Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence

Mediating Effect of Chronic Illnesses in the Relationship Between Psychological Distress and COVID-19 Vaccine Acceptance

The impact of the COVID-19 pandemic on mental health is an emerging problem globally. This study aimed to examine the mediating effect of chronic illnesses in the relationship between psychological health and the acceptance of the COVID-19 vaccine, prior to the national vaccine rollout in Malaysia. An online cross-sectional study was conducted in Malaysia between December 10, 2020, and February 9, 2021. In addition to the descriptive analyses, a mediation analysis was performed to examine the mediating effect of chronic illnesses in the relationship between psychological distress and the willingness to accept the vaccine. A total of 1738 participants completed the survey. The psychological distress levels were found to be significantly different across demographic factors such as age, gender, and social economic status. This study demonstrated a partial mediating effect of chronic illnesses in the relationship between psychological distress and vaccine acceptance.

Is It All a Conspiracy? Conspiracy Theories and People's Attitude to COVID-19 Vaccination

A large body of research has found that people's beliefs in conspiracy theories about infectious diseases negatively impacts their health behaviors concerning vaccination. Conspiracy belief-based vaccination hesitancy has become more rampant after the global outbreak of COVID-19. However, some important questions remain unanswered. For instance, do different versions of conspiracy theories-particularly conspiracy theories about the origin of the epidemic (e.g., that the SARS-CoV-2 leaked from a Wuhan virology laboratory or that the virus was of foreign origin) and the general theories about vaccine conspiracies (e.g., pharmaceutical companies covered up the danger of vaccines or people are being deceived about the effectiveness of vaccines)-have the same effect on vaccination intentions? Through a national survey adopting quota sampling in China, the current study tested the relationship between people's conspiracy beliefs and their intention to receive the COVID-19 vaccination. The findings show that people's embrace of conspiracy theories did indeed affect their intention to take COVID-19 shots. However, only conspiracy theories related to vaccines had a significant impact, while belief in more general theories about COVID-19 did not significantly affect vaccination intentions. People's knowledge of vaccines (vaccine literacy) played an important role in this relationship. People with lower beliefs in vaccines conspiracy theories and higher levels of vaccine literacy were more likely to receive the COVID-19 vaccination.

Attitudes of Dermatologic Patients Towards COVID-19 Vaccines: a Questionnaire-Based Survey

The objective of this paper is to evaluate the attitudes of patients with various dermatologic diseases towards coronavirus disease (COVID-19) vaccines. The present questionnaire-based study was conducted on patients admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between January 1 and 31, 2021. The study population was divided into two groups based on their ages: (1) < 40 age group (n = 188) and (2) ≥ 40 age group (n = 111), and answers given to 35 specific questions were compared between the groups. The older group had significantly higher levels of anxiety compared to the younger group (p = 0.017). Although approximately 60% of cases in the older group were dedicated to being vaccinated, 40% of the younger participants were not sure about vaccination (p < 0.001). The most frequently demanded vaccine types were the inactivated and mRNA vaccines in the elderly and young groups, respectively (p < 0.001). Statistically significant positive weak correlations were observed for age, chronic disease of medication, and presence of severe COVID 19 cases in the environment (r = 0.125 p = 0.031, r = 0.184 p = 0.001, r = 0.122 p = 0.035, respectively). Dermatologic patients had generally positive attitudes towards COVID-19 vaccination, and their preferences were affected by age.

'My primary purpose is to protect the unborn child': Understanding pregnant women's perceptions of maternal vaccination and vaccine trials in Europe

Despite the important benefits of maternal vaccination for pregnant women and newborns, vaccination uptake is low in many European countries. Differences in vaccination policies and recommendations, as well as concerns about vaccine safety can partly explain inadequate coverage rates and women's hesitancy to get vaccinated during pregnancy. This study aims to explore pregnant women's experiences, decision-making processes and perceptions towards maternal vaccination and maternal vaccine trials in France, Germany, Italy, Spain and the United Kingdom. Qualitative interviews and focus groups were conducted with 258 pregnant women identified through local research panels and snowballing. Topic guides translated in local languages were designed to explore women's awareness and perceptions of maternal vaccination, and willingness to participate in vaccine trials during pregnancy. A thematic analysis was conducted. Pregnant women were found to have low awareness about maternal vaccination, with many reporting not having received a recommendation to vaccinate from their doctors. Strong trust in health professionals indicate that strengthened recommendations could improve vaccination uptake. Vaccination decision-making in pregnancy was described in the context of a highly emotional period, generating anxiety and fears around the safety of vaccines. Pregnancy was also discussed as a period during which women develop nurturing and protective identities. However, depending on the information they received as well as influences from experts, families and peers, women either perceived vaccination as a threat to their babies' safety or as a means to protect them. Attitudes towards maternal vaccine trials were less ambiguous, with most pregnant women strongly rejecting the notion of taking part in trials. While strategies to improve pregnant women's awareness and perceptions of maternal vaccination are needed, it is equally important to understand why healthcare professionals may not be recommending vaccination. More coordinated strategies across Europe could help strengthen communication and trust in maternal vaccination.

Public attitudes toward COVID-19 vaccines on English-language Twitter: A sentiment analysis

OBJECTIVE

To identify themes and temporal trends in the sentiment of COVID-19 vaccine-related tweets and to explore variations in sentiment at world national and United States state levels.

METHODS

We collected English-language tweets related to COVID-19 vaccines posted between November 1, 2020, and January 31, 2021. We applied the Valence Aware Dictionary and sEntiment Reasoner tool to calculate the compound score to determine whether the sentiment mentioned in each tweet was positive (compound ≥ 0.05), neutral (-0.05 < compound < 0.05), or negative (compound ≤ -0.05). We applied the latent Dirichlet allocation analysis to extract main topics for tweets with positive and negative sentiment. Then we performed a temporal analysis to identify time trends and a geographic analysis to explore sentiment differences in tweets posted in different locations.

RESULTS

Out of a total of 2,678,372 COVID-19 vaccine-related tweets, tweets with positive, neutral, and negative sentiments were 42.8%, 26.9%, and 30.3%, respectively. We identified five themes for positive sentiment tweets (trial results, administration, life, information, and efficacy) and five themes for negative sentiment tweets (trial results, conspiracy, trust, effectiveness, and administration). On November 9, 2020, the sentiment score increased significantly (score = 0.234, p = 0.001), then slowly decreased to a neutral sentiment in late December and was maintained until the end of January. At the country level, tweets posted in Brazil had the lowest sentiment score of -0.002, while tweets posted in the United Arab Emirates had the highest sentiment score of 0.162. The overall average sentiment score for the United States was 0.089, with Washington, DC having the highest sentiment score of 0.144 and Wyoming having the lowest sentiment score of 0.036.

CONCLUSIONS

Public sentiment on COVID-19 vaccines varied significantly over time and geography. Sentiment analysis can provide timely insights into public sentiment toward the COVID-19 vaccine and guide public health policymakers in designing locally tailored vaccine education programs.

Determinants of COVID-19 vaccine hesitancy in French hospitals

Objectives

COVID-19 vaccines have become the new hope for stemming the pandemic. We aimed to assess pre-launch vaccine acceptance among hospital workers in the Auvergne-Rhône-Alpes Administrative Region of France.

Methods

We performed a cross sectional study involving all hospital workers in 11 Auvergne-Rhône-Alpes hospitals in December 2020. Univariate and multivariate analyses were performed to identify factors associated with vaccine hesitancy.

Results

We analyzed completed questionnaires from 1,964 respondents (78% women, mean age 42 years, 21.5% physicians, 41% private care centers). A total of 1,048 (53%) hospital workers were in favor of COVID-19 vaccination. Vaccine hesitancy was associated with: female gender; young age; paramedical, technical, and administrative professions (i.e., all non-medical professions); no prior flu vaccination; and employment in the private medical care sector (p < 0.05). Distrust of health authorities and pharmaceutical lobbying were the main obstacles to vaccination. Inversely, creating herd immunity and protecting patients and household members were the most frequently cited reasons in favor of vaccination. More than two-thirds of participants feared that the clinical and biological research was too rapid and worried about serious adverse effects. Most participants were interested in written information on the available vaccines, but the most vaccine-hesitant categories preferred oral information. Only 35% supported mandatory vaccination.

Conclusions

Targeted written and oral information campaigns will be necessary to improve vaccination coverage among hospital workers who show a surprisingly high hesitancy rate. Imposing mandatory vaccination could be counterproductive.

Willingness and SARS-CoV-2 Vaccination Coverage among Healthcare Workers in China: A Nationwide Study

Background: The SARS-CoV-2 vaccine has been widely rolled out globally in the general populations. However, specific data on vaccination confidence, willingness or coverage among health care workers (HCWs) has been less reported. Methods: A cross-sectional online survey was conducted to specify the basic data and patterns of vaccination confidence, willingness and coverage among HCWs nationwide. Results: In total, 2386 out of 2583 (92.4%) participants were enrolled for analysis, and the rates of confidence in vaccine, professional institutes and government were 75.1%, 85.2% and 85.4%, respectively. The overall vaccination coverage rate was 63.6% which was adjusted as 82.8% for participants under current medical conditions or having contraindications. Confidence in vaccine safety was shown to be the most related factor to willingness among doctors, nurses, medical technicians and hospital administrators, while confidence in vaccine effectiveness as well as trust in government played the key role in formulating public health employees' willingness. 130 (7.1% of 1833) participants reporting willingness still not been vaccinated regardless of contraindications. Multivariate analysis among willingness participants showed that males, aged over 30 years, public health employees and higher vaccination confidence had significantly higher vaccination rates with ORs (95% confidence intervals) as 1.64 (1.08-2.49), 3.14 (2.14-4.62), 2.43 (1.46-4.04) or 2.31 (1.24-4.33). Conclusions: HCWs' confidence, willingness and coverage rates to the vaccine were generally at high levels. Heterogeneity among HCWs should be considered for future vaccination promotion strategies. The population's confidence in vaccination is not only the determinant to their willingness, but also guarantees their actual vaccine uptake.

Parental psychological distress and attitudes towards COVID-19 vaccination: A cross-sectional survey in Shenzhen, China

BACKGROUND

Parental attitudes towards the vaccines play a key role in the success of the herd immunity for the COVID-19. Psychological health seems to be a controversial determinant of vaccine hesitancy and remains to be investigated. This study attempted to measure parental psychological distress, attitudes towards the COVID-19 vaccine, and to explore the potential associations.

METHODS

An online survey using convenience sampling method was conducted among parents within the school public health network of Shenzhen. Demographic information and attitudes towards COVID-19 vaccination were collected. The Patient Health Questionnaire (PHQ-4) was applied to measure psychological distress.

RESULTS

Overall, 4,748 parents were included (average age: 40.28, standard deviation: 5.08). More than one fifth of them demonstrated psychological distress, in which only 3.3% were moderate to severe symptom. The proportions of COVID-19 vaccine hesitancy for themselves, their spouses, and their children were 25.2%, 26.1%, and 27.3%, respectively. Parents with psychological distress were more likely to suffer vaccine hesitancy for themselves (OR: 1.277, 95%CI: 1.091~1.494), for their spouses (OR:1.276, 95%CI: 1.088~1.496) and children (OR:1.274, 95%CI: 1.092~1.486). These associations tended to be more significant among parents with mild or severe psychological distress.

LIMITATION

Non-random sampling limited the generalization of our findings to all parents.

CONCLUSION

Parents had a low level of psychological distress but relatively high willingness of COVID-19 vaccination when there was no local epidemic but persistent risk of imported cases. Targeted health education and intervention strategies should be provided to people with vaccine hesitancy, especially for those who are susceptible to psychological distress.

SARS-CoV-2 Threat Perception and Willingness to Vaccinate: The Mediating Role of Conspiracy Beliefs

In the current exploratory study, we investigated the willingness of participants to vaccinate against the novel coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] that has shaken up the world since the beginning of 2020. More specifically, we tested the mediating role of conspiracy beliefs (CBs) on the relationship between threat perception (TP) and willingness of participants to vaccinate against coronavirus disease 2019 (COVID-19), along with a series of associated demographic variables. Overall, 40% of our sample expressed total rejection of the COVID-19 vaccine. Our results suggested no significant differences in gender, age, educational level, and vaccine acceptance or hesitancy of participants. The results also indicated that CBs partially mediated the relationship between TP and willingness of participants to vaccinate. The current findings are discussed within the theory of planned behavior (TPB) framework and their importance for public health communication and practices and building public trust within the global fight against COVID-19. We considered the present results as a valuable starting point in understanding the psychological constructs related to the extended model of TPB and other personal factors and addressed the attitudinal roots that shape the acceptance and rejection of COVID-19 vaccination.

Leveraging Transfer Learning to Analyze Opinions, Attitudes, and Behavioral Intentions Toward COVID-19 Vaccines: Social Media Content and Temporal Analysis

BACKGROUND

The COVID-19 vaccine is considered to be the most promising approach to alleviate the pandemic. However, in recent surveys, acceptance of the COVID-19 vaccine has been low. To design more effective outreach interventions, there is an urgent need to understand public perceptions of COVID-19 vaccines.

OBJECTIVE

Our objective was to analyze the potential of leveraging transfer learning to detect tweets containing opinions, attitudes, and behavioral intentions toward COVID-19 vaccines, and to explore temporal trends as well as automatically extract topics across a large number of tweets.

METHODS

We developed machine learning and transfer learning models to classify tweets, followed by temporal analysis and topic modeling on a dataset of COVID-19 vaccine-related tweets posted from November 1, 2020 to January 31, 2021. We used the F1 values as the primary outcome to compare the performance of machine learning and transfer learning models. The statistical values and P values from the Augmented Dickey-Fuller test were used to assess whether users' perceptions changed over time. The main topics in tweets were extracted by latent Dirichlet allocation analysis.

RESULTS

We collected 2,678,372 tweets related to COVID-19 vaccines from 841,978 unique users and annotated 5000 tweets. The F1 values of transfer learning models were 0.792 (95% CI 0.789-0.795), 0.578 (95% CI 0.572-0.584), and 0.614 (95% CI 0.606-0.622) for these three tasks, which significantly outperformed the machine learning models (logistic regression, random forest, and support vector machine). The prevalence of tweets containing attitudes and behavioral intentions varied significantly over time. Specifically, tweets containing positive behavioral intentions increased significantly in December 2020. In addition, we selected tweets in the following categories: positive attitudes, negative attitudes, positive behavioral intentions, and negative behavioral intentions. We then identified 10 main topics and relevant terms for each category.

CONCLUSIONS

Overall, we provided a method to automatically analyze the public understanding of COVID-19 vaccines from real-time data in social media, which can be used to tailor educational programs and other interventions to effectively promote the public acceptance of COVID-19 vaccines.

A global pandemic in the time of viral memes: COVID-19 vaccine misinformation and disinformation on TikTok

Misinformation and disinformation regarding COVID-19 and vaccination against it may be contributing to vaccine hesitancy. Social media outlets have reportedly made efforts to limit false information yet untruths related to COVID-19 persist online. The purpose of this study was to describe the content on COVID-19 vaccination on TikTok, an emerging social media platform. One-hundred trending videos were identified from the hashtag #covidvaccine and were coded for content. Collectively, these videos garnered over 35 million views. The coding category with the highest number of videos was "Discouraged a Vaccine" (n = 38), followed by "Encouraged a Vaccine" (n = 36). While only 36 videos encouraged a vaccine, these videos garnered over 50% of the total cumulative views and just under 50% of the total likes; the 38 videos that discouraged a vaccine garnered 39.6% of the total cumulative views, 44.3% of likes, and 47.4% of comments. Of the 38 videos discouraging the vaccine, 25 (65.79%) showed a parody of an adverse reaction and, collectively, received 71.07% of the total views among videos in this category. Twenty-two of these 38 videos (57.89%) falsely conveyed that a vaccine was available, as they were not at the time of the study. Anti-vaccination messaging may undermine efforts to ensure widespread uptake of the various COVID-19 vaccines, particularly for young people who are more likely than other age cohorts to use TikTok.

Understanding COVID-19 misinformation and vaccine hesitancy in context: Findings from a qualitative study involving citizens in Bradford, UK

BACKGROUND

COVID-19 vaccines can offer a route out of the pandemic, yet initial research suggests that many are unwilling to be vaccinated. A rise in the spread of misinformation is thought to have played a significant role in vaccine hesitancy. To maximize uptake, it is important to understand why misinformation has been able to take hold at this time and why it may pose a more significant problem within certain contexts.

OBJECTIVE

To understand people's COVID-19 beliefs, their interactions with (mis)information during COVID-19 and attitudes towards a COVID-19 vaccine.

DESIGN AND PARTICIPANTS

Bradford, UK, was chosen as the study site to provide evidence to local decision makers. In-depth phone interviews were carried out with 20 people from different ethnic groups and areas of Bradford during Autumn 2020. Reflexive thematic analysis was conducted.

RESULTS

Participants discussed a wide range of COVID-19 misinformation they had encountered, resulting in confusion, distress and mistrust. Vaccine hesitancy could be attributed to three prominent factors: safety concerns, negative stories and personal knowledge. The more confused, distressed and mistrusting participants felt about their social worlds during the pandemic, the less positive they were about a vaccine.

CONCLUSIONS

COVID-19 vaccine hesitancy needs to be understood in the context of the relationship between the spread of misinformation and associated emotional reactions. Vaccine programmes should provide a focused, localized and empathetic response to counter misinformation.

PATIENT OR PUBLIC CONTRIBUTION

A rapid community and stakeholder engagement process was undertaken to identify COVID-19 priority topics important to Bradford citizens and decision makers.

COVID-19 vaccination intention and influencing factors among different occupational risk groups: a cross-sectional study

As an effective measure to manage the Coronavirus disease 2019 (COVID-19) pandemic, the acceptance of the COVID-19 vaccine and understanding the influencing factors of vaccination intention is particularly important. This study aimed to describe the COVID-19 vaccination intention among three different occupational risk groups and identify influencing factors of vaccination intention since a COVID-19 vaccine is available in China. A cross-sectional questionnaire survey was conducted from January 10 to February 5, 2021 in Hangzhou city of Zhejiang Province, an eastern coastal province in China. The intention to accept COVID-19 vaccination and health beliefs based on the Health Belief Model were collected. Of the participants, college students reported the lowest COVID-19 vaccination intention (64.6%), followed by public transportation workers (72.4%) and health care workers (79.9%). Perceived barriers were identified as negative factors of vaccination intention among all three occupational groups. For college students and public transportation workers, perceived benefits and cues to action were identified as protective factors, and cues to action had a positive effect on vaccination intention of health care workers. Tailored interventions are encouraged to reduce barriers of vaccination, improve health beliefs and promote COVID-19 vaccination intentions.

Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography

(1) Background: Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare’s interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor “The stone that refuses to be sculpted”, accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also included.

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Willingness to Receive the COVID-19 and Seasonal Influenza Vaccines among the Saudi Population and Vaccine Uptake during the Initial Stage of the National Vaccination Campaign: A Cross-Sectional Survey

This study aimed to assess the willingness to receive the coronavirus disease 2019 (COVID-19) and seasonal influenza vaccines and vaccine uptake during the early stage of the national vaccination campaign in Saudi Arabia. A cross-sectional online survey was conducted among adult Saudis between 20 January and 20 March 2021. The questionnaire addressed vaccine hesitancy, perceived risk, willingness, and vaccine uptake. Approximately 39% of the participants expressed vaccine hesitancy, and 29.8% and 24% felt highly vulnerable to contracting COVID-19 and seasonal influenza, respectively. The majority (59.5%) were willing to receive the COVID-19 vaccine, although only 31.7% were willing to receive the flu vaccine. Adjusted analysis showed that vaccine hesitancy (OR 0.34, 95% CI 0.27-0.43) and the perception of being at high risk (OR 2.78, 95% CI 1.68-4.60) independently affected the intention to be vaccinated. Vaccine hesitancy was similar among those who were willing to be vaccinated (29.8%) and those who had already been vaccinated (33.1%). The perceived risk was significantly higher among those who had been vaccinated (48.1%) than among those who were willing to be vaccinated but had not yet been vaccinated (29.1%). In conclusion, the acceptance of the COVID-19 vaccine in Saudi Arabia is high. Saudis who received the vaccine had a similar level of vaccine hesitancy and a higher level of perceived risk.

Identifying HPV vaccine narrative communication needs among parents on social media

Sharing personal experiences is an important communication strategy in public health, including vaccination. This study sought to understand if parents would be receptive to learning about the HPV vaccine from other parent experiences, and what format this information should take on social media. In May 2020, we conducted a qualitative study of six online focus groups across the U.S. with parents (n = 48) of children ages 9–14. Using a text-based discussion format, we discussed their experiences getting information about the HPV vaccine and using Twitter to learn about health topics. Four coders structured qualitative findings by themes including content, delivery, and source of information. An accompanying survey was used to describe participant Twitter use and HPV vaccine knowledge and attitudes. The average participant age was 44.6 years old, 63% were mothers, and the majority had high HPV vaccine knowledge. Parents indicated that they want to hear from other parents about their experiences with the HPV vaccine. However, it was hard to know where to find this information. When experiences are shared on social media, the negative ones are more memorable and more personal. Parents thought Twitter could be an important space to communicate about the HPV vaccine if it was done in a credible, verifiable, and authentic way. Parents want to learn about the HPV vaccine through other parent experiences, especially when this aligns with science supporting the vaccine. Public health and medical communities must embrace this mix of evidence and lived experiences to deliver and discuss health information.

COVID-19 Vaccine Acceptance among Health Care Workers in the Kingdom of Saudi Arabia

Objectives

The purpose of our study was to assess COVID-19 vaccine acceptance among health care workers (HCWs) in the Kingdom of Saudi Arabia (KSA) and identify: 1) vaccine acceptance barriers; 2) demographic differences; and 3) the most trusted COVID-19 sources of information.

Methods

Between October and December 2020, all registered HCWs in the KSA were emailed a survey questionnaire, using Qualtrics® and Google Forms®, evaluating their acceptance of a COVID-19 vaccine.

Results

Of the 23,582 participants surveyed, 15,299 (64.9%) said they would accept a COVID-19 vaccine. Vaccine acceptance among HCWs differed by several demographic characteristics, with males (69.7%), Christians (71.9%), and Pakistanis (81.6%) most likely to accept a COVID-19 vaccine. Of the 8,202 (35.1%) who said they would not accept a COVID-19 vaccine, the main reason reported was fear of potential side effects (58.5%). Participants reported health officials (84.6%) as the most reliable source of COVID-19 information. Additionally, participants reported the highest confidence in the KSA Ministry of Health (88.5%).

Conclusions

Overall, these findings provide KSA health care authorities with the information needed to develop public health messaging campaigns for HCWs to best address COVID-19 vaccine concerns—especially as the country prepares to vaccinate its general population.

Mistrust and Beliefs in Conspiracy Theories Differently Mediate the Effects of Psychological Factors on Propensity for COVID-19 Vaccine

Vaccination is considered a key factor in the sanitary resolution of the COVID-19 pandemic. However, vaccine hesitancy can undermine its diffusion with severe consequences on global health. While beliefs in conspiracy theories, mistrust in science and in policymakers, and mistrust in official information channels may also increment vaccine hesitancy, understanding their psychological causes could improve our capacity to respond to the pandemic. Thus, we designed a cross-sectional study with the aim of probing vaccine propensity in the Italian population and explored its relationship with sociodemographic and psychological variables, and with misbeliefs in COVID-19. A battery of questionnaires was administered to a sample of 374 Italian adults during the first national lockdown (April 2020). The materials included an original instrument—Beliefs in COVID-19 Inventory—and questionnaires measuring perceived stress, anxiety, death anxiety, psychological distress, psychoticism, paranoia, anger, and somatization. The exploratory factor analysis (EFA) on Beliefs in COVID-19 suggested the existence of three factors: belief in conspiracy theories, mistrust in medical information, and mistrust in medicine and science. These factors were positively correlated with female sex, age, religious beliefs, psychiatric conditions, and psychological variables, while negatively correlated with education levels. We conducted a mediation analysis by means of a structural equation model, including psychological factors as predictors, beliefs in COVID-19 scales as mediators, and vaccine propensity as an outcome. The model showed that death anxiety had a direct positive effect on the propensity to get vaccinated. It also showed that death anxiety reduced the propensity to get vaccinated through a mediated path in believing in conspiracy theories, whereas paranoia was linked to a reduction in vaccination adherence with the mediation effect of mistrust in medical science. Psychological distress reduced vaccination propensity by increasing both conspiracy beliefs and mistrust. On the other hand, anxiety increased the propensity to get vaccinated through a decrease in both belief in conspiracy theories and mistrust in science. Our results suggest that psychological dimensions are differentially related to belief in conspiracy theories, to mistrust in science, and to the propensity to get vaccinated. Based on this result, we propose an original interpretation of how conspiracy beliefs build on a paranoid and suspicious attitude. We also discuss the possible clinical implications of treatment for such pathological beliefs.

COVID-19 Vaccine Discourse on Twitter: A Content Analysis of Persuasion Techniques, Sentiment and Mis/Disinformation

This research aims to understand the persuasion techniques used in Twitter posts about COVID-19 vaccines by the different vaccine sentiments (i.e., Pro-Vaccine, Anti-Vaccine, and Neutral) using the Elaboration Likelihood Model, Social judgment Theory, and the Extended Parallel Process Model as theoretical frameworks. A content analysis was conducted on a data set of 1,000 Twitter posts. The corpus of Tweets was examined using the persuasion frameworks; tweets that were identified as emanating from bots were further examined. Results found Anti-Vaccine messages predominantly used Anecdotal stories, Humor/Sarcasm, and Celebrity figures as persuasion techniques, while Pro-Vaccine messages primarily used Information, Celebrity figures, and Participation. Results also showed the Anti-Vaccine messages primarily focused on values related to the categories of Safety, Political/Conspiracy Theories, and Choice. Finally, results revealed Anti-Vaccine messages primarily used Perceived Severity and Perceived Susceptibility, which are fear appeal elements. The findings for messages by bots were comparable to the messages in the larger corpus of tweets. Based on the findings, a response framework-Health Information Persuasion Exploration (HIPE)-is proposed to address mis/disinformation and Anti-Vaccine messaging. The results of this study and the HIPE framework can inform a national COVID-19 vaccine health campaign to increase vaccine adoption.

A National Survey to Assess the COVID-19 Vaccine-Related Conspiracy Beliefs, Acceptability, Preference, and Willingness to Pay among the General Population of Pakistan

The current study aims to assess the beliefs of the general public in Pakistan towards conspiracy theories, acceptance, willingness to pay, and preference for the COVID-19 vaccine. A cross-sectional study was conducted through an online self-administered questionnaire during January 2021. The Chi-square test or Fisher exact test was utilized for statistical data analysis. A total of 2158 respondents completed the questionnaire, among them 1192 (55.2%) were male with 23.87 (SD: ±6.23) years as mean age. The conspiracy beliefs circulating regarding the COVID-19 vaccine were believed by 9.3% to 28.4% of the study participants. Among them, 1040 (48.2%) agreed to vaccinate on its availability while 934 (43.3%) reported the Chinese vaccine as their preference. The conspiracy beliefs of the participants were significantly associated with acceptance of the COVID-19 vaccine. The existence of conspiracy beliefs and low vaccine acceptance among the general population is a serious threat to successful COVID-19 vaccination.

Risk, Trust, and Flawed Assumptions: Vaccine Hesitancy During the COVID-19 Pandemic

Background: The pace at which the present pandemic and future public health crises involving viral infections are eradicated heavily depends on the availability and routine implementation of vaccines. This process is further affected by a willingness to vaccinate, embedded in the phenomenon of vaccine hesitancy. The World Health Organization has listed vaccine hesitancy among the greatest threats to global health, calling for research to identify the factors associated with this phenomenon. Methods: The present cross-sectional study seeks to investigate the psychological, contextual, and sociodemographic factors associated with vaccination hesitancy in a large sample of the adult population. 4,571 Norwegian adults were recruited through an online survey between January 23 to February 2, 2021. Subgroup analyzes and multiple logistic regression was utilized to identify the covariates of vaccine hesitancy. Results: Several subgroups hesitant toward vaccination were identified, including males, rural residents, and parents with children below 18 years of age. No differences were found between natives and non-natives, across education or age groups. Individuals preferring unmonitored media platforms (e.g., information from peers, social media, online forums, and blogs) more frequently reported hesitance toward vaccination than those relying on information obtainment from source-verified platforms. Perceived risk of vaccination, belief in the superiority of natural immunity, fear concerning significant others being infected by the virus, and trust in health officials' dissemination of vaccine-related information were identified as key variables related to vaccine hesitancy. Conclusion: Given the heterogeneous range of variables associated with vaccine hesitancy, additional strategies to eradicate vaccination fears are called for aside from campaigns targeting the spread of false information. Responding to affective reactions in addition to involving other community leaders besides government and health officials present promising approaches that may aid in combating vaccination hesitation.

Building public trust: a response to COVID-19 vaccine hesitancy predicament

With the rollout of vaccines against COVID-19, an optimistic and a negative attitude among people have arisen. Surprisingly, surveys among people reveal that there is a significant rate of distrust against the vaccines. In a recent short report published in this journal, vaccine hesitancy was found out among medical students. Hence, wide array of research has been springing, recommending various approaches in assisting authorities deal with vaccine hesitancy such as proper and effective strategic communication as a solution. This study suggests however that a more 'localized' public education and role-modelling from public officials and health authorities can help a lot in building public trust. The study aims to contribute to the further development of public health mechanisms in the rolling-out and distribution of vaccines against COVID-19.

A qualitative study of the views of healthcare professionals on providing vaccines information to patients

Background Healthcare professionals (HCPs) such as pharmacists, general practitioners and practice nurses are a trusted source of vaccines information for patients in primary care. Global regulators have highlighted the key role of HCPs in fostering confidence in COVID-19 vaccines. Objective This study aims to gain insight into the views and experiences of HCPs on providing vaccines information to patients. Setting Primary care general practice surgeries and community pharmacies in Ireland. Methods Qualitative, semi-structured interviews were conducted with 14 HCPs (five General practitioners [GPs], four practice nurses and five community pharmacists) identified through purposive and convenience sampling. The interviews were analysed by inductive thematic analysis. Main outcome measure Participants’ views and experiences of providing vaccines information to patients. Results Five key themes were identified: roles and responsibilities, perception of risk, perception of the public, building a relationship, and emotion. HCPs were motivated by duty and care for their patients. They respected patient autonomy and were driven by their concern for public health. HCPs were influenced by their perception of risk and their perceptions of the public. HCPs practiced patient-centred care by providing tailored vaccines information. They favoured an approach of providing patients with information and support to make their own decision. The topic was emotive; HCPs empathised with patients but were also frustrated by their perceived inability to change some patients’ views. Conclusion The provision of vaccines information by HCPs to patients is multifactorial with participants mindful of patient autonomy and the HCP role to support vaccinations as a public health priority. Participants suggested that education and support on vaccines communication would enable them to support the vaccines uptake in their practice.

COVID-19 Vaccine Hesitancy and Its Associated Factors in Japan

The vaccine confidence index in Japan is one of the lowest worldwide. This study aimed to examine the proportion of COVID-19 vaccine hesitancy in the Japanese population using a larger sample and more robust statistical methods than previously, and to identify factors associated with vaccine hesitancy. We conducted a nationwide, cross-sectional Internet survey on 8–26 February 2021, and calculated the proportion and odds ratios for vaccine hesitancy. Among 23,142 responses analyzed, the proportion of COVID-19 vaccine hesitancy was 11.3% (10.9–11.7%). The proportion was higher among younger respondents and female respondents, and especially among younger female respondents (15.6%) compared with the lowest proportion among older male respondents (4.8%). The most cited reason for not getting vaccinated was concerns about adverse reactions in more than 70% of the respondents. The proportion of COVID-19 vaccine hesitancy in Japan was comparable to that in previous studies overseas, and the proportion among younger respondents was more than double that among older respondents. Factors associated with the hesitancy were female sex, living alone, low socioeconomic status, and presence of severe psychological distress, especially among older respondents. Thus, adequate measures should be taken to ensure that vaccines are delivered to people with these factors.

Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study

Background

Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions.

Objective

This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination.

Methods

We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization’s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media.

Results

Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online.

Conclusions

COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts.

Sociodemographic factors associated with acceptance of COVID-19 vaccine and clinical trials in Uganda: a cross-sectional study in western Uganda

BACKGROUND

Health experts agree that widespread use of safe and effective vaccines will rapidly contain the COVID-19 pandemic. The big question is whether these vaccines can easily be accepted by their end-users. Our study aimed at determining sociodemographic factors associated with acceptance of vaccines and clinical trials of COVID-19 in western Uganda.

METHOD

A simplified snowball sampling technique was used to select 1067 respondents of 18-70 years in western Uganda using an online questionnaire from July to September 2020. Vaccine acceptability and risk perception were assessed using odds ratio at 95% confidence interval in R software version 3.6.3.

RESULTS

There were 1067 participants in the study. The majority were males (73.2%) and age group 31-40 years (32.6%). The acceptance rate for COVID-19 vaccination was (53.6%; 572/1067) with those aged 18-20 years, males, elites at tertiary level of education (degree or diploma), students, Muslims, married, non-salary earners and rural dwellers having better odds and likeliness to accept vaccination. Only 44.6% (476/1067) showed interest in clinical trials among which; males, primary school leavers, students, Christians, un-married, respondents who didn't earn any salary and rural dwellers had better odds and likelihood to participate in clinical trials.

CONCLUSION

There was a low level of vaccine acceptance and clinical trial interest in western Uganda. Minority groups in the study i.e., Muslims, students, primary school leavers, un-married rural dwellers among others showed more interest in vaccination and clinical trials. We anticipated fears in the larger part of this community that health experts need to address through reassurance of the community that vaccines are tested and that they are safe and important if we are to rapidly contain the COVID-19 pandemic.

Adherence to preventive behaviors among college students during COVID-19 pandemic in China: The role of health beliefs and COVID-19 stressors

Before herd immunity is reached, preventive practices still play an important role in controlling the COVID-19 pandemic. Adherence to preventive behaviors could be determined by individuals' health beliefs, which would be influenced by antecedent factors such as previous exposure to pandemic stressors. Applying the health belief model (HBM), this study aims to examine the mediation association among COVID-19 stressors, HBM constructs, and preventive behaviors. Longitudinal data were collected from 1225 Chinese college students using web-based surveys at wave 1 (w1; between January 31 and February 11, 2020) and wave 2 (w2; between March 20 and April 3, 2020). Participants reported their COVID-19 stressors (w1), five HBM constructs (w2), and preventive behaviors (w1 and w2). Paired t-tests suggested that social distancing and self-quarantine behaviors decreased while precautionary behaviors increased from w1 to w2. Path analysis indicated that two HBM constructs (perceived barriers and self-efficacy) mediated the association between COVID-19 stressors and precautionary behaviors. These findings suggested that tailored prevention intervention for college students should attend to perceived barriers and self-efficacy. Individuals who exposed to multiple pandemic stressors merit particular attention and intervention should account for their early pandemic stress experiences.

Perception of Health, Mistrust, Anxiety, and Indecision in a Group of Italians Vaccinated against COVID-19

The objectives of this study were to evaluate the psychological factors of health perception, mistrust, anxiety, fear, and indecision of Italians vaccinated against COVID-19, and conduct an analysis of the relationships between these factors and other variables: sex, vaccine priority ministerial categories, and the type and dose of vaccine. The participants included 1564 subjects who joined the vaccination campaign at the COVID-19 Vaccination Center in Salerno, Italy. A survey was conducted in the reference period March-April 2021 using a brief anamnestic questionnaire. In addition, the following standardized scales were used: the State-Trait Anxiety Inventory (STAI-Y) and the Short Form Health Survey (SF-12). The results showed that, in terms of the type of vaccine received, the interviewees felt more confident in having received the Comirnaty (Pfizer-BioNTech, 23.5%) and Vaxzevria (AstraZeneca, 18.6%) vaccines-feeling less tense (2.1%; Vaxzevria (AstraZeneca) = 3.2%), frightened (1%; Vaxzevria (AstraZeneca) = 1.4%), not at all nervous (61.1%; Vaxzevria (AstraZeneca), 43.6%), and not at all/undecided (67.9%; Vaxzevria (AstraZeneca), 58.6%). Regarding the mood and psychological states considered at the different vaccine administration times, other important differences emerged as the interviewees reported higher levels of tension, nervousness, and fear during the first phase of vaccine administration. Specifically, 40.7% (second dose, 32.7%) felt somewhat tense at the first dose, 26.4% felt frightened (second dose, 21.8%), and 33.8% felt nervous (second dose, 26.8%). The perceived state of health also increased at the end of the vaccination cycle, as, at the second dose, 15.4% of the sample reported an evaluation of "excellent" (first dose, 12.4%).

Effective Communication at Different Phases of COVID-19 Prevention: Roles, Enablers and Barriers

In an age of globalisation and hyperconnectivity, the COVID-19 pandemic has caused unprecedented and sustained impact worldwide. This article discusses issues related to (science) communication at different phases of the COVID-19 epidemic timeline. We consider the role of communication for prevention from the ecological perspective, taking into consideration that many emerging pathogens, including COVID-19, likely arise in part due to anthropogenic changes to natural environments. Communication forms part of the early response setting the scene for public buy-in of public health interventions at the start of an outbreak, as well as to maintain precautions over time. Finally, communication is a key element in increasing acceptance for new tools that require mass uptake to be effective, as seen with roll-out challenges for the COVID-19 vaccines, which faced heightened concerns of efficacy and safety while mired with rampant misinformation. Ultimately, strategies for prevention of viral epidemics such as COVID-19 must include communication strategies at the forefront to reduce the risk of the emergence of new diseases and enhance efforts to control their spread and burden. Despite key themes emerging, what constitutes effective communication strategies for different people and contexts needs to be investigated further.

Social Advertising Effectiveness in Driving Action: A Study of Positive, Negative and Coactive Appeals on Social Media

Background: Social media offers a cost-effective and wide-reaching advertising platform for marketers. Objectively testing the effectiveness of social media advertising remains difficult due to a lack of guiding frameworks and applicable behavioral measures. This study examines advertising appeals’ effectiveness in driving engagement and actions on and beyond social media platforms. Method: In an experiment, positive, negative and coactive ads were shared on social media and promoted for a week. The three ads were controlled in an A/B testing experiment to ensure applicable comparison. Measures used included impressions, likes, shares and clicks following the multi-actor social media engagement framework. Data were extracted using Facebook ads manager and website data. Significance was tested through a series of chi-square tests. Results: The promoted ads reached over 21,000 users. Significant effect was found for appeal type on engagement and behavioral actions. The findings support the use of negative advertising appeals over positive and coactive appeals. Conclusion: Practically, in the charity and environment context, advertisers aiming to drive engagement on social media as well as behavioral actions beyond social media should consider negative advertising appeals. Theoretically, this study demonstrates the value of using the multi-actor social media engagement framework to test advertising appeal effectiveness. Further, this study proposes an extension to evaluate behavioral outcomes.

Equal access of COVID-19 vaccine distribution in Africa: Challenges and way forward

The World Health Organization (WHO) in Africa and Africa Center Disease Control (Africa CDC) urge the international community and different countries in Africa to ensure sustainable and concrete action to ensure equal and easy access to the COVID-19 vaccines, as different countries in Africa are still struggling to develop a safe and effective strategy to ensure equal vaccine distribution, if available. Africa CDC has called on the international community to come together to help Africa with COVID-19 vaccines to make equal the vaccine distribution among African countries as many cannot afford the vaccine costs due to the level of poverty and other negative factors. The African Union has endorsed the need for Africa to develop a framework to actively engage in easy accessibility to COVID-19 vaccines, which will allow different countries in Africa to take easy steps that will strengthen the local vaccine distribution system, building workforce skills and knowledge, and enrich outreach services in Africa. The article discusses the need for equal access in the distribution of COVID-19 vaccines in Africa, the challenges, and the necessary recommendations that can help to mitigate these challenges.

Willingness of Ethiopian Population to Receive COVID-19 Vaccine

BACKGROUND

Despite efforts to decrease the burden, vaccine reluctance is increasing worldwide and hindering efforts to control the spread of COVID-19. Therefore, understanding the willingness of a community to receive a COVID-19 vaccine will help to develop and implement effective means of promoting COVID-19 vaccine uptake.

OBJECTIVES

This study was aimed to assess the willingness of the Ethiopian population to receive the COVID-19 vaccine and its determinant factors.

METHODS

E-survey was conducted from February 2021 to March 2021. After developing the questionnaire, the template was created on Google Forms and disseminated in public on different social media channels (e.g., Telegram, WhatsApp, Facebook, email, etc.) by using a shareable link. Descriptive statistics were performed. Finally, multivariable logistic regression analysis was done to assess their relationship with socio-demographic factors.

RESULTS

In total, 31.4% (n = 372) of respondents were willing to get a vaccine. One-third of respondents, 32.2% (n = 381), reported that COVID-19 vaccines are safe. Almost all 94.9% (n = 1124) responded that health workers should be vaccinated first. Only 21.7% (n = 257) willing to buy the vaccine if it is not provided free. Being female [OR (95% CI):1.85 (1.05-3.25)], aged less than 25 years old [OR (95% CI): 5.09 (3.41-7.59)], aged between 26-30 years [OR (95% CI): 3.57 (2.55-5.00)], being unmarried[OR (95% CI):1.12 (0.81-1.55)], urban in residence [OR (95% CI): 1.06 (0.69-1.62)], private sector worker in occupation [OR (95% CI):0.45 (0.26 -0.77)], university/college student [OR (95% CI): 0.88 (0.59-1.32)], not having a health-related job [OR (95% CI): 4.08 (2.57-6.48)], orthodox [OR (95% CI): 1.16 (0.61-2.19)], Muslim [OR (95% CI): 0.285 (0.13 -0.61)], educational status of university/above [OR (95% CI): 4.87 (3.15-7.53)] have a statistically significant association and were more likely willing to take COVID-19 than their counterparts.

CONCLUSION

This study found that only 31.4% were willing to take the COVID-19 vaccine. Being female, older age, marital status, residence, occupations, not having a health-related job, religion, educational status were statistically significantly associated with willingness to receive the COVID-19 vaccine.

Psychological factors affecting COVID-19 vaccine hesitancy

Background

Vaccine hesitancy is an important public health problem.

Aims

Identifying and understanding COVID-19 vaccine hesitancy may aid future public health messaging. This study, in which we planned to study the determinants of COVID-19 vaccine hesitancy, aims to reveal the relationship between “intolerance of uncertainty,” “belief in conspiracy theories,” and “COVID-19 phobia” with vaccine hesitancy.

Methods

This is a cross-sectional study conducted during a COVID-19 outbreak. Participants were reached via various social media platforms and e-mailing lists for convenience. Data were collected with an online survey using SurveyMonkey application. “Intolerance of Uncertainty Scale (IUS-12),” “Conspiracy Mentality Scale (CMS),” and “COVID-19 Phobia Scale” were applied to 488 participants. Statistical significance level was considered p < 0.05.

Results

Four hundred eighty-eight people between the ages of 18 and 65 participated. Twenty-one participants were excluded from the analysis due to random marking and unreasonable filling times (< 10 min). In this way, analyzes were made with 467 people. We found a positive correlation between the belief in conspiracy theories and vaccine hesitancy (p < 0.05). And also found that individuals with low fear of COVID-19 would hesitate about vaccination (p < 0.05).

Conclusions

Vaccine hesitancy is an important public health problem, and it puts public health at risk, especially during the epidemic period we live in. Therefore, it is important to understand the psychological factors involved in vaccine hesitancy. It would be useful to look for ways to spread accurate information about the vaccine in a healthier way in this case.

The Role of Trauma in Mothers' COVID-19 Vaccine Beliefs and Intentions

OBJECTIVE

Research on COVID-19 vaccine beliefs has focused primarily on adults' intentions to vaccinate themselves; however, many parents will also face decisions about vaccinating their children. In this study, we examine how maternal posttraumatic stress disorder (PTSD) and trauma history relate to mothers' beliefs and intentions about the COVID-19 vaccine for themselves and their children.

METHODS

A total of 240 mothers with a mental health history participating in a parenting study answered online survey questions via Prolific. Questions assessed: (a) trauma indictors (past diagnosis, current symptoms, and lifetime exposure to events); (b) vaccine measures (intentions for self and child, COVID-19 vaccine confidence, general vaccine perceived safety, reasoning about vaccine intentions, sources of influence on intentions); and (c) possible explanatory variables (institutional distrust, negative worldviews). ANCOVAs and regression analyses were used.

RESULTS

When compared with mothers with other mental health diagnoses, mothers with a PTSD history had significantly less confidence in the COVID-19 vaccine and less intent to get the vaccine for themselves or their child. These effects were explained by greater institutional distrust (i.e., significant indirect effects). Mothers with a previous PTSD diagnosis also expressed different reasons for vaccine hesitancy (e.g., less belief in science) and ascribed less influence to healthcare and governmental sources in vaccine decision-making.

CONCLUSION

Findings highlight the potential utility of a trauma-informed approach in efforts to reduce COVID-19 vaccine hesitancy. For mothers with a history of PTSD, addressing institutional distrust, including towards the healthcare industry, may be an important element to consider in the content, delivery, and mode of vaccine messaging.

Associations Between Health Literacy, eHealth Literacy, and COVID-19-Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study

Background

During the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19–related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors.

Objective

The objective of this study was to develop and verify a COVID-19–related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants’ health literacy and eHealth literacy.

Methods

A snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19–related health behaviors.

Results

Of 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19–related health behavior questionnaire presented a two-factor structure—COVID-19–specific precautionary behaviors and conventional health behaviors—with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19–related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19–specific precautionary behaviors (β_{health literacy}=.149, β_{eHealth literacy}=.368; P<.001) and conventional health behaviors (β_{health literacy}=.219, β_{eHealth literacy}=.277; P<.001).

Conclusions

The COVID-19–related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19–related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19–related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19–related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students.

Correlates of COVID-19 vaccine hesitancy in Austria: trust and the government

Background

With the coronavirus disease 2019 (COVID-19) pandemic surging and new mutations evolving, trust in vaccines is essential.

Methods

We explored correlates of vaccine hesitancy, considering political believes and psychosocial concepts, conducting a non-probability quota-sampled online survey with 1007 Austrians.

Results

We identified several important correlates of vaccine hesitancy, ranging from demographics to complex factors such as voting behavior or trust in the government. Among those with hesitancy towards a COVID-19 vaccine, having voted for opposition parties (opp) or not voted (novote) were (95% Confidence Intervall (CI)opp, 1.44–2.95) to 2.25-times (95%CI_novote, 1.53–3.30) that of having voted for governing parties. Only 46.2% trusted the Austrian government to provide safe vaccines, and 80.7% requested independent scientific evaluations regarding vaccine safety to increase willingness to vaccine.

Conclusions

Contrary to expected, psychosocial dimensions were only weakly correlated with vaccine hesitancy. However, the strong correlation between distrust in the vaccine and distrust in authorities suggests a common cause of disengagement from public discourse.

Willing or Hesitant? A Socioeconomic Study on the Potential Acceptance of COVID-19 Vaccine in Japan

The worldwide COVID-19 vaccination program is already underway, raising hopes and aspirations to contain the spread of the COVID-19 pandemic that halted economic and social activities. However, the issue of vaccine effectiveness and its side-effects is influencing the potential acceptance of vaccines. In this uncertain situation, we used data from a nationwide survey in Japan during February 2021, following the Japanese government's initial phase of COVID-19 vaccination. Our results show that 47% of the respondents are willing to take a vaccine once it is available, while 22% are not willing and another 31% remain indecisive. Our ordered probit regression results show that demographic, socioeconomic, and behavioral variables such as gender, age, subjective health status, children, household income, household assets, financial literacy, future anxiety, and myopic view of the future are associated with willingness to take a COVID-19 vaccine. Our findings suggest that Japan's government should not adopt a one-size-fits-all policy to promote the vaccination program, but rather target people with specific socioeconomic backgrounds who are less willing and more hesitant to take a vaccine.

Vaccine hesitancy in the era of COVID-19

OBJECTIVES

In 2019, a new coronavirus has been identified and many efforts have been directed toward the development of effective vaccines. However, the willingness for vaccination is deeply influenced by several factors. So the aim of our review was to analyze the theme of vaccine hesitancy during COVID-19 pandemic, with a particular focus on vaccine hesitancy toward COVID-19 vaccine.

STUDY DESIGN

Narrative review.

METHODS

In November 2020, we performed a search for original peer-reviewed articles in the electronic database PubMed (MEDLINE). The key search terms were "Vaccine hesitancy AND COVID-19". We searched for studies published during COVID-19 pandemic and reporting information about the phenomenon of vaccine hesitancy.

RESULTS

Fifteen studies were included in the review. The percentage of COVID-19 vaccine acceptance was not so high (up to 86.1% students or 77.6% general population); for influenza vaccine, the maximum percentage was 69%. Several factors influenced the acceptance or refusal (ethnicity, working status, religiosity, politics, gender, age, education, income, etc.). The most given reasons to refuse vaccine were as follows: being against vaccines in general, concerns about safety/thinking that a vaccine produced in a rush is too dangerous, considering the vaccine useless because of the harmless nature of COVID-19, general lack of trust, doubts about the efficiency of the vaccine, belief to be already immunized, doubt about the provenience of vaccine.

CONCLUSIONS

The high vaccine hesitancy, also during COVID-19 pandemic, represents an important problem, and further efforts should be done to support people and give them correct information about vaccines.

Review the safety of Covid-19 mRNA vaccines: a review

The novel coronavirus disease 2019 (COVID-19) has infected more than 100 million people globally within the first year of the pandemic. With a death toll surpassing 500,000 in the United States alone, containing the pandemic is predicated on achieving herd immunity on a global scale. This implies that at least 70-80 % of the population must achieve active immunity against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), either as a result of a previous COVID-19 infection or by vaccination against SARS-CoV-2. In December 2020, the first two vaccines were approved by the FDA through emergency use authorization in the United States. These vaccines are based on the mRNA vaccine platform and were developed by Pfizer/BioNTech and Moderna. Published safety and efficacy trials reported high efficacy rates of 94-95 % after two interval doses, in conjunction with limited side effects and a low rate of adverse reactions. The rapid pace of vaccine development and the uncertainty of potential long-term adverse effects raised some level of hesitation against mRNA vaccines in the global community. A successful vaccination campaign is contingent on widespread access to the vaccine under appropriate storage conditions, deployment of a sufficient number of vaccinators, and the willingness of the population to be vaccinated. Thus, it is important to clarify the objective data related to vaccine safety, including known side effects and potential adverse reactions. The present review was designed to provide an update on the current state of science related to the safety and efficacy of SARS-CoV-2 mRNA vaccines.

Analysis of the potential impact of durability, timing, and transmission blocking of COVID-19 vaccine on morbidity and mortality

BACKGROUND

COVID-19 vaccines have been approved and made available. While questions of vaccine allocation strategies have received significant attention, important questions remain regarding the potential impact of the vaccine given uncertainties regarding efficacy against transmission, availability, timing, and durability.

METHODS

We adapted a susceptible-exposed-infectious-recovered (SEIR) model to examine the potential impact on hospitalization and mortality assuming increasing rates of vaccine efficacy, coverage, and administration. We also evaluated the uncertainty of the vaccine to prevent infectiousness as well as the impact on outcomes based on the timing of distribution and the potential effects of waning immunity.

FINDINGS

Increased vaccine efficacy against disease reduces hospitalizations and deaths from COVID-19; however, the relative benefit of transmission blocking varied depending on the timing of vaccine distribution. Early in an outbreak, a vaccine that reduces transmission will be relatively more effective than one introduced later in the outbreak. In addition, earlier and accelerated implementation of a less effective vaccine is more impactful than later implementation of a more effective vaccine. These findings are magnified when considering the durability of the vaccine. Vaccination in the spring will be less impactful when immunity is less durable.

INTERPRETATION

Policy choices regarding non-pharmaceutical interventions, such as social distancing and face mask use, will need to remain in place longer if the vaccine is less effective at reducing transmission or distributed slower. In addition, the stage of the local outbreak greatly impacts the overall effectiveness of the vaccine in a region and should be considered when allocating vaccines.

FUNDING

Centers for Disease Control and Prevention (CDC) MInD-Healthcare Program (U01CK000589, 1U01CK000536), James S. McDonnell Foundation 21st Century Science Initiative Collaborative Award in Understanding Dynamic and Multiscale Systems, National Science Foundation (CNS-2027908), National Science Foundation Expeditions (CCF1917819), C3.ai Digital Transformation Institute (AWD1006615), and Google, LLC.

COVID-19 vaccine hesitancy and related fears and anxiety

Background

Vaccination is crucial to limit the pandemic spread of SARS-CoV-2/COVID-19. Therefore, besides the development and supply of vaccines, it is essential that sufficient individuals are willing to get vaccinated, but concerning proportions of populations worldwide show vaccine hesitancy. This makes it important to determine factors that are associated with vaccine acceptance.

Methods

1779 adults of a non-probability convenience sample in Germany were assessed with an online survey in a cross-sectional survey period from 1st to 11th January 2021 (a few days after the beginning of vaccinations in Germany).

Results

64.5% of the sample stated that they absolutely would accept the vaccination, 13.8% would rather accept it, 10.4% were undecided, and 5.2% would rather not and 6.0% absolutely not get vaccinated. COVID-19-related anxiety, and fears of infection and health-related consequences correlated significantly positively with vaccine acceptance (all p < .001). In contrast, social (p = .006) and economic fears (p < .001) showed significant negative associations with vaccination willingness. The broader constructs of unspecific anxiety and depressive symptoms were not significantly associated with vaccine acceptance. Vaccine acceptance differed between users/non-users of social media and official websites to gain information about the pandemic (p < .001).

Conclusions

COVID-19-related anxiety and health-related fears were associated with higher vaccine acceptance, whereas the fear of social and economic consequences showed the contrary direction. These findings highlight the need to differentiate between several types of fears and anxiety to predict their influence on vaccine acceptance, and provide important information and an essential base for future studies and interventions.

A behavioral economics perspective on the COVID-19 vaccine amid public mistrust

The COVID-19 vaccine development, testing, and approval processes have moved forward with unprecedented speed in 2020. Although several vaccine candidates have shown promising results in clinical trials, resulting in expedited approval for public use from the U.S. Food and Drug Administration, recent polls suggest that Americans strongly distrust the vaccine and its approval process. This mistrust stems from both the unusual speed of vaccine development and reports about side effects. This article applies insights from behavioral economics to consider how the general public may make decisions around whether or not to receive a future COVID-19 vaccine in a context of frequent side effects and preexisting mistrust. Three common cognitive biases shown to influence human decision-making under a behavioral economics framework are considered: confirmation bias, negativity bias, and optimism bias. Applying a behavioral economics framework to COVID-19 vaccine decision-making can elucidate potential barriers to vaccine uptake and points of intervention for clinicians and public health professionals.

Resilience Predicts the Trajectories of College Students' Daily Emotions During COVID-19: A Latent Growth Mixture Model

The objective of this study was to examine the association between resilience and trajectories of college students’ negative and positive affect during the COVID-19 pandemic. A total of 391 college students recruited from China completed a daily online negative and positive affect scale for 1 week, and their resilience was also measured. Profiles of brief trajectories of negative and positive affect over time were identified using the latent growth mixture model, and the effect of resilience on these trajectories was further explored. Two latent profiles of negative affect were found: a constant high negative affect profile and a slowly decreasing low negative affect profile, while three latent profiles of positive affect were identified: a slowly increasing high positive affect profile, a rapidly decreasing medium positive affect profile, and a constant medium positive affect profile. The optimism dimension of resilience predicted the membership in the various profiles significantly, whereas the prediction of tenacity and strength dimensions of resilience was not significant. Activities that promote resilience, especially optimism, should be included to improve the daily emotions of college students during COVID-19.

Vaccination willingness, vaccine hesitancy, and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study

Background

Vaccination against coronavirus disease 2019 (COVID-19) has become an important public health solution. To date, there has been a lack of data on COVID-19 vaccination willingness, vaccine hesitancy, and vaccination coverage in China since the vaccine has become available.

Methods

We designed and implemented a cross-sectional, population-based online survey to evaluate the willingness, hesitancy, and coverage of the COVID-19 vaccine among the Chinese population. 8742 valid samples were recruited and classified as the vaccine-priority group (n = 3902; 44.6%) and the non-priority group (n = 4840; 55.4%).

Results

The proportion of people’s trust in the vaccine, delivery system, and government were 69.0%, 78.0% and 81.3%, respectively. 67.1% of the participants were reportedly willing to accept the COVID-19 vaccination, while 9.0% refused it. 834 (35.5%) reported vaccine hesitancy, including acceptors with doubts (48.8%), refusers (39.4%), and delayers (11.8%). The current coverage was 34.4%, far from reaching the requirements of herd immunity. The predicted rate of COVID-19 vaccination was 64.9%, 68.9% and 81.1% based on the rates of vaccine hesitancy, willingness, and refusal, respectively.

Conclusions

The COVID-19 vaccine rate is far from reaching the requirements of herd immunity, which will require more flexible and comprehensive efforts to improve the population’s confidence and willingness to vaccinate. It should be highlighted that vaccination alone is insufficient to stop the pandemic; further efforts are needed not only to increase vaccination coverage but also to maintain non-specific prevention strategies.

Primary Care Clinicians as COVID-19 Vaccine Ambassadors

The development of highly efficacious COVID-19 vaccines has brought a feeling of hope to many in the US (United States) and across the globe. However, it is estimated that approximately one-third of the US and international population are hesitant to receive the COVID-19 vaccine. For most Western countries with the economic means to purchase sufficient vaccine for their citizens, the medical community now has the opportunity to lead the vaccination communication campaign. Because frontline clinicians were the first to be vaccinated in the United States (US), they are uniquely positioned to be the most trusted source of vaccine information. Primary care clinicians, more than other groups of clinicians, scientists, government officials, media, etc. have the greatest chance for instilling confidence about the vaccine to their patients, including the most vulnerable and the most distrusting. They are considered credible and trustworthy allies for their patients in the US, however, clinicians receive little to no formal training in communication related to controversial topics, such as vaccine hesitancy. With the increasing worry about highly transmissible COVID-19 viral mutations and possible related vaccine resistance, it becomes even more critical to accelerate vaccination efforts across every community. Educating primary care clinicians regarding the importance of talking to their patients regarding their COVID-19 vaccination plans is essential.

Increased COVID-19 Vaccination Hesitancy and Health Awareness amid COVID-19 Vaccinations Programs in Israel

In January 2021, Israel started vaccinating healthcare workers (HCWs) and individuals older than 65 years with COVID-19 vaccines. Scientific literature points to vaccine hesitancy as being a major health concern. During time of pandemics, increased consciousness of health behaviors may be encountered. The current study aimed to assess attitudes to general vaccines and to COVID-19 vaccines in particular among adult (>18) Israeli general public, and among Israeli dentists and dental hygienists. Cross-sectional surveys were filled out by a total of 501 participants (361 Israeli adults >18 years, 73 dental hygienists, and 67 dentists). Along with basic demographics, participants responded to the Hebrew VAX, COVID-VAX and HCS scales. Group comparisons were analyzed using t tests and ANOVAs with Scheffe's test used for post hoc comparisons. Dental hygienists demonstrated significantly higher anti-vaccinations approaches than both dentists (p < 0.01) and the general public (p < 0.05). In all groups, attitudes towards the COVID-19 vaccines were more negative compared to attitudes towards general vaccines, with hygienists demonstrating significant negative attitudes compared to dentists (p < 0.05). The general public (p = 0.56) and hygienists demonstrated increased health awareness compared to dentists (p < 0.05). As health awareness has increased during the COVID-19 pandemic primary strategies to combat vaccine hesitancy should be implemented in the general public, and in particular, an dental teams.