Barriers to vaccination for coronavirus disease 2019 (COVID-19) control: experience from the United States

Barriers to Childhood Immunization in Rural and Remote Areas: A Qualitative Exploration From the Perspectives of Community Leaders in Sindh, Pakistan

Despite overall improvements observed at the national level, there is a significant disparity in childhood vaccination coverage rates between urban and rural regions, particularly within tribal and remote areas in Pakistan. Our study aimed to explore the views of community/tribal leaders concerning barriers and their local solutions for improving vaccine uptake, with a specific focus on remote settings. An exploratory qualitative research study was conducted from July to September 2019 in Shikarpur, Sindh, Pakistan. We interviewed 11 community leaders, after developing a semi-structured interview guide based on the health belief model. Following validation, the collected data was transcribed and subsequently translated into the English language. A stepwise process of manual familiarization, coding, theme generation, and theme review using an inductive approach was followed. While most of the rural community leaders expressed a willingness to support vaccinations, numerous unexplored barriers were identified. These barriers included an unsustainable communication system heavily dependent on polio mobile teams, discourteous behavior of healthcare personnel, cultural restrictions that limited women's involvement, economic hardships, limited transportation options, insufficient collaboration with the education sector, poor knowledge among community leaders, and security concerns. Additionally, they proposed some innovative solutions of information dissemination methods through the Ottaque system, ethics-based training, subsidized transportation services or voucher system, and addressing security concerns in collaboration with community leaders. Our findings suggest policymakers take both community leaders and members for an inclusive policy-making process to redraft the special policy for these remote and rural areas.

Strategies and resources used by public health units to encourage COVID-19 vaccination among priority groups: a behavioural science-informed review of three urban centres in Canada

BACKGROUND

Ensuring widespread COVID-19 vaccine uptake is a public health priority in Canada and globally, particularly within communities that exhibit lower uptake rates and are at a higher risk of infection. Public health units (PHUs) have leveraged many resources to promote the uptake of recommended COVID-19 vaccine doses. Understanding barriers and facilitators to vaccine uptake, and which strategies/resources have been used to address them to date, may help identify areas where further support could be provided. We sought to identify the strategies/resources used by PHUs to promote the uptake of the first and third doses of the COVID-19 vaccine among priority groups in their jurisdictions. We examined the alignment of these existing strategies/resources with behavioral science principles, to inform potential complementary strategies/resources.

METHODS

We reviewed the online and in-person strategies/resources used by three PHUs in Ontario, Canada to promote COVID-19 vaccine uptake among priority groups (Black and Eastern European populations, and/or neighbourhoods with low vaccine uptake or socioeconomic status). Strategies/resources were identified from PHU websites, social media, and PHU liaison. We used the Behaviour Change Techniques (BCT) Taxonomy - which describes 93 different ways of supporting behaviour change - to categorise the types of strategies/resources used, and the Theoretical Domains Framework - which synthesises 14 factors that can be barriers or facilitators to decisions and actions - to categorise the barriers and facilitators addressed by strategies/resources.

RESULTS

PHUs operationalised 21 out of 93 BCTs, ranging from 15 to 20 BCTs per PHU. The most frequently operationalised BCTs were found in strategies/resources that provided information about COVID-19 infection and vaccines, increased access to COVID-19 vaccination, and integrated social supports such as community ambassadors and engagement sessions with healthcare professionals. Identified BCTs aligned most frequently with addressing barriers and facilitators related to Knowledge, Environmental context and resources, and Beliefs about consequences domains.

CONCLUSION

PHUs have used several BCTs to address different barriers and facilitators to COVID-19 vaccine uptake for priority groups. Opportunities should be pursued to broaden the scope of BCTs used (e.g., operationalizing the pros and cons BCT) and barriers/facilitators addressed in strategies/resources for ongoing and future COVID-19 vaccine uptake efforts among general and prioritised populations.

Modifiable social and structural factors influence COVID-19 vaccine intention among frontline workers in the Midwestern USA: a community-engaged survey study

Introduction

COVID-19 vaccines have been a crucial measure in the pandemic response, yet vaccine uptake has been variable across the population. We sought to identify social and structural factors associated with COVID-19 vaccine intention among adults in the Midwestern USA who worked in one or more frontline industries during the COVID-19 pandemic.

Methods

A community-engaged, cross-sectional online survey study was conducted between May and July 2022 among 889 workers. Guided by Thomas and Penchasky's 5As theory of access and Thomson et al's 5As taxonomy of vaccine uptake, we assessed modifiable social and structural factors related to access (transportation and convenient locations), affordability (time and incentives), activation (reminders), acceptability (experiences in a healthcare setting, political confidence and vaccine confidence) and accommodation (language inclusion and flexible appointments). Multinomial logistic regression was used to identify potentially modifiable factors that may influence vaccine intention among more than 200 surveyed workers who had not yet been vaccinated.

Results

Workers who intended not to receive the vaccine were at least three times more likely to report transportation challenges, limited time off work and inflexible vaccine appointments compared with those who intended to vaccinate. Interest in financial incentives was strongly endorsed among workers who did not intend to vaccinate and among those who were undecided. Concerns about vaccine safety or side effects did not influence intention, whereas concerns about vaccine effectiveness were more common among workers who did not intend to vaccinate. Mistrust in government leaders was associated with positive vaccine intention.

Conclusions

Vaccine intention among frontline workers is strongly influenced by social and structural factors and not solely by hesitancy about the vaccine itself.

Parental decisions regarding the vaccination of children and adolescents against SARS-CoV-2 from 2020 to 2023: A descriptive longitudinal study of parents and children in Montreal, Canada

BACKGROUND

Given the growing evidence on the benefits of hybrid immunity, continued monitoring of vaccine uptake is warranted, particularly of socio-demographic subgroups with early vaccine hesitancy. Racial/ethnic and lower income groups experienced a high infection incidence, but few studies account for the child's history of SARS-CoV-2 infection on the parent's decision to vaccinate their child.

METHODS

EnCORE is a SARS-CoV-2 pediatric cohort study comprising five rounds of data collection from 2020 to 2023, with parental questionnaires at each round. Parent's responses on their intention to vaccinate their child and their reasons were summarized descriptively. Vaccine uptake was estimated through time and in relation to participant characteristics, using multivariable regression to adjust for covariates including a history of PCR/serology-confirmed SARS-CoV-2 infection prior to vaccine eligibility. At study end, we estimated the average time lapsed from last vaccine dose.

RESULTS

The samples for vaccine uptake and intention to vaccinate analyses were 631 and 1137 participants, respectively. At study end, uptake was 88 % but approximately 49 % of 2-to-4-year-olds remained unvaccinated (95 % CI 39.0, 58.1) and for vaccinated participants the median time since last vaccination was 353 days. In regression analyses, after adjusting for infection prior to vaccine eligibility and other covariates, we found approximately a two-fold increase in unvaccinated status associated with the parent's identification as a racial/ethnic minority and with household income in the lowest sample tercile (minority: adjusted relative risk [aRR] 2.45, 95 % CI 1.56, 3.86; income: aRR 1.76, 95 % CI 1.17, 2.66).

CONCLUSION

By mid-2023, most participants were not protected by vaccine-induced antibodies, because they were unvaccinated or several months had lapsed from their last dose. A COVID-19 infection prior to vaccine eligibility was associated with a greater risk of remaining unvaccinated but did not fully account for low uptake in ethnic/racial minorities and lower income groups.

Analysis of public opinion polls about COVID-19 vaccines: Theoretical and policy implications for vaccine communication and campaigns to address vaccine hesitancy

This study analyzed 1432 questions asked in 19 surveys (N = 43,014) on COVID-19 vaccines between January 2020 and August 2022 using dimensions including (1) information sources about COVID-19 vaccine, (2) information about the access, effectiveness, and side effects of COVID-19 vaccine, (3) COVID-19 vaccine hesitancy (i.e. false perception, skepticism, and vaccine refusal), (4) motivations to get the COVID-19 vaccine (i.e. to perform routine activities, convenience, incentives, influences, and travel requirement), (5) false perceptions caused vaccine refusal, and (6) intentions to get vaccinated. Our results show that vaccine refusal was rampant throughout the pandemic and mostly attributed to the rush in the vaccine development process and perceived safety risks. Additionally, our analysis indicates that people's motivation to get vaccinated came from varied sources such as doctors, family members, and politicians. Lastly, mandating vaccines during the pandemic did not significantly increase uptake among individuals who were initially skeptical, and concerns about the rapid development of the vaccine were a major cause of vaccine hesitancy. Findings were discussed and interpreted using the information deficit model, the two-step flow theory, and the reactance theory. This research provides valuable insights and practical implications, along with significant theoretical contributions and policy recommendations.

Perceptions of COVID-19 vaccination and factors influencing COVID-19 vaccine acceptance among indigenous peoples in Quebec, Canada: Insights from a facebook posts and comments analysis

Vaccination rates in Canada tend to be lower among Indigenous peoples than the rest of the population. The COVID-19 pandemic provided an unprecedented opportunity to better understand Indigenous perceptions about vaccination. The aim of this study was to explore perceptions of COVID-19 vaccine and other factors influencing COVID-19 vaccine acceptance as evidenced by public posts and comments on Facebook by Indigenous peoples in Quebec, Canada. We collected data on 95 Facebook pages or groups used by Indigenous peoples in Quebec between November 1, 2020, to June 15, 2021. To identify posts relating to COVID-19 vaccination, a keyword search ("vaccination," "vaccine," "shot," "does," "Moderna," "Pfizer") was carried out in English and French in the search bar of each Facebook page/group. Results show that First Nations peoples and Inuit in Quebec had important concerns about the usefulness, safety and effectiveness of COVID-19 vaccine. They also expressed fear of being used as test subjects for the rest of the population. Motivations mentioned by First Nations peoples and Inuit to get vaccinated against COVID-19 included to travel again and return to normal life with their loved ones, and the desire to protect the most vulnerable in their communities, especially Elders. Results show that Indigenous health care professionals were considered as reliable and trustful source of information regarding COVID-19, and that seeing role models being vaccinated build confidence and foster acceptance of the vaccine. Culturally adapted messages and vaccination campaigns by and for Indigenous peoples appear to be key to building trust toward COVID-19 vaccination.

Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study

Objectives

Mobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies.

Study design

The study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022.

Methods

Prisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models.

Results

The MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22-58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare.

Conclusions

The high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.

Causes and countermeasures for the increased infection and COVID-19 mortality rates in patients with schizophrenia

Schizophrenia (SCZ) is a common psychiatric disorder that has a complex pathological mechanism. During the Coronavirus disease 2019 (COVID-19) epidemic, patients with SCZ had substantially higher rates of infection with SARS-CoV-2, the virus that causes COVID-19, as well as higher COVID-19 mortality relative to patients with other mental disorders. However, the reasons for these increased rates in patients with SCZ remain unknown. In this review, we hypothesize that certain molecular pathways exhibit abnormal function in both COVID-19 and SCZ, with a focus on those related to energy metabolism dysregulation, immune system disruption, and abnormalities of the central nervous system. We review that dysregulation of energy metabolism can result in disruptions to the immune system and abnormalities within the central nervous system (CNS). Furthermore, immune system disturbances may also contribute to CNS abnormalities in both SCZ and COVID-19. We also discuss macro-factors associated with the high infection and mortality rates of COVID-19 in patients with SCZ, including sociodemographic factors, reduced access to psychiatric healthcare, structural barriers to COVID-19 vaccination, and proposed approaches to mitigate these macro-factors.

Stakeholders' perspectives on barriers to and facilitators of school-based HPV vaccination in the context of COVID-19 pandemic-related disruption: a qualitative mixed methods study

Despite successfully implementing the Human Papilloma Virus Vaccine (HPVV) program, Saskatchewan (SK) struggled to improve HPVV uptake rates. This suboptimal uptake of HPVV with a status quo of HPV-linked cervical cancer incidence rate is mainly because HPVV's impact on cancer prevention has not been realized adequately by vaccine providers and receivers. Further exploration of determinants of HPVV uptake is required to uncover high-resolution quality improvement targets for investment and situate contextually appropriate policies to improve its uptake. The study undertook a qualitative inquiry into understanding stakeholders' perspectives on HPVV experience through school-based programmes. It collected data through semi-structured initial interviews (N = 16) and follow-up interviews (N = 10) from across Saskatchewan's four Integrated Service Areas. Document analysis was conducted on all publicly available documents that included information on HPVV from January 2015 to July 2023. Thematic analysis of the data identified that inadequate information, awareness and education about HPV infection and HPVV among several groups, especially, parents, youth and school staff, was the main barrier to optimal HPVV uptake. Vaccine-related logistics, including the technical and text-heavy vaccine information sheet, understaffing, and time constraints, were other important factors that impeded HPVV uptake. A person-centred approach could educate parents in multiple dimensions.

Understanding structural inequities in Covid-19 vaccine access and uptake among disability, transgender and gender-diverse communities in India

INTRODUCTION

Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India.

METHODS

Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach.

RESULTS

Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions.

CONCLUSION

This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms.

COVID-19 Vaccine decision-making: trust among the transgender and disability communities in India

BACKGROUND

Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India.

METHODS

Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model.

RESULTS

Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional.

CONCLUSION

These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.

A health equity science approach to assessing drivers of COVID-19 vaccination coverage disparities over the course of the COVID-19 pandemic, United States, December 2020-December 2022

INTRODUCTION

Health equity science examines underlying social determinants, or drivers, of health inequities by building an evidence base to guide action across programs, public health surveillance, policy, and communications efforts. A Social Vulnerability Index (SVI) was utilized during the COVID-19 response to identify areas where inequities exist and support communities with vaccination. We set out to assess COVID-19 vaccination coverage by two SVI themes, Racial and Ethnicity Minority Status and Housing Type and Transportation to examine disparities.

METHODS

US county-level COVID-19 vaccine administration data among persons aged 5 years and older reported to the Centers for Disease Control and Prevention from December 14, 2020 to December 14, 2022, were analyzed. Counties were categorized 1) into tertiles (low, moderate, high) according to each SVI theme's level of vulnerability or 2) dichotomized by urban or rural classification. Primary series vaccination coverage per age group were assessed for SVI social factors by SVI theme tertiles or urbanicity.

RESULTS

Older adults aged 65 years and older had the highest vaccination coverage across all vulnerability factors compared with children aged 5-17 years and adults aged 18-64 years. Overall, children and adults had higher vaccination coverage in counties of high vulnerability. Greater vaccination coverage differences were observed by urbanicity as rural counties had some of the lowest vaccination coverage for children and adults.

CONCLUSION

COVID-19 vaccination efforts narrowed gaps in coverage for adults aged 65 years and older but larger vaccination coverage differences remained among younger populations. Moreover, greater disparities in coverage existed in rural counties. Health equity science approaches to analyses should extend beyond identifying differences by basic demographics such as race and ethnicity and include factors that provide context (housing, transportation, age, and geography) to assist with prioritization of vaccination efforts where true disparities in vaccination coverage exist.

Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey

BACKGROUND

The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death.

OBJECTIVE

Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors.

METHODS

Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves.

RESULTS

A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents.

CONCLUSIONS

Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases.

Determining factors for COVID-19 vaccine hesitancy among Brazilians: a study using structural equation modeling

OBJECTIVES

to investigate the factors influencing vaccine hesitancy against COVID-19 among Brazilians.

METHODS

this research employed an observational and analytical approach, utilizing a web-based survey. Data collection took place in 2020, and data analysis was conducted using structural equation modeling.

RESULTS

the prevalence of vaccine hesitancy was found to be 27.5% (1182 individuals). There is a negative correlation between belief in conspiracy theories and social influence. Among the various beliefs associated with vaccination intentions, only conspiracy beliefs exhibited significant predictive value. Thus, the findings suggest that personal beliefs significantly impact hesitancy towards vaccination, and also indicate that trust in governmental bodies is inversely related to hesitancy.

CONCLUSIONS

vaccine hesitancy emerges as a multifaceted phenomenon influenced by a complex array of factors, including personal beliefs, trust in governmental bodies, and healthcare systems.

Motivators and Barriers to COVID-19 Vaccination Intentions Across U.S. County-Level Barriers in the COVID-19 Vaccine Coverage Index

BACKGROUND

County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine.

METHODS

This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups.

RESULTS

Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05).

CONCLUSIONS

Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

Coronavirus Disease 2019 (COVID-19) Vaccination Status Prior to Delivery and Administration Among Hospitalized Obstetric Patients

Background

This chart review aimed to assess the COVID-19 vaccination status of pregnant patients prior to hospitalization for delivery and vaccine administration while hospitalized postpartum.

Methods

This was a retrospective chart review of pregnant patients admitted for delivery at WakeMed Hospital during a six-month period who were offered COVID-19 vaccination immediately following delivery. We analyzed demographic characteristics by vaccination status prior to admission, during hospitalization, and at discharge. ANOVA, chi-squared, and multinomial logistic regression analyses were performed.

Results

Data analysis was performed on 1,476 obstetric patients admitted for delivery, of which 260 (17.6%) were vaccinated prior to admission. Of the 1,216 unvaccinated postpartum patients, 257 (21.1%) received a vaccine dose. Among our population, for every year increase in age, the odds of being vaccinated before admission and receiving vaccination while hospitalized postpartum were higher than those of remaining unvaccinated. The odds of being vaccinated before admission versus remaining unvaccinated at discharge were lower for Black patients compared to White patients. The odds of receiving vaccination during hospitalization were higher for Asian and Hispanic/ Latino patients compared to White patients. The odds of being vaccinated prior to admission versus remaining unvaccinated at discharge were higher for those with private insurance compared to those with public insurance.

Limitations

At the time of our intervention, we did not collect data on COVID-19 infection status of the patient at the time of admission. Additionally, vaccination counseling and administration had not been added to standardized order sets, thus variations in counseling by providers may have impacted patient acceptance.

Conclusions

Compared to patients who remained unvaccinated following discharge, patients vaccinated prior to admission were more likely to be older with private insurance, and less likely to be Black, while patients vaccinated during hospitalization once postpartum were more likely to be older and either Asian or Hispanic/Latino.

Development, Implementation, and Evaluation of Three Outreach Events to Improve COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Communities in Houston, Texas, 2022

OBJECTIVES

Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities.

METHODS

Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January-March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated.

RESULTS

Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day.

CONCLUSION

Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake.

Immunization against Medically Important Human Coronaviruses of Public Health Concern

SARS-CoV-2 is a virus that affects the human immune system. It was observed to be on the rise since the beginning of 2020 and turned into a life-threatening pandemic. Scientists have tried to develop a possible preventive and therapeutic drug against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and other related coronaviruses by assessing COVID-19-recovered persons' immunity. This study aims to review immunization against SARS-CoV-2, along with exploring the interventions that have been developed for the prevention of SARS-CoV-2. This study also highlighted the role of phototherapy in treating SARS-CoV infection. The study adopted a review approach to gathering the information available and the progress that has been made in the treatment and prevention of COVID-19. Various vaccinations, including nucleotide, subunit, and vector-based vaccines, as well as attenuated and inactivated forms that have already been shown to have prophylactic efficacy against the Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV, have been summarized. Neutralizing and non-neutralizing antibodies are all associated with viral infections. Because there is no specific antiviral vaccine or therapies for coronaviruses, the main treatment strategy is supportive care, which is reinforced by combining broad-spectrum antivirals, convalescent plasma, and corticosteroids. COVID-19 has been a challenge to keep reconsidering the usual approaches to regulatory evaluation as a result of getting mixed and complicated findings on the vaccines, as well as licensing procedures. However, it is observed that medicinal herbs also play an important role in treating infection of the upper respiratory tract, the principal symptom of SARS-CoV due to their natural bioactive composite. However, some Traditional Chinese Medicines contain mutagens and nephrotoxins and the toxicological properties of the majority of Chinese herbal remedies are unknown. Therefore, to treat the COVID-19 infection along with conventional treatment, it is recommended that herb-drug interaction be examined thoroughly.

Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic

BACKGROUND

As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic.

AIM

Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments.

OBJECTIVES

To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital.

METHODS

Mixed-methods study using quantitative and qualitative methods.

RESULTS

Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters.

CONCLUSIONS

This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.

Understanding Reasons for Vaccination Hesitancy and Implementing Effective Countermeasures: An Online Survey of Individuals Unvaccinated against COVID-19

This online survey of unvaccinated people living in Japan aimed to identify the reasons for declining vaccination and to develop effective countermeasures. We conducted a hierarchical class analysis to classify participants, examine factors influencing their classification, and provide the information they needed about coronavirus disease 2019 (COVID-19) and trusted sources of COVID-19 information for each group. A total of 262 participants were classified into three groups: Group 1 with no specific reason (28 participants, 10.69%); Group 2 with clear concerns about trust in the vaccine (85 participants, 32.44%), and Group 3 with attitudinal barriers, such as distrust of the vaccine and complacency towards COVID-19, and structural barriers, such as vaccination appointments (149 participants, 56.87%). For each group, females tended to be classified in Group 2 more than Group 1 (Odds ratio (OR) [95% confidential intervals (95%CI)] = 1.64 (0.63 to 2.66), p = 0.001) and in Group 3 more than Group 1 (OR [95%CI] = 1.16 (0.19 to 2.12), p = 0.019). The information that the participants wanted to know about COVID-19 was different among each group (Safety: p < 0.001, Efficacy: p < 0.001, Genetic effects: p < 0.001). Those who did not receive the COVID-19 vaccine also had lower influenza vaccination coverage (8.02%). Additionally, 38 participants (14.50%) were subject to social disadvantages because they had not received the COVID-19 vaccine. Countermeasures should be carefully tailored according to the target population, reasons for hesitancy, and specific context. The findings of this study may help develop individualized countermeasures to address vaccine hesitancy.

Racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19

BACKGROUND

Trust in the healthcare system may impact adherence to recommended healthcare practices, including willingness to test for and vaccinate against COVID-19. This study examined racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19 during the first year of the pandemic.

METHODS

This cross-sectional study used data from the REACH-US study, a nationally representative online survey conducted among a diverse sample of U.S. adults from January 26, 2021-March 3, 2021 (N = 5,121). Multivariable logistic regression estimated the associations between trust in the U.S. healthcare system (measured as "Always", "Most of the time", "Sometimes/Almost Never", and "Never") and willingness to test for COVID-19, and willingness to receive the COVID-19 vaccine. Racial/ethnic differences in these associations were examined using interaction terms and multigroup analyses.

RESULTS

Always trusting the U.S. healthcare system was highest among Hispanic/Latino Spanish Language Preference (24.9%) and Asian (16.7%) adults and lowest among Multiracial (8.7%) and Black/African American (10.7%) adults. Always trusting the U.S. healthcare system, compared to never, was associated with greater willingness to test for COVID-19 (AOR: 3.20, 95% CI: 2.38-4.30) and greater willingness to receive the COVID-19 vaccine (AOR: 2.68, 95% CI: 1.97-3.65).

CONCLUSIONS

Trust in the U.S. healthcare system was associated with greater willingness to test for COVID-19 and receive the COVID-19 vaccine, however, trust in the U.S. healthcare system was lower among most marginalized racial/ethnic groups. Efforts to establish a more equitable healthcare system that increases trust may encourage COVID-19 preventive behaviors.

Important Barriers to COVID-19 Vaccination Among African Americans in Black Belt Region

BACKGROUND

To identify important barriers to COVID-19 vaccination among African Americans living in the Black Belt region.

METHODS

A cross-sectional, web-based questionnaire survey was conducted using best-worst scaling case 1 (the object case). Thirty-two potential barriers to COVID-19 vaccination were identified from the literature and confirmed by an expert. A nested balanced incomplete block design was used to generate 62 sets of 16 choice tasks. Each choice task included six barriers. Participants were asked to choose the most and least important barriers to their COVID-19 vaccination in each choice task of one set. The natural logarithm of the square root of best counts divided by the worst counts of each barrier was calculated to rank the importance of barriers.

RESULTS

Responses from a total of 808 participants were included. Among 32 barriers to COVID-19 vaccination, the five most important barriers were "safety concern of COVID-19 vaccines," "rapid mutation of COVID-19," "ingredients of COVID-19 vaccines," "Emergency Use Authorization (Fast-track approval) of COVID-19 vaccines," and "inconsistent information of COVID-19 vaccines." On the other hand, the five least important barriers were "religious reasons," "lack of time to get COVID-19 vaccine," "no support from my family and friends," "political reasons," and "fear of the needle."

CONCLUSIONS

Important barriers to the COVID-19 vaccination for African Americans living in the Black Belt region centered around the issues that could be resolved by communication strategies.

Combating COVID-19 Vaccine Inequity During the Early Stages of the COVID-19 Pandemic

Throughout the COVID-19 pandemic, populations of color have been disproportionately impacted, with higher rates of infection, hospitalization, and mortality, compared to non-Hispanic whites. These disparities in health outcomes are likely related to a combination of factors including underlying socioeconomic inequities, unequal access to healthcare, higher rates of employment in essential or public-facing occupations, language barriers, and COVID-19 vaccine inequities. In this manuscript the authors discuss strategies of how one local health department responded to vaccine inequities to better serve historically excluded communities throughout the early stages of the COVID-19 pandemic in 2021. These efforts helped increase vaccination rates in marginalized communities, primarily in the Black or African American population in Durham County, North Carolina.

Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study

BACKGROUND

In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold.

OBJECTIVE

The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination.

METHODS

As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good (κ=0.81).

RESULTS

A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45%), low estimates of risk (33/235, 14%), and fear of physical discomfort (29/235, 12%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine).

CONCLUSIONS

Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors.

Predictors of Acute Kidney Injury (AKI) among COVID-19 Patients at the US Department of Veterans Affairs: The Important Role of COVID-19 Vaccinations

BACKGROUND

There are knowledge gaps about factors associated with acute kidney injury (AKI) among COVID-19 patients. To examine AKI predictors among COVID-19 patients, a retrospective longitudinal cohort study was conducted between January 2020 and December 2022. Logistic regression models were used to examine predictors of AKI, and survival analysis was performed to examine mortality in COVID-19 patients.

RESULTS

A total of 742,799 veterans diagnosed with COVID-19 were included and 95,573 were hospitalized within 60 days following COVID-19 diagnosis. A total of 45,754 developed AKI and 28,573 AKI patients were hospitalized. Use of vasopressors (OR = 14.73; 95% CL 13.96-15.53), history of AKI (OR = 2.22; CL 2.15-2.29), male gender (OR = 1.90; CL 1.75-2.05), Black race (OR = 1.62; CL 1.57-1.65), and age 65+ (OR = 1.57; CL 1.50-1.63) were associated with AKI. Patients who were vaccinated twice and boosted were least likely to develop AKI (OR = 0.51; CL 0.49-0.53) compared to unvaccinated COVID-19 patients. Patients receiving two doses (OR = 0.77; CL = 0.72-0.81), or a single dose (OR = 0.88; CL = 0.81-0.95) were also less likely to develop AKI compared to the unvaccinated. AKI patients exhibited four times higher mortality compared to those without AKI (HR = 4.35; CL 4.23-4.50). Vaccinated and boosted patients had the lowest mortality risk compared to the unvaccinated (HR = 0.30; CL 0.28-0.31).

CONCLUSION

Use of vasopressors, being unvaccinated, older age, male gender, and Black race were associated with post COVID-19 AKI. Whether COVID-19 vaccination, including boosters, decreases the risk of developing AKI warrants additional studies.

"I shall not poison my child with your human experiment": Investigating predictors of parents' hesitancy about vaccinating younger children (<12) in Canada

BACKGROUND

Since the approval of SARS-CoV-2 vaccines for younger children (those under the age of 12), uptake has been low. Despite widespread vaccination among older children and adults, these trends may undermine public health efforts to manage future waves of SARS-CoV-2 or spill over into other childhood vaccines. The objectives of this study were to understand parents' intentions to vaccinate their children (under age 12) against SARS-CoV-2, and to explore reasons for and against SARS-CoV-2 vaccination.

METHODS

A representative sample of parents of school-aged children (ages 3-11 years) from Canada's four largest provinces were invited in June 2021 to complete a survey on the impact of COVID-19 on schooling. The survey included specific questions on parents' intentions to vaccinate their child(ren) against SARS-CoV-2. Multinomial regression models were run to estimate associations between demographic factors, political affiliation and voting, concerns about individual / family health and vaccination intention.

RESULTS

A total of 74.0 % of parents (n = 288) intended to vaccinate their children with the SARS-CoV-2 vaccine, 18.3 % (n = 71) did not intend to vaccinate and 7.7 % (n = 30) were unsure. The strongest predictor of parental hesitancy was whether a parent had themselves been vaccinated. Other factors including past voting behaviour, dissatisfaction with the government's response to the pandemic, and relatively less concern about contracting SARS-CoV-2 were also correlated with hesitancy. Parents of older children were more likely to indicate plans to vaccinate their child(ren). Analysis of the reasons for hesitancy showed parents are concerned about the safety and side effects of the vaccine, as well as with processes of testing and approval.

INTERPRETATION

A considerable proportion of Canadian parents of younger school-aged children (ages 3-11) were unsure and/or hesitant about vaccinating their children against SARS-CoV-2. As well, a much larger proportion who are not necessarily hesitant have also not had their children vaccinated. Given the evolving nature of SARS-CoV-2, including the continued emergence of new variants, reaching younger children will be important for population health. Health providers should continue to work with government institutions to ensure clear communication regarding the safety, efficacy, and importance of child vaccines for reaching public health goals.

Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021

Understanding the extent of coronavirus disease 2019 (COVID-19) nonvaccination attributable to vaccine hesitancy versus other barriers can help prioritize approaches for increasing vaccination uptake. Using data from the Centers for Disease Control and Prevention's Research and Development Survey, a nationally representative survey fielded from May 1 to June 30, 2021 (n = 5,458), we examined the adjusted population attribution fraction (PAF) of COVID-19 vaccine hesitancy attributed to nonvaccination according to sociodemographic characteristics and health-related variables. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 76.1%. The PAF was highest among adults who were ≥50 years of age (87.9%), were non-Hispanic White (83.7%), had a bachelor's degree or higher (82.7%), had an annual household income of at least $75,000 (85.5%), were insured (82.4%), and had a usual place for health care (80.7%). The PAF was lower for those who were current smokers (65.3%) compared with never smokers (77.9%), those who had anxiety or depression (65.2%) compared with those who did not (80.1%), and those who had a disability (64.5%) compared with those who did not (79.2%). Disparities in PAF suggest areas for prioritization of efforts for intervention and development of messaging campaigns that address all barriers to uptake, including hesitancy and access, to advance health equity and protect individuals from COVID-19.

Reducing Vaccination Disparities During a National Emergency Response: The US Mpox Vaccine Equity Pilot Program

CONTEXT

In response to the first reported mpox cases in May 2022, the US government implemented plans to bring testing, treatment, and vaccines to communities disproportionately affected by mpox-including the population of men who have sex with men (MSM) and Black/African American and Hispanic/Latino men, 2 subpopulations experiencing vaccination disparities. We describe the development and implementation of the US Mpox Vaccine Equity Pilot Program (MVEPP), characteristics of completed vaccination projects, and challenges that occurred. We also discuss opportunities for reducing vaccination disparities in future outbreaks.

PROGRAM

To address reported vaccination disparities, the US government launched MVEPP in 2 phases. Phase 1 centered around public events attended by large numbers of gay, bisexual, and other MSM, such as Pride festivals. Phase 2 asked health departments to propose mpox vaccination projects specifically aimed at reducing or eliminating racial/ethnic and other demographic disparities in mpox vaccination.

IMPLEMENTATION

MVEPP received 35 vaccination project proposals. We analyzed data from 22 completed projects that resulted in 25 675 doses of JYNNEOS administered. We note 3 innovative strategies that were implemented in several projects: direct collaboration with organizations providing services to MSM and transgender women; implementation of MVEPP projects in unique nonclinical community settings and at venues frequented by MSM and transgender women; and offering an array of services as part of mpox vaccination projects, rather than offering only mpox vaccination.

EVALUATION

MVEPP highlighted the importance of recognizing and working to eliminate racial/ethnic and other disparities in access to medical countermeasures during a public health emergency. Jurisdictions developed and implemented innovative strategies to bring mpox vaccination and related services to communities disproportionately affected by mpox-including MSM and the subpopulations of Black/African American and Hispanic/Latino MSM. Lessons learned from MVEPP may inform efforts to reduce disparities during future public health responses.

Hyperlocal lessons from the COVID-19 pandemic: Toward an equity-centered implementation science approach

COVID-19 vaccination campaigns across the US were implemented to mitigate the disproportionate hospitalizations and unnecessary deaths across many communities that experienced unequal gaps in initial vaccine distribution rollout and uptake. In parallel, the COVID-19 pandemic created declines in routine vaccination coverage for adults, adolescents, and children; particularly, in communities experiencing overlapping social disadvantage. Community-based efforts offer a solution to narrow immunization gaps but have not been replicated consistently nor demonstrated widespread success during the pandemic as evidenced by prevailing disparities in immunization uptake. We offer an equity centered implementation science approach that involves co-designing, co-implementing, and co-evaluating solutions with the community and all partners investing in the shared goal of sustainable improvement in health outcomes.

Barriers and facilitators in uptake of human papillomavirus vaccine across English Canada: A review

Human Papillomavirus (HPV) is a highly contagious sexually transmitted infection that leads to preventable cancers of the mouth, throat, cervix, and genitalia. Despite the wide availability of HPV Vaccine (HPVV) in Canada, its uptake remains suboptimal. This review aims to identify factors (barriers and facilitators) in HPV vaccine uptake across English Canada at three levels (provider, system, and patient). We explored academic and gray literature to examine factors involved in HPVV uptake and synthesized results based on interpretive content analysis. The review identified the following factors of prime significance in the uptake of the HPV vaccine (a) at the provider level, 'acceptability' of the HPV vaccine, and 'appropriateness' of an intervention (b) at the patient level, the 'ability to perceive' and 'knowledge sufficiency' (c) at the system level, 'attitudes' of different players in vaccine programming, planning and delivery. Further research is needed to conduct population health intervention research in this area.

Exclusive and dual influenza and COVID-19 vaccination among U.S. adults and adolescents in 2021

INTRODUCTION

Despite recommendations for influenza and COVID-19 vaccines, studies have documented gaps and disparities in vaccination coverage for adults and adolescents. Understanding the proportion and demographics of those unvaccinated against influenza and/or COVID-19 is important for tailoring appropriate messaging and strategies to increase confidence and uptake.

METHODS

Using the 2021 National Health Interview Survey (NHIS), we assessed the prevalence of four vaccination patterns (exclusive influenza vaccination, exclusive COVID-19 vaccination, dual influenza and COVID-19 vaccination, and neither vaccination) by sociodemographic and other characteristics among adults and adolescents 12-17 years. Adjusted multivariable regression analyses were conducted to examine factors associated with each of the four vaccination categories among adults and adolescents.

RESULTS

In 2021, 42.5% of adults and 28.3% of adolescents received both influenza and COVID-19 vaccines, while approximately a quarter (22.4%) of adults and a third (34.0%) of adolescents did not receive either vaccine. Among adults and adolescents, 6.0% and 11.4% were exclusively vaccinated against influenza and 29.1% and 26.4% were exclusively vaccinated against COVID-19, respectively. Among adults, exclusive COVID-19 or dual vaccination was more likely to be associated with older age, non-Hispanic multi/other race, and having a college degree compared to their respective counterparts. Exclusive influenza or neither vaccination was more likely to be associated with younger age, having a high school diploma or less, living below the poverty level, and having a previous COVID-19 diagnosis.

CONCLUSION

During the COVID-19 pandemic, approximately two-thirds of adolescents and three-fourths of adults received exclusive influenza or COVID-19 vaccines or both vaccines in 2021. Vaccination patterns differed by sociodemographic and other characteristics. Promoting confidence in vaccines and reducing barriers to access is needed to protect individuals and families from severe health consequences of vaccine-preventable diseases. Being up-to-date with all recommended vaccinations can prevent a future resurgence of hospitalizations and cases.Key messages42.5% of adults and 28.3% of adolescents received both influenza and COVID-19 vaccines in 2021, while approximately a quarter (22.4%) of adults and a third (34.0%) of adolescents did not receive either vaccine; 6.0% of adults and 11.4% of adolescents were exclusively vaccinated against influenza and 29.1% of adults and 26.4% of adolescents were exclusively vaccinated against COVID-19.Among adults, exclusive COVID-19 vaccination or dual vaccination was more likely to be associated with older age, non-Hispanic multi/other race, and having a college degree or higher compared to their respective counterparts; exclusive influenza vaccination or neither vaccination was more likely to be associated with younger age, having a high school diploma or less, living below poverty level, and having a previous COVID-19 diagnosis compared to their respective counterparts.Promoting confidence in vaccines and reducing barriers to access is needed to protect individuals and families from severe health consequences of vaccine-preventable diseases. Being up-to-date with all recommended vaccinations can prevent a future resurgence of hospitalizations and cases, especially as new variants emerge.

Barriers to COVID-19 vaccine uptake: classification and the role of Health Literacy and Media Literacy

Background

Vaccination is one of the most influential and cost-effective health interventions for preventing and reducing COVID-19 diseases. Unfortunately, the majority of the world's population is deprived of vaccination. Health Literacy (HL) and Media Literacy (ML) are essential to the COVID-19 vaccination. The present study investigates the barriers to COVID-19 vaccine uptake, focusing on classification and the roles of HL and ML.

Methods

A cross-sectional study was conducted among people 18-65 years old in Sarab City, located in East Azerbaijan, Iran, between September to October 2020. Multistage cluster sampling was employed to recruit 298 people from Health Care Services Centers (HCCs).

Results

The results of this research demonstrated that about 32.6% of participants reported that they have fully injected COVID-19 vaccines. Also, HL was positively associated with ML (r = 0.214, p < 0.05). Barriers of COVID-19 vaccine uptake were classified into personal, interpersonal, group and organizational, society and decision-making factors. Besides, barriers to the COVID-19 vaccine were significantly correlated with HL (r = -0.298, p < 0.05) and ML (r = 0.266, p < 0.05). Additionally, in the hierarchical regression model, demographic characteristics accounted for 8.2% of the variation in barriers to the COVID-19 vaccine (F = 4.34; p = 0.001), that monthly income (ß = -0.237; p < 0.05) and marriage statues (ß = 0.131; p < 0.05) were statistically associated with low barriers. HL as predictor variables explained an additional 14.4% of variation in barriers of COVID-19 vaccine (F = 53.84; p < 0.001) and ML explained an extra 9.2% of the variation (F = 38.83; p < 0.001). In total, demographic characteristics, HL dimensions and ML were able to explain 31.8% of the variation in barriers to COVID-19 vaccine.

Conclusions

According to the findings, various strategies are needed to increase the COVID-19 vaccination uptake. This is due to the fact that barriers to COVID-19 vaccination uptake are multifactorial. These facts can help health policymakers and healthcare providers design media-based interventions to reduce barriers to COVID-19 vaccination uptake among adults. Enhancing vaccine HL and ML for adults and improving vaccine confidence are of high priority.

Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC

OBJECTIVE

The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC.

METHODS

We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed.

RESULTS

Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001).

CONCLUSIONS

This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.

Contribution of vaccinations to reducing socioeconomic disparities in COVID-19 deaths across U.S. counties

PURPOSE

Although increasing vaccine uptake is a key strategy to minimize Coronavirus Disease 2019 (COVID-19) deaths, evidence of the role of vaccination rates in attenuating the socioeconomic disparity in COVID-19 deaths is limited. We thus aimed to quantify the extent to which vaccination rates contribute to the association between U.S. county-level poverty rates and COVID-19 mortality rates.

METHODS

This nationwide study analyzed data on 3142 U.S. counties. We conducted mediation analyses to calculate the proportions eliminated (PE) of the association between poverty rate and COVID-19 deaths per 100,000 population by setting the COVID-19 vaccination rate (the proportion of fully vaccinated individuals as of December 31, 2021) to different observed values.

RESULTS

Adjusted for county-level characteristics, we estimate an additional 25.3 COVID-19 deaths per 100,000 population for each 10% increase in a county's poverty rate. When we set the vaccination rate at its maximum, 90th percentile, and 75th percentile of the observed values, the PE was estimated to be 81% (P < .001), 37% (P < .001), and 21% (P < .001), respectively.

CONCLUSIONS

Higher county-level poverty rates and lower vaccination rates were associated with greater COVID-19 mortality rates in the United States. Aggressive interventions to increase vaccine uptake could substantially reduce the social disparity in COVID-19 mortality.

Correlates of COVID-19 vaccine uptake among U.S. College students

Hesitance toward COVID-19 vaccination has greatly decreased over the course of the pandemic in the U.S. However, some populations have lower vaccination rates than the general population. This study was conducted to identify correlates of being fully vaccinated (i.e., having received all doses required to be fully vaccinated) among college students using students' responses to the 2022 Spring American College Health Association-National College Health Assessment. The surveys were administered in March of 2022. The sample (n = 617) included 18-to-30-year-old students. Firth logistic regression models were performed that controlled for age, sex assigned at birth, and food security (at a 5% significance level). The model-assisted results indicated that being a member of sexual and gender minority communities, being a graduate student, and being concerned about someone close getting COVID-19 were positively associated with being fully vaccinated, while current use of any tobacco product and current use of e-cigarettes were negatively associated with being fully vaccinated (all p-values < 0.05). In addition, the percentage of fully vaccinated students was higher among transgender/gender non-binary students (95%) than among cisgender men and women (85-87%), and among sexual minority groups (93-97%) than among heterosexual/straight students (82%). Among the racial/ethnic groups considered, the percentage of fully vaccinated students was lowest among non-Hispanic Black/African American students (77%), but the racial/ethnic differences were not statistically significant (at 5% level). The study points to a critical need for development and implementation of tailored vaccination campaigns to help students from diverse communities, including tobacco users, make informed decisions and become fully vaccinated.

A Mother's Dilemma: The 5-P Model for Vaccine Decision-Making in Pregnancy

Pregnant women are a highly vaccine-resistant population and face unique circumstances that complicate vaccine decision-making. Pregnant women are also at increased risk of adverse maternal and neonatal outcomes to many vaccine-preventable diseases. Several models have been proposed to describe factors informing vaccine hesitancy and acceptance. However, none of these existing models are applicable to the complex decision-making involved with vaccine acceptance during pregnancy. We propose a model for vaccine decision-making in pregnancy that incorporates the following key factors: (1) perceived information sufficiency regarding vaccination risks during pregnancy, (2) harm avoidance to protect the fetus, (3) relationship with a healthcare provider, (4) perceived benefits of vaccination, and (5) perceived disease susceptibility and severity during pregnancy. In addition to these factors, the availability of research on vaccine safety during pregnancy, social determinants of health, structural barriers to vaccine access, prior vaccine acceptance, and trust in the healthcare system play roles in decision-making. As a final step, the pregnant individual must balance the risks and benefits of vaccination for themselves and their fetus, which adds greater complexity to the decision. Our model represents a first step in synthesizing factors informing vaccine decision-making by pregnant women, who represent a highly vaccine-resistant population and who are also at high risk for adverse outcomes for many infectious diseases.

Community-based organization perspectives on participating in state-wide community canvassing program aimed to reduce COVID-19 vaccine disparities in California

BACKGROUND

Inequities in COVID-19 vaccine accessibility and reliable COVID-related information disproportionately affected marginalized racial and ethnic communities in the U.S. The Get Out the Vaccine (GOTVax) program, an innovative statewide government-funded COVID-19 vaccine canvassing program in California, aimed to reduce structural barriers to COVID-19 vaccination in high-risk communities with low vaccination rates. GOTVax consisted of a community-academic-government partnership with 34 local trusted community-based organizations' (CBOs) to conduct COVID-19 vaccine outreach, education, and vaccine registration. The purpose of this qualitative evaluation study was to explore the barriers and facilitators of using local CBOs to deploy a geographically, racially, and ethnically diverse state-wide COVID-19 vaccine outreach program.

METHODS

Semi-structured online interviews were conducted with participating GOTVax CBO leaders from November 2021 to January 2022. Transcripts were analyzed using reflexive thematic analysis.

RESULTS

Thirty-one of 34 CBOs participated (91% response rate). Identified themes encompassed both facilitators and barriers to program participation. Key facilitators included leveraging trust through recognized entities; promoting empathetic, tailored outreach; and flexibility of milestone-based CBO funding contracts for rapid program implementation. Barriers included navigating community sociopolitical, geographic, and cultural factors; managing canvassers' safety; desiring metrics for self-evaluation of outreach success; mitigating canvassing technology challenges; and concerns of program infrastructure initially limiting outreach. CBOs problem-solved barriers with academic and government partners.

CONCLUSIONS

Between May and December 2021, the GOTVax program reached over 2 million California residents and registered over 60,000 residents for COVID-19 vaccination. Public health campaigns may improve benefits from leveraging the expertise of community-trusted CBOs and universities by providing flexible infrastructure and funding, allowing CBOs to seamlessly tailor outreach most applicable to local minoritized communities.

Adaptation and Validation of a French Version of the Vaccination Attitudes Examination (VAX) Scale

Over the past decades, vaccination has proven to be largely beneficial to global health. Despite vaccine efficacy, the French population has been recently affected by more anti-vaccination attitudes and vaccine refusal, and it is therefore necessary to validate tools to study this health issue. The Vaccination Attitudes Examination scale (VAX) is a 12-item questionnaire targeting adults that assesses general attitudes towards vaccination. The aims of the study were to translate and adapt the original English version of the scale into French and to test the psychometric properties of the scale in a French-population-based sample of adults. We included 450 French speaking adults that completed the French VAX and other questionnaires to assess convergent and divergent validities. Exploratory and confirmatory factor analyses showed that the French version of the VAX replicated the factorial structure of the original scale. Moreover, it demonstrated high internal consistency, good convergent and divergent validities, and excellent temporal stability. Furthermore, scores on the scale differentiated vaccinees from non-vaccinee respondents. Results on the scale provide us with insight into factors involved in vaccine hesitancy in France, therefore allowing French authorities and policy makers to address these specific concerns and improve vaccine acceptance rates in this country.

COVID-19 Vaccine Hesitancy: Disadvantaged Groups' Experience with Perceived Barriers, Cues to Action, and Attitudes

PURPOSE

Drawing from the Health Belief Model, we explored how disadvantaged groups in the U.S., including Black, Hispanic, less educated and wealthy individuals, experienced perceived barriers and cues to action in the context of the COVID-19 vaccination.

DESIGN

A cross-sectional survey administered in March 2021.

SETTING

USA.

SUBJECTS

A national sample of U.S. residents (n = 795) recruited from Prolific.

MEASURES

Perceived barriers (clinical, access, trust, religion/spiritual), cues to action (authorities, social circles), attitudes toward COVID-19 vaccination.

ANALYSIS

Factor analysis and Structural Equation Model (SEM) were performed in STATA 16.

RESULTS

Black and less educated individuals experienced higher clinical barriers (CI [.012, .33]; CI [.027, .10]), trust barriers (CI [.49, .92]; CI [.057, .16]), and religious/spiritual barriers (CI [.28, .66]; CI [.026, .11]). Hispanics experienced lower levels of clinical barriers (CI [-.42, .0001]). Clinical, trust, and religious/spiritual barriers were negatively related to attitudes toward vaccination (CI [-.45, -.15]; CI [-.79, -.51]; CI [-.43, -.13]). Black and less educated individuals experienced fewer cues to action by authority (CI [-.47, -.083]; CI [-.093, -.002]) and social ties (CI [-.75, -.33]; CI [-.18, -.080]). Lower-income individuals experienced fewer cues to action by social ties (CI [-.097, -.032]). Cues from social ties were positively associated with vaccination attitudes (CI [.065, .26]).

CONCLUSION

Communication should be personalized to address perceived barriers disadvantaged groups differentially experience and use sources who exert influences on these groups.

Multi-Perspective Views and Hesitancy toward COVID-19 Vaccines: A Mixed Method Study

The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.

COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study

Background

COVID-19 vaccination is the latest preventive intervention strategy in an attempt to control the global pandemic. Its efficacy has come under scrutiny because of break through infections among the vaccinated and need for booster doses. Besides, although health workers were prioritized for COVID-19 vaccine in most countries, anecdotal evidence points to high levels of reluctance to take the vaccine among health workers. We assessed COVID-19 vaccine hesitancy among health workers in Dokolo district, northern Uganda.

Methods

This was a mixed-method, cross-sectional descriptive study. A customised self-administered data collection tool was used to collect quantitative data on characteristics, vaccination status and factors for or rejection of vaccine uptake. We conducted multivariable logistic regression to assess the association between selected exposures and vaccine hesitancy using Stata version 15. Conversely, qualitative data were collected using key informant interviews (KIIs) among 15 participants that were purposively selected. Data were analysed using thematic content analysis with the help of NVivo 12.0.

Results

Of the 346 health workers enrolled, (13.3% [46/346]) were vaccine hesitant. Factors associated with vaccine hesitancy included fear of side effects (Adjusted Odds Ratio [AOR]: 2.55; 95% Confidence Interval [95%CI]: 1.00, 6.49) and health workers' lack of trust in the information provided by health authorities (AOR: 6.74; 95% CI: 2.43, 18.72). Similar factors were associated with vaccine hesitancy when we used the vaccine hesitancy score. Fear of side effects, distrust in vaccine stakeholders, and lack of trust in the vaccine were barriers to COVID-19 vaccination among health workers.

Conclusion

A small proportion of health workers were found to be hesitant to take the COVID-19 vaccine in this study. The paucity of COVID-19 vaccine safety information, which eroded the health workers' trust in the information they received on the vaccine, was responsible for health workers hesitancy to take up the vaccine in Uganda.

The effect of SARS-CoV-2 variant on respiratory features and mortality

SARS-CoV-2 (COVID-19) has caused over 80 million infections 973,000 deaths in the United States, and mutations are linked to increased transmissibility. This study aimed to determine the effect of SARS-CoV-2 variants on respiratory features, mortality, and to determine the effect of vaccination status. A retrospective review of medical records (n = 55,406 unique patients) using the University of California Health COvid Research Data Set (UC CORDS) was performed to identify respiratory features, vaccination status, and mortality from 01/01/2020 to 04/26/2022. Variants were identified using the CDC data tracker. Increased odds of death were observed amongst unvaccinated individuals and fully vaccinated, partially vaccinated, or individuals who received any vaccination during multiple waves of the pandemic. Vaccination status was associated with survival and a decreased frequency of many respiratory features. More recent SARS-CoV-2 variants show a reduction in lower respiratory tract features with an increase in upper respiratory tract features. Being fully vaccinated results in fewer respiratory features and higher odds of survival, supporting vaccination in preventing morbidity and mortality from COVID-19.

Decisions about adopting novel COVID-19 vaccines among White adults in a rural state, USA: A qualitative study

PURPOSE

Many people, especially in rural areas of the United States, choose not to receive novel COVID-19 vaccinations despite public health recommendations. Understanding how people describe decisions to get vaccinated or not may help to address hesitancy.

METHODS

We conducted semistructured interviews with 17 rural inhabitants of Maine, a sparsely populated state in the northeastern US, about COVID-19 vaccine decisions during the early rollout (March-May 2021). We used the framework method to compare responses, including between vaccine Adopters and Non-adopters.

FINDINGS

Adopters framed COVID-19 as unequivocally dangerous, if not personally, then to other people. Describing their COVID concerns, Adopters emphasized disease morbidities. By contrast, Non-adopters never mentioned morbidities, referencing instead mortality risk, which they perceived as minimal. Instead of risks associated with the disease, Non-adopters emphasized risks associated with vaccination. Uncertainty about the vaccine development process, augmented by social media, bolstered concerns about the long-term unknown risks of vaccines. Vaccine Adopters ultimately described trusting the process, while Non-adopters expressed distrust.

CONCLUSION

Many respondents framed their COVID vaccination decision by comparing the risks between the disease and the vaccine. Associating morbidity risks with COVID-19 diminishes the relevance of vaccine risks, whereas focusing on low perceived mortality risks heightens their relevance. Results could inform efforts to address COVID-19 vaccine hesitancy in the rural US and elsewhere.

PATIENT OR PUBLIC CONTRIBUTION

Members of Maine rural communities were involved throughout the study. Leaders of community health groups provided feedback on the study design, were actively involved in recruitment, and reviewed findings after analysis. All data produced and used in this study were co-constructed through the participation of community members with lived experience.

Using Location Intelligence to Evaluate the COVID-19 Vaccination Campaign in the United States: Spatiotemporal Big Data Analysis

BACKGROUND

Highly effective COVID-19 vaccines are available and free of charge in the United States. With adequate coverage, their use may help return life back to normal and reduce COVID-19-related hospitalization and death. Many barriers to widespread inoculation have prevented herd immunity, including vaccine hesitancy, lack of vaccine knowledge, and misinformation. The Ad Council and COVID Collaborative have been conducting one of the largest nationwide targeted campaigns ("It's Up to You") to communicate vaccine information and encourage timely vaccination across the United States. More than 300 major brands, digital and print media companies, and community-based organizations support the campaigns to reach distinct audiences.

OBJECTIVE

The goal of this study was to use aggregated mobility data to assess the effectiveness of the campaign on COVID-19 vaccine uptake.

METHODS

Campaign exposure data were collected from the Cuebiq advertising impact measurement platform consisting of about 17 million opted-in and deidentified mobile devices across the country. A Bayesian spatiotemporal hierarchical model was developed to assess campaign effectiveness through estimating the association between county-level campaign exposure and vaccination rates reported by the Centers for Disease Control and Prevention. To minimize potential bias in exposure to the campaign, the model included several control variables (eg, age, race or ethnicity, income, and political affiliation). We also incorporated conditional autoregressive residual models to account for apparent spatiotemporal autocorrelation.

RESULTS

The data set covers a panel of 3104 counties from 48 states and the District of Columbia during a period of 22 weeks (March 29 to August 29, 2021). Officially launched in February 2021, the campaign reached about 3% of the anonymous devices on the Cuebiq platform by the end of March, which was the start of the study period. That exposure rate gradually declined to slightly above 1% in August 2021, effectively ending the study period. Results from the Bayesian hierarchical model indicate a statistically significant positive association between campaign exposure and vaccine uptake at the county level. A campaign that reaches everyone would boost the vaccination rate by 2.2% (95% uncertainty interval: 2.0%-2.4%) on a weekly basis, compared to the baseline case of no campaign.

CONCLUSIONS

The "It's Up to You" campaign is effective in promoting COVID-19 vaccine uptake, suggesting that a nationwide targeted mass media campaign with multisectoral collaborations could be an impactful health communication strategy to improve progress against this and future pandemics. Methodologically, the results also show that location intelligence and mobile phone-based monitoring platforms can be effective in measuring impact of large-scale digital campaigns in near real time.

Barriers to COVID-19 vaccine uptake among resource-limited adults diagnosed with chronic illness

Background

Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ethnicity, suggesting that these interventions may not be adequately addressing the barriers faced by these populations. Among a sample of resource-limited individuals with chronic illnesses, we (1) described the prevalence of different types of barriers to the COVID-19 vaccination and (2) identified associations between patients' sociodemographic characteristics and barriers to vaccination.

Methods

We surveyed a national sample of patients with chronic illness and demonstrated healthcare affordability and/or access challenges about barriers to COVID-19 vaccination in July 2021. We categorized participant responses into cost, transportation, informational, and attitudinal barrier domains and assessed the prevalence of each domain, both overall and by self-reported vaccination status. Using logistic regression models, we examined unadjusted and adjusted associations between respondent characteristics (sociodemographic, geographic, and healthcare access) and self-reported barriers to vaccination.

Results

Of 1,342 respondents in the analytic sample, 20% (264/1,342) reported informational barriers and 9% (126/1,342) reported attitudinal barriers to COVID-19 vaccination. Transportation and cost barriers were reported much less commonly, by only 1.1% (15/1,342) and 0.7% (10/1,342) of the sample, respectively. Controlling for all other characteristics, respondents with either a specialist as their usual source of care or no usual source of care had an 8.4 (95% CI: 1.7-15.1) and 18.1 (95% CI: 4.3-32.0) percentage point higher predicted probability, respectively, of reporting informational barriers to care. Compared to females, males had an 8.4% point (95% CI: 5.5-11.4) lower predicted probability of reporting attitudinal barriers. Only attitudinal barriers were associated with COVID-19 vaccine uptake.

Conclusion

Among a sample of adults with chronic illnesses who had received financial assistance and case management services from a national non-profit, informational and attitudinal barriers were more commonly reported than logistical or structural access barriers (i.e., transportation and cost barriers). Interventions should target attitudinal barriers among patients with chronic illness, who may have particular concerns about the interaction of the vaccine with ongoing medical care. Additionally, interventions targeting informational barriers are particularly needed among individuals without a usual source of care.

Global state of education-related inequality in COVID-19 vaccine coverage, structural barriers, vaccine hesitancy, and vaccine refusal: findings from the Global COVID-19 Trends and Impact Survey

BACKGROUND

COVID-19 vaccine coverage and experiences of structural and attitudinal barriers to vaccination vary across populations. Education-related inequality in COVID-19 vaccine coverage and barriers within and between countries can provide insight into the hypothesised role of education as a correlate of vaccine access and acceptability. We aimed to characterise patterns of within-country education-related inequality in COVID-19 vaccine indicators across 90 countries.

METHODS

This study used data from the University of Maryland Social Data Science Center Global COVID-19 Trends and Impact Survey. Data from 90 countries (more than 14 million participants aged 18 years and older) were included in our analyses. We assessed education-related inequalities globally, across country-income groupings, and nationally for four indicators (self-reported receipt of COVID-19 vaccine, structural barriers to vaccination, vaccine hesitancy, and vaccine refusal) for the study period June 1-Dec 31, 2021. We calculated an absolute summary measure of inequality to assess the latest situation of inequality and time trends and explored the association between government vaccine availability policies and education-related inequality.

FINDINGS

Nearly all countries had higher self-reported receipt of a COVID-19 vaccine among the most educated respondents than the least educated respondents. Education-related inequality in structural barriers, vaccine hesitancy, and vaccine refusal varied across countries, and was most pronounced in high-income countries, overall. Low-income and lower-middle-income countries reported widespread experiences of structural barriers and high levels of vaccine hesitancy alongside low levels of education-related inequality. Globally, vaccine hesitancy in unvaccinated people was higher among those with lower education and vaccine refusal was higher among those with higher education, especially in high-income countries. Over the study period, education-related inequalities in self-reported receipt of a COVID-19 vaccine declined, globally and across all country income groupings. Government policies expanding vaccine availability were associated with lower education-related inequality in self-reported receipt of vaccine.

INTERPRETATION

This study serves as a baseline for continued inequality monitoring and could help to inform targeted actions for the equitable uptake of vaccines.

FUNDING

Gavi, the Vaccine Alliance.

Understanding the Impact of General Vaccine Attitudes on the Intent for Early COVID-19 Vaccination

Despite relatively high rates of population spread, morbidity and mortality, the adoption of COVID-19 vaccines among the eligible populations was relatively slow. Some of the reasons for vaccination hesitancy and refusals have been attributed to unique aspects of this pandemic, including attitudes toward COVID-19 vaccines. However, little attention has been paid to the role of underlying vaccine beliefs in the likelihood of early vaccine adoption for COVID-19. This study provides a more comprehensive assessment of factors influencing willingness to get an early vaccination, and the relative contribution of general vaccine attitudes, compared to demographics, perceived threat and institutional trust. Monthly national surveys were conducted between June and November 2020 using a national consumer panel of U.S. adults (n = 6185). By late November, only 24% of respondents said they were very likely to get a Food and Drug Administration (FDA)-approved COVID-19 vaccine as soon as it became available. While COVID-19 risk perceptions, confidence and trust in key institutions and information sources, and some demographic variables, were predictive of early vaccination intent, general beliefs regarding vaccines played a significant role, even compared to demographics, perceived risk and institutional trust. This lesson from the COVID-19 experience could help inform public health communications in future epidemics.

U.S. adults' reasons for changing their degree of willingness to vaccinate against COVID-19

Introduction

COVID-19 vaccines significantly reduce the risk of complications and hospitalizations due to this virus. When COVID-19 vaccines first became commercially available, roughly 30% of U.S. adults reported being hesitant to receive these newly developed vaccines, and 15% said they would not receive the vaccine. However, by May 2021, 19% of adults were vaccine-hesitant, and 13% refused to vaccinate against COVID-19. It is critical to understand why adults' degree of willingness to vaccinate against COVID-19 changed over time to plan for future pandemics and vaccination campaigns.

Methods

We conducted two waves of survey research over five months (January and May 2021) with a panel of 890 U.S. adults. One survey question assessed willingness to vaccinate against COVID-19. The response option included a slider scale ranging from 0 (signifying complete unwillingness) to 10 (complete willingness). We asked participants whose willingness score changed by more than one point to report their rationale for their change in perceptions. We conducted a conventional content analysis on all qualitative responses.

Results

We analyzed qualitative responses for 289 participants, 54.7% of whom had not been vaccinated against COVID-19 by May 2021. Among those who remained unvaccinated, 36.1% reported increased willingness to vaccinate. The most commonly cited reasons for becoming more willing to receive the vaccine include believing that COVID-19 vaccines are safe and effective, protecting against the pandemic, and desiring to return to pre-pandemic life. Reasons for increased COVID-19 vaccine hesitancy include vaccine safety concerns, the low perceived need for the vaccine, distrust in how COVID-19 vaccines are made and of larger institutions such as the government and pharmaceutical companies, and concerns about vaccine effectiveness.

Conclusion

Findings illuminate the rationale behind individuals' changes in their degree of willingness to vaccinate against COVID-19. It is critical to incorporate these considerations in future vaccine rollout initiatives to increase the public's vaccine confidence.

Impact of Personal Experience of COVID-19 Disease on Recreational Anglers' Attitudes and Behaviors

BACKGROUND

Anglers are a large social group with access to a "relatively safe" form of recreation, that allows the opportunity to relieve stress. An important question, however, is how they did so, and to what extent their perceived COVID-19 transition status influenced decisions both in life and at the fishing site.

AIM

Our study aimed to determine the dynamics of anglers' attitudes and behaviors during the COVID-19 pandemic as a result of the different statuses of their exposure to the SARS-CoV-2 virus. We assumed that the behavior of anglers who have not experienced the disease (were not ill and not sure if ill) will be similar and, on the other hand, different from the behavior of those who have experienced COVID-19.

METHODS

The web-assisted interviews survey was used among 586 anglers with different COVID-19 disease experience statuses. Their pandemic behavior and activities by four age groups were studied using non-metric multidimensional scaling. Redundancy analysis has been used to identify the relationship between anglers' life attitudes and socioeconomic and demographic factors, taking into account their preferences and involvement in fishing.

RESULTS

We have demonstrated that the behavior of anglers who have not experienced COVID-19 disease and do not present a reckless attitude toward pandemic threats, do not show significant differences from the life attitudes of the group experienced by the SARS-CoV-2 virus. These two groups comprise more than 70% of anglers. However, the rest show a lack of interest in an aware diagnosis of their health and a low level of acceptance of self-restraint in the area of direct social contact.

CONCLUSIONS

Unawareness, combined with ignorance, could be a potential factor in the transmission of the virus while fishing. The behaviors of almost 30% of anglers are particularly risky when combined with a strong need to fish in the company of friends and familiar people. Anglers' social identity should be tapped by fishery managers. Targeted educational campaigns should be aimed at groups around specific fishing spots. The need for self-limitation under the pandemic should be promoted for the benefit of the general public and to maintain the reputation of angling as a safe recreational activity.