neuroscience and clinical research. Reliable microstructural maps usually require long scan times because many measurements are needed to sample the underlying parameter space. This limits clinical feasibility and accessibility. The aim of this study is to determine whether simulation-based inference can reduce the amount of diffusion data required while preserving estimation fidelity across commonly used diffusion models.</p><p><strong>Methods: </strong>We apply simulation-based inference using neural posterior estimation to infer diffusion parameters directly from measured signals. The approach is tested on diffusion tensor imaging, diffusion kurtosis imaging, and biophysical models of axonal density and size. Models are trained entirely on simulated data and evaluated using both simulated datasets and experimental brain data from healthy and pathological individuals. Performance is compared with standard non-linear least squares fitting under noisy and sparsely sampled conditions.</p><p><strong>Results: </strong>Here we show that simulation-based inference achieves reliable parameter estimates using up to 90% fewer measurements than conventional approaches. The method consistently outperforms standard fitting when data are noisy or limited and remains robust across models, sampling schemes, and both healthy and pathological brain data.</p><p><strong>Conclusions: </strong>This study demonstrates that simulation-based inference enables fast and robust microstructural imaging with substantially reduced scan times. The approach supports privacy-preserving workflows, could expand dMRI access, e.g., for pediatric and other time-sensitive patients, enable advanced microstructure-sensitive protocols, and rescue legacy data with suboptimal quality.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological impacts of nonpharmaceutical interventions are modulated by immunity exposure trade offs.","authors":"Chadi M Saad-Roy, Bjarke Frost Nielsen, Margaret L Lind, Caroline E Wagner, Arne Traulsen, C Jessica E Metcalf, Mike Boots, Derek A T Cummings, Bryan T Grenfell","doi":"10.1038/s43856-026-01492-y","DOIUrl":"10.1038/s43856-026-01492-y","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has illustrated how nonpharmaceutical interventions (NPIs), such as mask-wearing, social distancing, and purifying air, can successfully mitigate transmission and reduce infections in the short term. However, the longer-term implications of these interventions on infection levels are less clear. In tandem, recent observational evidence suggests that the relative susceptibility of partially immune individuals to infection may be dose-dependent, i.e., higher exposures are more likely to result in (re)infection in individuals with prior immunity from infection or vaccination.</p><p><strong>Methods: </strong>To examine this question, we use mechanistic immuno-epidemiological models to determine the equilibrium infection levels with NPI-induced reductions in transmission in the presence of this dose-dependency.</p><p><strong>Results: </strong>We find that NPIs can successfully decrease the number of infections at endemicity, even in high transmission scenarios. We also show that this effect is heightened by vaccination, especially if a durable, broadly-protective (i.e., broad antigen specificity) vaccine is deployed. Finally, we find that NPI-induced declines in infection levels are strongly magnified if the characteristics of subsequent infections, such as transmissibility or duration, are also dose-dependent.</p><p><strong>Conclusions: </strong>Overall, our results suggest that the long-term usage of NPIs could successfully reduce infections especially where immunity-exposure trade-offs apply due to dose-dependency, and illustrate the urgent need to characterize the underlying relationships between exposure and host immune responses.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"6 1","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza vaccine responses differ between young children previously exposed to influenza antigens via infection versus vaccination.","authors":"Annette Fox, Annette Alafaci, Louise Carolan, Rebecca Burrell, Stephany Sánchez-Ovando, A Jessica Hadiprodjo, Alissa McMinn, Kristine Macartney, André Nicolás León, Andrew B Ward, Adam Wheatley, Sheena G Sullivan, Nigel W Crawford, Philip N Britton, Kanta Subbarao","doi":"10.1038/s43856-026-01610-w","DOIUrl":"https://doi.org/10.1038/s43856-026-01610-w","url":null,"abstract":"<p><strong>Background: </strong>Annual influenza vaccination is recommended for young children with limited understanding of how this may imprint influenza immunity. We conducted a pilot study to examine whether early life exposure to influenza through vaccination versus infection affects subsequent vaccination responses.</p><p><strong>Methods: </strong>Nineteen children aged 6-60 months were enrolled at two Australian hospitals during 2019-2021. Plasma was collected before and after vaccination for up to three successive years to measure antibody titres by hemagglutinination (HA) and neuraminidase (NA) inhibiting (HI, NI) assays and ELISA. Medical records and seropositivity (HI titre ≥40) at enrolment were used to classify seven children as having prior vaccination(s) and eight as having prior influenza A(H3N2) infection. Others had mixed, no, or unclear prior exposures. Post-vaccination antibody titres and seroconversion (HI fold-rise ≥4) were compared across the two main prior exposure groups.</p><p><strong>Results: </strong>Here we show that post-vaccination HI and NI antibody titres and titre-rises against A(H3N2) are far higher among children classified as having had prior A(H3N2) infection compared to prior vaccination; 8/8 versus 3/7 seroconverted, respectively. A(H3N2) HA-stem binding antibody titres are modest but rise more after vaccination among children classified as having had prior A(H3N2) infection. A(H1N1)-reactive antibody responses are not significantly different between groups.</p><p><strong>Conclusions: </strong>These results suggest that for priming subsequent vaccine antibody responses against A(H3N2), infection may be superior to vaccination.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiome responses to anthelmintic treatment depend on pre-treatment helminth infection status in young Ethiopian children.","authors":"Polina Tikhonova, Zeleke Mekonnen, Kenneth D Belanger, Ahmet Ay, Emily R Davenport, Bineyam Taye","doi":"10.1038/s43856-026-01625-3","DOIUrl":"https://doi.org/10.1038/s43856-026-01625-3","url":null,"abstract":"<p><strong>Background: </strong>Mass deworming programs using anthelmintic drugs are a common public health strategy for controlling soil-transmitted helminth (STH) infections in high-risk, low-income countries. However, whether routine deworming induces long-term changes in gut microbiome composition remains unclear. We used longitudinal data to examine how anthelmintics alter the gut microbiome profiles of Ethiopian children.</p><p><strong>Methods: </strong>Fecal samples were collected from school-aged children enrolled in a mass deworming program in Jimma, Ethiopia, before and after receiving a 400 mg dose of albendazole. Baseline samples were collected from 132 participants between April and May 2020, prior to treatment. Follow-up samples were obtained one year later from 67 children who remained in the study.</p><p><strong>Results: </strong>We observed a significant change in gut microbiome diversity metrics one year following treatment, characterized by fewer observed taxa and increased community evenness (Shannon and Simpson indices, p < 0.01), indicating substantial perturbation of microbial community structure. Furthermore, we identified six significantly enriched genera post-treatment (FDR-adjusted p < 0.05) among participants who were helminth-negative at the baseline, including Blautia, Senegalimassilia, Coprococcus 1, Marvinbryantia, Clostridium sensu stricto 1, and Lachnospiraceae ND3007 group. In contrast, individuals who had at least one egg count of Ascaris lumbricoides, Trichuris trichiura, or hookworm before treatment exhibited enrichment in five taxa (Senegalimassilia, Lachnospiraceae ND3007 group, Lachnospiraceae FCS020 group, Collinsella, and Intestinimonas).</p><p><strong>Conclusions: </strong>Our findings suggest that baseline helminth infection status influences the microbiome changes induced by anthelmintic treatment. Further controlled animal studies are needed to clarify how anthelmintic treatment affects taxon shifts in gut microbiota.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic interrogation of drug sensitivities in melanoma reveals potent synergistic and antagonistic drug combinations with translational potential.","authors":"Pilar Ayuda-Durán, Robert Hanes, Leiv Rønneberg, Tine Norman Alver, Geir Frode Øy, Sissel Hauge, Aram N Andersen, Eivind Valen Egeland, Siri Juell, Sigve Nakken, Theophilus Quachie Asenso, Manuela Zucknick, Randi G Syljuåsen, Gunhild M Mælandsmo, Eivind Hovig, Jorrit M Enserink","doi":"10.1038/s43856-026-01583-w","DOIUrl":"https://doi.org/10.1038/s43856-026-01583-w","url":null,"abstract":"<p><strong>Background: </strong>Targeted therapies have become mainstream anticancer treatments, although their efficacy is limited by low response rates, drug resistance, and therapy-related toxicities. Drug combinations have the potential to overcome these challenges. However, identifying effective drug combinations is a major challenge.</p><p><strong>Methods: </strong>Focusing on melanoma, we systematically interrogated drug-drug interactions to identify synergistic and antagonistic drug combinations. We screened 23 melanoma and 2 melanocyte cell lines with a library of 61 drugs belonging to 11 different drug classes.</p><p><strong>Results: </strong>We have identified multiple antagonistic and synergistic drug interactions. For instance, the CDK inhibitor abemaciclib strongly reduces the antiproliferative effect of nucleosides. Interestingly, this antagonistic interaction can be converted into a potent synergistic interaction by modifying the sequence of treatment; treating cells first with abemaciclib followed by nucleoside treatment results in antagonism, whereas pretreatment with nucleoside analogs followed by abemaciclib results in strong synergy. Furthermore, strong synergy is observed between combinations of Chk1 inhibitors with nucleoside analogs, especially in cell lines with defects in DNA damage response pathways, such as mutations in TP53 or CDKN2A. A combination of low doses of a Chk1 inhibitor and a nucleoside analog also synergizes in a mouse model of melanoma using female mice and significantly reduces tumor growth without noticeable toxic side effects.</p><p><strong>Conclusions: </strong>Taken together, our study underscores the importance of careful design of treatment sequence algorithms and identifies actionable drug-drug interactions for treatment of melanoma with translational potential.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring gross motor skills in African children using the PERF-FIT.","authors":"Bouwien Smits-Engelsman, Dané Coetzee, Rosemary Xorlanyo Doe-Asinyo, Oluwakemi Adebukola Ituen, Faical Farhat, Yabsra Melaku Dubale, Evi Verbecque","doi":"10.1038/s43856-026-01592-9","DOIUrl":"https://doi.org/10.1038/s43856-026-01592-9","url":null,"abstract":"<p><strong>Background: </strong>Africa is facing a rising prevalence of non-communicable diseases (NCDs), driven by shifts in lifestyle and dietary habits. Children with delays in motor coordination are less likely to participate in physical activity, active play, and sports, placing them at increased risk for obesity, reduced physical fitness, and cardiovascular diseases. Existing motor performance tests for school-aged children were not designed for African populations and lack culturally valid normative data.</p><p><strong>Methods: </strong>As part of an African-led initiative, the PERFormance and FITness test battery (PERF-FIT) was developed to assess motor performance and motor skill-related physical fitness in children aged 6-12 years. The PERF-FIT test battery is open-source, contextually relevant, and tailored for low-resource settings. This study involved the collection of motor performance data from a large sample of African children to establish age- and sex-specific normative values.</p><p><strong>Results: </strong>This study generates normative data for motor skills in African children aged 6-12 years (n = 2604), stratified by age and sex. These norms complement the previously validated psychometric properties of the PERF-FIT, confirming its reliability and applicability across diverse African contexts.</p><p><strong>Conclusions: </strong>The PERF-FIT test battery provides a culturally appropriate and psychometrically sound tool for assessing motor performance in African children. It serves as a valuable resource for clinicians, educators, and policymakers to monitor motor skill related physical fitness and detect motor delays in children aged 6-12 years in African countries.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"6 1","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral blood mononuclear cell DNA methylation signatures guide surgical decision-making in indeterminate pulmonary nodules.","authors":"Haofan Yin, Ningfang Zhang, Lumei Qiu, Jiaju Zhang, Jiahui Ding, Jiannan Xu, Zhijian Huang, Xiaopeng Yuan","doi":"10.1038/s43856-026-01616-4","DOIUrl":"https://doi.org/10.1038/s43856-026-01616-4","url":null,"abstract":"<p><strong>Background: </strong>Distinguishing malignant from benign pulmonary nodules remained a significant clinical challenge. Given the involvement of DNA methylation in anti-tumor immunity, we aimed to investigated whether DNA methylation patterns in peripheral blood mononuclear cells (PBMCs) could serve as non-invasive biomarkers for pulmonary nodule classification.</p><p><strong>Methods: </strong>Genome-wide DNA methylation profiling was performed using Methylome-seq on PBMCs from Discovery cohort, including patients with benign pulmonary nodules (BPN), minimally invasive adenocarcinoma (MIA), and early-stage invasive adenocarcinoma (eIAC). Differential analysis identified 56 candidates differentially methylated cytosines (DMCs) and regions (DMRs). Subsequently, 2 methylation features were validated using targeted bisulfite sequencing (TBS) in the Train cohort and Test cohort. We further developed 2 machine learning models integrating the DNA methylation features and routine blood biomarkers to enhance pulmonary nodule classification accuracy. SurgMalig Model was a surgical malignancy classifier used to differentiate between benign nodules and malignant nodules requiring surgical resection. And ResectGuide Model was a resection guide classifier used to subdivide malignant nodules into MIA and eIAC to inform surgical planning.</p><p><strong>Results: </strong>The validated methylation features demonstrate significant discriminatory ability for pulmonary nodules properties compared to conventional blood biomarkers. SurgMalig Model achieves high performance in distinguishing benign from malignant nodules, with area under the curve (AUC) of 0.926 in the Train cohort and 0.806 in the Test cohort. ResectGuide Model effectively classifies MIA and eIAC subtypes, yielding AUC of 0.862 and 0.843 in the respective cohorts.</p><p><strong>Conclusions: </strong>PBMC methylation signatures provide clinically actionable tools for surgical triage in indeterminate pulmonary nodules.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status and future perspectives on the mechanistic and pathophysiological understanding of long COVID.","authors":"Mark A Faghy, Rob C I Wüst, Daniel M Altmann, Ruth Em Ashton, Sarah Barley McMullen, Rae Duncan, Andrew G Ewing, Elke Hausmann, Sanjay Gupta, Mady Hornig, David Joffe, Binita Kane, M Asad Khan, Micheal Natt, Rebecca Owen, David Putrino, Lindsay Skipper, Claire Taylor, Callum Thomas, David Tuller, Danielle Beckman, Arneaux Kruger, Etheresia Pretorius","doi":"10.1038/s43856-025-01300-z","DOIUrl":"10.1038/s43856-025-01300-z","url":null,"abstract":"<p><strong>Background: </strong>Viral and infectious illnesses can exert profound and enduring effects on population health and well-being. In the aftermath of SARS-CoV-2 infection, post-acute sequelae, collectively referred to as Long COVID, have emerged as a major global health challenge, affecting more than 400 million people and contributing to estimated annual economic costs exceeding $1 trillion.</p><p><strong>Scope of the review: </strong>Long COVID encompasses a wide and heterogeneous spectrum of debilitating symptoms, including cognitive dysfunction, sleep disturbances, severe fatigue, and post-exertional malaise. Despite its substantial burden, fundamental uncertainties remain regarding its underlying pathophysiology, the development of robust diagnostic criteria, and the identification of effective therapeutic options.</p><p><strong>Key insights: </strong>This review synthesises current evidence on the biological mechanisms thought to contribute to Long COVID, spanning immune dysregulation, viral persistence, autonomic dysfunction, microvascular pathology, and other emerging hypotheses. We examine advances and limitations in contemporary diagnostic approaches and critically appraise existing treatment strategies, highlighting inconsistencies and gaps that hinder clinical consensus.</p><p><strong>Implications: </strong>By integrating interdisciplinary insights, this review underscores the urgent need for mechanistic clarity, validated diagnostic frameworks, and rigorously evaluated treatment pathways. Addressing these gaps will be essential to developing effective, evidence-based management strategies and mitigating the long-term impact of Long COVID on global health.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"6 1","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and strategies for delivering effective breast cancer care in conflict zones.","authors":"Nader Hirmas, Johannes Holtschmidt, Stephan Falk, Ernst Hanisch, Carsten Denkert, Jörg Heil, Thomas Decker, David Krug, Sibylle Loibl","doi":"10.1038/s43856-026-01600-y","DOIUrl":"10.1038/s43856-026-01600-y","url":null,"abstract":"<p><p>Breast cancer remains the most frequently diagnosed cancer among women worldwide, and its burden is particularly severe in regions affected by conflict and war. In these settings, oncology care is often disrupted by the destruction of healthcare infrastructure, displacement of populations, shortages of trained personnel, and limited access to diagnostics and treatment. This paper presents a multidisciplinary, practice-oriented, and resource-stratified framework for delivering breast cancer care in conflict zones, offering practical guidance for clinicians, healthcare workers, and humanitarian organizations. Drawing on literature, field experiences, and expert insight across oncology, pathology, radiology, surgery, radiation oncology, psycho-oncology, and public health, we outline key challenges and propose context-adapted strategies spanning early detection, diagnosis, treatment, and psychosocial support. Emphasis is also placed on multidisciplinary and collaborative efforts, policy and strong advocacy at local, national, and international levels, as well as ethical considerations in humanitarian settings.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"6 1","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutional trust and vaccination delay as key metrics for vaccination rollout success.","authors":"Cyrus Lap Kwan Leung, Kin-Kit Li, Arthur Tang, Wilson Wai San Tam, Samuel Yeung Shan Wong, Wan In Wei, Kin On Kwok","doi":"10.1038/s43856-026-01597-4","DOIUrl":"https://doi.org/10.1038/s43856-026-01597-4","url":null,"abstract":"<p><strong>Background: </strong>Timely vaccination effectively reduced COVID-19 hospitalizations and mortality, yet vaccination hesitancy undermined this benefit. Understanding the factors contributing to hesitancy is critical for improving future pandemic control by identifying barriers to timely vaccination. This paper operationalizes hesitancy in terms of vaccine delay-a key public health metric that reflects changing vaccination policies and infection status, factors that can alter individuals' eligibility, and real-world complexities like infections.</p><p><strong>Method: </strong>Using longitudinal data from the earliest stage of the pandemic in Hong Kong, we examined how institutional trust and the 5C constructs (confidence, complacency, constraints, calculation, and collective responsibility) influenced both vaccination intention and timing.</p><p><strong>Results: </strong>Our results show that only 34.89% and 42.97% of vaccinated participants received their first and third doses within 100 days of eligibility, respectively, despite rising uptake prior to government mandates. Confidence and vaccination intention are key predictors of delay, and higher institutional trust boosts both confidence and collective responsibility, thereby enhancing intention and reducing delays.</p><p><strong>Conclusions: </strong>These findings underscore the importance of building institutional trust and public confidence to minimize vaccine delay, particularly among vulnerable populations. Ultimately, incorporating vaccine delay as a key metric into public health strategies can guide more effective interventions and strengthen pandemic preparedness.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}