The recent expansion of virtual exchange (VE) in lieu of the Covid-19 pandemic and the ongoing advance of technology has resulted in considerably larger numbers of VE participants for those in certain areas and contexts, yet not all would-be participants have been so fortunate. In some regions and in various contexts, challenges in VE implementation have resulted in disadvantaged populations in terms of underrepresentation and marginalization in global VE networks. To illuminate such challenges, a mixed-method approach was utilized in the current study, beginning with a global survey to elucidate reasons for underrepresentation in terms of political, governmental, institutional, administrative, technological, pedagogical, cultural and personal challenges. Thereafter, semi-structured interviews with instructors, administrators, and educational decision makers were conducted to gain further insights. Although VE is now well established as an impactful mode of studying abroad, various region-specific challenges remain. We conclude with recommendations for underrepresented regions and populations.

Global vaccine hesitancy, intensified by crises such as the COVID-19 pandemic, represents a significant threat to immunization coverage. This narrative review discusses immunization safety monitoring frameworks and vaccine hesitancy in crisis-affected regions, particularly in Lebanon, Ukraine, and Sudan. By examining and reflecting on these case studies, this review aims to examine challenges, highlight context-specific strategies, and propose solutions for enhancing vaccine uptake and trust in fragile and conflict-affected areas. A structured narrative review was conducted, collecting evidence from global frameworks and region-specific case studies. The review explored factors impacting vaccine hesitancy, the role of adverse events following immunization (AEFI) monitoring systems, and innovative technological interventions. Key sources included peer-reviewed articles, reports from humanitarian organizations, and systematic reviews. The review showed that vaccine hesitancy is affected by interconnected factors, including sociopolitical and cultural conflicts, and misinformation. Lebanon’s persistent economic and political instability, Ukraine’s disruptions caused by the ongoing war, and Sudan’s fragile healthcare infrastructure pose challenges to vaccine coverage. Successful interventions to address hesitancy included transparency in AEFI reporting, integration of real-time monitoring systems, and community-led initiatives. It is critical to mitigate vaccine hesitancy in crisis-affected regions through robust safety monitoring frameworks and tailored communication strategies. Global cooperation and frameworks, technological innovations, and context-specific approaches are imperative for improving the resilience of immunization systems and ensuring health security in fragile settings. Furthermore, these insights are crucial in informing public health communication policies and behavior change interventions to improve public trust and thus reduce vaccine hesitancy.

The Parental Stress Scale (PSS) is a well-known tool widely used for assessing parenting stress. However, there is a lack of an Arabic-validated version. T