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Pattyn J, Hanning N, Valckx S, Claessens T, Karafillakis E, Jong V, Theeten H, Hendrickx G, Van Damme P. Investigating the state of vaccine confidence among the general public and parents with children up to 13 years in Flanders (Belgium). Vaccine 2025; 58:127250. [PMID: 40378551 DOI: 10.1016/j.vaccine.2025.127250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 04/24/2025] [Accepted: 05/08/2025] [Indexed: 05/19/2025]
Abstract
AIM The aim of this study was to explore vaccine confidence, a factor influencing vaccination uptake, in Flanders (Belgium) during November 2023. The study evaluated confidence in vaccines generally and in specific vaccines: MMR, HPV, seasonal influenza, and COVID-19. METHODS This cross-sectional study surveyed 1500 individuals: 1000 from the general population (>18 years) and 500 parents with children (≤13 years). Vaccine confidence was measured using the Vaccine Confidence Index™ (VCI). Weighted analysis and multivariable binary logistic regressions were employed to explore the association between sociodemographic and other potential predictors influencing vaccine confidence. RESULTS The results showed that 77.9 % (CI 75.0-80.8) of the general population and 81.6 % (CI 76.5-86.6) of parents considered vaccines to be generally safe, while >80 % of both groups saw them as effective and important for children. A total of 56.9 % (CI 53.2-60.6) of the general population and 64.5 % (CI 54.5-74.5) of the parents agreed that vaccines are important, safe, effective, and compatible with their beliefs. Lower VCI scores were observed for COVID-19 (52.1 % (CI 48.2-55.9)) and HPV vaccines (56.2 % (CI 52.2-60.2)) in the general population, and for COVID-19 (50.2 % (CI 39.4-61.0)) and influenza vaccines (61.7 % (CI 51.5-72.0)) among parents. Higher VCI scores were observed in older generations (>45 years) and higher-educated individuals. CONCLUSION Most participants are confident in vaccines. While quantitative monitoring has been conducted across Europe, including in Belgium, this monitoring study focuses on Flanders, providing a valuable baseline for future reference. Longitudinal research, preferably including also qualitative research, is needed to further understand trends and how to build and sustain confidence in Flanders.
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Affiliation(s)
- Jade Pattyn
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Nikita Hanning
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Sara Valckx
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Toni Claessens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Emilie Karafillakis
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium; Department of Infectious Disease Epidemiology, London, School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Veerle Jong
- Preventive Health Policy Division, Department of Care, Flemish Ministry of Welfare, Public Health and Family, Marie-Elisabeth Belpairegebouw, Simon Bolivarlaan 17, 1000 Brussel, Belgium.
| | - Heidi Theeten
- Preventive Health Policy Division, Department of Care, Flemish Ministry of Welfare, Public Health and Family, Marie-Elisabeth Belpairegebouw, Simon Bolivarlaan 17, 1000 Brussel, Belgium.
| | - Greet Hendrickx
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
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Stanberry LR, Makadzange T, James WG, Dietrich JJ, Hotez PJ, Madhi SA, Rosenthal SL, Veller M, Taschner NP, Le Duc JW, Jee Y, Cunningham AL, Danchin M, Leask J. Proposal for a fourth indicator on vaccine uptake in the joint external evaluation tool. Bull World Health Organ 2025; 103:226-228. [PMID: 40026667 PMCID: PMC11865845 DOI: 10.2471/blt.24.292086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 11/21/2024] [Accepted: 12/10/2024] [Indexed: 03/05/2025] Open
Affiliation(s)
- Lawrence R Stanberry
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH-17, New York, 10032, United States of America (USA)
| | | | - Wilmot G James
- School of Public Health, Brown University, Providence, USA
| | - Janan J Dietrich
- African Social Sciences Unit of Research and Evaluation (ASSURE), University of the Witwatersrand, Johannesburg, South Africa
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH-17, New York, 10032, United States of America (USA)
| | - Martin Veller
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Youngmee Jee
- Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - Anthony L Cunningham
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Margie Danchin
- Vaccine Clinical trials and Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney, Australia
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Machida M, Fukushima S, Tabuchi T, Nakaya T, Fukushima W, Inoue S. Regional Disparities in Measles Vaccination Coverage and Their Associated Factors: An Ecological Study in Japan. J Epidemiol 2025; 35:100-105. [PMID: 38972730 PMCID: PMC11706677 DOI: 10.2188/jea.je20240129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The decline in measles vaccination coverage is a global concern. In Japan, coverage of the first dose of measles vaccine, which had exceeded the target of 95.0% since fiscal year (FY) 2010, fell to 93.5% in FY 2021. Vaccination coverage increased to 95.4% in FY 2022 but varied by municipality. Few studies have focused on regional disparities in measles vaccination coverage. This study aimed to clarify the regional disparities in measles vaccination coverage by municipality in Japan and their associated factors. METHODS In this ecological study, the measles vaccination coverage in FY 2022; population density; area deprivation index (ADI; an indicator of socioeconomic status); proportion of foreign nationals, single-father households, single-mother households, and mothers aged ≥30 years; and number of medical facilities, pediatricians, and non-pediatric medical doctors in 1,698 municipalities were extracted from Japanese government statistics. Negative binomial regression was performed with the number of children vaccinated against measles as the dependent variable, number of children eligible for measles vaccination as the offset term, and other factors as independent variables. RESULTS Vaccination coverage was less than 95.0% in 54.3% of municipalities. Vaccination coverage was significantly positively associated with population density and negatively associated with the proportion of single-father households, mothers aged ≥30 years, and the ADI (incidence rate ratios: 1.004, 0.976, 0.999, and 0.970, respectively). CONCLUSION This study showed regional disparities in measles vaccination coverage in Japan. Single-father households, age of mothers, and socioeconomic status may be key factors when municipalities consider strategies to improve vaccination coverage.
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Affiliation(s)
- Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shinji Fukushima
- Travellers’ Medical Center, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takahiro Tabuchi
- Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Japan
- Graduate School of Science, Tohoku University, Sendai, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa DSJ, Trevena L, Henseler J, Danchin M. Development and validation of the Vaccine Barriers Assessment Tool for identifying drivers of under-vaccination in children under five years in Australia. Hum Vaccin Immunother 2024; 20:2359623. [PMID: 38845399 PMCID: PMC11164230 DOI: 10.1080/21645515.2024.2359623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants' immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
| | - Carissa Bonner
- School of Public Health, University of Sydney, Camperdown, Australia
| | - David N. Durrheim
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
- Health Protection, Hunter New England Population Health, Wallsend, Australia
| | | | - Lyndal Trevena
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Jörg Henseler
- Department of Design, Production & Management, University of Twente, Enschede, Netherlands
- Nova Information Management School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
- Department of General Medicine, Royal Children’s Hospital, Parkville, Australia
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5
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Betsch C, Eitze S, Korn L, Shamsrizi P, Taubert F. [Vaccine hesitancy in postpandemic times-A guide for physicians]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:1056-1065. [PMID: 39327285 DOI: 10.1007/s00108-024-01784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/28/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic emphasized the importance of vaccinations for the prevention of life-threatening diseases and for avoiding the overburdening of the healthcare system. Despite the clear advantage of vaccinations, increasing vaccine hesitancy has been observed worldwide, especially among young people who are potential future parents. Vaccine hesitancy describes the delayed or lack of willingness to utilize recommended vaccinations and represents a substantial challenge for public health. This article analyzes the causes of vaccine hesitancy in the postpandemic period and discusses factors that could make communication successful. The role of artificial intelligence and structured evidence-based discussion techniques, such as the empathetic refutation interview, are emphasized. The aim is to provide practice-oriented recommendations to be able to provide physicians with tools that can help in the education counselling with insecure patients and can promote the acceptance of vaccinations.
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Affiliation(s)
- Cornelia Betsch
- Institute for Planetary Health Behaviour, Gesundheitskommunikation, Universität Erfurt, Max-Weber-Allee 3, 99089, Erfurt, Deutschland.
- Implementationsforschung, Gesundheitskommunikation, Bernhard-Nocht-Institut für Tropenmedizin, Bernhard-Nocht-Straße 74, 20359, Hamburg, Deutschland.
| | - Sarah Eitze
- Institute for Planetary Health Behaviour, Gesundheitskommunikation, Universität Erfurt, Max-Weber-Allee 3, 99089, Erfurt, Deutschland
- Implementationsforschung, Gesundheitskommunikation, Bernhard-Nocht-Institut für Tropenmedizin, Bernhard-Nocht-Straße 74, 20359, Hamburg, Deutschland
| | - Lars Korn
- Institute for Planetary Health Behaviour, Gesundheitskommunikation, Universität Erfurt, Max-Weber-Allee 3, 99089, Erfurt, Deutschland
- Implementationsforschung, Gesundheitskommunikation, Bernhard-Nocht-Institut für Tropenmedizin, Bernhard-Nocht-Straße 74, 20359, Hamburg, Deutschland
| | - Parichehr Shamsrizi
- Institute for Planetary Health Behaviour, Gesundheitskommunikation, Universität Erfurt, Max-Weber-Allee 3, 99089, Erfurt, Deutschland
- Implementationsforschung, Gesundheitskommunikation, Bernhard-Nocht-Institut für Tropenmedizin, Bernhard-Nocht-Straße 74, 20359, Hamburg, Deutschland
| | - Frederike Taubert
- Institute for Planetary Health Behaviour, Gesundheitskommunikation, Universität Erfurt, Max-Weber-Allee 3, 99089, Erfurt, Deutschland
- Implementationsforschung, Gesundheitskommunikation, Bernhard-Nocht-Institut für Tropenmedizin, Bernhard-Nocht-Straße 74, 20359, Hamburg, Deutschland
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6
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Wang X, Xing Y, Zhang E, Dai Z, Li Y, Shang S, Hu J, Zhang X, Fang Q. Understanding herpes zoster vaccine hesitancy and information asymmetry: a qualitative study in China. Front Public Health 2024; 12:1429522. [PMID: 39286749 PMCID: PMC11402811 DOI: 10.3389/fpubh.2024.1429522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024] Open
Abstract
Background Herpes zoster is more prevalent among the older adult due to the age-related immune decline, leading to significant pain and complications. Although vaccination effectively prevents viral infections, vaccine hesitancy remains a major barrier to achieving high vaccination rates.To address this, we conducted a qualitative survey using Vaccine Hesitancy Determinants Matrix and 5C model to understand and improve vaccination rates in this group. Methods Descriptive qualitative research design based on the philosophical underpinnings of naturalistic inquiry and purposive sampling methodology was conducted on adults aged 50 and above, as well as community health workers. Data were collected through semi-structured, in-depth personal interviews. The interview outline was constructed following a comprehensive review of the literature and consideration of the theoretical framework. Results Seventeen adults over 50 years and four community healthcare workers were included in this study. The study found that information asymmetry in immunization planning was evident at all stages of vaccine supply, dissemination and demand. The main manifestations included limited access to authoritative information, insufficient community awareness of herpes zoster as a route of vaccination, insufficient vocational training, significant gaps in vaccine knowledge, and high levels of complacency among individual residents. Conclusion Herpes zoster vaccine hesitancy is prevalent among middle-aged and older adults in China due to information asymmetry, vaccine complacency, inadequate community services, and other multiple layers of factors. Public health strategies should aim to reduce cognitive biases and information gaps by disseminating diverse and credible vaccine information through social media, medical institutions, and offline channels to promote higher vaccination rates.
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Affiliation(s)
- Xiaolong Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yufei Xing
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Enming Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyue Dai
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Li
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhui Shang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jiale Hu
- Department of Nurse Anesthesia, College of Health Professions, Virginia Commonwealth University, Richmond, CA, United States
| | - Xian Zhang
- Department of Nursing, Caohejing Community Health Service Center, Shanghai, China
| | - Qiong Fang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Parsekar SS, Vadrevu L, Jain M, Menon S, Taneja G. Interventions addressing routine childhood immunization and its behavioral and social drivers. Front Public Health 2024; 12:1364798. [PMID: 38966698 PMCID: PMC11223502 DOI: 10.3389/fpubh.2024.1364798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Despite the advances in vaccination, there are still several challenges in reaching millions of children in low- and middle-income countries (LMICs). In this review, we present an extensive summary of the various strategies used for improving routine immunization in LMICs to aid program implementers in designing vaccination interventions. Methods Experimental and quasi-experimental impact evaluations conducted in LMICs evaluating the effectiveness of interventions in improving routine immunization of children aged 0-5 years or the intermediate outcomes were included from 3ie's review of systematic reviews. Some additional impact evaluation studies published in recent years in select LMICs with large number of unvaccinated children were also included. Studies were coded to identify interventions and the barriers in the study context using the intervention framework developed in 3ie's Evidence Gap Map and the WHO's Behavioral and Social Drivers (BeSD) of vaccination framework, respectively. Qualitative analysis of the content was conducted to analyze the intervention strategies and the vaccination barriers that they addressed. Results and conclusion One hundred and forty-two impact evaluations were included to summarize the interventions. To address attitudinal and knowledge related barriers to vaccination and to motivate caregivers, sensitization and educational programs, media campaigns, and monetary or non-monetary incentives to caregivers, that may or may not be conditional upon certain health behaviors, have been used across contexts. To improve knowledge of vaccination, its place, time, and schedule, automated voice messages and written or pictorial messages have been used as standalone or multicomponent strategies. Interventions used to improve service quality included training and education of health workers and providing monetary or non-monetary perks to them or sending reminders to them on different aspects of provision of vaccination services. Interventions like effective planning or outreach activities, follow-up of children, tracking of children that have missed vaccinations, pay-for-performance schemes and health system strengthening have also been used to improve service access and quality. Interventions aimed at mobilizing and collaborating with the community to impact social norms, attitudes, and empower communities to make health decisions have also been widely implemented.
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Affiliation(s)
| | - Lalitha Vadrevu
- International Initiative for Impact Evaluation (3ie), New Delhi, India
| | - Monica Jain
- International Initiative for Impact Evaluation (3ie), New Delhi, India
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Abad N, Bonner KE, Huang Q, Baack B, Petrin R, Das D, Hendrich MA, Gosz MS, Lewis Z, Lintern DJ, Fisun H, Brewer NT. Behavioral and social drivers of COVID-19 vaccination initiation in the US: a longitudinal study March─ October 2021. J Behav Med 2024; 47:422-433. [PMID: 38587765 PMCID: PMC11026250 DOI: 10.1007/s10865-024-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p < .01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p < .01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p < .01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial.
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Affiliation(s)
- Neetu Abad
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Brittney Baack
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Dhiman Das
- Ipsos US Public Affairs, Washington, DC, USA
| | | | | | | | | | - Helen Fisun
- Ipsos US Public Affairs, Washington, DC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Attwell K, Turvey J, Wood L. COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake. Soc Sci Med 2024; 348:116812. [PMID: 38636209 DOI: 10.1016/j.socscimed.2024.116812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
Recent studies have used the World Health Organization's new Behavioural and Social Drivers (BeSD) framework to analyse vaccine uptake. However, this study of COVID-19 vaccination among marginalised population groups highlights the framework's limitations regarding the centrality of the state in shaping people's vaccination intentions in high income countries. We conducted interviews and focus groups with service providers and community members to explore COVID-19 vaccination amongst Western Australians experiencing homelessness and/or from other marginalised populations (such as people with substance use dependence). Analysing this data iteratively to emphasise the state's role and functions, we elaborate how trauma and mistrust of government drive thoughts, feelings, and social interactions regarding vaccination programs, which are mutually reinforcing and which inhibit individuals' willingness to engage. Government systems that leave some populations behind increase those populations' susceptibility to misinformation. Policies may generate new unintended problems: social service providers worried about vaccine advocacy damaging clients' trust, especially in the context of vaccine mandates. Reframing the state's responsibility for designing culturally and socially appropriate services, we outline how end-users and trusted providers can lead this process. We share a new framework, "Recentering the State in Vaccine Uptake," arising from our analyses.
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Affiliation(s)
- Katie Attwell
- VaxPol Lab, Political Science and International Relations, School of Social Sciences, The University of Western Australia, Perth, WA, Australia.
| | - Jake Turvey
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
| | - Lisa Wood
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
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Malas O, Boustani NM, Duradoni M, Omotoso D, Avşar AŞ, Shyroka A, Colombini G, Blanch A. The Vaccination Fear Scale (VFS-6): Adaptation, Cross-Cultural Validation, and Invariance among Genders and Six Different Cultures, Applying Classical Test Theory (CTT) and Item Response Theory (IRT). Eur J Investig Health Psychol Educ 2024; 14:808-822. [PMID: 38667807 PMCID: PMC11049080 DOI: 10.3390/ejihpe14040052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had a meaningful impact on several areas of human activity. With respect to psychological assessment, the requirements to study the fear of vaccination as a means to diminish negative behaviour towards vaccination had been reported. This study aimed to evaluate the factorial invariance of the six-item Vaccination Fear Scale (VFS-6) across individuals and cultures. To achieve this goal, a sample of university students was recruited (n = 2535; mean age = 20.59, SD = 2.04; males: 26.75%, females: 73.25%) from Spain (n = 388; 15.3%), Italy (n = 376; 14.83%), Lebanon (n = 487; 19.21%), Nigeria (n = 561; 22.13%), Turkey (n = 410; 16.17%), and Ukraine (n = 313; 12.34%). The results showed that the most appropriate factorial structure, exhibiting excellent fit indices, was a model with two correlated factors (cognitive symptoms: items 1, 2, and 4; somatic symptoms: items 3, 5, and 6) for both the total sample and individual samples from each country and language (Spanish, Italian, Arabic, English, Turkish, and Ukrainian). Notably, the VFS-6 demonstrated configural, metric, scalar, and strict invariance across sex. Regarding countries and languages, configural invariance was observed between them. Also, metric invariance was observed between Spain, Italy, and Ukraine and between Lebanon, Nigeria, and Turkey, which indicates the presence of two well-differentiated groups of countries and the possibility of inferential analysis between them. Item Response Theory analysis suggested an appropriate level of discrimination and difficulty of the test. These significant findings lay the groundwork for future investigations into vaccination fear across diverse cultural backgrounds, providing valuable insights for addressing vaccination-related concerns worldwide.
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Affiliation(s)
- Olga Malas
- Department of Psychology, Sociology and Social Work, University of Lleida, Avinguda de l’Estudi General, 4, 25001 Lleida, Spain
| | - Nada Mallah Boustani
- Faculty of Business and Management, Saint Joseph University, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon
| | - Mirko Duradoni
- Department of Education, Languages, Interculture, Literatures and Psychology, University of Florence, Via di San Salvi, 12, Building 26, 50135 Florence, Italy
| | - Dayo Omotoso
- Department of Human Anatomy, Redeemer’s University, Ede 232103, Nigeria
| | - Asiye Şengül Avşar
- Department of Measurement and Evaluation in Education, Recep Tayyip Erdoğan University, 53100 Rize, Turkey
| | - Anastasiia Shyroka
- Department of Psychology and Psychotherapy, Ukrainian Catholic University, Sventsitskogo 17, 79011 Lviv, Ukraine
| | - Giulia Colombini
- Department of Education, Languages, Interculture, Literatures and Psychology, University of Florence, Via di San Salvi, 12, Building 26, 50135 Florence, Italy
| | - Angel Blanch
- Department of Psychology, Sociology and Social Work, University of Lleida, Avinguda de l’Estudi General, 4, 25001 Lleida, Spain
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Machida M, Inoue S, Tabuchi T. General Vaccination Readiness in Japan: Results from the JASTIS 2023 Study. Jpn J Infect Dis 2024; 77:34-39. [PMID: 37914292 DOI: 10.7883/yoken.jjid.2023.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
General vaccine hesitancy is a global concern. Clarifying general vaccination readiness and the psychological factors comprising it is important. Previous studies reported that Japan has one of the lowest vaccine confidence levels worldwide. However, the status of other psychological factors comprising general vaccination readiness in Japan remains unclear. Therefore, we aimed to clarify the status of seven psychological factors comprising general vaccination readiness and their patterns in Japan. This descriptive study utilized data from a large-scale nationwide internet survey (Japan Society and New Tobacco Internet Survey 2023 study, N = 31,037). Seven psychological factors were assessed using the 7C of vaccination readiness scale. Cluster analysis was performed using k-means++ clustering to clarify patterns. Of the seven factors, support for social monitoring of people refusing vaccination (e.g., vaccine passports) was very low among the participants. Cluster analysis showed that the participants' vaccination readiness could be classified into six patterns, of which the very low vaccination readiness cluster, with the lowest scores for most psychological factors, accounted for 11.1% and was more common among those aged 30-49 years (13.1-16.4%). Individuals in this cluster may refuse to receive recommended vaccines.
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Affiliation(s)
- Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Japan
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Japan
- The Tokyo Foundation for Policy Research, Japan
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12
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Limaye RJ, Sauer M, Njogu R, Singh P, Fesshaye B, Karron RA. Characterizing Attitudes Toward Maternal RSV Vaccines Among Pregnant and Lactating Persons in Kenya: Key Considerations for Demand Generation Efforts for Vaccine Acceptance. J Pediatric Infect Dis Soc 2023; 12:638-641. [PMID: 37944043 DOI: 10.1093/jpids/piad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
This study examined attitudes toward maternal RSV vaccines among pregnant and lactating persons in Kenya. First pregnancy was associated with higher vaccine hesitancy among pregnant and lactating people, and social norms were associated with higher vaccine hesitancy among lactating people. Understanding maternal RSV attitudes is critical for vaccine acceptance.
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Affiliation(s)
- Rupali J Limaye
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior & Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rosemary Njogu
- Department of International Health, Jhpiego, Nairobi, Kenya
| | - Prachi Singh
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Berhaun Fesshaye
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruth A Karron
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
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Roy DN, Tanvir MRS, Pallab MF, Ferdiousi N, Islam E, Azam MS. Potential determinants of childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh: A cross-sectional study to assess the effects of education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:420. [PMID: 38333173 PMCID: PMC10852184 DOI: 10.4103/jehp.jehp_1153_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/24/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Rapid corona virus disease 2019 (COVID-19) vaccination drives aimed to immunize primary school-aged youth have a potential for health safety and supportive academic attainment. This study aimed to identify the potential factors influencing childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh and assess the effects of health education on vaccine confidence and receptivity. MATERIALS AND METHODS This cross-sectional study used a bilingual, multi-item, closed-ended, anonymous questionnaire adopted from the extant literature studies on the topic. Data were collected purposively by the face-to-face interview approach. In total, 627 primary school's stakeholders participated in this study. The binary logistic regressions and Chi-square tests were employed to investigate and rationalize the study-outlined objectives where <0.05 was considered statistically significant. RESULTS The pooled childhood vaccine confidence and receptivity against COVID-19 was 91% (95% CI 89-93) among the primary school's stakeholders. The regression analysis revealed that of eight potential determinants of vaccine confidence, "safety" and "effectiveness" had a highly significant (P = 0.006, P = 0.001, respectively) and positive association and "efficacy" had a significant (P = 0.03) and positive association, while "rumor" had a highly significant (P = 0.000) and negative association with childhood vaccine confidence. The analysis also showed that"health education" had a significant (P = 0.04) and positive association with childhood vaccine confidence and receptivity against COVID-19. Although the odds ratio for receiving childhood vaccine was found to be 0.6, the result was insignificant (P > 0.05) in the Chi-squared test. Hence, there was no vaccine-hesitant risky recipient group identified in implementing upcoming childhood COVID-19 vaccination programs. CONCLUSIONS This study confirms the importance of a positive perception of vaccine safety, efficacy, effectiveness, and health education for vaccine confidence under any circumstances. Childhood COVID-19 vaccine confidence is Improved if vaccination data become more available to the guardians and school community. Public health education would be considered a preferred approach for building trust and fostering childhood vaccine confidence against COVID-19 in Bangladesh.
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Affiliation(s)
- Debendra Nath Roy
- Department of Pharmacy, Jashore University of Science and Technology, Jashore, Bangladesh
- Institute of Education and Research, University of Rajshahi, Rajshahi, Bangladesh
| | | | - Maruf Faisal Pallab
- Department of Pharmacy, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Nowrin Ferdiousi
- Department of Pharmacy, Dhaka International University, Dhaka, Bangladesh
| | - Ekramul Islam
- Department of Pharmacy, University of Rajshahi, Bangladesh
| | - Md. Shah Azam
- Department of Marketing, University of Rajshahi, Rajshahi, Bangladesh
- Office of the Vice Chancellor, Rabindra University, Shahjadpur, Bangladesh
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14
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Oudin Doglioni D, Gagneux-Brunon A, Gauchet A, Bruel S, Olivier C, Pellissier G, Thilly N, Sicsic J, Raude J, Mueller JE. Psychometric validation of a 7C-model of antecedents of vaccine acceptance among healthcare workers, parents and adolescents in France. Sci Rep 2023; 13:19895. [PMID: 37963903 PMCID: PMC10646074 DOI: 10.1038/s41598-023-46864-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Support for vaccine decision-making requires a tailored approach taking into account psychological antecedents of vaccine acceptance. We aimed at validating an extended 7C-model of antecedents in three different target population groups (healthcare workers [n = 3870], parents [n = 2002] and adolescents [n = 7118]) and two vaccinations (COVID-19, HPV) in France. We performed a secondary analysis of questionnaires collecting sociodemographic characteristics, attitudes and knowledge on vaccination, and vaccine status and intention. We used standard psychometric techniques to validate a first and second order latent structure, and evaluated their association with vaccine intentionality in three levels (refusal, indecision, acceptance). In all populations, the 7C-model yielded a very good model fit (CFI and TLI > 0.90) and, in comparison with non-nested and nested 5C-models, significantly improved the model performance (Ω2, p < 0.05; Wald's test, p < 0.05). The resulting vaccine readiness score was strongly associated with vaccine intentionality (acceptance vs. indecision: βHCW = 2.93, βParents = 2.41, βAdolescents = 1.34; refusal vs. indecision: βHCW = - 1.68, βParents = - 0.16, βAdolescents = - 0.89.). The addition of confidence in the system and social conformism among antecedents of vaccine acceptance allowed a finer understanding of the continuum moving from refusal to indecision and acceptance. To work with these antecedents in interventional research, appropriate questionnaire items should be developed for various vaccines and target populations.
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Affiliation(s)
- Damien Oudin Doglioni
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, 75015, Paris, France
- Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Univ. Grenoble Alpes, Univ. Savoie Mont-Blanc, 38000, Grenoble, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Étienne - Service d'infectiologie, Saint-Étienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Inserm, U1111, CNRS, UMR530, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Saint-Étienne, France
| | - Aurélie Gauchet
- Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Univ. Savoie Mont-Blanc, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Sebastien Bruel
- Department of General Practice, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Université de Lyon, Saint-Étienne, France
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Cyril Olivier
- GERES (Groupe d'Étude sur le Risque d'Exposition des Soignants), UFR de Médecine Bichat, Paris, France
| | - Gérard Pellissier
- GERES (Groupe d'Étude sur le Risque d'Exposition des Soignants), UFR de Médecine Bichat, Paris, France
| | - Nathalie Thilly
- APEMAC, Université de Lorraine, 54000, Nancy, France
- Département Méthodologie, Promotion, Investigation, CHRU-Nancy, Université de Lorraine, 54000, Nancy, France
| | | | - Jocelyn Raude
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Université de Rennes, 35000, Rennes, France
| | - Judith E Mueller
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, 75015, Paris, France.
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Université de Rennes, 35000, Rennes, France.
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15
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Alkeridy WA, Alquaydheb H, Almuhaidib S, Sindi NA, Aljasser A, Kushner Kow J, Alqahtani AS. Determinants of Vaccine Hesitancy among Home Health Care Service Recipients in Saudi Arabia. Vaccines (Basel) 2023; 11:1436. [PMID: 37766113 PMCID: PMC10534424 DOI: 10.3390/vaccines11091436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Vaccine hesitancy has been identified by the World Health Organization (WHO) as a major worldwide health threat. Home Health Care (HHC) service recipients represent a vulnerable group and were prioritized to receive coronavirus disease (COVID-19) vaccination during the national vaccine campaigns in Saudi Arabia. We aimed to investigate the most frequent reasons for vaccine hesitancy among home health care recipients in Saudi Arabia. METHODS This cross-sectional survey was conducted among home health care (HHC) service recipients in Saudi Arabia from February 2022 to September 2022. The behavioral and social drivers (BeSD) model developed by the WHO was used to understand the factors affecting vaccination decision making in our cohort. RESULTS Of the 426 HHC service recipients enrolled in the study, a third were hesitant to complete the COVID-19 vaccination series. The most prevalent reported reason for COVID-19 vaccine refusal was concerns about the vaccine side effects (41.6%). Factors independently associated with COVID-19 vaccination hesitancy were: having chronic conditions (odds ratio [OR] = 2.59; 95% confidence interval [CI] = 1.33-5.05, p = 0.005), previous COVID-19 diagnosis (OR = 0.48; 95% CI: 0.28-0.82, p = 0.008), ease of getting the COVID-19 vaccine by themselves (OR = 0.49; 95% CI: 0.28-0.89, p = 0.018), belief in the importance of COVID-19 vaccine in protecting their health (OR = 0.60; 95% CI: 0.38-0.96, p = 0.032), and confidence in the safety of COVID-19 vaccination (OR = 0.38; 95% CI: 0.21-0.69, p = 0.001). CONCLUSION Only one-third of the study participants were hesitant to complete the series of COVID-19 vaccination. Understanding the factors underpinning vaccine hesitancy among this group would help healthcare workers and policymakers in developing personalized health awareness campaigns aimed at improving vaccine acceptance levels.
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Affiliation(s)
- Walid A. Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
- Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh 12382, Saudi Arabia;
| | - Hisham Alquaydheb
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Shadan Almuhaidib
- Scientific Research Center, Ministry of Defense Health Services, Riyadh 12426, Saudi Arabia;
| | - Nawal A. Sindi
- General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh 12382, Saudi Arabia;
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Janet Kushner Kow
- Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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16
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Patel C, Rendell N, Sargent GM, Ali A, Morgan C, Fields R, Sheel M. Measuring National Immunization System Performance: A Systematic Assessment of Available Resources. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e220055. [PMID: 37348935 PMCID: PMC10285727 DOI: 10.9745/ghsp-d-22-00555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Vaccination coverage is widely used to assess immunization performance but, on its own, provides insufficient information to drive improvements. Assessing the performance of underlying components of immunization systems is less clear, with several monitoring and evaluation (M&E) resources available for use in different operational settings and for different purposes. We studied these resources to understand how immunization system performance is measured. METHODS We reviewed peer-reviewed and gray literature published since 2000 to identify M&E resources that include national-level indicators measuring the performance of immunization systems or their components (governance, financing, regulation, information systems, vaccine logistics, workforce, service delivery, and demand generation). We summarize indicators by the system components or outcomes measured and describe findings narratively. RESULTS We identified 20 resources to monitor immunization program objectives and guide national strategic decision-making, encompassing 631 distinct indicators. Indicators for immunization program outcomes comprised the majority (124/631 [19.7%]), largely vaccination coverage (110/124 [88.7%]). Almost all resources (19/20 [95%]) included indicators for vaccine logistics (83/631 [13.2%]), and those for regulation (19/631 [3.0%]) and demand generation (28/631 [4.4%]) were least common. There was heterogeneity in how information systems (92/563 [14.6%]) and workforce (47/631 [7.4%]) were assessed across resources. Indicators for vaccination coverage in adults, data use in decision-making, equity and diversity, effectiveness of safety surveillance, and availability of a public health workforce were notably lacking. CONCLUSIONS Between the resources identified in this review, we identified considerable variability and gaps in indicators assessing the performance of some immunization system components. Given the multitude of indicators, policymakers may be better served by tailoring evaluation resources to their specific context to gain useful insight into health system performance and improve data use in decision-making for immunization programs.
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Affiliation(s)
- Cyra Patel
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia.
| | - Nicole Rendell
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
| | - Ginny M Sargent
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
| | - Akeem Ali
- World Health Organization, Seoul, Republic of Korea
| | - Christopher Morgan
- Jhpiego, Baltimore, MD, USA
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
| | - Rebecca Fields
- JSI Research & Training Institute, Inc., Arlington, VA, USA
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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17
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de Figueiredo A, Temfack E, Tajudeen R, Larson HJ. Declining trends in vaccine confidence across sub-Saharan Africa: A large-scale cross-sectional modeling study. Hum Vaccin Immunother 2023:2213117. [PMID: 37290478 DOI: 10.1080/21645515.2023.2213117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Current WHO/UNICEF estimates of routine childhood immunization coverage reveal the largest sustained decline in uptake in three decades with pronounced setbacks across Africa. Although the COVID-19 pandemic has induced significant supply and delivery disruptions, the impact of the pandemic on vaccine is less understood. We here examine trends in vaccine confidence across eight sub-Saharan countries between 2020 and 2022 via a total of 17,187 individual interviews, conducted via a multi-stage probability sampling approach and cross-sectional design and evaluated using Bayesian methods. Multilevel regression combined with poststratification weighting using local demographic information yields national and sub-national estimates of vaccine confidence in 2020 and 2022 as well as its socio-demographic associations. We identify declines in perceptions toward the importance of vaccines for children across all eight countries, with mixed trends in perceptions toward vaccine safety and effectiveness. We find that COVID-19 vaccines are perceived to be less important and safe in 2022 than in 2020 in six of the eight countries, with the only increases in COVID-19 vaccine confidence detected in Ivory Coast. There are substantial declines in vaccine confidence in the Democratic Republic of Congo and South Africa, notably in Eastern Cape, KwaZulu-Natal, Limpopo, and Northern Cape (South Africa) and Bandundu, Maniema, Kasaï-Oriental, Kongo-Central, and Sud-Kivu (DRC). While over 60-year-olds in 2022 have higher vaccine confidence in vaccines generally than younger age groups, we do not detect other individual-level socio-demographic associations with vaccine confidence at the sample sizes studied, including sex, age, education, employment status, and religious affiliation. Understanding the role of the COVID-19 pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunization system resilience.
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Affiliation(s)
- A de Figueiredo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - E Temfack
- Africa Centers for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - R Tajudeen
- Africa Centers for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - H J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Health Metrics and Evaluation, University of Washington, Hans Rosling Center, Seattle, WA, USA
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18
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Machida M, Inoue S. Patterns of HPV vaccine hesitancy among catch-up generations in Japan: A descriptive study. Vaccine 2023; 41:2956-2960. [PMID: 37024410 DOI: 10.1016/j.vaccine.2023.03.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Cervical cancer is a preventable disease caused by human papillomavirus (HPV). The HPV vaccine uptake in Japan has been slow since the Ministry of Health, Labour and Welfare suspended the recommendation for proactive HPV vaccination in 2013. In April 2022, Japan initiated catch-up vaccinations for women who missed the opportunity to receive the HPV vaccine. However, as of September 2022, very few women had received catch-up vaccination, raising concerns about vaccine hesitancy in the target population. It is necessary to understand the thinking and motivation of the target population to develop effective strategies to improve vaccination rates. Therefore, using cluster analysis, this study aimed to clarify the pattern of HPV vaccine hesitancy among the catch-up generations in Japan. METHODS This descriptive study was based on an Internet survey completed by 3,790 women in Japan aged over 18 years who were eligible for catch-up vaccination and had not yet received an HPV vaccine. Participants were asked about their intention and thinking about the HPV vaccine and descriptive norms on vaccination intention. Cluster analysis using k-means clustering was performed to clarify these patterns. RESULTS Cluster analysis revealed three hesitancy patterns: acceptance, neutral and refusal. The acceptance group, with high intention, comprised 28.2% of the participants, and students and a high-income level mainly dominated this group. The refusal group, with negative thinking and low intention, accounted for 20.1% and was more prevalent among workers and the unemployed. The neutral group, with neutral thinking and intention, accounted for 51.6%. The perceived effect of descriptive norms on vaccination intention was large in the acceptance group but small in the refusal group. CONCLUSION HPV vaccine awareness promotion strategies must be based on the characteristics of each group and the different distributions of sociodemographic factors.
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Affiliation(s)
- Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan; Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
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19
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Christou-Ergos M, Wiley KE, Leask J. Association between traumatic life events and vaccine hesitancy: A cross-sectional Australian study. Public Health 2023; 216:1-6. [PMID: 36669258 DOI: 10.1016/j.puhe.2022.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to identify associations between the experience of traumatic life events and vaccination intention to inform whether trauma-affected individuals require targeted interventions when addressing vaccine hesitancy. STUDY DESIGN We conducted an online cross-sectional survey to identify whether direct or indirect exposure to various traumatic life events and the presence of post-traumatic stress disorder (PTSD) symptoms are associated with willingness to receive a COVID-19 vaccine in an Australian sample. METHODS A national online questionnaire was administered to a representative sample of 1050 Australian adults in September 2021. RESULTS Lower willingness to receive a COVID-19 vaccine was associated with direct experience of a fire or explosion (adjusted odds ratio [aOR]: 0.42; 95% confidence interval [CI]: 0.23-0.78; P = 0.006), direct experience of severe human suffering (aOR:0.39; 95% CI: 0.21-0.71; P = 0.002) and screening positive for PTSD symptoms (aOR:0.52; 95% CI: 0.33-0.82; P = 0.005). Conversely, higher willingness to receive a COVID-19 vaccine was associated with indirect exposure to severe human suffering (aOR: 2.0; 95% CI: 1.21-3.22; P = 0.007). CONCLUSIONS Our findings suggest that the experience of traumatic events and the presence of PTSD symptoms can contribute to vaccination decisions. Our work adds to the growing recognition of the need to effectively mediate the influence of traumatic experiences on encounters within the medical setting and supports the importance of addressing the needs of trauma-affected individuals in their vaccination experiences.
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Affiliation(s)
- Maria Christou-Ergos
- University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Kerrie E Wiley
- University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia; Sydney Infectious Diseases Institute, Westmead, NSW, Australia
| | - Julie Leask
- University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, NSW, Australia; Sydney Infectious Diseases Institute, Westmead, NSW, Australia
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20
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Jiang B, Cao Y, Qian J, Jiang M, Huang Q, Sun Y, Dai P, Yi H, Zhang R, Xu L, Zheng J, Yang W, Feng L. Healthcare Workers' Attitudes toward Influenza Vaccination: A Behaviour and Social Drivers Survey. Vaccines (Basel) 2023; 11:143. [PMID: 36679986 PMCID: PMC9863509 DOI: 10.3390/vaccines11010143] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
This study aimed to understand the intention and correlation of receiving and recommending influenza vaccine (IV) among healthcare workers (HCWs) in China during the 2022/2023 season using the behavior and social drivers (BeSD) tools. A self-administered electronic survey collected 17,832 participants on a media platform. We investigated the willingness of IV and used multivariate logistic regression analysis to explore its associated factors. The average scores of the 3Cs’ model were compared by multiple comparisons. We also explored the factors that potentially correlated with recommendation willingness by partial regression. The willingness of IV was 74.89% among HCWs, and 82.58% of the participants were likely to recommend it to others during this season. Thinking and feeling was the strongest domain independently associated with willingness. All domains in BeSD were significantly different between the hesitancy and acceptance groups. Central factors in the 3Cs model were significantly different among groups (p < 0.01). HCWs’ willingness to IV recommendation was influenced by their ability to answer related questions (r = 0.187, p < 0.001) after controlling for their IV willingness and perceived risk. HCWs’ attitudes towards IV affect their vaccination and recommendation. The BeSD framework revealed the drivers during the decision-making process. Further study should classify the causes in detail to refine HCWs’ education.
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Affiliation(s)
- Binshan Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yanlin Cao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Qian
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Mingyue Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Qiangru Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yanxia Sun
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Peixi Dai
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Heya Yi
- Department of International Affairs, Chinese Preventive Medicine Association, Beijing 100062, China
| | - Run Zhang
- “Breath Circles” Network Platform, Beijing 100026, China
| | - Lili Xu
- Institute for Non-Communicable Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China
| | - Jiandong Zheng
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Christou-Ergos M, Wiley KE, Leask J. Willingness to receive a vaccine is influenced by adverse events following immunisation experienced by others. Vaccine 2023; 41:246-250. [PMID: 36446655 DOI: 10.1016/j.vaccine.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022]
Abstract
An adverse event following immunization (AEFI) can have consequences for an individual's future decision making and may contribute to vaccine hesitancy. AEFIs vary in severity and can be experienced directly (by an individual themselves) or indirectly (through witnessed or recounted events). We sought to measure the prevalence of specific AEFIs and understand which AEFIs have the greatest associations with reduced willingness to receive a vaccine and how injection anxiety may moderate the relationship. We conducted a cross-sectional online survey with both qualitative and quantitative elements in a sample of adults aged 18 years and over in Australia. Nineteen percent of the 1050 respondents reported experiencing an AEFI that they found stressful. Those who experienced an AEFI reported significantly higher levels of injection anxiety than those who did not. Within the group who reported experiencing an AEFI, respondents were significantly less likely to be willing to receive a COVID-19 vaccine if they reported: indirect exposure to an uncommon/rare AEFI compared with other AEFIs (aOR:0.39; 95% CI: 0.18-0.87); indirect exposure to a scientifically unsupported AEFI compared with other AEFIs (aOR:0.18; 95% CI: 0.05-0.57). Direct exposure to an AEFI was not associated with willingness to receive a COVID-19 vaccine. For those who reported experiencing an AEFI, the odds of willingness to receive a COVID-19 vaccine decreased significantly with an increase in injection anxiety (aOR:0.94; 95% CI: 0.9-0.98). Our results suggest that more is needed to mitigate the consequences of AEFIs on vaccine willingness. Empathically acknowledging at a community level, the experience of both real and perceived AEFIs and incorporating accounts of positive vaccination experiences in vaccine hesitancy interventions may be useful.
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Affiliation(s)
- Maria Christou-Ergos
- University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia.
| | - Kerrie E Wiley
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia; Sydney Infectious Diseases Institute, Westmead Hospital, Westmead, NSW, Australia
| | - Julie Leask
- University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia; Sydney Infectious Diseases Institute, Westmead Hospital, Westmead, NSW, Australia
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22
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Lee JT, Sean Hu S, Zhou T, Bonner KE, Kriss JL, Wilhelm E, Carter RJ, Holmes C, de Perio MA, Lu PJ, Nguyen KH, Brewer NT, Singleton JA. Employer requirements and COVID-19 vaccination and attitudes among healthcare personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August - September 2021. Vaccine 2022; 40:7476-7482. [PMID: 35941037 PMCID: PMC9234000 DOI: 10.1016/j.vaccine.2022.06.069] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. METHODS Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August-September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. RESULTS Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements-a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18-29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). CONCLUSION In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines.
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Affiliation(s)
- James T. Lee
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Corresponding author
| | - S. Sean Hu
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Tianyi Zhou
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Leidos Inc, 2295 Parklake Dr NE Suite 300, Atlanta, GA 30345, USA
| | - Kimberly E. Bonner
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Epidemic Intelligence Service, CDC, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | | | | | - Carissa Holmes
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | - Peng-jun Lu
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | - Noel T. Brewer
- UNC Gillings School of Global Public Health, 325 Rosenau Hall CB #7440 Chapel Hill, NC 27599, USA
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23
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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24
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Mavundza EJ, Ndwandwe D, Wiysonge CS. COVID-19 vaccine demand protest might have increased vaccine acceptance and uptake in South Africa. Hum Vaccin Immunother 2022; 18:2064691. [PMID: 35435798 PMCID: PMC9897633 DOI: 10.1080/21645515.2022.2064691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Safe and efficacious COVID-19 vaccines exist, but their success against the disease depends on public willingness to receive them. Vaccine hesitancy is one major obstacle to the achievement of herd immunity. On 25 June 2021, about 2000 supporters of the Economic Freedom Fighters (EFF) (the third biggest political party in South Africa) marched to the offices of the national regulatory authority (NRA) supporting COVID-19 vaccination and demanding approval of two additional vaccines (Sputnik V and Sinovac) in South Africa. The march was led by EFF leader, Julius Malema. By then, only three COVID-19 vaccines had received emergency use authorization in the country-the Janssen, AstraZeneca and Pfizer-BioNtech vaccines. It is worth noting that NRAs should only approve a vaccine if they are satisfied that its benefits outweigh any potential risks and not through political pressure. Nevertheless, we believe that this march might have increased COVID-19 vaccine acceptance and uptake among EFF supporters. The endorsement of COVID-19 vaccines by Malema, an influential political figure in South Africa, probably convinced some vaccine hesitant South Africans that COVID-19 vaccination is important. Therefore, we suggest vaccine endorsement by influential individuals in South Africa as one of the strategies to increase COVID-19 vaccine uptake.
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Affiliation(s)
- Edison Johannes Mavundza
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,CONTACT Edison Johannes Mavundza Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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25
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Mitilian E, Gosselin V, Casanova L, Fressard L, Berthiaume P, Verger P, Gagneur A. Assessment of training of general practice interns in motivational interviews about vaccination. Hum Vaccin Immunother 2022; 18:2114253. [PMID: 36494997 PMCID: PMC9746523 DOI: 10.1080/21645515.2022.2114253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The effectiveness of motivational interviewing (MI) for reducing vaccine hesitancy (VH) has been demonstrated in Quebec. We conducted a study to evaluate the acquisition of MI skills after MI training via videoconferencing for interns training as general practitioners (GPs) in southeastern France. A vaccination-specific MI training workshop was offered to interns in 2021, consisting of two separate Zoom videoconference sessions. Participants completed the Motivational Interviewing Skills in Immunization questionnaire before and after the training to measure skills acquisition. We used pairwise exact Wilcoxon-Pratt signed rank tests for the analysis. Among 45 GP interns enrolled in the first MI session, 34 (75.6%) attended both sessions and completed the questionnaire at 3 different time points. After the first session, MI knowledge scores improved significantly (+21.1 ± 21.6; P < .0001), as did application of MI skills (+36.8 ± 36.7; P < .0001), and MI practice confidence (+21.2 ± 11.1; P < .0001). The second MI session maintained the skills developed after the first session without further improvement. Participant satisfaction was high. This is the first study in France assessing the impact of a vaccination-specific MI training for GP interns. It shows a substantial improvement in knowledge, application of MI skills, and self-confidence in the practice of MI. GP interns were highly satisfied with the training despite the videoconference format. These promising results will allow the integration of MI training in GP medical curricula in order to prepare future GPs for communication in the field of vaccination.
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Affiliation(s)
- Eva Mitilian
- Aix Marseille Univ, DUMG, département universitaire de médecine générale, Marseille, France,ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France,CONTACT Eva Mitilian Aix Marseille Univ, DUMG, département universitaire de médecine générale, 40, rue Saint-Bruno, Marseille13004
| | - Virginie Gosselin
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ludovic Casanova
- Aix Marseille Univ, DUMG, département universitaire de médecine générale, Marseille, France,ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France
| | - Lisa Fressard
- ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France
| | | | - Pierre Verger
- ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France
| | - Arnaud Gagneur
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada,Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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26
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Engelbert M, Jain M, Bagai A, Parsekar SS. Improving routine childhood immunisation outcomes in low-income and middle-income countries: an evidence gap map. BMJ Open 2022; 12:e058258. [PMID: 36356993 PMCID: PMC9660714 DOI: 10.1136/bmjopen-2021-058258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To support evidence-informed decision-making, we created an evidence gap map to characterise the evidence base on the effectiveness of interventions in improving routine childhood immunisation outcomes in low-income and middle-income countries (LMICs). METHODS We developed an intervention-outcome matrix with 38 interventions and 43 outcomes. We searched academic databases and grey literature sources for relevant impact evaluations (IEs) and systematic reviews (SRs). Search results were screened on title/abstract. Those included on title/abstract were retrieved for full review. Studies meeting the eligibility criteria were included and data were extracted for each included study. All screening and data extraction was done by two independent reviewers. We analysed these data to identify trends in the geographic distribution of evidence, the concentration of evidence across intervention and outcome categories, and attention to vulnerable populations in the literature. RESULTS We identified 309 studies, comprising 226 completed IEs, 58 completed SRs, 24 ongoing IEs and 1 ongoing SR. Evidence from IEs is heavily concentrated in a handful of countries in sub-Saharan Africa and South Asia. Among interventions, the most frequently evaluated are those related to education and material incentives for caregivers or health workers. There are gaps in the study of non-material incentives and outreach to vulnerable populations. Among outcomes, those related to vaccine coverage and health are well covered. However, evidence on intermediate outcomes related to health system capacity or barriers faced by caregivers is much more limited. CONCLUSIONS There is valuable evidence available to decision-makers for use in identifying and deploying effective strategies to increase routine immunisation in LMICs. However, additional research is needed to address gaps in the evidence base.
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Affiliation(s)
- Mark Engelbert
- International Initiative for Impact Evaluation, London, UK
| | - Monica Jain
- International Initiative for Impact Evaluation, New Delhi, India
| | | | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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27
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Rughiniș C, Vulpe SN, Flaherty MG, Vasile S. Shades of doubt: Measuring and classifying vaccination confidence in Europe. Vaccine 2022; 40:6670-6679. [PMID: 36216651 DOI: 10.1016/j.vaccine.2022.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
The anti-vaccination movement, vaccine hesitancy, and wavering vaccination confidence have increasingly become matters of public interest, in parallel with an increasing normalization of representations of vaccination as risky. In this study, we used data on vaccination beliefs and behaviors from two Eurobarometer surveys to classify attitudes towards vaccination and to discuss comparability, acquiescence, and other measurement issues. Through cluster analysis, we found that individuals in the European Union (EU27) can be classified into five opinion types, differentiating the poles ("vaccine-trusting" and "vaccine-distrusting") from the "hesitant & free choice" cluster and from two relatively uncommitted clusters, the "agreeable" (or acquiescent) and the "fence-sitters." Opinion configurations on vaccination were linked to the broader social structures of age, gender, and educational attainment, to experiences of adult vaccination, and trust in different information sources. We found that trust, distrust, and confusion about vaccination have permeated all social strata in EU countries. The pandemic years have amplified uncertainty concerning vaccine safety and its effectiveness. We also noticed a decrease of trust in the voices of mainstream medical experts during the pandemic period, from about 92 % in 2019 to 73 % in 2021, and a significant increase in people who declared that they "don't know" whom to trust about vaccine information, ranging from 1 % to about 13 %. Measurements of vaccination confidence in Europe should control for acquiescence, through positively and negatively formulated items, and ensure comparability in time. We strongly recommend the inclusion of a battery of critical items in all future European Commission-funded surveys on vaccination to allow the monitoring of European public confidence in vaccination and in the relevant information sources, including trust in pharmaceutical companies; this will provide an avenue for re-establishing a broader confidence among citizens, health authorities, and specialists.
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Affiliation(s)
- Cosima Rughiniș
- Department of Sociology, University of Bucharest, Bucharest 030167, Romania.
| | - Simona-Nicoleta Vulpe
- Interdisciplinary School of Doctoral Studies, University of Bucharest, Bucharest 050107, Romania.
| | - Michael G Flaherty
- Department of Sociology, Eckerd College, St. Petersburg, FL 33711, United States.
| | - Sorina Vasile
- Interdisciplinary School of Doctoral Studies, University of Bucharest, Bucharest 050107, Romania.
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28
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Abstract
Purpose of Review In 2019, vaccine hesitancy (VH) was named as one of the top 10 threats to global health by the World Health Organization (WHO). We highlight the factors affecting VH, the role of VH in limiting vaccine uptake and inability to achieve collective immunity, and possible solutions. Recent Findings There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote VH and undermine public confidence in immunization. WHO has designed the behavioral and social drivers (BeSD) tools and survey instruments that can be used by countries to assess reasons for poor vaccine uptake in childhood for COVID-19 and plan national vaccination programs to counter these misconceptions. Summary Vaccines are one of the best preventative measures that public health care has to offer. Evidence from across the world both in high-income countries (HICs) and low/middle-income countries (LMICs) show that VH is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunization program to be successful. A context-specific and multifactorial intervention with more high-quality research is needed globally.
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29
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Pathak P, Pajai S, Kesharwani H. A Review on the Use of the HPV Vaccine in the Prevention of Cervical Cancer. Cureus 2022; 14:e28710. [PMID: 36211088 PMCID: PMC9529156 DOI: 10.7759/cureus.28710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
The main risk factor for invasive cervical carcinoma is persistent infection by the high-risk human papillomavirus (HPV). HPV is the most prevalent sexually transmitted infection (STI) and has been linked to 15 different cancers. Cervical cancer is one of the most frequent cancers among women, particularly in resource-limited countries. Cervical cancer is an HPV disease with the highest worldwide burden in resource-limited nations. With improved medical care and nationwide screening programmes, the mortality rate from cervical cancer has decreased in the past 40 years. Many developing nations have been shown to have inadequate knowledge and health-seeking practices, making proper awareness and immunisation programmes necessary. The best strategy to reduce the incidence of cervical cancer is through the administration of HPV vaccines along with routine cervical screening. The HPV vaccine is crucial for public health. Vaccinations against all HPV subtypes, namely, bivalent, quadrivalent, and nonavalent, are available. Financial issues are the main barrier to HPV vaccination. The framework for behavioural and social drivers of vaccination, which includes practical concerns, motivation, social processes, thoughts, and feelings, is widely used to uncover important aspects linked with HPV vaccination. The burden of cervical cancer due to HPV and the advantages of HPV vaccination are summarised in this review article.
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30
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Perroud JM, Soldano S, Avanceña ALV, Wagner A. Adult vaccination uptake strategies in low- and middle-income countries: A systematic review. Vaccine 2022; 40:5313-5321. [PMID: 35953323 DOI: 10.1016/j.vaccine.2022.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Evidence-based strategies can maximize vaccination intent and uptake among adults. This systematic review summarizes the existing literature on strategies to improve vaccination intent and uptake among adults in low- and middle-income countries (LMICs) to inform future implementation in various populations and contexts. METHODS Eligible studies were identified through a systematic search in Medline, Embase, Cochrane Libraries, as well as grey literature databases published between January 2010 and March 2021. The search was limited to studies in LMICs that evaluated adult vaccination interventions. Data were extracted from the included studies and evaluated against the World Health Organization's Behavioral and Social Drivers of Vaccination Framework. The National Institutes of Health study quality assessment tools were used to evaluate study quality. RESULTS The initial literature review identified 2,854 records, 22 of which met the inclusion criteria. The majority (n = 19 or 86%) of studies were from middle-income countries, with the remaining studies (n = 3 or 13%) set in low-income countries. The majority (15/22, 68%) of interventions were multi-component. 82% (18/22) of studies addressed thoughts and feelings, 59% (13/22) addressed social processes, and 73% (16/22) addressed practical issues. Five studies reported primary outcomes of vaccination intent, and the remaining 17 reported vaccine uptake. 36% (8/22) of the studies cited statistically significant positive intervention effects on vaccination intent or uptake. Few of the included studies (6/22, 27%) were RTCs, and most studies (15/22, 68%) were of poor study quality. The studies reporting the highest increase in vaccination intent and uptake were multi-component interventions that addressed all three determinants of vaccination. DISCUSSION The results of this review highlight levers that can be used to encourage vaccine intent and uptake in the ongoing rollout of COVID-19 vaccines, as well as the deployment of other vaccines to adult populations in LMICs. Of the included studies, multicomponent interventions were most effective, mainly when targeting multiple determinants of vaccination. However, poor study quality indicates the need for additional research to validate these findings.
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Affiliation(s)
- Janamarie M Perroud
- Department of Health Management and Policy, School of Public Health, University of Michigan. 1415 Washington Heights, SPH II, Ann Arbor, MI 48109, USA.
| | - Shad Soldano
- School of Public Health, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI 48109, USA
| | - Anton L V Avanceña
- Department of Health Management and Policy, School of Public Health, University of Michigan. 1415 Washington Heights, SPH II, Ann Arbor, MI 48109, USA
| | - Abram Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI 48109, USA
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31
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Espejo B, Martín-Carbonell M, Romero-Acosta KC, Fernández-Daza M, Paternina Y. Evidence of Validity and Measurement Invariance by Gender of the Vaccination Attitudes Examination (VAX) Scale in Colombian University Students. J Clin Med 2022; 11:jcm11164682. [PMID: 36012920 PMCID: PMC9409776 DOI: 10.3390/jcm11164682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Having a valid tool to assess attitudes toward vaccination and identify the concerns that drive vaccine refusal can facilitate population studies and help guide public health interventions. The objective of this study has been to adapt the Vaccination Attitudes Examination (VAX) scale in Colombian university students and to study its psychometric properties in a non-probabilistic sample of 1074 Colombian university students. Methods: A confirmatory factor analysis was used to study the factorial structure. A structural equation model was tested to study concurrent validity and to check whether the factors predicted having received the coronavirus vaccine. Gender-based measurement invariance was also studied for the best model. Results: The results support the structure of four related factors. The composite reliability index was good for all the factors, but the average variance extracted was not as good for the second factor. There was strong measurement invariance by gender, and two factors are good predictors of being vaccinated or not. Conclusions: The VAX has shown construct and concurrent validity and is a reliable tool for evaluating attitudes towards vaccines in university students in Colombia. It may help guide the implementation of actions for the National Vaccination Plan and institutional policies.
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Affiliation(s)
- Begoña Espejo
- Department of Methodology of Behavioral Sciences, University of Valencia, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-963864503
| | - Marta Martín-Carbonell
- Psychology Department, Cooperative University of Colombia, Troncal del Caribe S/N, Santa Marta 470002, Colombia
| | | | - Martha Fernández-Daza
- Psychology Department, Cooperative University of Colombia, Troncal del Caribe S/N, Santa Marta 470002, Colombia
| | - Yadid Paternina
- Psychology Department, Cooperative University of Colombia, Troncal del Caribe S/N, Santa Marta 470002, Colombia
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32
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Oduwole EO, Pienaar ED, Mahomed H, Wiysonge CS. Overview of Tools and Measures Investigating Vaccine Hesitancy in a Ten Year Period: A Scoping Review. Vaccines (Basel) 2022; 10:1198. [PMID: 36016086 PMCID: PMC9412526 DOI: 10.3390/vaccines10081198] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/23/2022] Open
Abstract
The challenge of vaccine hesitancy, a growing global concern in the last decade, has been aggravated by the COVID-19 pandemic. The need for monitoring vaccine sentiments and early detection of vaccine hesitancy in a population recommended by the WHO calls for the availability of contextually relevant tools and measures. This scoping review covers a ten year-period from 2010-2019 which included the first nine years of the decade of vaccines and aims to give a broad overview of tools and measures, and present a summary of their nature, similarities, and differences. We conducted the review using the framework for scoping reviews by Arksey and O'Malley (2005) and reported it following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' guidelines. Of the 26 studies included, only one was conducted in the WHO African Region. Measures for routine childhood vaccines were found to be the most preponderant in the reviewed literature. The need for validated, contextually relevant tools in the WHO Africa Region is essential, and made more so by the scourge of the ongoing pandemic in which vaccination is critical for curtailment.
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Affiliation(s)
- Elizabeth O. Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (E.D.P.); (C.S.W.)
| | - Elizabeth D. Pienaar
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (E.D.P.); (C.S.W.)
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (E.D.P.); (C.S.W.)
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
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Alobwede SM, Kidzeru EB, Katoto PDMC, Lumngwena EN, Cooper S, Goliath R, Jackson A, Wiysonge CS, Shey MS. Influenza Vaccination Uptake and Hesitancy among Healthcare Workers in Early 2021 at the Start of the COVID-19 Vaccine Rollout in Cape Town, South Africa. Vaccines (Basel) 2022; 10:1176. [PMID: 35893825 PMCID: PMC9332543 DOI: 10.3390/vaccines10081176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination attitudes among healthcare workers (HCWs) predict their level of vaccination uptake and intention to recommend vaccinations to their patients. To our knowledge, no study has been conducted in South Africa to assess hesitancy toward influenza vaccines among HCWs. We adapted a questionnaire developed and validated by Betsch and colleagues and used it to conduct online and face-to-face interviews among HCWs at the start of the COVID-19 vaccine rollout. Multivariate logistic regression was used to assess predictors of influenza vaccine hesitancy. Of 401 participants, 64.5% were women, 49.2% were nurses, and 12.5% were physicians. A total of 54.9% were willing to accept, 20.4% were undecided, and 24.7% intended to refuse influenza vaccination. Participants who were above 25 years of age and physicians were more likely to accept the vaccine. Key predictors of vaccine acceptance were confidence in the effectiveness, consideration of benefits and risks, and willingness to be vaccinated to protect others. Influenza vaccine hesitancy was highest in those who did not trust that influenza vaccines are safe. For future flu seasons, tailored education programs on the safety and effectiveness of flu vaccines targeting younger HCWs, could be vital to improving vaccine uptake.
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Affiliation(s)
- Samuel M. Alobwede
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Clinical Division, Department of Research and Innovation, Partners in Sexual Health, Cape Town 7500, South Africa
| | - Elvis B. Kidzeru
- Centre for Research on Health and Priority Pathologies (CRHPP), Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaounde P.O. Box 13033, Cameroon;
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine and Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
- Division of Radiation Oncology, Department of Radiation Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Patrick D. M. C. Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Evelyn N. Lumngwena
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
- Centre for the Study of Emerging and Re-Emerging Infections (CREMER), Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaounde P.O. Box 13033, Cameroon
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
| | - Amanda Jackson
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Muki S. Shey
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
- Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
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Shapiro GK. HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr Oncol 2022; 29:3780-3792. [PMID: 35621693 PMCID: PMC9140027 DOI: 10.3390/curroncol29050303] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world's cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.
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Affiliation(s)
- Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2C1, Canada;
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, 700 Bay Street, Suite 2303, Toronto, ON M5G 1Z6, Canada
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35
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Affiliation(s)
- Jane Tuckerman
- From the Vaccine Uptake Group, Infection Immunity Theme, Murdoch Children’s Research Institute, Parkville
- Dentistry and Health Sciences, University of Melbourne, Parkville
| | - Jessica Kaufman
- From the Vaccine Uptake Group, Infection Immunity Theme, Murdoch Children’s Research Institute, Parkville
- Dentistry and Health Sciences, University of Melbourne, Parkville
| | - Margie Danchin
- From the Vaccine Uptake Group, Infection Immunity Theme, Murdoch Children’s Research Institute, Parkville
- Dentistry and Health Sciences, University of Melbourne, Parkville
- Department of General Medicine, Royal Children’s Hospital, Parkville
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36
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Huang Q, Gilkey MB, Thompson P, Grabert BK, Dailey SA, Brewer NT. Explaining higher Covid-19 vaccination among some US primary care professionals. Soc Sci Med 2022; 301:114935. [PMID: 35334260 PMCID: PMC8933282 DOI: 10.1016/j.socscimed.2022.114935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Background and objective Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. Methods In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling, social processes, and direct behavior change. Results Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p < .05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p < .05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p < .05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p < .05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. Conclusions Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings.
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Affiliation(s)
- Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, University of North Carolina, USA
| | - Brigid K Grabert
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA.
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37
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J Maria AR, Cooper S, Glenton C, Lewin S, Meskell P, Suleman M, Shepperd S. Adults' views and experiences of vaccines developed in response to the COVID-19 pandemic: a qualitative evidence synthesis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ana Rita J Maria
- Nova Medical School, Faculdade de Ciências Médicas; Universidade NOVA de Lisboa; Lisbon Portugal
| | - Sara Cooper
- Cochrane South Africa; South African Medical Research Council; Cape Town South Africa
| | | | - Simon Lewin
- Division of Health Services; Norwegian Institute of Public Health; Oslo Norway
- Health Systems Research Unit; South African Medical Research Council; Cape Town South Africa
| | - Pauline Meskell
- Department of Nursing and Midwifery; University of Limerick; Limerick Ireland
| | - Mehrunisha Suleman
- Ethox Centre; Nuffield Department of Population Health, University of Oxford; Oxford UK
| | - Sasha Shepperd
- Nuffield Department of Population Health; University of Oxford; Oxford UK
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38
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Wiysonge CS, Alobwede SM, de Marie C Katoto P, Kidzeru EB, Lumngwena EN, Cooper S, Goliath R, Jackson A, Shey MS. COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa. Expert Rev Vaccines 2022; 21:549-559. [PMID: 34990311 DOI: 10.1080/14760584.2022.2023355] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND We assessed willingness to accept vaccination against coronavirus disease 2019 (COVID-19) among healthcare workers(HCWs) at the start of South Africa's vaccination roll-out. RESEARCH DESIGN AND METHODS We conducted a cross-sectional survey among HCWs in Cape Town in March-May 2021 and assessed predictors of vaccination intentions. RESULTS We recruited 395 participants; 64% women, 49% nurses, and 13% physicians. Of these, 233(59.0%) would accept and 163 (41.0%) were vaccine hesitant i.e. would either refuse or were unsure whether they would accept COVID-19 vaccination. People who did not trust that COVID-19 vaccines are effective were the most hesitant (p = 0.038). Older participants and physicians were more likely to accept vaccination than younger participants (p < 0.01) and other HCWs (p = 0.042) respectively. Other predictors of vaccine acceptance were trust that vaccines are compatible with religion (p < 0.001), consideration of benefits and risks of vaccination (p < 0.001), willingness to be vaccinated to protect others (p < 0.001), and viewing vaccination as a collective action for COVID-19 control (p = 0.029). CONCLUSIONS COVID-19 vaccine hesitancy is high among HCWs in Cape Town. Reducing this would require trust-building interventions, including tailored education.
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Affiliation(s)
- Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Samuel M Alobwede
- Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Patrick de Marie C Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Francie van Zijl Drive, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Elvis B Kidzeru
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- The Medical Research Centre (CRM), Institute of Medical Research and Medicinal Plant Studies (Impm), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Evelyn N Lumngwena
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Centre for the Study of Emerging and Re-emerging Infections (CREMER), Institute of Medical Research and Medicinal Plant Studies (Impm), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
| | - Amanda Jackson
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
| | - Muki S Shey
- Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
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39
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Verger P, Botelho-Nevers E, Garrison A, Gagnon D, Gagneur A, Gagneux-Brunon A, Dubé E. Vaccine hesitancy in health-care providers in Western countries: a narrative review. Expert Rev Vaccines 2022; 21:909-927. [PMID: 35315308 DOI: 10.1080/14760584.2022.2056026] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant. AREAS COVERED This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience. EXPERT OPINION Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.
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Affiliation(s)
- Pierre Verger
- ORS Paca, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Lyon, France.,Univ Lyon, Jean Monnet University, Saint-Etienne, France.,Chair PreVacCi, Presage Institut, Jean Monnet University, Saint-Etienne, France
| | - Amanda Garrison
- ORS Paca, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Quebec, Canada
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Quebec, Canada.,Faculté de médecine et des sciences de la santé, Département de pédiatrie, Université de Sherbrooke-Campus de la Santé, Quebec, Canada
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Lyon, France.,Univ Lyon, Jean Monnet University, Saint-Etienne, France.,Chair PreVacCi, Presage Institut, Jean Monnet University, Saint-Etienne, France.,CIC INSERM Vaccinology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Eve Dubé
- Deptartment of Anthropology, Laval University, Quebec, Canada
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Verger P, Fressard L, Soveri A, Dauby N, Fasce A, Karlsson L, Lewandoswky S, Schmid P, Dube E, Gagneur A. An instrument to measure psychosocial determinants of health care professionals' vaccination behavior: Validation of the Pro-VC-Be questionnaire. Expert Rev Vaccines 2022; 21:693-709. [PMID: 35238274 DOI: 10.1080/14760584.2022.2046467] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The lack of validated instruments assessing vaccine hesitancy/confidence among health care professionals (HCPs) for themselves, and their patients led us to develop and validate the Pro-VC-Be instrument to measure vaccine confidence and other psychosocial determinants of HCPs' vaccination behavior among diverse HCPs in different countries. METHODS Cross-sectional survey in October-November 2020 among 1,249 GPs in France, 432 GPs in French-speaking parts of Belgium, and 1,055 nurses in Quebec (Canada), all participating in general population immunization. Exploratory and confirmatory factor analyses evaluated the instrument's construct validity. We used HCPs' self-reported vaccine recommendations to patients, general immunization activity, self-vaccination, and future COVID-19 vaccine acceptance to test criterion validity. RESULTS The final results indicated a 6-factor structure with good fit: vaccine confidence (combining complacency, perceived vaccine risks, perceived benefit-risk balance, perceived collective responsibility), trust in authorities, perceived constraints, proactive efficacy (combining commitment to vaccination and self-efficacy), reluctant trust, and openness to patients. The instrument showed good convergent and criterion validity and adequate discriminant validity. CONCLUSIONS This study found that the Pro-VC-Be is a valid instrument for measuring psychosocial determinants of HCPs' vaccination behaviors in different settings. Its validation is currently underway in Europe among various HCPs in different languages.
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Affiliation(s)
- Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Anna Soveri
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Centre for Environmental Health and Occupational Health, School of Public health, Université Libre de Bruxelles (ULB), Brussel, Belgium.,Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussel, Belgium
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Linda Karlsson
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Stephan Lewandoswky
- School of Psychological Science, University of Bristol, Bristol, United Kingdom.,School of Psychological Science, University of Western Australia, Perth, Australia
| | - Philipp Schmid
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Eve Dube
- Département d'Anthropologie, Faculté des Sciences Sociales, Université Laval, Quebec, Canada.,Institut National de la Santé Publique du Québec, Quebec, Canada.,Centre de Recherche du CHU de Québec, Université Laval, Quebec, Canada
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Sherbrooke, Canada.,Université de Sherbrooke-Campus de la Santé, Sherbrooke,Canada
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Kulkarni S, Sengeh P, Eboh V, Jalloh MB, Conteh L, Sesay T, Ibrahim N, Manneh PO, Kaiser R, Jinnai Y, Wallace AS, Prybylski D, Jalloh MF. Role of Information Sources in Vaccination Uptake: Insights From a Cross-Sectional Household Survey in Sierra Leone, 2019. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00237. [PMID: 35294376 PMCID: PMC8885335 DOI: 10.9745/ghsp-d-21-00237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
Our findings suggest that health workers and faith leaders are important sources of information to deliver vaccination messages, given their strong association with vaccination confidence and uptake. In this context, vaccination promotion efforts that integrate faith leaders and health workers may help increase vaccination uptake. Introduction: There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone. Methods: In 2019, a household survey was conducted using multistage cluster sampling to randomly select 621 caregivers of children aged 12–23 months in 4 districts in Sierra Leone. We measured exposure to various sources of immunization information and 2 outcomes: (1) vaccination confidence using an aggregate score (from 12 Likert items, informed by previously validated scale) that was dichotomized into a binary variable; (2) uptake of the third dose of diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influenzae type-b-pentavalent vaccine (penta-3) based on card record or through caregiver recall when card was unavailable. Associations between information sources and the outcomes were examined using modified Poisson regression with robust variance estimator. Results: Weighted estimate for penta-3 uptake was 81% (75.2%–85.5%). The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Exposure to greater number of information sources was associated with high penta-3 uptake (aPR=1.05, 95% CI=1.02, 1.1). Discussion: Immunization information received during health facility visits and through engagement with religious leaders may enhance vaccination uptake. Assessments to understand context-specific information dynamics should be prioritized in optimizing immunization outcomes.
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Affiliation(s)
- Shibani Kulkarni
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Victor Eboh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lansana Conteh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Reinhard Kaiser
- U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Yuka Jinnai
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Aaron S Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dimitri Prybylski
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed F Jalloh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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42
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Jalloh MF, Sengeh P, Ibrahim N, Kulkarni S, Sesay T, Eboh V, Jalloh MB, Abu Pratt S, Webber N, Thomas H, Kaiser R, Singh T, Prybylski D, Omer SB, Brewer NT, Wallace AS. Association of community engagement with vaccination confidence and uptake: A cross-sectional survey in Sierra Leone, 2019. J Glob Health 2022; 12:04006. [PMID: 35265325 PMCID: PMC8876869 DOI: 10.7189/jogh.12.04006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The 2014-2016 Ebola epidemic disrupted childhood immunization in Sierra Leone, Liberia, and Guinea. After the epidemic, the Government of Sierra Leone prioritized community engagement to increase vaccination confidence and uptake. To support these efforts, we examined potential drivers of vaccination confidence and uptake in Sierra Leone. Methods We conducted a population-based household survey with primary caregivers of children in a birth cohort of 12 to 23 months in four districts with low vaccination coverage in Sierra Leone in 2019. Modified Poisson regression modeling with robust variance estimation was used to examine if perceived community engagement in planning the immunization program in the community was associated with vaccination confidence and having a fully vaccinated child. Results The sample comprised 621 age-eligible children and their caregivers (91% response rate). Half of the caregivers (52%) reported that it usually takes too long to get to the vaccination site, and 36% perceived that health workers expect money for vaccination services that are supposed to be given at no charge. When mothers were the decision-makers of the children's vaccination, 80% of the children were fully vaccinated versus 69% when fathers were the decision-makers and 56% when other relatives were the decision-makers. Caregivers with high confidence in vaccination were more likely to have fully vaccinated children compared to caregivers with low confidence (78% versus 53%). For example, caregivers who thought vaccines are 'very much' safe were more likely to have fully vaccinated children than those who thought vaccines are 'somewhat' safe (76% versus 48%). Overall, 53% of caregivers perceived high level of community engagement, 41% perceived medium level of engagement, and 6% perceived low level of engagement. Perceiving high community engagement was associated with expressing high vaccination confidence (adjusted prevalence ratio (aPR) = 2.60; 95% confidence interval (CI) = 1.67-4.04) and having a fully vaccinated child (aPR = 1.67; 95% CI = 1.18-2.38). Conclusions In these four low coverage districts in Sierra Leone, the perceived level of community engagement was strongly associated with vaccination confidence among caregivers and vaccination uptake among children. We have provided exploratory cross-sectional evidence to inform future longitudinal assessments to further investigate the potential causal effect of community engagement on vaccination confidence and uptake.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Sesay
- Expanded Program on Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Eboh
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Harold Thomas
- Health Education Division, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Reinhard Kaiser
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Tushar Singh
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Dimitri Prybylski
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saad B Omer
- Yale Institute of Global Health, Yale University, New Haven, Connecticut, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kaufman J, Bagot KL, Tuckerman J, Biezen R, Oliver J, Jos C, Ong DS, Manski‐Nankervis J, Seale H, Sanci L, Munro J, Bell JS, Leask J, Danchin M. Qualitative exploration of intentions, concerns and information needs of vaccine-hesitant adults initially prioritised to receive COVID-19 vaccines in Australia. Aust N Z J Public Health 2022; 46:16-24. [PMID: 34897909 PMCID: PMC9968588 DOI: 10.1111/1753-6405.13184] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine. METHOD In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. RESULTS Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.
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Affiliation(s)
- Jessica Kaufman
- Murdoch Children's Research Institute, Victoria,Department of Paediatrics, The University of Melbourne, Victoria,Correspondence to: Dr Jessica Kaufman, Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052
| | | | - Jane Tuckerman
- Murdoch Children's Research Institute, Victoria,Department of Paediatrics, The University of Melbourne, Victoria
| | - Ruby Biezen
- Department of General Practice, The University of Melbourne, Victoria
| | - Jane Oliver
- Murdoch Children's Research Institute, Victoria,The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria
| | - Carol Jos
- Murdoch Children's Research Institute, Victoria
| | | | | | - Holly Seale
- School of Population Health, University of New South Wales, New South Wales
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Victoria
| | - Jane Munro
- Murdoch Children's Research Institute, Victoria,The Royal Children's Hospital, Victoria
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, New South Wales
| | - Margie Danchin
- Murdoch Children's Research Institute, Victoria,Department of Paediatrics, The University of Melbourne, Victoria,The Royal Children's Hospital, Victoria
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Kaufman J, Bagot KL, Hoq M, Leask J, Seale H, Biezen R, Sanci L, Manski-Nankervis JA, Bell JS, Munro J, Jos C, Ong DS, Oliver J, Tuckerman J, Danchin M. Factors Influencing Australian Healthcare Workers' COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey. Vaccines (Basel) 2021; 10:3. [PMID: 35062664 PMCID: PMC8781521 DOI: 10.3390/vaccines10010003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
Healthcare workers' COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February-26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Kathleen L. Bagot
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
| | - Monsurul Hoq
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney 2052, Australia;
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney 2052, Australia;
| | - Ruby Biezen
- Department of General Practice, University of Melbourne, Carlton 3010, Australia; (R.B.); (L.S.); (J.-A.M.-N.)
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Carlton 3010, Australia; (R.B.); (L.S.); (J.-A.M.-N.)
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, Carlton 3010, Australia; (R.B.); (L.S.); (J.-A.M.-N.)
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne 3052, Australia;
| | - Jane Munro
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
- The Royal Children’s Hospital, Melbourne 3052, Australia
| | - Carol Jos
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
| | - Darren Suryawijaya Ong
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
| | - Jane Oliver
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne 3000, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
- The Royal Children’s Hospital, Melbourne 3052, Australia
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The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study. LANCET REGIONAL HEALTH. AMERICAS 2021; 8:100128. [PMID: 36778727 PMCID: PMC9904075 DOI: 10.1016/j.lana.2021.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Reaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors. Methods Data were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points. Findings The sample included parents of boys (n = 716) and girls (n = 843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability. Interpretation This gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake. Funding This work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.
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Court J, Carter SM, Attwell K, Leask J, Wiley K. Labels matter: Use and non-use of 'anti-vax' framing in Australian media discourse 2008-2018. Soc Sci Med 2021; 291:114502. [PMID: 34715625 DOI: 10.1016/j.socscimed.2021.114502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Childhood vaccine refusal is a globally contentious topic, with some jurisdictions addressing it with punitive policies. Media discourse influences how solutions are framed by implying blame - a process known as framing. We examined Australian media discourse on vaccine rejection over a period in which mandatory childhood vaccination policies were discussed and introduced, focusing on the common Australian pejorative term 'anti-vaxxer'. We mapped frequency of use from January 2008 to December 2018. We then searched Factiva for print media articles on childhood vaccination and parents published in that period, searching separately for articles using and not using 'anti-vaxxer' and variants. We constructed a set of 85 articles that did, and 85 articles date-matched that did not use the term to make comparisons and conducted a frame analysis of each set. 'Anti-vaxxer' was absent in Australian media discourse 2008-2010, rising to a peak of 247 articles using the term at the height of legislative change in 2017. Parents were framed as: 1) deviant "others"; 2) ignorant and in need of informing; 3) vulnerable and in need of protection from anti-vaccination activists; 4) thoughtful, critical, informed, and in need of agency and respect; 5) entitled, privileged and selfish; and finally, 6) lacking access to vaccination, rather than being unwilling. Articles using 'anti-vax' terms were more likely to negatively characterise non-vaccinating parents, while articles not including this language were more likely to frame them as thoughtful or lacking access. This study clearly demonstrates strategic use of pejoratives in the Australian mass media around a time of pressure for legislative change and conflation of anti-vaccination activists with non-vaccinating parents. We suggest fundamental changes to how non-vaccination is framed and dealt with in the media to curb polarization and fostering more respectful dialogue, and better social and public health outcomes.
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Affiliation(s)
- Jay Court
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Australia
| | - Katie Attwell
- Faculty of Arts, Business, Law and Education, School of Social Sciences, University of Western, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia; School of Public Health, University of Sydney, Australia
| | - Kerrie Wiley
- School of Public Health, University of Sydney, Australia.
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Carson SL, Casillas A, Castellon-Lopez Y, Mansfield LN, Morris D, Barron J, Ntekume E, Landovitz R, Vassar SD, Norris KC, Dubinett SM, Garrison NA, Brown AF. COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California. JAMA Netw Open 2021; 4:e2127582. [PMID: 34591103 PMCID: PMC8485164 DOI: 10.1001/jamanetworkopen.2021.27582] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022] Open
Abstract
Importance The COVID-19 pandemic has had disproportionate effects on racial and ethnic minority communities, where preexisting clinical and social conditions amplify health and social disparities. Many of these communities report lower vaccine confidence and lower receipt of the COVID-19 vaccine. Understanding factors that influence the multifaceted decision-making process for vaccine uptake is critical for narrowing COVID-19-related disparities. Objective To examine factors that members of multiethnic communities at high risk for COVID-19 infection and morbidity report as contributing to vaccine decision-making. Design, Setting, and Participants This qualitative study used community-engaged methods to conduct virtual focus groups from November 16, 2020, to January 28, 2021, with Los Angeles County residents. Potential participants were recruited through email, video, and telephone outreach to community partner networks. Focus groups were stratified by self-identified race and ethnicity as well as age. Transcripts were analyzed using reflexive thematic analysis. Main Outcomes and Measures Themes were categorized by contextual, individual, and vaccine-specific influences using the World Health Organization's Vaccine Hesitancy Matrix categories. Results A total of 13 focus groups were conducted with 70 participants (50 [71.4%] female) who self-identified as American Indian (n = 17 [24.3%]), Black/African American (n = 17 [24.3%]), Filipino/Filipina (n = 11 [15.7%]), Latino/Latina (n = 15 [21.4%]), or Pacific Islander (n = 10 [14.3%]). A total of 39 participants (55.7%) were residents from high-poverty zip codes, and 34 (48.6%) were essential workers. The resulting themes included policy implications for equitable vaccine distribution: contextual influences (unclear and unreliable information, concern for inequitable access or differential treatment, references to mistrust from unethical research studies, accessibility and accommodation barriers, eligibility uncertainty, and fears of politicization or pharmaceutical industry influence); social and group influences (inadequate exposure to trusted messengers or information, altruistic motivations, medical mistrust, and desire for autonomy); and vaccination-specific influences (need for vaccine evidence by subpopulation, misconceptions on vaccine development, allocation ambiguity, vaccination safety preferences, the importance of perceiving vaccine equity, burden of vaccine scheduling, cost uncertainty, and desire for practitioner recommendation). Conclusions and Relevance In this qualitative study, participants reported a number of factors that affected their vaccine decision-making, including concern for inequitable vaccine access. Participants endorsed policy recommendations and strategies to promote vaccine confidence. These results suggest that support of informed deliberation and attainment of vaccine equity will require multifaceted, multilevel policy approaches that improve COVID-19 vaccine knowledge, enhance trust, and address the complex interplay of sociocultural and structural barriers to vaccination.
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Affiliation(s)
- Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Yelba Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles
| | - Lisa N. Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Raphael Landovitz
- Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles
| | - Stefanie D. Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Steven M. Dubinett
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Nanibaa’ A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
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