Coronavirus disease 2019 (COVID-19) remains a public health concern even after its pandemic status officially ended on May 5, 2023, when XBB became the globally predominant SARS-CoV-2 variant. Amid population immunity, the benefit of the monovalent XBB.1.5 vaccines remains uncertain. This systematic review searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials through November 30, 2024, for studies evaluating the effectiveness of XBB.1.5 vaccines in adults during the 2023-2024 season. Meta-analyses were conducted using a random-effects model (PROSPERO registration: CRD42024513730). Twenty-one eligible studies, with a total of 53,396,781 participants, were included. Vaccine effectiveness (VE) in the first month post-vaccination was 52.9 % (95 % CI: 47.6 %-57.6 %) against SARS-CoV-2 infection, 64.4 % (95 % CI: 59.3 %-68.9 %) against COVID-19-related hospitalization, and 77.3 % (95 % CI: 67.1 %-84.3 %) against COVID-19-related death. However, by the fifth month, VE declined to 26.7 %, 52.3 %, and 69.4 %, respectively. Notably, against the JN.1 variant that replaced XBB in December 2023, VE against infection, hospitalization, and death dropped significantly by 47 % (from 53.7 % to 28.3 %), 32 % (from 67.8 % to 46.2 %), and 26 % (from 77.3 % to 57.1 %), respectively. VE against hospitalization in individuals aged >60 years was not inferior to that in those aged <60 years (57.2 % versus 49.2 %; subgroup difference, p = 0.24). XBB.1.5 vaccines provided substantial protection against severe COVID-19 outcomes in the 2023-2024 season prior to the emergence of the JN.1 variant. These findings underscore the need for updated COVID-19 vaccinations to maintain protection against evolving SARS-CoV-2 variants.

Based on the 1978 Alma-Ata Declaration, the key to achieving health for all is primary health care, and many countries have established various comprehensive health care systems. Because of the financial toll of a public health care system, government-sponsored public health insurance is not universally accepted. This study used Taiwan as the backdrop to understand why many health clinics have chosen not to accept the National Health Insurance (NHI), despite it covering 99.93% of the country’s population. The clinics’ operational details were garnered from the datasets of Taiwan’s open government data platforms and checked against the list of contracting clinics within the NHI. Of 10,907 Western medicine primary care clinics in 2016, as many as 9846 (90.3%) clinics had signed contracts with the NHI. The remaining 1061 noncontracting clinics were distributed in urban (94.5%, n = 1003), suburban (4.9%, n = 52), and rural/remote areas (0.6%, n = 6). The NHI did not have contracts with 183 plastic surgery, 88 internal medicine, and 85 surgery clinics. In conclusion, nearly one-tenth of clinics practiced independently of the NHI in Taiwan. Their reasons for declining the contract and practices for delivering their services deserve further studies.

Research plays a crucial role in the development of primary health care. Researchers in other specialities have studied the internationalisation of their journals, but no such study has been conducted for general practice. The aim of this study was to analyse the volume of publication and internationalisation of general practice journals indexed in the Science Citation Index (SCI) database in 2019. Of the total 1573 articles and reviews in 19 journals indexed under the subject category of ‘primary health care’ in the SCI database, 86.4% (n = 1359) were published in four English-speaking countries (32.8% in seven US journals, 34.8% in five UK journals, 12.5% in two Australian journals and 6.4% in one Canadian journal) and 40.6% (n = 639) were authored or coauthored by authors from a country other than that in which the journal was published. There was a significant (P < 0.05) relationship between the country of publication and the degree of internationalisation of the journal. The degree of internationalisation of general practice journals varied from 94.2% for family practice to 2.0% for primary care. There are wide disparities in internationalisation among different countries and general practice journals. There is much room for improvement in the internationalisation of general practice journals in the SCI database.

The quality and quantity of papers published in journals play a crucial role in achieving an academic promotion in medical schools. Reports on the criteria for promotion and their impact on different specialties, especially on primary health care, which has low research output, are rare. We investigated the scoring systems generally adopted for academic promotion at most medical schools in Taiwan. The weighted scores were derived from the multiplication of weights from categories of paper, journal impact factor, or ranking in a certain category by impact factor, and author order. To determine the thresholds of papers required for different levels of promotion, we took papers in the highest- or lowest-ranked journals in the primary health care category in 2019 Journal Citation Reports as examples. Considering publications in the highest-ranked journals, a median of 4.6 first or corresponding author papers were required for a professorship, as well as 3.3 for an associate professorship, and 2.5 for an assistant professorship. In contrast, a median of 30, 20, and 13.5 papers in the lowest-ranked journals was required for the corresponding positions. Thus, academic promotions for primary health care educators in Taiwan are highly demanding. The detrimental effects of scoring systems deserve further research.