The web and public confidence in MMR vaccination in Italy

Spreading of misinformation on mass media and digital platforms regarding vaccines. A systematic scoping review on stakeholders, policymakers, and sentiments/behavior of Italian consumers

Studies on traditional and social media have found that misinformation about vaccines has been widely spread over the last decade, negatively impacting public opinion and people's willingness to get vaccinated. We reviewed the sentiments of Italian users to define the characteristic of anti-vax and pro-vax contents and defined the strategies to deal with the misinformation. Scopus, MEDLINE/PubMed, Google Scholar (up to page 10), and ISI Web of Knowledge databases were systematically searched. Research articles, brief reports, commentaries, and letters published between January 1, 2010 and March 30, 2022 were included in the search. No-vax or ambiguous contents in Italian mass media are not prevalent compared to neutral and pro-vax content; the communication of no-vax groups is significantly simplified, favoring the understanding of the topics by users. Events related to vaccinations are associated with news coverage by media, search engine consultations, and user reactions on social networks. In this context, the activity of no-vax groups is triggered, and misinformation and fake news spread even further. A multifactorial approach is necessary to manage online user sentiment and use mass and social media as health promotion tools.

Vaccination, information and parental confidence in the digital age in England

Background

Immunisation programmes have led to substantial reductions in vaccine-preventable infectious diseases globally. A variety of factors have been shown to impact parental confidence and uptake of childhood vaccines, from concerns about vaccine safety to a lack of perceived need. Determinants of vaccine decision making include information, risk perceptions, and modifying factors such as attitude, identity, norms, habit and barriers. With the rise of the internet and social media, there has been a vast increase in information available about vaccines, not all scientifically-based and well-informed.

Methods

285 locations in England were randomly selected to survey a nationally representative sample of the English population. 1735 primary care givers of children aged between 2 months and <5 years old from England were randomly selected and surveyed via face-to-face interviews between January and March 2019.

Results

A much higher percentage of parents surveyed trust health care workers, the NHS, pharmacists and government for advice about immunisation, in comparison to media, the internet and social media. Most parents use official sources to obtain information on vaccines including parents who use the internet. The small proportion of parents who reported having seen negative information about vaccines were more likely to find it on the internet. Parents who felt they did not have enough information were more likely to have delayed or refused a vaccine for their child.

Interpretation

This study showed that for parents of young children in England, vaccination continues to be the social norm but this can rapidly change and clear, consistent messaging from trusted sources continues to be important. Although a proportion do seek vaccine information on the internet, the majority use official sources. Representative attitudinal surveys continue to be key in identifying any emerging threats to parental vaccine confidence.

The Correlation Among COVID-19 Vaccine Acceptance, the Ability to Detect Fake News, and e-Health Literacy

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has seen a rise in the spread of misleading and deceptive information, leading to a negative impact on the acceptance of the COVID-19 vaccine and public opinion. To address this issue, the importance of public e-Health literacy cannot be overstated. It empowers individuals to effectively utilize information technology and combat the dissemination of inaccurate narratives.

OBJECTIVE

This study aimed to investigate the relationship between the ability to identify disingenuous news, electronic health literacy, and the inclination to receive the COVID-19 immunization.

METHODS

In this descriptive-analytical cross-sectional study conducted during summer 2021 in Isfahan, Iran, 522 individuals older than age 18 years, seeking medical attention at health centers, were surveyed. The participants were selected through a meticulous multistage cluster sampling process from the pool of individuals referred to these health centers. Along with demographic information, data collection instruments included the standard e-Health literacy questionnaire and a researcher-developed questionnaire designed to identify misinformation. The collected questionnaires were entered into SPSS 24 for statistical analysis, which included the Kruskal-Wallis test, the Chi-square test, the Spearman test, and logistic regression models.

KEY RESULTS

The study findings revealed a statistically significant relationship between acceptance of the COVID-19 vaccine and the ability to identify deceptive news. An increase of one unit in the score for recognizing misinformation led to a 24% and 32% reduction in vaccine hesitancy and the intention to remain unvaccinated, respectively. Furthermore, a significant correlation was found between the intention to receive the vaccine and e-Health literacy, where an increase of one unit in e-Health literacy score corresponded to a 6% decrease in the intention to remain unvaccinated. Additionally, the study found a notable association between the ability to detect false and misleading information and e-Health literacy. Each additional point in e-Health literacy was associated with a 0.33% increase in the capacity to identify fake news (Spearman's Rho = 0.333, p < .001).

CONCLUSION

The study outcomes demonstrate a positive correlation between the COVID-19 vaccine acceptance, the ability to identify counterfeit news, and proficiency in electronic health literacy. These findings provide a strong foundation for policymakers and health care practitioners to develop and implement strategies that counter the dissemination of spurious and deceitful information related to COVID-19 and COVID-19 immunization. [HLRP: Health Literacy Research and Practice. 2023;7(3):e130-e138.].

COVID-19 vaccination coverage and its cognitive determinants among older adults in Shanghai, China, during the COVID-19 epidemic

Objectives

This study aimed to examine the coverage of coronavirus disease 2019 (COVID-19) vaccination and its cognitive determinants among older adults.

Methods

A cross-sectional study was conducted using a questionnaire to conduct a survey among 725 Chinese older adults aged 60 years and above in June 2022, 2 months after the mass COVID-19 outbreak in Shanghai, China. The questionnaire covered demographic characteristics, COVID-19 vaccination status, internal risk perception, knowledge, and attitude toward the efficacy and safety of COVID-19 vaccines.

Results

The vaccination rate was 78.3% among the surveyed individuals. Self-reported reasons for unwillingness to get vaccinated (multiple selections) were "concerns about acute exacerbation of chronic diseases after vaccination (57.3%)" and "concerns regarding vaccine side effects (41.4%)." Compared to the unvaccinated group, the vaccinated group tended to have a higher score in internal risk perception (t = 2.64, P < 0.05), better knowledge of COVID-19 vaccines (t = 5.84, P < 0.05), and a more positive attitude toward the efficacy and safety of COVID-19 vaccines (t = 7.92, P < 0.05). The path analysis showed that the cognitive effect on vaccination behavior is relatively large, followed by the internal risk perception, and then the attitude toward COVID-19 vaccines. The more knowledgeable the participants were about COVID-19 vaccines, the more likely they were to receive the COVID-19 vaccines. In the multivariate logistic regression, the increased coverage of COVID-19 vaccination was associated with reduced age (OR = 0.53 95% CI 0.43-0.66, P < 0.001), being a resident in other places than Shanghai (OR = 0.40, 95% CI 0.17-0.92, P < 0.05), a shorter time of lockdown (OR = 0.33, 95% CI 0.13-0.83, P < 0.05), a history of other vaccines (OR = 2.58, 95% CI 1.45-4.60, P < 0.01), a fewer number of chronic diseases (OR = 0.49, 95% CI 0.38-0.62, P < 0.001), better knowledge about COVID-19 vaccines (OR = 1.60, 95% CI 1.17-2.19, P < 0.01), and a positive attitude toward COVID-19 vaccines (OR = 9.22, 95% CI 4.69-18.09, P < 0.001).

Conclusion

Acquiring accurate knowledge and developing a positive attitude toward COVID-19 vaccines are important factors associated with COVID-19 vaccination. Disseminating informed information on COVID-19 vaccines and ensuring efficacious communication regarding their efficacy and safety would enhance awareness about COVID-19 vaccination among older adults and consequently boost their vaccination coverage.

Reacting, Sharing, and Commenting: How Many Facebook Users Are Engaging with Posts Related to Dental Caries That Contain Misinformation?

Recent studies have been concerned about the vast amount of misinformation detected on social media that directly hampers the prevention and control of chronic diseases. Based on these facts, the aim of this study was to identify and characterize misinformation about dental caries-related content found on Facebook, regarding the predictive factors of user interaction with posts. Then, CrowdTangle retrieved 2,436 posts published in English, ordered by the total interaction of the highest users. A total of 1,936 posts were selected for inclusion and exclusion criteria to select a sample of 500 posts. Subsequently, two independent investigators characterized the posts by their time of publication, author's profile, motivation, the aim of content, content facticity, and sentiment. The statistical analysis was performed using Mann-Whitney U and χ2 tests and multiple logistic regression models to determine differences and associations between dichotomized characteristics. p values <0.05 were considered significant. In general, posts were predominantly originated from the USA (74.8%), related to business profiles (89%), presented preventive content (58.6%), and noncommercial motivation (91.6%). Furthermore, misinformation was detected in 40.8% of the posts and was positively associated with positive sentiment (OR = 3.43), business profile (OR = 2.22), and treatment of dental caries (OR = 1.60). While the total interaction was only positively associated with misinformation (OR = 1.44), the overperforming score was associated with posts from the business profile (OR = 5.67), older publications (OR = 1.57), and positive sentiment (OR = 0.66). In conclusion, misinformation was the unique predictive factor of increased user interaction with dental caries-related posts on Facebook. However, it did not predict the performance of the diffusion of posts such as business profiles, older publications, and negative/neutral sentiment. Therefore, it is essential to promote the development of specific policies toward good quality information on social media, which includes the production of adequate materials, the increase of the critical sense of consuming health content, and information filtering mediated by digital solutions.

Examining Homophily, Language Coordination, and Analytical Thinking in Web-Based Conversations About Vaccines on Reddit: Study Using Deep Neural Network Language Models and Computer-Assisted Conversational Analyses

BACKGROUND

Vaccine hesitancy has been deemed one of the top 10 threats to global health. Antivaccine information on social media is a major barrier to addressing vaccine hesitancy. Understanding how vaccine proponents and opponents interact with each other on social media may help address vaccine hesitancy.

OBJECTIVE

We aimed to examine conversations between vaccine proponents and opponents on Reddit to understand whether homophily in web-based conversations impedes opinion exchange, whether people are able to accommodate their languages to each other in web-based conversations, and whether engaging with opposing viewpoints stimulates higher levels of analytical thinking.

METHODS

We analyzed large-scale conversational text data about human vaccines on Reddit from 2016 to 2018. Using deep neural network language models and computer-assisted conversational analyses, we obtained each Redditor's stance on vaccines, each post's stance on vaccines, each Redditor's language coordination score, and each post or comment's analytical thinking score. We then performed chi-square tests, 2-tailed t tests, and multilevel modeling to test 3 questions of interest.

RESULTS

The results show that both provaccine and antivaccine Redditors are more likely to selectively respond to Redditors who indicate similar views on vaccines (P<.001). When Redditors interact with others who hold opposing views on vaccines, both provaccine and antivaccine Redditors accommodate their language to out-group members (provaccine Redditors: P=.044; antivaccine Redditors: P=.047) and show no difference in analytical thinking compared with interacting with congruent views (P=.63), suggesting that Redditors do not engage in motivated reasoning. Antivaccine Redditors, on average, showed higher analytical thinking in their posts and comments than provaccine Redditors (P<.001).

CONCLUSIONS

This study shows that although vaccine proponents and opponents selectively communicate with their in-group members on Reddit, they accommodate their language and do not engage in motivated reasoning when communicating with out-group members. These findings may have implications for the design of provaccine campaigns on social media.

Communicating with Patients about COVID-19 Vaccination: A Qualitative Study on Vaccinators in Tuscany Region, Italy

The rapid development of the vaccine and the infodemia have challenged communication about COVID-19 vaccines. This study aims to characterize-through the experience of vaccinators-the challenges faced during COVID-19 vaccination consultations and the communication strategies adopted. A qualitative study was conducted on COVID-19 vaccinators in Tuscany, Italy. Face-to-face interviews were conducted and examined by thematic analysis. In total, 30 vaccinators were interviewed. Four main themes emerged. The first highlighted distinct profiles of users' attitudes toward COVID-19 vaccination. Barriers and promoters of vaccine uptake emerged in the second theme: concerns over the vaccine, excessive exposure to information, and a lack of clear guidance from institutions were the main factors behind hesitancy. The third theme highlighted users' information-seeking behaviors; vaccinators observed that users ideologically opposed to the vaccine (IOV) unconsciously seek information that confirms their theories. The last theme comprised communication strategies for dealing with hesitancy. Empathy, first-hand examples, transparency, and tailored communication style appear to be effective in building vaccine trust. Lastly, the impossibility of developing a decision-making partnership with IOVs was noticed. These findings may help to better characterize public attitudes toward COVID-19 vaccination and highlight key communication principles and strategies to foster vaccine confidence.

How Behavioral Economics Can Inform the Next Mass Vaccination Campaign: A Narrative Review

Designing the next mass vaccination campaign will require ideas and techniques from behavioral economics. History and current events have shown how failing to consider features of human behavior, from individual biases in information processing to the relationships between people and policymakers, frustrated public health efforts. Behavioral economics can inform how a vaccination campaign needs to deliver processes and information necessary to help people decide to vaccinate, especially when mandates to vaccinate are not possible. Such campaigns need to employ both "nudges" (i.e., promote action) and remove "sludge" (i.e., break down blockers) to influence decisions directly. Strategies must be both acute and systemic to the current approach to public health.

Anti-Vaccine Discourse on Social Media: An Exploratory Audit of Negative Tweets about Vaccines and Their Posters

As the anti-vaccination movement is spreading around the world, this paper addresses the ever more urgent need for health professionals, communicators and policy-makers to grasp the nature of vaccine mis/disinformation on social media. A one-by-one coding of 4511 vaccine-related tweets posted from the UK in 2019 resulted in 334 anti-vaccine tweets. Our analysis shows that (a) anti-vaccine tweeters are quite active and widely networked users on their own; (b) anti-vaccine messages tend to focus on the "harmful" nature of vaccination, based mostly on personal experience, values and beliefs rather than hard facts; (c) anonymity does not make a difference to the types of posted anti-vaccine content, but does so in terms of the volume of such content. Communication initiatives against anti-vaccination should (a) work closely with technological platforms to tackle anonymous anti-vaccine tweets; (b) focus efforts on mis/disinformation in three major arears (in order of importance): the medical nature of vaccines, the belief that vaccination is a tool of manipulation and control for money and power, and the "freedom of health choice" discourse against mandatory vaccination; and (c) go beyond common factual measures-such as detecting, labelling or removing fake news-to address emotions induced by personal memories, values and beliefs.

Review of scientific evidence to support recommendations of the full-dose DTaP-IPV vaccination in pre-school age children in Italy

INTRODUCTION

Two vaccine formulations are available to prevent diphtheria, tetanus, pertussis, and poliomyelitis: the pediatric full-dose (DTaP-IPV) and the reduced dose formulation (dTap-IPV). Different immunization schedules are internationally recommended for the pre-school booster dose.

AREAS COVERED

International and Italian recommendations, scientific evidence on immunogenicity and safety of DTaP/dTap vaccines to support the full dose as a pre-school booster and Italian vaccination coverage (VC) up to adolescence.

EXPERT OPINION

The WHO recommends a '3+1' schedule with DTaP vaccine for primary immunization, followed by a pre-school booster with DTaP or dTap vaccine. In Italy, a '2+1' schedule, with no booster in the second year, and a pre-school booster dose are recommended with DTPa-IPV vaccines. Studies showed a non-inferior immunogenicity in dTap vaccinees in pre-school age; nevertheless, the antibody titers were usually greater in children vaccinated with DTaP, while lower frequencies of adverse events were recorded in children receiving dTap. Italian VCs for pre-school and adolescent boosters have not been satisfactory, which further reduced during the COVID-19 period. In Italy, the pre-school booster offers the last chance to receive a full dose of DTaP vaccine, thus, representing the most suitable intervention to provide lasting protection in children.

Media Data and Vaccine Hesitancy: Scoping Review

Background

Media studies are important for vaccine hesitancy research, as they analyze how the media shapes risk perceptions and vaccine uptake. Despite the growth in studies in this field owing to advances in computing and language processing and an expanding social media landscape, no study has consolidated the methodological approaches used to study vaccine hesitancy. Synthesizing this information can better structure and set a precedent for this growing subfield of digital epidemiology.

Objective

This review aimed to identify and illustrate the media platforms and methods used to study vaccine hesitancy and how they build or contribute to the study of the media's influence on vaccine hesitancy and public health.

Methods

This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search was conducted on PubMed and Scopus for any studies that used media data (social media or traditional media), had an outcome related to vaccine sentiment (opinion, uptake, hesitancy, acceptance, or stance), were written in English, and were published after 2010. Studies were screened by only 1 reviewer and extracted for media platform, analysis method, the theoretical models used, and outcomes.

Results

In total, 125 studies were included, of which 71 (56.8%) used traditional research methods and 54 (43.2%) used computational methods. Of the traditional methods, most used content analysis (43/71, 61%) and sentiment analysis (21/71, 30%) to analyze the texts. The most common platforms were newspapers, print media, and web-based news. The computational methods mostly used sentiment analysis (31/54, 57%), topic modeling (18/54, 33%), and network analysis (17/54, 31%). Fewer studies used projections (2/54, 4%) and feature extraction (1/54, 2%). The most common platforms were Twitter and Facebook. Theoretically, most studies were weak. The following five major categories of studies arose: antivaccination themes centered on the distrust of institutions, civil liberties, misinformation, conspiracy theories, and vaccine-specific concerns; provaccination themes centered on ensuring vaccine safety using scientific literature; framing being important and health professionals and personal stories having the largest impact on shaping vaccine opinion; the coverage of vaccination-related data mostly identifying negative vaccine content and revealing deeply fractured vaccine communities and echo chambers; and the public reacting to and focusing on certain signals-in particular cases, deaths, and scandals-which suggests a more volatile period for the spread of information.

Conclusions

The heterogeneity in the use of media to study vaccines can be better consolidated through theoretical grounding. Areas of suggested research include understanding how trust in institutions is associated with vaccine uptake, how misinformation and information signaling influence vaccine uptake, and the evaluation of government communications on vaccine rollouts and vaccine-related events. The review ends with a statement that media data analyses, though groundbreaking in approach, should supplement-not supplant-current practices in public health research.

Influenza vaccination hesitancy and its determinants among elderly in China: A national cross-sectional study

BACKGROUND

The Chinese elderly face a significant threat from seasonal influenza, owing to the consistently low vaccination coverage. This study investigated the prevalence and determinants of influenza vaccination hesitancy among the Chinese elderly.

METHODS

In 2019, 3849 elderly individuals from 10 provinces in China were recruited in a cross-sectional survey. Multinomial logistic regression was applied to investigate the determinants of influenza vaccination hesitancy.

RESULTS

Among the elderly respondents, 37.18% expressed some degree of hesitancy towards influenza vaccination: 19.28% were hesitant, and 17.90% refused influenza vaccination, including 19.28% acceptors with doubts and 17.90% refusers. Only 39.10% of the respondents considered themselves as the priority group for influenza vaccination, and 13.93% reported receiving a recommendation for vaccination from healthcare workers. Respondents with higher education levels and from urban areas had significantly higher odds of vaccine hesitancy than their counterparts. Confidence in the safety of vaccines was negatively associated with vaccine hesitancy, but confidence in vaccine efficacy had no such association. Respondents who perceived themselves as highly susceptible to influenza (AOR = 0.85; 95 %CI = 0.77-0.93) and those aware of the elderly as a priority group for influenza vaccination (AOR = 0.51; 95 %CI = 0.41-0.64) had a significantly lower odds of being refusers.

CONCLUSION

This study found a high prevalence of hesitancy towards influenza vaccination among the Chinese elderly, especially well-educated and urban-dwelling respondents. The government should address vaccine hesitancy through culturally appropriate communication, subsidies for vaccination, and actively promoting vaccines through primary care professionals.

Using supervised learning to analyze the French vaccine debate on Twitter

Background

As the COVID-19 pandemic progressed, disinformation, fake news, and conspiracy theories spread through many parts of society. However, the disinformation spreading through social media is, according to the literature, one of the causes of increased COVID-19 vaccine hesitancy. In this context, the analysis of social media posts is particularly important, but the large amount of data exchanged on social media platforms requires specific methods. This is why machine learning and natural language processing models are increasingly applied to social media data.

Objective

The aim of this study is to examine the capability of the CamemBERT French-language model to faithfully predict the elaborated categories, with the knowledge that tweets about vaccination are often ambiguous, sarcastic, or irrelevant to the studied topic.

Methods

A total of 901,908 unique French-language tweets related to vaccination published between July 12, 2021, and August 11, 2021, were extracted using Twitter’s application programming interface (version 2; Twitter Inc). Approximately 2000 randomly selected tweets were labeled with 2 types of categorizations: (1) arguments for (pros) or against (cons) vaccination (health measures included) and (2) type of content (scientific, political, social, or vaccination status). The CamemBERT model was fine-tuned and tested for the classification of French-language tweets. The model’s performance was assessed by computing the F1-score, and confusion matrices were obtained.

Results

The accuracy of the applied machine learning reached up to 70.6% for the first classification (pro and con tweets) and up to 90% for the second classification (scientific and political tweets). Furthermore, a tweet was 1.86 times more likely to be incorrectly classified by the model if it contained fewer than 170 characters (odds ratio 1.86; 95% CI 1.20-2.86).

Conclusions

The accuracy of the model is affected by the classification chosen and the topic of the message examined. When the vaccine debate is jostled by contested political decisions, tweet content becomes so heterogeneous that the accuracy of the model drops for less differentiated classes. However, our tests showed that it is possible to improve the accuracy by selecting tweets using a new method based on tweet length.

#DoctorsSpeakUp: Exploration of Hashtag Hijacking by Anti-Vaccine Advocates and the Influence of Scientific Counterpublics on Twitter

The #DoctorsSpeakUp hashtag, which was designed by physicians to collectively promote vaccines on Twitter in Spring of 2020, was hijacked by anti-vaccine advocates. Through the lens of counterpublic sphere theory, thematic analysis revealed that the hashtag hijacking by a scientific counterpublic was successful, and the majority of #DoctorsSpeakUp tweets were oriented against vaccines. Five overarching themes emerged in anti-vaccine hijacked tweets, including: personal experience with vaccine injury, profits over people, lack of liability, perception that doctors are uninformed, and 'We are the Herd.' In contrast, fewer than 17% of tweets originated from pro-vaccine doctors who openly identified themselves as such in their tweets or profiles. Thus, using the #DoctorsSpeakUp hashtag, anti-vaccine advocates dominated the discourse, which speaks to the communication dynamics afforded within the information ecosystem of a social network. Hashtag activism can connect individuals and promote grassroots movements but may also backfire, allowing a vocal minority of individuals to shout the loudest through the digital megaphone.

Parents' Willingness to Vaccinate Their Children With COVID-19 Vaccine: Results of a Survey in Italy

PURPOSE

This cross-sectional study was conducted to assess the parents' willingness to vaccinate their children with the COVID-19 vaccine and related determinants with specific attention to willingness for adolescents as compared to younger children.

METHODS

Data were collected through a confidential online questionnaire.

RESULTS

A total of 607 parents agreed to participate. More than two-thirds of the parents had good knowledge about the modes of transmission of COVID-19, knew that subjects of any age may be susceptible to SARS-CoV-2 infection, and 85.5% correctly indicated the main behavioral preventive measures against COVID-19. With regard to attitudes, 78.7% agreed that COVID-19 is a serious disease, whereas only 42.3% agreed that it is preventable. Overall, 68.5% were willing to vaccinate their children with the COVID-19 vaccine, specifically 74.5% of parents of adolescents and 65.5% of those of younger children, and the results of the multivariate analysis showed that parents of adolescents aged 12-15 years or 16-18 years compared to those of children aged 11 years or less, those who had more than two children, those who reported that their children had been visited by the primary care pediatrician/physician in the previous 12 months, those who agreed that COVID-19 is a serious disease, considered very useful the COVID-19 vaccine, had been vaccinated against influenza in the previous season, and had received at least one shot of COVID-19 vaccine were more likely to be willing to vaccinate their children.

CONCLUSION

In conclusion, a relevant proportion of parents are willing to vaccinate their children, with the parents of adolescents showing a higher willingness compared to those of younger children. However, there is still room for reducing hesitancy and refusal of the COVID-19 vaccine in this strategic population group by promoting communication to mitigate concerns toward the COVID-19 vaccine.

COVID-19 Vaccination and Mental Disorders, What Has Been Accomplished and Future Direction

The consequences of the pandemic on mental health are among the most important side effects of COVID-19. Wide concerns have emerged both regarding vaccine hesitation in the general population, and the vaccine's implementation plan. The aim of this study is to evaluate how the scientific community has investigated the relationship between the COVID-19 vaccine and mental disorders. Contrary to expectations, having a full-blown psychiatric pathology seems to positively affect the attitude towards the vaccine, except for PTSD. The intense fear that accompanied the current world emergency has made this pandemic unique; we discuss how it might be one of the factors involved in this result. Further experimental investigations are needed to estimate how personality traits, hyperarousal, and negative emotions influence vaccine compliance both in the general population and in people living with mental disorders.

COVID-19 vaccine hesitancy among different population groups in China: a national multicenter online survey

Background

COVID-19 vaccine has been available in China since the beginning of the 2021, however, certain numbers of people are reluctant for some reasons to vaccinate. The high vaccine coverage is crucial for controlling disease transmission, however, the vaccine hesitancy might be a barrier to the establishment of sufficient herd immunization. This study aims to investigate the prevalence of the COVID-19 vaccine hesitancy among different population groups, and explore common barriers and facilitators to vaccination decisions.

Methods

The current survey was performed among Chinese students, public health professionals, medical workers and general population from January to March 2021 from seven cities in China. The questionnaire contained sociodemographic information, concerns about infection with COVID-19, general vaccination behaviors and attitudes, the General Vaccine Hesitancy Scale, the COVID-19 Vaccine Hesitancy Scale and other potential factors. Univariate analysis was conducted by chi-squared test, and variables significant at P < 0.10 were then included in a multivariable regression model.

Results

The prevalence of COVID-19 vaccine hesitancy was 15.6% in our study, and 23.9% of students, 21.2% of the general population, 13.1% of medical workers, and 10.4% of public health professionals had vaccine hesitancy. The results of multivariate analysis indicated that participants who had received negative information of COVID-19 vaccine (OR: 1.563, 95% CI: 1.229–1.986) and who had doubts about the information source (OR: 2.157, 95% CI: 1.697–2.742) were more likely to have vaccine hesitancy. While those who needed transparent information about COVID-19 vaccine (OR: 0.722, 95% CI: 0.535–0.973) and who would get COVID-19 vaccine if doctors recommended (OR: 0.176, 95% CI: 0.132–0.234) were less likely to have COVID-19 vaccine hesitancy.

Conclusions

Given recommendations from medical workers about vaccination can motivate people to accept COVID-19 vaccination, appropriate training in knowledge about vaccines and communication skills are necessary for them to increase public’s willingness of vaccination. Reducing the spread of misinformation and disseminating facts in a timely and accurate way will likely reduce vaccine hesitancy. Moreover, to establish suitable communication strategies and information exchange platforms between the government and the public and a warning system on infodemic would be helpful to improve public’s confidence in vaccination.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07111-0.

Conspiracy beliefs and vaccination intent for COVID-19 in an infodemic

BACKGROUND

The massive, free and unrestricted exchange of information on the social media during the Covid-19 pandemic has set fertile grounds for fear, uncertainty and the rise of fake news related to the virus. This "viral" spread of fake news created an "infodemic" that threatened the compliance with public health guidelines and recommendations.

OBJECTIVE

This study aims to describe the trust in social media platforms and the exposure to fake news about COVID-19 in Lebanon and to explore their association with vaccination intent.

METHODS

In this cross-sectional study conducted in Lebanon during July-August, 2020, a random sample of 1052 participants selected from a mobile-phone database responded to an anonymous structured questionnaire after obtaining informed consent (response rate = 40%). The questionnaire was conducted by telephone and measured socio-demographics, sources and trust in sources of information and exposure to fake news, social media activity, perceived threat and vaccination intent.

RESULTS

Results indicated that the majority of participants (82%) believed that COVID-19 is a threat and 52% had intention to vaccinate. Exposure to fake/ unverified news was high (19.7% were often and 63.8% were sometimes exposed, mainly to fake news shared through Watsapp and Facebook). Trust in certain information sources (WHO, MoPH and TV) increased while trust in others (Watsapp, Facebook) reduced vaccination intent against Covid-19. Believing in the man-made theory and the business control theory significantly reduced the likelihood of vaccination intent (Beta = 0.43; p = 0.01 and Beta = -0.29; p = 0.05) respectively.

CONCLUSION

In the context of the infodemic, understanding the role of exposure to fake news and of conspiracy believes in shaping healthy behavior is important for increasing vaccination intent and planning adequate response to tackle the Covid-19 pandemic.

COVID-19 vaccine brand hesitancy and other challenges to vaccination in the Philippines

Effective and safe COVID-19 vaccines have been developed at a rapid and unprecedented pace to control the spread of the virus, and prevent hospitalisations and deaths. However, COVID-19 vaccine uptake is challenged by vaccine hesitancy and anti-vaccination sentiments, a global shortage of vaccine supply, and inequitable vaccine distribution especially among low- and middle-income countries including the Philippines. In this paper, we explored vaccination narratives and challenges experienced and observed by Filipinos during the early vaccination period. We interviewed 35 individuals from a subsample of 1,599 survey respondents 18 years and older in the Philippines. The interviews were conducted in Filipino, Cebuano, and/or English via online platforms such as Zoom or via phone call. All interviews were recorded, transcribed verbatim, translated, and analysed using inductive content analysis. To highlight the complex reasons for delaying and/or refusing COVID-19 vaccines, we embedded our findings within the social ecological model. Our analysis showed that individual perceptions play a major role in the decision to vaccinate. Such perceptions are shaped by exposure to (mis)information amplified by the media, the community, and the health system. Social networks may either positively or negatively impact vaccination uptake, depending on their views on vaccines. Political issues contribute to vaccine brand hesitancy, resulting in vaccination delays and refusals. Perceptions about the inefficiency and inflexibility of the system also create additional barriers to the vaccine rollout in the country, especially among vulnerable and marginalised groups. Recognising and addressing concerns at all levels are needed to improve COVID-19 vaccination uptake and reach. Strengthening health literacy is a critical tool to combat misinformation that undermines vaccine confidence. Vaccination systems must also consider the needs of marginalised and vulnerable groups to ensure their access to vaccines. In all these efforts to improve vaccine uptake, governments will need to engage with communities to 'co-create' solutions.

Rotavirus and the web: analysis of online conversations in Italy during 2020

Rotavirus is the most common cause of severe diarrhea among children worldwide. In 2017, Italy included rotavirus vaccination in its National Immunization Program. The use of social media monitoring, an efficient tool to understand vaccine hesitancy, has increased in recent years; however, only a few examples of such monitoring are available for Italy. Present study analyzed content on online sources, including social media, to identify factors contributing to Italian parents’ decisions to vaccinate or not their children against rotavirus. Blogmeter Suite was used to search and analyze conversations related to rotavirus in Italian on online sources during 2020. These data were compared with data from 2019. There were 2250 mentions of “rotavirus” recorded; 1080 were related to the rotavirus vaccine. Terms and hashtags used were similar in both years. Facebook was the main source of influence, Instagram dominated the engagement (the sum of interactions related to a post), and Google Trends showed a 5-year upward trend in searches for rotavirus vaccine. Of 1270 sentiment opinions, 60.7% were negative. More parents were familiar with the disease and the vaccine in 2020 compared with 2019. Pediatricians were the most influential healthcare professionals (59.2% of mentions), followed by vaccination staff (33.4%). The most relevant factors for vaccine hesitancy were fear of adverse events, concerns about the vaccination schedule, and COVID-19. Present study represents the first web listening analysis of online discussions about rotavirus. The results can be used to inform targeted communication to counteract misinformation and raise awareness about rotavirus vaccination among parents.

Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models

Background

The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy.

Objective

Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media.

Methods

This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine–related information on Twitter.

Results

We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine–related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary.

Conclusions

Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media.

Information in Spanish on YouTube about Covid-19 vaccines

Our objective was to analyze the sources, characteristics, tone, and content of the most viewed YouTube videos in Spanish about Covid-19 vaccines. In February 2021, a search was carried out on YouTube using the terms "Vacuna Covid," "Vacuna coronavirus," and "Vacuna Covid19." Associations between tone, source, and others variables (e.g. number of views or dislikes) were studied with a Mann-Whitney U-test and a chi-square test. A total of 118 videos were analyzed; 63.6% were originated from Mexico and the USA; media created 57.6% of the videos. Positive tone was observed in 53.4%. The most discussed topics were target groups for vaccination (38.9%) and safety (43.2%). The 68 videos produced by media accumulated 31,565,295 views (55.0% of views), and the 19 videos created by health professionals obtained 10,742,825 views (18.7% of views). A significantly smaller number of likes was obtained in videos of media compared to those created by health professionals (p = .004). Videos made by health professionals, compared to those of media, showed a greater positive tone (OR = 3.09). Hoaxes/conspiracy theories were identified in 1.7% of the videos. Monitoring that the information on YouTube about Covid-19 vaccines is reliable should be a central part of Covid-19 vaccination campaigns.

Agent Based Model of Anti-Vaccination Movements: Simulations and Comparison with Empirical Data

Background: A realistic description of the social processes leading to the increasing reluctance to various forms of vaccination is a very challenging task. This is due to the complexity of the psychological and social mechanisms determining the positioning of individuals and groups against vaccination and associated activities. Understanding the role played by social media and the Internet in the current spread of the anti-vaccination (AV) movement is of crucial importance. Methods: We present novel, long-term Big Data analyses of Internet activity connected with the AV movement for such different societies as the US and Poland. The datasets we analyzed cover multiyear periods preceding the COVID-19 pandemic, documenting the behavior of vaccine related Internet activity with high temporal resolution. To understand the empirical observations, in particular the mechanism driving the peaks of AV activity, we propose an Agent Based Model (ABM) of the AV movement. The model includes the interplay between multiple driving factors: contacts with medical practitioners and public vaccination campaigns, interpersonal communication, and the influence of the infosphere (social networks, WEB pages, user comments, etc.). The model takes into account the difference between the rational approach of the pro-vaccination information providers and the largely emotional appeal of anti-vaccination propaganda. Results: The datasets studied show the presence of short-lived, high intensity activity peaks, much higher than the low activity background. The peaks are seemingly random in size and time separation. Such behavior strongly suggests a nonlinear nature for the social interactions driving the AV movement instead of the slow, gradual growth typical of linear processes. The ABM simulations reproduce the observed temporal behavior of the AV interest very closely. For a range of parameters, the simulations result in a relatively small fraction of people refusing vaccination, but a slight change in critical parameters (such as willingness to post anti-vaccination information) may lead to a catastrophic breakdown of vaccination support in the model society, due to nonlinear feedback effects. The model allows the effectiveness of strategies combating the anti-vaccination movement to be studied. An increase in intensity of standard pro-vaccination communications by government agencies and medical personnel is found to have little effect. On the other hand, focused campaigns using the Internet and social media and copying the highly emotional and narrative-focused format used by the anti-vaccination activists can diminish the AV influence. Similar effects result from censoring and taking down anti-vaccination communications by social media platforms. The benefit of such tactics might, however, be offset by their social cost, for example, the increased polarization and potential to exploit it for political goals, or increased 'persecution' and 'martyrdom' tropes.

Evidence of disorientation towards immunization on online social media after contrasting political communication on vaccines. Results from an analysis of Twitter data in Italy

Background

In Italy, in recent years, vaccination coverage for key immunizations as MMR has been declining to worryingly low levels, with large measles outbreaks. As a response in 2017, the Italian government expanded the number of mandatory immunizations introducing penalties to unvaccinated children’s families. During the 2018 general elections campaign, immunization policy entered the political debate with the government in-charge blaming oppositions for fuelling vaccine scepticism. A new government (formerly in the opposition) established in 2018 temporarily relaxed penalties and announced the introduction of forms of flexibility.

Objectives and methods

First, we supplied a definition of disorientation, as the “lack of well-established and resilient opinions among individuals, therefore causing them to change their positions as a consequence of sufficient external perturbations”. Second, procedures for testing for the presence of both short and longer-term collective disorientation in Twitter signals were proposed. Third, a sentiment analysis on tweets posted in Italian during 2018 on immunization topics, and related polarity evaluations, were used to investigate whether the contrasting announcements at the highest political level might have originated disorientation amongst the Italian public.

Results

Vaccine-relevant tweeters’ interactions peaked in response to main political events. Out of retained tweets, 70.0% resulted favourable to vaccination, 16.4% unfavourable, and 13.6% undecided, respectively. The smoothed time series of polarity proportions exhibit frequent large changes in the favourable proportion, superimposed to a clear up-and-down trend synchronized with the switch between governments in Spring 2018, suggesting evidence of disorientation among the public.

Conclusions

The reported evidence of disorientation for opinions expressed in online social media shows that critical health topics, such as vaccination, should never be used to achieve political consensus. This is worsened by the lack of a strong Italian institutional presence on Twitter, calling for efforts to contrast misinformation and the ensuing spread of hesitancy. It remains to be seen how this disorientation will impact future parents’ vaccination decisions.

Inaction, under-reaction action and incapacity: communication breakdown in Italy's vaccination governance

This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Do we need the criminalization of medical fake news?

Uncontrolled access to information on the Internet has many advantages, but it also leads to the phenomenon of fake news. Fake news is dangerous in many spheres, including that of health. For example, we are facing an increase in the amount of vaccine hesitancy. This has been w considered by the World Health Organization in 2019 as one of the greatest threats to public health. This specific phenomenon is linked with the spread of information on the Internet around that issue. In this paper, I discuss a proposition of new crime, which has the aim of fighting medical fake news by stopping its spread. This proposition should be considered only if other non-criminal measures are inefficient. The proposal is "Whoever publicly disseminates information evidently discrepant with medical knowledge is subject to a penalty."

A Multi-platform Approach to Monitoring Negative Dominance for COVID-19 Vaccine-Related Information Online

OBJECTIVE

The aim of this study was to test the appearance of negative dominance in COVID-19 vaccine-related information and activity online. We hypothesized that if negative dominance appeared, it would be a reflection of peaks in adverse events related to the vaccine, that negative content would attract more engagement on social media than other vaccine-related posts, and posts referencing adverse events related to COVID-19 vaccination would have a higher average toxicity score.

METHODS

We collected data using Google Trends for search behavior, CrowdTangle for social media data, and Media Cloud for media stories, and compared them against the dates of key adverse events related to COVID-19. We used Communalytic to analyze the toxicity of social media posts by platform and topic.

RESULTS

While our first hypothesis was partially supported, with peaks in search behavior for image and YouTube videos driven by adverse events, we did not find negative dominance in other types of searches or patterns of attention by news media or on social media.

CONCLUSION

We did not find evidence in our data to prove the negative dominance of adverse events related to COVID-19 vaccination on social media. Future studies should corroborate these findings and, if consistent, focus on explaining why this may be the case.

Pro-Vaxxers Get Out: Anti-Vaccination Advocates Influence Undecided First-Time, Pregnant, and New Mothers on Facebook

Social media has revolutionized health information-seeking behavior with crowd-based medical advice. Decreased vaccination uptake and subsequent disease outbreaks have generally occurred in localized clusters based on social norms; however, geographically unrestricted Facebook networks promote parental vaccination refusal congruent with digital identity formation. Interactions within the largest closed Facebook group for vaccination choice were analyzed through the lens of Social Influence Theory. Anti-vaccination advocates impacted first-time mothers' expressed vaccination intentions through both informational and normative influence processes. Six overarching themes were identified as strategies used by these individuals to persuade fence sitting parents to delay or decline vaccinations, including: natural solutions, maternal empowerment, distrust of conventional medicine establishment, fear appeals, 'Russian Roulette' risk benefit analysis, and misinformation and misunderstandings.

Determinants of Infodemics During Disease Outbreaks: A Systematic Review

Background: The widespread use of social media represents an unprecedented opportunity for health promotion. We have more information and evidence-based health related knowledge, for instance about healthy habits or possible risk behaviors. However, these tools also carry some disadvantages since they also open the door to new social and health risks, in particular during health emergencies. This systematic review aims to study the determinants of infodemics during disease outbreaks, drawing on both quantitative and qualitative methods. Methods: We searched research articles in PubMed, Scopus, Medline, Embase, CINAHL, Sociological abstracts, Cochrane Library, and Web of Science. Additional research works were included by searching bibliographies of electronically retrieved review articles. Results: Finally, 42 studies were included in the review. Five determinants of infodemics were identified: (1) information sources; (2) online communities' structure and consensus; (3) communication channels (i.e., mass media, social media, forums, and websites); (4) messages content (i.e., quality of information, sensationalism, etc.,); and (5) context (e.g., social consensus, health emergencies, public opinion, etc.). Studied selected in this systematic review identified different measures to combat misinformation during outbreaks. Conclusion: The clarity of the health promotion messages has been proven essential to prevent the spread of a particular disease and to avoid potential risks, but it is also fundamental to understand the network structure of social media platforms and the emergency context where misinformation might dynamically evolve. Therefore, in order to prevent future infodemics, special attention will need to be paid both to increase the visibility of evidence-based knowledge generated by health organizations and academia, and to detect the possible sources of mis/disinformation.

Access to Vaccination Information and Confidence/Hesitancy Towards Childhood Vaccination: A Cross-Sectional Survey in China

Access to vaccination information could influence public attitudes towards vaccination. This study investigated the number and types of vaccination-related information sources, and estimated their associations with vaccine confidence and hesitancy in China. In January 2019, we conducted a cross-sectional survey in China, and 2122 caregivers with children <6 years completed self-administered questionnaires. Logistic regressions were used to assess associations between caregivers’ primary information sources and vaccine confidence/hesitancy. A majority (72%) of caregivers had multiple sources of vaccination-related information. The proportions of caregivers reporting professional sources, media, and peers as primary information sources were 81%, 63%, and 26%. Internal migrants were less likely to get information from professional sources; more educated and wealthier caregivers reported more information sources and were more likely to get information from media and peers. Caregivers who reported professional information sources had significantly higher odds of being confident about the safety of vaccines and lower odds of being hesitant toward vaccination than those who did not. Caregivers who reported the media as a primary information source had significantly higher odds of being hesitant toward vaccination than those who did not. To address vaccine hesitancy, it is essential to promote universal access to professional vaccination-related information sources, and to use the media to disseminate evidence-based information and clarify misinformation. Health communication should target internal migrants, and more educated and wealthier caregivers.

Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review

Background

Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring.

Objective

The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations.

Methods

A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles’ titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses.

Results

This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes).

Conclusions

Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design.

Social amplification of risk and "probable vaccine damage": A typology of vaccination beliefs in 28 European countries

BACKGROUND

Despite lacking scientific support, vaccine hesitancy is widespread. While serious vaccine damage as a scientific fact is real yet statistically highly uncommon, emerging social and technological forces have amplified perceptions of risk for "probable vaccine damage", making it a widely shared intersubjective reality.

METHODS

Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis.

RESULTS

The public beliefs in significant vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider that vaccines are not rigorously tested before authorization, one-third believe that vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe that vaccines can cause serious side effects. We identified three belief configurations: hesitant, confident, and trade-off clusters. The hesitant type (approx. 11% of EU27-UK respondents) is defined by the perception that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59%) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29%) combines beliefs that vaccines are effective, well-tested and useful, with perceptions of probable vaccine damage. The vaccine-confident and the trade-off types have similar vaccination histories, indicating the significant role of other factors besides beliefs in inducing behavior.

CONCLUSIONS

The high proportion of varying public beliefs in significant vaccine risks and the presence of a trade-off type of vaccination assessment indicate the social normality of beliefs in probable vaccine damage. Communication campaigns should take into account the social normality of the perceived risk of "probable vaccine damage" across various social types, and patterns of concomitant trust and mistrust in vaccination.

Vaccines and autism: a preliminary qualitative study on the beliefs of concerned mothers in Italy

Purpose: While a large body of evidence has shown that the administration of the measles-mumps-rubella (MMR) vaccine is not associated with an increased risk of autism spectrum disorder (ASD), a hesitant attitude towards childhood vaccination is still present among the public. In this study, we aim to investigate the mothers’ perceptions of the cause of their child’s ASD in order to increase our understanding of vaccine hesitancy.

Methods: This study draws on the analysis of 18 semi-structured interviews of mothers of children with ASD on the causes of autism.

Results: The interview material was content-analysed. The main themes were 1) childhood vaccines; 2) genetics; 3) specific conditions of the mother or the newborn at the moment of delivery; 4) environmental factors such as the mother’s lifestyle or her diet. The link between vaccines and autism was prevalent. About one third of the mothers reported that their child’s ASD was a consequence of a combination of two or more factors, i.e., childhood vaccines and specific conditions of the newborn or the mother at the moment of delivery.

Conclusion: This study provides preliminary insights into recurring sets of beliefs concerning the causes of ASD among the mothers of affected children.

Paradoxical health care utilization patterns among children in Korea who did not receive mandatory pneumococcal vaccination

BACKGROUND

Unvaccinated children in the National Immunization Program (NIP) are a public health concern. We used Korean national population data to analyze health care utilization patterns of NIP-eligible children and identify the unvaccinated group.

METHODS

Pneumococcal vaccination (PCV) records were reviewed to determine the vaccination status of children born between 2013 and 2015. Children who received three doses or more from a 3 + 1 schedule were defined as vaccinated, while those who had not received any pneumococcal vaccinations were defined as unvaccinated. Corresponding health care utilization records were retrieved from the National Health Insurance Review and Assessment Service. The incidence of combined pneumococcal infections and health care utilization rates were estimated and the proportion of complementary and alternative medicine (CAM) utilization among the total health care utilization records was measured.

RESULTS

In total, 26,893 (2.1%) of 1,272,685 children remained unvaccinated. The incidence of pneumococcal infection was lower in unvaccinated children, at 10.1 cases (9.8-10.3) per 1000 person-months. However, their health care utilization was significantly lower than that noted for vaccinated children (hospital visit rate: 26.6 (95% confidence interval [CI] 26.5-26.7) vs. 3.2 (3.2-3.3) visits annually), indicating underdetection. CAM treatment was sought at least three times often more in unvaccinated children than in vaccinated children (3.5% vs. 1.1%).

CONCLUSION

Unvaccinated children showed significantly lower utilization of overall health care than the vaccinated children; however, a higher preference for CAM was noted among unvaccinated children than among vaccinated children. These differences in care-seeking patterns should be considered when identifying unvaccinated children and providing protection through vaccination programs.

YouTube as a Source of Influenza Vaccine Information in Spanish

Our objective was to analyze the information in Spanish on YouTube about the influenza vaccine. In August 2020, a search was conducted on YouTube using the terms “Vacuna gripe”, “Vacuna influenza”, and “Vacuna gripa”. Associations between the type of authorship, country of publication, and other variables (such as tone, hoaxes, and vaccination recommendations) were studied via univariate analysis. A total of 100 videos were evaluated; 57.0% were created in Mexico (24.0%), Argentina (17.0%), and Spain (16.0%), and 74.0% were produced by mass media or health professionals. Positive messages were detected in 65.0%. The main topics were the benefits of the vaccine (59.0%) and adverse effects (39.0%). Hoaxes were detected in 19 videos. User-generated content, compared to that of health professionals, showed a higher probability of hoaxes (odds ratio (OR) = 15.56), a lower positive tone (OR = 0.04), and less evidence of recommendations to vaccinate pregnant individuals (OR = 0.09) and people aged 60/65 or older. Videos published in Spain, in comparison with those from Hispanic America, presented significant differences in the positive tone of their messages (OR = 0.19) and in the evidence of the benefits of vaccination (OR = 0.32). A higher probability of hoaxes was detected in videos from Spain and the USA. Information in Spanish about the influenza vaccine on YouTube is usually not very complete. Spanish health professionals are urged to produce pro-vaccination videos that counteract hoaxes, and users in Hispanic America should be advised to consult videos produced in Hispanic American countries by health professionals to obtain reliable information.

What Motivates Internet Users to Search for Asperger Syndrome and Autism on Google?

Social campaigns are carried out to promote autism spectrum disorder (ASD) awareness, normalization, and visibility. The internet helps to shape perceptions of Asperger syndrome and autism. In fact, these campaigns often coincide with the increase in searches for both diagnoses on Google. We have two study objectives: to use Google Trends to identify the annual time points from 2015 to 2019 with the highest Google search traffic in Spain for the terms "autism" and "Asperger", and to identify news and trending topics related to ASD that took place during the weeks with the highest number of Google searches for these terms. Google Trend, MyNews and Trendinalia were used to analyze the volume of searches and trending topics related to ASD. As a result, social marketing campaigns, social networks and the publication of news items act as powerful voices that can provide a realistic or sensationalist picture of the disorder. For this reason, we concluded that campaigns play an important role in the normalization of ASD, and that it is important for organizations concerned with the visibility and social inclusion of people with ASD to check the way ASD is portrayed through the internet, media, and social networks.

Misinformation, internet honey trading and beekeepers drive a plant invasion

Biological invasions are a major human induced global change that is threatening global biodiversity by homogenizing the world's fauna and flora. Species spread because humans have moved species across geographical boundaries and have changed ecological factors that structure ecosystems, such as nitrogen deposition, disturbance, etc. Many biological invasions are caused accidentally, as a byproduct of human travel and commerce driven product shipping. However, humans also have spread many species intentionally because of perceived benefits. Of interest is the role of the recent exponential growth in information exchange via internet social media in driving biological invasions. To date, this has not been examined. Here, we show that for one such invasive species, goldenrod, social networks spread misleading and incomplete information that is enhancing the spread of goldenrod invasions into new environments. We show that the notion of goldenrod honey as a "superfood" with unsupported healing properties is driving a demand that leads beekeepers to produce goldenrod honey. Social networks provide a forum for such information exchange and this is leading to further spread of goldenrod in many countries where goldenrod is not native, such as Poland. However, this informal social information exchange ignores laws that focus on preventing the further spread of invasive species and the strong negative effects that goldenrod has on native ecosystems, including floral resources that negatively impact honeybee performance. Thus, scientifically unsupported information on "superfoods" such as goldenrod honey that is disseminated through social internet networks has real world consequences such as increased goldenrod invasions into novel geographical regions which decreases native biodiversity.

[How to improve vaccination coverage in France? Qualitative study among health care workers]

BACKGROUND

The risk benefit ratio has been clearly proven for a long time to be in favor of vaccination. However, the vaccine distrust is still increasing in the French population and vaccination coverage could be improved. There is a real need to increase confidence in vaccination. In this study, we interviewed heath care workers to collect their opinion concerning vaccination hesitancy amongst their patients.

METHODS

A qualitative study, using semi structured interviews, was performed. All the Pharmacists and doctors were interviewed by the same person using an interview guide prepared by a multidisciplinary team. Interviews were recorded and transcribed verbatim, then used as a basis for analysis and synthesis of the areas where improvement seems possible for the health care workers interviewed.

RESULTS

Data saturation was obtained after 10 interviews. Analysis of the verbatim allowed the classification of the leads proposed by health care workers in three main themes: improvement of transparency and restoration of the trust for vaccine policy, improved initial and further training of health care workers, and a better communication towards the population.

CONCLUSION

Results provide helpful insights into practical avenues to improve the vaccination confidence. If some of them need an in-depth reflection, others could be easily implemented in order to increase the adhesion of the population to vaccination, and consequently the vaccination coverage.

Risk Perception of Air Pollution: A Systematic Review Focused on Particulate Matter Exposure

The adverse health effects of exposure to air pollutants, notably to particulate matter (PM), are well-known, as well as the association with measured or estimated concentration levels. The role of perception can be relevant in exploring effects and pollution control actions. The purpose of this study was to explore studies that analyse people’s perception, together with the measurement of air pollution, in order to elucidate the relationship between them. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In March 2020, PubMed, EMBASE, and Scopus databases were explored in an attempt to search for studies published from 2000 to 2020. The review included 38 studies, most of which were conducted in China (n = 13) and the United States (n = 11) and published over the last four years (n = 26). Three studies were multicenter investigations, while five articles were based on a national-level survey. The air quality (AQ) was assessed by monitoring stations (n = 24) or dispersion models (n = 7). Many studies were population questionnaire-based, air monitoring and time-series studies, and web-based investigations. A direct association between exposure and perception emerged in 20 studies. This systematic review has shown that most of the studies establish a relationship between risk perception measurement. A broad spectrum of concepts and notions related to perception also emerged, which is undoubtedly an indicator of the wealth of available knowledge and is promising for future research.

Beliefs towards vaccination and trust in the scientific community in Italy

BACKGROUND

In 2017 the Italian government introduced compulsory vaccination for Italian school children for ten diseases, in response to an alarmingly decrease in coverage and measles outbreak. A hot social debate arose around the issue of the law. Studies on the opinion of Italians on this topic are rare, so we investigated the socio-cultural profile of Italians about beliefs towards vaccination.

METHODS

Data were extracted from the Italian section of the European Social Survey (ESS), conducted by the Italian National Institute for Public Policies Analysis during 2017. The main outcome assessed was the opinion about the supposed harmfulness of vaccines. We analysed the association between the outcome and a selected group of socio-cultural characteristics, with a specific interest in examining the interaction between our main outcome and the perceived trust in the scientific community in regards to vaccines. A principal component analysis was then performed for determining the socio-cultural profile of respondents.

RESULTS

Among the 2,626 subjects interviewed face to face, 19% believed that vaccines were harmful and 10% did not have trust in the scientific community in regards to vaccines. Out of the respondents who believed in the harmfulness of vaccines, 29% neither had trust in the scientific community. Principal Component Analysis suggested that this group (Anti-vax/science sceptic) was characterised by low participation in political and cultural life, being male, older of age and politically oriented towards the right. People agreeing about harmfulness of vaccines are mostly males, have a lower education level, poor attendance in political and cultural life and are politically oriented to the right.

CONCLUSIONS

The ESS survey is unique in its capacity to deal with emerging themes of the social debates. Results paint a picture of the opinions of Italians on vaccines. This profile may be useful for policymakers to design targeted vaccination campaigns and to intervene more efficaciously in the public debate.

Twitter as a sentinel tool to monitor public opinion on vaccination: an opinion mining analysis from September 2016 to August 2017 in Italy

Social media have become a common way for people to express their personal viewpoints, including sentiments about health topics. We present the results of an opinion mining analysis on vaccination performed on Twitter from September 2016 to August 2017 in Italy. Vaccine-related tweets were automatically classified as against, in favor or neutral in respect of the vaccination topic by means of supervised machine-learning techniques. During this period, we found an increasing trend in the number of tweets on this topic. According to the overall analysis by category, 60% of tweets were classified as neutral, 23% against vaccination, and 17% in favor of vaccination. Vaccine-related events appeared able to influence the number and the opinion polarity of tweets. In particular, the approval of the decree introducing mandatory immunization for selected childhood diseases produced a prominent effect in the social discussion in terms of number of tweets. Opinion mining analysis based on Twitter showed to be a potentially useful and timely sentinel system to assess the orientation of public opinion toward vaccination and, in future, it may effectively contribute to the development of appropriate communication and information strategies.

Medical science faces the post-truth era: a plea for the grassroot values of science

PURPOSE OF REVIEW

Science and its public perception are compromised by scientific fraud and predatory journals, and also by the general erosion of the meaning of truth in the so-called post-truth era. These developments have significant influence on scientific medicine and their impact on the public discourse. The purpose of this article is to show how fake science, and also the uncritical dissemination of compromised results in public and social media, threatens scientific medicine.

RECENT FINDINGS

As social media rises to the preferred source of information of ever larger parts of the modern societies, the dissemination of falsified scientific results within the communities is almost unstoppable. With growing numbers of predatory journals and repetitive cases of fake science, the risk of publication of false results increases. Due to the underlying mechanisms of the post-truth era and social media, these compromised results find their way to the public discourse and continue to be disseminated even when they were, beyond all doubt, proven to be a lie. In medical sciences, dissemination of falsified results directly threats health and life of patients.

SUMMARY

In the post-truth era, publication of false results in predatory journals and by fraudulent authors become even more dangerous for the health and life of patients, as their dissemination via new social media is nearly unstoppable and in the public perception truth is losing its meaning. The scientific community has implemented specific counter-measures to minimize the chances of false results being published. However, it is even more important that every participant in the scientific process assumes the responsibility according to his or her role. An orientation towards the values that have constituted and formed science is helpful in fulfilling this responsibility.

Monitoring stance towards vaccination in twitter messages

Background

We developed a system to automatically classify stance towards vaccination in Twitter messages, with a focus on messages with a negative stance. Such a system makes it possible to monitor the ongoing stream of messages on social media, offering actionable insights into public hesitance with respect to vaccination. At the moment, such monitoring is done by means of regular sentiment analysis with a poor performance on detecting negative stance towards vaccination. For Dutch Twitter messages that mention vaccination-related key terms, we annotated their stance and feeling in relation to vaccination (provided that they referred to this topic). Subsequently, we used these coded data to train and test different machine learning set-ups. With the aim to best identify messages with a negative stance towards vaccination, we compared set-ups at an increasing dataset size and decreasing reliability, at an increasing number of categories to distinguish, and with different classification algorithms.

Results

We found that Support Vector Machines trained on a combination of strictly and laxly labeled data with a more fine-grained labeling yielded the best result, at an F1-score of 0.36 and an Area under the ROC curve of 0.66, considerably outperforming the currently used sentiment analysis that yielded an F1-score of 0.25 and an Area under the ROC curve of 0.57. We also show that the recall of our system could be optimized to 0.60 at little loss of precision.

Conclusion

The outcomes of our study indicate that stance prediction by a computerized system only is a challenging task. Nonetheless, the model showed sufficient recall on identifying negative tweets so as to reduce the manual effort of reviewing messages. Our analysis of the data and behavior of our system suggests that an approach is needed in which the use of a larger training dataset is combined with a setting in which a human-in-the-loop provides the system with feedback on its predictions.

Measles Immunization Policies and Vaccination Coverage in EU/EEA Countries over the Last Decade

BACKGROUND

Starting from 2016, a major measles epidemic affected EU/EEA countries, after the measles incidence rate had progressively decreased from 2011 to 2015.

METHODS

This study describes measles incidences (ECDC reports), the vaccination coverages (VCs) (WHO/UNICEF reports) and the vaccination strategies, whether mandatory or recommended (ECDC Vaccine Scheduler), in 30 European countries over the last decade.

RESULTS

VCs were higher in countries with historically mandatory vaccination. However, in these countries, VCs declined between 2010 and 2018, in two cases to levels below 90% at the second dose. Instead, 9 and 12 countries with recommended vaccination increased their VCs, respectively, for the first and the second dose. Overall, the countries with VC ≥ 95% decreased from 20 to 15 for the first dose and from 10 to 7 for the second dose. This trend led Italy, France and Germany to make vaccination mandatory. In Italy this provision was introduced in 2017, and together with the catch-up campaigns on children between 1 and 15 years at school entry, led immediately to a strong effect: the first dose VC passed from 87% in 2016 to 93% in 2018, and from 82% to 89% for the second dose.

CONCLUSIONS

Mandatory vaccination is certainly a policy producing positive effects; however, it seems to require additional strategies in order to reach the WHO goal of 95% of VC. Measures such as catch-up action on susceptible populations and communication strategies aimed at increasing awareness and acceptance should be considered.