Words matter: Vaccine hesitancy, vaccine demand, vaccine confidence, herd immunity and mandatory vaccination

Vaccine Acceptance in Patients with Inflammatory Bowel Disease: Lessons Learned from the COVID-19 Pandemic

BACKGROUND

Immunomodulating therapies, which are commonly used in patients with Crohn's disease (CD) and ulcerative colitis (UC), have been linked to an increased risk of contracting opportunistic infectious diseases, the majority of which are preventable through vaccination. Nonetheless, vaccination rates in these patients are suboptimal, and frequently lower than in the general population. The COVID-19 immunization schedule provided a new scenario for investigating vaccine acceptance in patients with inflammatory bowel disease (IBD), with uncertainty and concerns emerging and the number of subjects receiving the third and fourth doses of the vaccine gradually decreasing. This study investigated IBD patients' attitudes towards previous COVID-19 vaccine programs and identified the factors that influence their adherence. It considered demographic and disease-related factors as well as the role of gastroenterologists and primary care physicians (PCPs).

METHODS

Data were collected through a self-completed questionnaire administered to all adult IBD patients (age > 18) who visited the Gastroenterology, Hepatology, and Nutrition division at the University of L'Aquila (Italy) for a regular follow-up between November 2021 and December 2022. Non-IBD gastroenterological outpatients who visited during the same period were included as a control group.

RESULTS

A total of 178 patients were included in the analysis. The IBD group consisted of 77 patients, 48.1% with CD and 51.9% with UC; the mean age was 49.5 years and 51.9% were female. Overall, 94.8% of IBD patients had undergone at least one vaccine dose and 79.2% had received two doses, versus 8% of the control group (p < 0.0001). A total of 84.4% of IBD patients reported their propensity towards COVID-19 vaccination, with an average agreement score significantly higher than the controls (p = 0.0044). The trust of IBD patients in the effectiveness of the COVID-19 vaccine (p < 0.0001) and its role in hastening pandemic resolution (p < 0.0001) is strongly related to motivation and propensity. Concerns about the safety of the COVID-19 vaccine in IBD (p = 0.0202) and fear of vaccine-induced flare-ups (p = 0.0192) were reported as the main barriers. No correlation was found between COVID-19 vaccine propensity and clinical features like the type of IBD, years of disease, activity, and ongoing treatment. Regarding the recommendations received from physicians to get vaccinated against COVID-19, IBD patients relied heavily on their gastroenterologists for advice, while the control group relied mainly on their PCPs.

CONCLUSIONS

The overall positive attitude towards vaccinations reported in our study was better than that observed for other vaccines. The relationship of trust with the gastroenterologist should be used to boost vaccination against other preventable diseases in IBD patients. Our findings add information on the factors influencing vaccine propensity, which can be used to improve current vaccination strategies.

Strategies for Improving Vaccine Communication and Uptake

Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.

COVID Vaccine Hesitancy and Long-Term Traffic Risks

BACKGROUND

COVID vaccine hesitancy identifies a discrepancy between personal decisions and public guidelines. We tested whether COVID vaccine hesitancy was associated with the long-term risks of a traffic crash.

METHODS

We conducted a population-based longitudinal cohort analysis of adults by determining COVID vaccination status through linkages to electronic medical records. Traffic crashes requiring emergency medical care were defined by multicenter outcome ascertainment of all hospitals throughout the region over the subsequent year.

RESULTS

We identified 11,598,549 total individuals, of whom 1,210,754 had not received a COVID vaccine. A total of 54,558 were subsequently injured in traffic crashes during the 1-year follow-up interval, equal to a risk of 4704 per million. Those who had not received a COVID vaccine had a 58% higher risk than those who had received a COVID vaccine (6983 vs 4438 per million, P < .001). The increased traffic risks among unvaccinated individuals included diverse subgroups, were accentuated for single-vehicle crashes, extended to fatal outcomes, exceeded the risks associated with sleep apnea, and persisted after adjustment for baseline characteristics. The increased risks were validated in analyses using Artificial Intelligence techniques and generally larger than the risks of other adverse events frequently ascribed to COVID vaccination.

CONCLUSIONS

COVID vaccine hesitancy is associated with significant increased long-term risks of a traffic crash. A greater awareness of traffic risks might encourage patients to take protective actions for personal safety.

Information gaps in persuasion knowledge: The discourse regarding the Covid-19 vaccination

Persuasion knowledge is personal knowledge about persuasion attempts that has an effect on the way people respond to these attempts. Persuasion attempts are made to effectively handling the Covid-19 pandemic, which is dependent on high public compliance with vaccination programs. Drawing on the idea of persuasion knowledge, we aimed at elaborating the various categories of perceived information gaps experienced by vaccine hesitants during the Covid-19 vaccination campaign. At the beginning of 2021 we conducted 20 in-depth interviews with Israelis who had decided not to be vaccinated against Covid-19. Analysis of the interviews revealed three main categories of information gaps experienced by the interviewees: missing information, manipulated information, and discrepant information. We analyzed how these are associated with distrust and may impair the persuasion efforts of governments and health authorities. Perceived information gaps, as part of persuasion knowledge, may increase negative responses, and therefore constitute an important factor in persuasion campaigns.

Relations of behavioral inhibition and activation system sensitivities with vaccination outcomes: Investigating the mediating role of vaccine hesitancy in older adults

The study of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities has produced a multitude of models and frameworks to better understand decision-making and behavior. We extend this research to the study of a vaccination by exploring the relation of BIS and BAS sensitivities with vaccination willingness, receipt, and word-of-mouth. We also assess whether dimensions of vaccine hesitancy mediate these relations, testing whether they are viable explanatory mechanisms. By conducting a multi-wave survey study, our results support that BIS sensitivity does not meaningfully relate to vaccine hesitancy or vaccination outcomes. On the other hand, BAS sensitivity related to detrimental vaccination outcomes, and these effects were mediated by vaccine hesitancy dimensions associated with perceptions that vaccines cause health risks and are not needed for healthy individuals. Based on extant BIS and BAS theory, these results suggest that certain people may see refraining from vaccination as a nonpunishment.

Vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland: protocol for an online national study

Background

Vaccine hesitancy is a persistent challenge in public health, exacerbated by the proliferation of anti-vaccine sentiments facilitated by social networks. The COVID-19 pandemic has underscored the importance of addressing vaccine hesitancy, designated by the WHO as a top global health threat. This study explores vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland-a cohort crucial to public health given their future roles as healthcare professionals-with a particular emphasis on the HPV vaccine, which exhibits lower confidence levels compared to other vaccines.

Methods

This study will employ an online questionnaire distributed to nursing and midwifery undergraduate students from various healthcare universities. The questionnaire will collect data on vaccine hesitancy (general confidence in vaccines and specifically in the HPV vaccine), HPV vaccine coverage, socio-demographics, likelihood to recommend vaccines to patients, perception of vaccination education and interest in complementary medicine.

Conclusion

The study's findings will contribute to our understanding of vaccine hesitancy among nursing and midwifery undergraduate students, providing insights that can inform targeted interventions and education strategies to bolster vaccine confidence among future healthcare professionals, thereby enhancing public health efforts.

COVID-19 Vaccine Acceptance Among Latino/a Immigrants: The Role of Collective Responsibility and Confidence

Research on COVID-19 vaccine hesitancy has been sparse among Latino/a immigrants, a population at high risk for infection. This exploratory study examines rates of vaccine acceptance and its association with psychological antecedents of vaccination among Latino/a immigrants. A cross-sectional telephone survey on perceptions of COVID-19 was administered between October 2020 to February 2021 in South Florida to 200 adult Latino/a immigrants. Descriptive statistics, bivariate analysis, and logistic regression were employed to determine the influence of independent variables on vaccine acceptance. Most participants indicated a willingness to get vaccinated. Participants with higher confidence (aOR = 10.2, 95% CI: 4.8-21.8) and collective responsibility scores were (aOR = 3.1, 95%CI:1.3-6.9) more likely to report vaccine acceptance than those with lower scores. No other psychological antecedents or demographic variables were significantly associated with vaccine acceptance. Study results provide insights into motivating factors for vaccination that can inform culturally tailored education campaigns to increase vaccine acceptability in this population.

Factors associated with receiving an initial COVID-19 vaccine among Alaskan residents: results from an online cross-sectional survey

We conducted an online survey of Alaskan adults between May and June, 2022 to identify factors associated with vaccine hesitancy. Of the 948 respondents, approximately 80% reported having received a COVID-19 vaccine. The factors significantly associated with ever receiving COVID-19 vaccine include perceived risk of harm if not vaccinated (PRH), the vaccination status of the respondent's social network (SNW), gender, and education. For each point increase in PRH score, there was more than three times the odds of having ever been vaccinated (OR = 3.42, p < 0.001); and for every point increase in SNW score, there was more than two times the odds of having ever been vaccinated (OR = 2.15, p < 0.001). Males had more than four times the odds of having ever been vaccinated compared to females (OR = 4.55, p < 0.001). Those with a college degree (OR = 2.80, p < 0.05) had greater odds of ever being vaccinated compared to their counterparts. Findings from this sample suggest that, among Alaskans, ever receiving a COVID-19 vaccine is associated with having a majority of their close social networks who have received COVID-19 vaccine and perceiving that not obtaining a COVID-19 vaccine can pose greater risk of harm to themselves than not getting vaccinated. Practical implications of these findings are provided.

Risk Awareness as a Key Determinant of Early Vaccine Uptake in the Mpox Vaccination Campaign in an Italian Region: A Cross-Sectional Analysis

BACKGROUND

we aim to investigate attitudes toward vaccination by analyzing empirical factors associated with vaccine acceptance in the Lazio region mpox vaccination (MpoxVax) campaign in Italy.

METHODS

all subjects who accessed MpoxVax and signed the informed consent were prospectively enrolled in the MPOX-VAC Study and were asked to fill out an anonymous survey. Two endpoints were selected: 'delayed acceptance' and 'early acceptance', defined as access for vaccination >60 and ≤30 days from the vaccination campaign starting (VCS), respectively.

RESULTS

over the study period, 1717 individuals underwent vaccination: 129 (7%) > 60 [1588 (92.5%) ≤ 60] and 676 (60%) ≤ 30 days from VCS. A bisexual orientation, a lower education level and a worse perceived physical and mental health were associated with delayed access to vaccination. Being pre-exposure prophylaxis (PrEP) users and, marginally, HIV positive; having a high perceived risk for mpox infection; and reporting high-risk behaviors like the use of recreational drugs/chems, sex under the influence of drugs and/or alcohol and having a higher number of principal sexual partners, were associated with early access to vaccination.

CONCLUSIONS

according to our data, risk awareness was a major determinant of early MpoxVax acceptance. Conversely, worse perceived health status and a low educational level were critical factors associated with delayed vaccination.

COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal

Importance

Hong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary.

Objectives

To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal.

Design, Setting, and Participants

This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022.

Exposures

Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass).

Main Outcomes and Measures

Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments.

Results

The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors-mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views-could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments.

Conclusions and Relevance

These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response.

Parental views and the key role of nurses for high vaccine acceptance in Sweden - a focus group study

BACKGROUND

In Sweden, vaccine uptake is exceptionally high due to an efficient child immunization program. More than 97% of Swedish children were vaccinated at child health care centers (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within the school health care. Maintaining high vaccination coverage over time is one of the central motives to explore and understand drivers for vaccine acceptance. The current study aimed to assess parental vaccine acceptance concerning the national immunization program and explore factors contributing to the high vaccine acceptance in Sweden.

METHODS

Parents of children aged 1-2 years and 8-12 years were recruited through purposive sampling and asked to participate in focus groups held in three cities in Sweden, in February and March 2019. In total, 47 parents participated in two focus groups per city, one session for parents of younger (1-2 years) and older (8-12 years) children respectively. The focus group discussions were analyzed using qualitative content analysis.

RESULTS

Parents of children aged 1-2 years expressed the themes; strong compliance to and protection of the value of vaccinations; parents feel safe with an attentive relationship with their nurse; the spectrum of communication needs is essential to meet. For parents to children aged 8-12 years, the themes expressed were; vaccinate to do good for the individual and society; a foundation of trust is built at CHCs for decisions later on; decisions for vaccination become more complex as children get older; communication changes as children get older and need to be explicit and tailored to the situation.

CONCLUSION

Both individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations, as manifested in parental reflections and experiences. As nurses have a key role, it is important to provide them with continued support and tools to facilitate their support for parents in making informed decisions. Continuous work for supporting driving factors for vaccination over time is needed to maintain high vaccine acceptance in Sweden.

Integrating the person-centered approach with the study of vaccine hesitancy: Applying latent profile analysis to identify vaccine hesitancy subpopulations and assess their relations with correlates and vaccination outcomes

In scholarly and popular discussions of vaccine hesitancy, authors have repeatedly referred to different "types" of vaccine hesitant individuals; however, almost all modern research on vaccine hesitancy utilizes variable-centered approaches to identify the relation of variables rather than a person-centered approach to identify subpopulations, which suggests that a discrepancy exists between conceptual discussions and empirical research on vaccine hesitancy. For this reason, the current article conducts a latent profile analysis (LPA) on the dimensions of a well-supported vaccine hesitancy measure, which assess hesitancy towards vaccines in general. We also assess the relations of the resultant profiles (e.g., subpopulations) with relevant self-reported outcomes and correlates, wherein most of our outcomes are associated with COVID-19 and flu vaccines. Our LPA results support the existence of eight vaccine hesitancy profiles. The profile with the most unfavorable vaccination outcomes (e.g., willingness, receipt, and word-of-mouth) was associated with greater perceptions that vaccines cause health risks and unneeded when healthy; the profile with the most favorable vaccination outcomes was associated with low levels of all vaccine hesitancy dimensions. The other profiles produced a clear gradient between these two extremes. The profiles also differed regarding their standing on correlates, but the clearest difference was their relation with political orientation. Profiles with more unfavorable vaccination outcomes were associated with conservatism, whereas profiles with more favorable vaccinations outcomes were associated with liberalism. These results provide a new perspective for current understandings of vaccine hesitancy and open several avenues for future research.

A diagnostic quandary: Rotavirus vaccine associated diarrhea

The patient is an otherwise healthy two-month-old boy who received the recommended vaccinations for his age group, which included the rotavirus pentavalent vaccine (RV5; RotaTeq) at his two-month well child visit. Three days later, he developed prolonged non-bloody diarrhea and was found to have persistently positive rotavirus antigen in his stool. Subsequent workup revealed mild defects in his functional T-cell immunocompetence. Genetic testing was obtained through the Invitae panel and was negative for hereditary forms of primary immunodeficiencies. The rotavirus antigen was found to have cleared from his stool around four months after receiving the RV5. Unfortunately, the source of the rotavirus infection was unable to be determined. The caregivers had misconceptions about the vaccine and the child's immune system function which led to refusal of any further vaccinations. Healthcare providers should strive to develop honest and respectful relationships with parents to have thoughtful dialogues regarding vaccine safety and efficacy.

Factors Associated With Coronavirus Disease 2019 Vaccine Uptake Among Pregnant Women and Nonpregnant Women of Reproductive Age in Jamaica

Background

Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women.

Methods

We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy.

Results

Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model.

Conclusions

Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.

The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago

BACKGROUND

A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas.

METHODS

Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI).

RESULTS

Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree).

CONCLUSIONS

Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity.

CLINICAL TRIALS NUMBER

NCT03584490.

State of Vaccine Hesitancy in the United States

Although the term "vaccine hesitancy" has achieved great prominence, the extent to which US parents have reluctance, doubts, or indecision when it comes to vaccines recommended for children and how such hesitancy is manifest are unclear. A narrative review approach that placed emphasis on recent data and published work is used to surface evidence and insights into the current state of US parent vaccine hesitancy. The assessment finds evidence that ∼6% to 25% of parents may be vaccine hesitant, that hesitancy is higher for influenza and HPV vaccines, and there are indications that addressing parent hesitancy has become more challenging.

Prevalence, Attitudes, and Factors Influencing Uptake of the COVID-19 Vaccine in Saudi Arabia

Background: The availability and access to COVID-19 vaccinations are critical to a successful pandemic response. More than 70% of the population reportedly needs to be vaccinated against COVID-19 to achieve herd immunity worldwide. However, the reluctance to get vaccinated with the COVID-19 vaccines is holding up the process of vaccination and efforts to control the pandemic and its negative consequences for the global health system, society, and economy. Previous studies have shown low uptake of vaccination in some Middle Eastern countries due to negative attitudes toward vaccination, including concerns about safety and efficacy and doubts about the need for vaccination. Aim: The aim of this study is to investigate the prevalence, attitudes, and factors influencing COVID-19 vaccine acceptance among healthcare workers, academic staff, and students in Saudi Arabia after the vaccine was made widely available by the government. Method: A cross-sectional survey was conducted to determine the prevalence, attitudes, and association between demographic factors and uptake of the first or second dose of vaccination among Saudi Arabian health workers and students. Data were collected using an online questionnaire administered and distributed through the Qualtrics platform. Results: The study recruited 173 participants from different countries and from different Saudi regions, most of whom were faculty members (n = 83). Results indicated significant differences between regions; the mean attitude score for the Western region (M 3.23) was significantly higher than that for other regions (M 3.08, p = 0.030). There was also an association between education level and number of vaccine doses received. Thus, the participants with higher education were the most compliant with national vaccination requirements (p = 0.004). Although the three professional groups reported social media as the most frequently reported source of information (p = 0.021), administrators were more likely to receive information from the MOH than other professional groups. Similarly, faculty members were more likely to receive information from colleagues and professional journals than the other two professional groups. Conclusions: Government officials should build public confidence through vaccination campaigns and devise effective health education programs to increase vaccination uptake. Authorized institutions can effectively use social media platforms to encourage vaccination and promote awareness among all audiences.

The mediating role of vaccine hesitancy in the relations of COVID-19 conspiracy beliefs and vaccination outcomes: Which dimensions matter?

COVID-19 conspiracy beliefs have a powerful detrimental influence on COVID-19 vaccine perceptions and behaviors. We investigate an expanded range of outcomes for COVID-19 conspiracy beliefs, and we test which vaccine hesitancy dimensions mediate these relations. Our results show that COVID-19 conspiracy beliefs relate to COVID-19 vaccination willingness and receipt, flu vaccination willingness and receipt, as well as vaccine word-of-mouth. Many of these relations are mediated by vaccine hesitancy dimensions that represent perceptions that vaccines pose health risks as well as perceptions that vaccines are not needed because the respondent is healthy. Our discussion identifies directions for future research.

Relation of Personal Characteristics with Human Papillomavirus Vaccination Outcomes: Assessing the Mediating Role of Vaccine Hesitancy Dimensions

Recent findings suggest that the rate of certain cancers can be reduced by increasing human papillomavirus (HPV) vaccination coverage, resulting in considerable research interest on the antecedents of HPV vaccine receipt to identify avenues to promote vaccination. The current article continues this stream of research by (1) studying the three HPV vaccination outcomes of willingness, receipt, and word-of-mouth, (2) investigating the antecedent effects of sociodemographic characteristics, health insurance status, provider conversation, and political orientation, and (3) testing the mediating role of vaccine hesitancy dimensions using a recently developed conceptualization. We achieve these goals by conducting a cross-sectional study with 404 participants (Agemean = 37.64; AgeSD = 14.91; 57% female; 72% white; 100% located in U.S.). Our results show that provider conversations and political orientation had the most consistent and strong effects of the personal characteristics, whereas perceptions that vaccines pose health risks and perceptions that vaccines are not needed for healthy individuals produced the most consistent and strong effects of the vaccine hesitancy dimensions. Other personal characteristics and vaccine hesitancy dimensions also produced intermittent significant effects, including age, education, and race. Together, these results support that personal characteristics and vaccine hesitancy dimensions relate to a broader range of outcomes associated with HPV vaccination than previously known, and these results also support that the recently developed conceptualization of vaccine hesitancy is apt for understanding HPV vaccine perceptions. Our discussion concludes with highlighting avenues for future research and practice that can leverage our discovered relations to improve HPV vaccination outcomes.

COVID Vaccine Hesitancy and Risk of a Traffic Crash

BACKGROUND

Coronavirus disease (COVID) vaccine hesitancy is a reflection of psychology that might also contribute to traffic safety. We tested whether COVID vaccination was associated with the risks of a traffic crash.

METHODS

We conducted a population-based longitudinal cohort analysis of adults and determined COVID vaccination status through linkages to individual electronic medical records. Traffic crashes requiring emergency medical care were subsequently identified by multicenter outcome ascertainment of all hospitals in the region over a 1-month follow-up interval (178 separate centers).

RESULTS

A total of 11,270,763 individuals were included, of whom 16% had not received a COVID vaccine and 84% had received a COVID vaccine. The cohort accounted for 6682 traffic crashes during follow-up. Unvaccinated individuals accounted for 1682 traffic crashes (25%), equal to a 72% increased relative risk compared with those vaccinated (95% confidence interval, 63-82; P < 0.001). The increased traffic risks among unvaccinated individuals extended to diverse subgroups, was similar to the relative risk associated with sleep apnea, and was equal to a 48% increase after adjustment for age, sex, home location, socioeconomic status, and medical diagnoses (95% confidence interval, 40-57; P < 0.001). The increased risks extended across the spectrum of crash severity, appeared similar for Pfizer, Moderna, or other vaccines, and were validated in supplementary analyses of crossover cases, propensity scores, and additional controls.

CONCLUSIONS

These data suggest that COVID vaccine hesitancy is associated with significant increased risks of a traffic crash. An awareness of these risks might help to encourage more COVID vaccination.

Stages of HPV Vaccine Hesitancy Among Guardians of Female Secondary School Students in China

PURPOSE

Female secondary school students are the primary recommended population for human papillomavirus (HPV) vaccines. However, vaccine hesitancy may affect uptake. In this study, we assessed the vaccine hesitancy levels among the guardians of female secondary school students in China.

METHODS

We developed a questionnaire and conducted cross-sectional surveys among guardians of secondary school girls aged 12-19 years in mainland China based on the Increasing Vaccination Model and the Precaution Adoption Process Model.

RESULTS

We collected 3,225 valid samples. Among the participating guardians, 53.9% were vaccine hesitant, although only 0.9% had refused HPV vaccines. Some individual characteristics of guardians (e.g. sex, education/income level) were associated with understanding HPV vaccines. Better knowledge of HPV vaccines and communication with reliable sources of information were associated with vaccine nonhesitancy. Practical barriers such as vaccine shortage and busy schedules prevented nonhesitant guardians from vaccinating their children.

DISCUSSION

A substantial proportion of the guardians surveyed were HPV vaccine hesitant. Promoting HPV knowledge and communication with reliable sources (e.g. clinical doctors) could help fight against vaccine hesitancy.

COVID-19 vaccination side effects among the child age group: a large cross-sectional online based survey in Saudi Arabia

BACKGROUND

Multiple vaccines have been tested in clinical trials for their efficacy and safety. In Saudi Arabia, Pfizer-BioNTech or Moderna were approved for children, however, previous studies to report their safety profile are limited. This research aims to understand the side effect of children's vaccination against SARS-CoV-2 infection in Saudi Arabia.

METHODS

This was an observational retrospective cross-sectional study was conducted using an online survey in Saudi Arabia from March to May 2022. The inclusion criteria were parents aged 18 years and above who live in Saudi Arabia and have vaccinated their children. The self-reported questionnaire was adopted from published studies to investigate the study objectives Descriptive statistics were used to describe patients' demographic characteristics, continuous data were reported as mean ± S.D., categorical data were reported as percentages (frequencies), and logistic regression was used to identify predictors of persistent post-COVID-19 symptoms.

RESULTS

This study had a total of 4,069 participants. Only 41.9% of the participants reported that their child(ren) had been infected with the coronavirus. 2.00 was the median number of children (IQR: 1.00-4.00). More than half of the study participants (64.2%) reported that a family member had been infected with the coronavirus. Both parents received COVID-19 vaccination, according to most participants (88.7%). Most participants (70.5%) stated that all children who met the vaccination criteria had received the vaccine. Most participants (83.5%) said their child or children had two doses of their vaccine, and about half (50.4%) of those who received the vaccine reported experiencing side effects. In addition, the majority (78.9%) reported that the side effects appeared within one day of receiving the vaccine, and nearly two-thirds (65.7%) reported that the side effects lasted between one and three. A total of 11,831 side effects cases were documented. Pain at the injection site, hyperthermia, and fatigue were the most reported side effects, accounting for 15.3%, 14.1%, and 13.2%, respectively.

CONCLUSION

It appears that the side effects of the COVID-19 vaccine for children are minor, tolerable, and like those described previously in clinical trials. Our data should encourage the public about the safety of receiving the COVID-19 vaccine for children.

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

BACKGROUND

The United States has the highest number of total cases and deaths due to coronavirus disease 2019 (COVID-19) worldwide (Johns Hopkins COVID Dashboard, 2021). Despite COVID-19 vaccine availability, uptake in the United States has been slow and vaccine hesitancy has been a significant barrier to achieving widespread vaccine uptake. Understanding determinants of vaccine acceptance is essential to implement successful population health interventions to increase COVID-19 vaccination.

METHODS

We developed an anonymous cross-sectional parent survey to assess factors associated with parent and child COVID-19 vaccine acceptance and hesitancy during the initial pediatric vaccine rollout amongst adolescents 16 years +. The survey was sent via email to 25,308 parents registered to the Alachua County Public School System in May 2021 and remained active until July 2021.

FINDINGS

There were a total of 2,620 survey responses. Overall, 31.5 % of parents with children ages 16 years + reported their child had received the COVID-19 vaccine, 65.2 % reported their (eligible) child had not received the vaccine, and 3.3 % reported their child was scheduled for the vaccine. A majority of parents (60.9 %) reported they planned to vaccinate all of their children once the COVID-19 vaccine was available for their children's age. COVID-19 vaccine uptake in adolescents ages 16 + reported by Hispanic and White parents was two times higher than that reported by Black parents. Parent COVID-19 and influenza vaccine uptake were associated with increased child COVID-19 vaccination. The most commonly reported reasons why parents chose not to have their child vaccinated against COVID-19 were concerns about long-term negative side effects (75.7 %) and a negative reaction (56.5 %). Medical providers were reported as the most trusted source of information.

CONCLUSION

Our study provides insight into determinants of vaccine acceptance, vaccine hesitancy, and trusted sources of information that may be helpful to develop targeted interventions to increase youth COVID-19 vaccination.

Knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in pregnancy in 7 low- and middle-income countries: An observational trial from the Global Network for Women and Children's Health Research

OBJECTIVES

We sought to determine the knowledge, attitudes and practices of pregnant women regarding COVID-19 vaccination in pregnancy in seven low- and middle-income countries (LMIC).

DESIGN

Prospective, observational, population-based study.

SETTINGS

Study areas in seven LMICs: Bangladesh, India, Pakistan, Guatemala, Democratic Republic of the Congo (DRC), Kenya and Zambia.

POPULATION

Pregnant women in an ongoing registry.

METHODS

COVID-19 vaccine questionnaires were administered to pregnant women in the Global Network's Maternal Newborn Health Registry from February 2021 through November 2021 in face-to-face interviews.

MAIN OUTCOME MEASURES

Knowledge, attitude and practice regarding vaccination during pregnancy; vaccination status.

RESULTS

No women were vaccinated except for small proportions in India (12.9%) and Guatemala (5.5%). Overall, nearly half the women believed the COVID-19 vaccine is very/somewhat effective and a similar proportion believed that the COVID-19 vaccine is safe for pregnant women. With availability of vaccines, about 56.7% said they would get the vaccine and a 34.8% would refuse. Of those who would not get vaccinated, safety, fear of adverse effects, and lack of trust predicted vaccine refusal. Those with lower educational status were less willing to be vaccinated. Family members and health professionals were the most trusted source of information for vaccination.

CONCLUSIONS

This COVID-19 vaccine survey in seven LMICs found that knowledge about the effectiveness and safety of the vaccine was generally low but varied. Concerns about vaccine safety and effectiveness among pregnant women is an important target for educational efforts to increase vaccination rates.

The Multidimensional Vaccine Hesitancy Scale: A Validation Study

Vaccination hesitancy (VH) is a phenomenon which increases the occurrence of vaccine-preventable diseases. The study tests the validity of the Multidimensional Vaccine Hesitancy Scale (MVHS) in the case of a sample of Romanian adults (n = 528; Meanage = 30.57). The latter filled in an online cross-sectional survey. The construct validity of MVHS was assessed by using confirmatory factor analysis (CFA), the reliability was calculated by using the internal consistency, and the convergent and discriminant validity was assessed by using the composite reliability (CR), and average variance extracted (AVE). The obtained model was invariant across gender. The structural equation model was designed for predictive validity by using the partial least square method (PLS-SEM) which analyses the relation between the MVHS dimensions and the vaccination willingness. The results show support for the 8-factor structure of the scale (χ2/df = 2.48; CFI = 0.95; RMSEA = 0.053). The Cronbach’s coefficients α > 0.70; McDonald’s ω > 0.70 and CR > 0.80 have very good values. The structural equation model shows that there are more dimensions of the scale which predict vaccination hesitancy in various types of vaccines—the main predictors remain the dimensions of health risk and healthy condition. The study’s conclusion led to the idea that the MVHS is suitable for medical practice and for research on the analysis of vaccination behaviours and intentions.

COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II

BACKGROUND

Our aim was to estimate provisional willingness to receive a coronavirus 2019 (COVID-19) vaccine, identify predictive socio-demographic factors, and, principally, determine potential causes in order to guide information provision.

METHODS

A non-probability online survey was conducted (24th September-17th October 2020) with 5,114 UK adults, quota sampled to match the population for age, gender, ethnicity, income, and region. The Oxford COVID-19 vaccine hesitancy scale assessed intent to take an approved vaccine. Structural equation modelling estimated explanatory factor relationships.

RESULTS

71.7% (n=3,667) were willing to be vaccinated, 16.6% (n=849) were very unsure, and 11.7% (n=598) were strongly hesitant. An excellent model fit (RMSEA=0.05/CFI=0.97/TLI=0.97), explaining 86% of variance in hesitancy, was provided by beliefs about the collective importance, efficacy, side-effects, and speed of development of a COVID-19 vaccine. A second model, with reasonable fit (RMSEA=0.03/CFI=0.93/TLI=0.92), explaining 32% of variance, highlighted two higher-order explanatory factors: 'excessive mistrust' (r=0.51), including conspiracy beliefs, negative views of doctors, and need for chaos, and 'positive healthcare experiences' (r=-0.48), including supportive doctor interactions and good NHS care. Hesitancy was associated with younger age, female gender, lower income, and ethnicity, but socio-demographic information explained little variance (9.8%). Hesitancy was associated with lower adherence to social distancing guidelines.

CONCLUSIONS

COVID-19 vaccine hesitancy is relatively evenly spread across the population. Willingness to take a vaccine is closely bound to recognition of the collective importance. Vaccine public information that highlights prosocial benefits may be especially effective. Factors such as conspiracy beliefs that foster mistrust and erode social cohesion will lower vaccine up-take.

Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review

Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.

The good, the bad, and the neutral: Vaccine hesitancy mediates the relations of Psychological Capital, the Dark Triad, and the Big Five with vaccination willingness and behaviors

The COVID-19 pandemic has made it apparent that many people are unwilling to be vaccinated, and certain types of people seem predisposed to support or oppose vaccines. We perform a multiple-wave survey study to determine whether the Big Five, Dark Triad, and Psychological Capital (PsyCap) indirectly relate via vaccine hesitancy to vaccination willingness, vaccination, and vaccine word-of-mouth. Our results show that conscientiousness, extraversion, narcissism, psychopathy, and PsyCap each influence our outcomes via dimensions of vaccine hesitancy. PsyCap had an additional direct effect beyond these mediators. The overall effects of extraversion and PsyCap were negative on vaccine hesitancy, positive on pro-vaccination outcomes, and negative on anti-vaccination outcomes. The overall effects of conscientiousness, narcissism, and psychopathy were positive on vaccine hesitancy, negative on pro-vaccination outcomes, and positive on anti-vaccination outcomes. To conclude, we identify theoretical frameworks that can provide further insights into these relations. We suggest that the effects of conscientiousness may be understood by integrating research on overconfidence; the effects of extraversion and PsyCap may be understood by applying the situation, trait, and outcome activation model; and the effects of narcissism and psychopathy may be understood with Life History Theory.

The COVID-19 Vaccine: Trust, doubt, and hope for a future beyond the pandemic in Germany

Public perceptions of COVID-19 vaccines are critical in reaching protective levels of herd immunity. Vaccine skepticism has always been relatively high in Germany, and surveys suggest that over the course of the pandemic, enthusiasm for the COVID-19 vaccine has dropped. Looking at the period just prior to the approval of the Pfizer/BioNTech and Moderna vaccines in Germany in the latter half of 2020, this paper aims to assess the reasons for and against COVID-19 vaccine uptake among residents of Germany, and to provide in-depth qualitative data to better understand and address concerns surrounding the safety and efficacy of a COVID-19 vaccine. Our findings indicate that there is widespread trust in German institutions and health experts to provide a safe vaccine for those who need it most. However, interviewees also point to the need for more information and the centrality of support from trusted medical authorities in making individual vaccination decisions. We also present the complexity of individual positions on vaccination, and suggest that vaccine hesitancy in relation to COVID-19 needs to be understood as a nuanced, and socially malleable, territory. This indicates that the goal of a vaccination campaign is not only achieving ‘herd immunity,’ but also a social endorsement of the collaborative effort that is required for a vaccine to be successful.

Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies

Ethnic minority communities in the UK have been disproportionately affected by the pandemic, with increased risks of infection, severe disease, and death. Hesitancy around the COVID-19 vaccine may be contributing to disparities in vaccine delivery to ethnic minority communities. This systematic review aims to strengthen understanding of COVID-19 vaccine concerns among ethnic minorities in the UK. Five databases were searched in February 2022, yielding 24 peer-reviewed studies reporting on vaccine hesitancy or acceptance in ethnic minority groups. Data were extracted using a standardised form, and quality assessment was carried out using the Standard Quality Criteria. There were three key themes: (1). Prevalence of vaccine hesitancy; (2). Reasons for vaccine hesitancy and acceptance; and (3). Recommendations to address vaccine concerns. Vaccine hesitancy, which was more common among some ethnic minority groups, is a complex phenomenon, driven by misinformation, mistrust, concerns about safety and efficacy, and structural and systemic inequities. Community engagement and tailored communication may help to address vaccine concerns. Robust data disaggregated by ethnicities are needed to better understand barriers and facilitators for COVID-19 vaccine delivery in ethnic minority communities. Strategies to address structural disadvantage need to be inclusive, comprehensive, and behaviorally informed and foster confidence in healthcare systems and governments. Community leaders and health care practitioners may prove to be the most important agents in creating an environment of trust within ethnic minority groups.

A Survey of Awareness of COVID-19 Knowledge, Willingness and Influencing Factors of COVID-19 Vaccination

New vaccines are being developed in response to the coronavirus disease 2019 (COVID-19) pandemic. Vaccination provides a crucial preventive approach for managing COVID-19. We investigated adults' willingness to take COVID-19 vaccines in the Zhejiang province, and their cognitions regarding COVID-19, when the COVID-19 vaccine is authorized under Emergency Use Administration. An online survey was conducted from September to October 2020, which included social-demographic characteristics, risk perception, acceptance and influencing factors in relation to COVID-19 vaccines. Multivariate logistic regression was performed to identify the influencing factors of vaccination acceptance. Of the participants, 70% intended to be vaccinated when the COVID-19 vaccine was approved under Emergency Use Administration, among 2171 valid questionnaires. Logistic regression revealed that being male, having a high cognitive score regarding COVID-19, the belief that the COVID-19 vaccine is safe and effective, and the belief that one will be infected with SARS-CoV-2 this fall and winter, were associated with a greater probability of accepting vaccination. Respondents with junior college/university education or above were less likely to accept vaccination. Concerns about the safety and effectiveness of the vaccine were the main factors hindering vaccination acceptance. Health education is important for promoting accurate public knowledge regarding COVID-19 vaccination.

Dynamic assessment of the COVID-19 vaccine acceptance leveraging social media data

Vaccination is the most effective way to provide long-lasting immunity against viral infection; thus, rapid assessment of vaccine acceptance is a pressing challenge for health authorities. Prior studies have applied survey techniques to investigate vaccine acceptance, but these may be slow and expensive. This study investigates 29 million vaccine-related tweets from August 8, 2020 to April 19, 2021 and proposes a social media-based approach that derives a vaccine acceptance index (VAI) to quantify Twitter users’ opinions on COVID-19 vaccination. This index is calculated based on opinion classifications identified with the aid of natural language processing techniques and provides a quantitative metric to indicate the level of vaccine acceptance across different geographic scales in the U.S. The VAI is easily calculated from the number of positive and negative Tweets posted by a specific users and groups of users, it can be compiled for regions such a counties or states to provide geospatial information, and it can be tracked over time to assess changes in vaccine acceptance as related to trends in the media and politics. At the national level, it showed that the VAI moved from negative to positive in 2020 and maintained steady after January 2021. Through exploratory analysis of state- and county-level data, reliable assessments of VAI against subsequent vaccination rates could be made for counties with at least 30 users. The paper discusses information characteristics that enable consistent estimation of VAI. The findings support the use of social media to understand opinions and to offer a timely and cost-effective way to assess vaccine acceptance.

The prevalence and determinants of COVID-19 vaccine hesitancy in the age of infodemic

Background

Addressing COVID-19 vaccine hesitancy is key to ending the COVID-19 pandemic. Communication and media environments are potential drivers of vaccine hesitancy. It is worthwhile to examine the relationship between social media use and COVID-19 vaccine hesitancy.

Objective

This study aims to understand the prevalence and determinants of COVID-19 vaccine hesitancy.

Methods

Questionnaires were administered to 463 participants in mainland China. Factor analysis, correlation analysis, and linear regression models were utilized to examine the prevalence and influencing factors of COVID-19 vaccine hesitancy in China, as well as the relationship between social media use, media trust, health information literacy, and COVID-19 vaccine hesitancy.

Results

Lack of confidence and risk were identified as factors of COVID-19 vaccine hesitancy. Age, occupation status and income levels were significantly associated with COVID-19 vaccine hesitancy. In addition, we observed that frequency of social media use, diversity of social media use, media trust and health information literacy were significantly correlated with COVID-19 vaccine hesitancy.

Conclusion

Increased frequency and diversity of social media use, media trust and health information literacy can mitigate COVID-19 vaccine hesitancy and promote COVID-19 vaccination.

Knowledge, attitudes, beliefs and barriers of healthcare professionals and adults ≥ 65 years about vaccine-preventable diseases in Spain: the ADult Vaccination drIverS and barriErs (ADVISE) study

Since 2018, Spanish National Immunization Guidelines include vaccination recommendations for adults ≥65 years. To determine whether health-care professionals and the ≥65 years target group value the need for these recommendations, a cross-sectional study was conducted to capture and describe their knowledge, attitudes, beliefs and behaviors about vaccination. Online surveys were administered to representative groups of general practitioners (GPs), primary care nurses and adults ≥65 years from six major cities (and surrounding rural areas) in Spain. Main topics were attitudes and awareness of vaccines, perceptions about vaccination in adults ≥65 years, and impact of the COVID-19 pandemic on vaccination uptake. A total of 286 health-care professionals (185 GPs, 101 nurses) and 400 adults aged ≥65 years participated in the survey. GP and nurse groups agreed strongly about the importance of influenza and pneumococcal vaccination in the target population. Longer patient visit times were identified as a key factor toward promoting vaccination. The ≥65 years sample group, especially those ≥75+ years and/or with chronic diseases, was reasonably positive about the effectiveness and benefits of vaccines. Lower vaccination rates for the pneumococcal than influenza vaccine (29% vs. 80%) in the ≥65 years sample group suggest that efforts are needed to improve pneumococcal vaccine uptake. Aligning with other published works, GPs have a key role in promoting vaccination in the target population. The COVID-19 pandemic appears to have heightened awareness about the importance of vaccination among health-care professionals and adults ≥65 years.

Ending the Pandemic: How Behavioural Science Can Help Optimize Global COVID-19 Vaccine Uptake

Governments, public health officials and pharmaceutical companies have all mobilized resources to address the COVID-19 pandemic. Lockdowns, social distancing, and personal protective behaviours have been helpful but have shut down economies and disrupted normal activities. Vaccinations protect populations from COVID-19 and allow a return to pre-pandemic ways of living. However, vaccine development, distribution and promotion have not been sufficient to ensure maximum vaccine uptake. Vaccination is an individual choice and requires acceptance of the need to be vaccinated in light of any risks. This paper presents a behavioural sciences framework to promote vaccine acceptance by addressing the complex and ever evolving landscape of COVID-19. Effective promotion of vaccine uptake requires understanding the context-specific barriers to acceptance. We present the AACTT framework (Action, Actor, Context, Target, Time) to identify the action needed to be taken, the person needed to act, the context for the action, as well as the target of the action within a timeframe. Once identified a model for identifying and overcoming barriers, called COM-B (Capability, Opportunity and Motivation lead to Behaviour), is presented. This analysis identifies issues associated with capability, opportunity and motivation to act. These frameworks can be used to facilitate action that is fluid and involves policy makers, organisational leaders as well as citizens and families.

Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents

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Providers (29%) experience HPV-specific vaccine hesitancy from parents.

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Providers feel least confident in responding to families’ religious beliefs.

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Some providers (25%) agree with dismissal policies for families refusing vaccines.

Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers’ confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher’s exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being “very confident” in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents’ religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.

Universal Predictors of Dental Students' Attitudes towards COVID-19 Vaccination: Machine Learning-Based Approach

BACKGROUND

young adults represent a critical target for mass-vaccination strategies of COVID-19 that aim to achieve herd immunity. Healthcare students, including dental students, are perceived as the upper echelon of health literacy; therefore, their health-related beliefs, attitudes and behaviors influence their peers and communities. The main aim of this study was to synthesize a data-driven model for the predictors of COVID-19 vaccine willingness among dental students.

METHODS

a secondary analysis of data extracted from a recently conducted multi-center and multi-national cross-sectional study of dental students' attitudes towards COVID-19 vaccination in 22 countries was carried out utilizing decision tree and regression analyses. Based on previous literature, a proposed conceptual model was developed and tested through a machine learning approach to elicit factors related to dental students' willingness to get the COVID-19 vaccine.

RESULTS

machine learning analysis suggested five important predictors of COVID-19 vaccination willingness among dental students globally, i.e., the economic level of the country where the student lives and studies, the individual's trust of the pharmaceutical industry, the individual's misconception of natural immunity, the individual's belief of vaccines risk-benefit-ratio, and the individual's attitudes toward novel vaccines.

CONCLUSIONS

according to the socio-ecological theory, the country's economic level was the only contextual predictor, while the rest were individual predictors. Future research is recommended to be designed in a longitudinal fashion to facilitate evaluating the proposed model. The interventions of controlling vaccine hesitancy among the youth population may benefit from improving their views of the risk-benefit ratio of COVID-19 vaccines. Moreover, healthcare students, including dental students, will likely benefit from increasing their awareness of immunization and infectious diseases through curricular amendments.

Parental vaccine hesitancy: scope, causes, and potential responses

PURPOSE OF REVIEW

We reviewed the literature about parental vaccine hesitancy, focusing on publications from October 2019 to April 2021 to describe patterns and causes of hesitancy and interventions to address hesitancy.

RECENT FINDINGS

Recent studies expand understanding of the prevalence of vaccine hesitancy globally and highlight associated individual and contextual factors. Common concerns underlying hesitancy include uncertainty about the need for vaccination and questions about vaccine safety and efficacy. Sociodemographic factors associated with parental vaccine hesitancy vary across locations and contexts. Studies about psychology of hesitancy and how parents respond to interventions highlight the role of cognitive biases, personal values, and vaccination as a social contract or norm. Evidence-based strategies to address vaccine hesitancy include presumptive or announcement approaches to vaccine recommendations, motivational interviewing, and use of immunization delivery strategies like standing orders and reminder/recall programs. A smaller number of studies support use of social media and digital applications to improve vaccination intent. Strengthening school vaccine mandates can improve vaccination rates, but policy decisions must consider local context.

SUMMARY

Vaccine hesitancy remains a challenge for child health. Future work must include more interventional studies to address hesitancy and regular global surveillance of parental vaccine hesitancy and vaccine content on social media.

Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review

BACKGROUND

High rates of vaccination worldwide are required to establish a herd immunity and stop the current COVID-19 pandemic evolution. Vaccine hesitancy is a major barrier in achieving herd immunity across different populations. This study sought to conduct a systematic review of the current literature regarding attitudes and hesitancy to receiving COVID-19 vaccination worldwide.

METHODS

A systematic literature search of PubMed and Web of Science was performed on July 5th, 2021, using developed keywords. Inclusion criteria required the study to (1) be conducted in English; (2) investigate attitudes, hesitancy, and/or barriers to COVID-19 vaccine acceptability among a given population; (3) utilize validated measurement techniques; (4) have the full text paper available and be peer-reviewed prior to final publication.

FINDINGS

Following PRISMA guidelines, 209 studies were included. The Newcastle Ottawa (NOS) scale for cross-sectional studies was used to assess the quality of the studies.Overall, vaccine acceptance rates ranged considerably between countries and between different time points, with Arabian countries showing the highest hesitancy rates compared with other parts of the world.

INTERPRETATION

A variety of different factors contributed to increased hesitancy, including having negative perception of vaccine efficacy, safety, convenience, and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, and people who were less educated, had lower income, had no insurance, living in a rural area, and self-identified as a racial/ethnic minority.

Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel

Background

Parents in the Arab population of Israel are known to be “pro-vaccination” and vaccinate their children at higher rates than the Jewish population, specifically against human papilloma virus (HPV) and seasonal influenza.

Objectives

This study seeks to identify and compare variables associated with mothers’ uptake of two vaccinations, influenza and HPV, among different subgroups in Arab and Jewish society in Israel.

Methods

A cross-sectional study of the entire spectrum of the Israeli population was conducted using a stratified sample of Jewish mothers (n = 159) and Arab mothers (n = 534) from different subgroups: Muslim, Christian, Druse and Northern Bedouins. From March 30, 2019 through October 20, 2019, questionnaires were distributed manually to eighth grade pupils (13–14 years old) who had younger siblings in second (7–8 years old) or third (8–9 years old) grades.

Results

Arab mothers exhibited a higher rate of uptake for both vaccinations (p < .0001, HPV – 90%; influenza – 62%) than Jewish mothers (p = 0.0014, HPV – 46%; influenza – 34%). Furthermore, results showed that HPV vaccination uptake is significantly higher than seasonal influenza vaccination uptake in both populations. Examination of the different ethnic subgroups revealed differences in vaccination uptake. For both vaccinations, the Northern Bedouins exhibited the highest uptake rate of all the Arab subgroups (74%), followed by the Druse (74%) and Muslim groups (60%). The Christian Arab group exhibited the lowest uptake rate (46%). Moreover, the uptake rate among secular Jewish mothers was lower than in any of the Arab groups (38%), though higher than among religious/traditional Jewish mothers, who exhibited the lowest uptake rate (26%). A comparison of the variables associated with mothers’ vaccination uptake revealed differences between the ethnic subgroups.

Moreover, the findings of the multiple logistic regression revealed the following to be the most significant factors in Arab mothers’ intake of both vaccinations: school-located vaccination and mothers’ perceived risk and perceived trust in the system and in the family physician. These variables are manifested differently in the different ethnic groups.

Conclusions

This research shows that all Arabs cannot be lumped together as one monolithic group in that they exhibit major differences according to religion, education and access to information. Ranking of variables associated with uptake of the two vaccines can provide decision-makers an empirical basis for tailoring appropriate and specific interventions to each subgroup to achieve the highest vaccine uptake rate possible. Media campaigns targeting the Arab population should be segmented to appeal to the various sub-groups according to their viewpoints, needs and health literacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01523-1.

A more comprehensive measure of vaccine hesitancy: Creation of the Multidimensional Vaccine Hesitancy Scale (MVHS)

This article aimed to develop the Multidimensional Vaccine Hesitancy Scale (MVHS). In Study 1 (n = 336), we identified 13 possible vaccine hesitancy dimensions and developed an item list. In Study 2 (n = 444), we performed an exploratory factor analysis that supported an eight-dimension structure and reduced our measure to 32 items. We supported its validity by establishing relations with associated variables, even while controlling for measures of the same and similar constructs. In Study 3 (n = 575), we confirmed its factor structure and replicated its validity results. Support was provided for the psychometric properties and validity of the MVHS.

Pharmacists to partner with religious leaders to overcome vaccine hesitancy among Christians

As pharmacists work to increase vaccine confidence and continued uptake, it is recommended to partner with trusted leaders to communicate these important messages. Evidence exists that religious leaders are effective messengers when it comes to encouraging coronavirus disease 2019 vaccination. Motivational interviewing employs empathy and reflective listening to promote self-change and is used to overcome vaccine hesitancy. Pharmacists are advised to work with religious leaders in their communities to reach the most vaccine-hesitant population through the shared resource of motivational interviewing. Pharmacists can refer interested religious leaders to available online resources to learn more about this effective tool.

Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health

An often-stated public health comment is that "vaccination is a victim of its own success." While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified "the reluctance or refusal to vaccinate despite availability of vaccines" as one of the 10 threats to global health in 2019. The negative influence of anti-vaccination movements is often named as a cause of increasing vaccine resistance in the public. In this review, we give an overview of the current literature on the topic, beginning by agreeing on terminology and concepts before looking at potential causes, consequences, and impacts of resistance to vaccination.

Seasonal influenza vaccine hesitancy profiles and determinants among Chinese children's guardians and the elderly

OBJECTIVES

Seasonal influenza vaccine coverage remains low in China due to possible influenza vaccine hesitancy (IVH) and practical issues. We sought to investigate IVH and its determinants among children's guardians and the elderly for a better understanding of the situation and for future intervention.

METHODS

We performed two cross-sectional studies to identify the profiles and determinants of IVH using stratified cluster random sampling in an eastern China province in 2019.

RESULTS

Of the 1564 guardians and 522 elders, 43.2% (95%CI: 40.4-46.0%) of guardians and 33.5% of elders (95%CI: 29.5-37.6%) had IVH. 'From rural area' (odds ratio: 1.36), 'don't know government recommendation for flu vaccination' (1.39), 'don't know flu vaccine is vaccinated annually' (1.93), and 'family members (0.22), friends and neighbors had positive attitude toward flu vaccine' (0.58) were related factors of the guardians' IVH. 'Aged 70-79 years' (0.46), 'had flu before' (0.35) and 'once had been vaccinated' (0.42) were related to the elderly's IVH.

CONCLUSION

Poor awareness of influenza and vaccination, relatives' negative/positive attitude, lack of government recommendations, anxiety about vaccine quality, and practical issues such as short supply are related to IVH in China. Precision education aimed at hesitancy in wider groups is anticipated to increase vaccine confidence and coverage in influenza-vulnerable groups.

Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada

COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies.

Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.

The Implementation of the Professional Role of the Community Pharmacist in the Immunization Practices in Italy to Counteract Vaccine Hesitancy

In Italy, the National Vaccinal Prevention Plan has renewed the commitment of the Italian government to promote a culture of vaccination practices in the general population and especially among healthcare professionals, considering it as a strategic goal. The search for useful tools and techniques to promote a layered and widespread information network capable of restoring a climate of trust and confidence towards vaccination, leads us to reflect on the possibility, already adopted in numerous countries, of enlisting community pharmacies in immunization campaigns also in Italy, positively implementing the professional role of the community pharmacist in immunization. The pharmacist is often the first point of contact with both the patients and the public, both for the relationship of trust and confidence that binds him to the citizens, and for the ease of access in relation to the widespread distribution of community pharmacies in the territory, the availability of prolonged operating hours, the absence of need for appointments and positions near/outside of healthcare facilities. Currently, in Italy the role of the community pharmacist is limited to counseling and providing advice and information regarding the benefits and/or any risks of vaccination practices, but does not imply a direct engagement in immunization programs, rather a collaboration to avoid straining and overwhelming the vaccination centers. Some recent questionnaire-based studies have shown that Italian community pharmacists have attitudes that are favorable to vaccinations, even though their knowledge is rather limited. Together with expanding the engagement of community pharmacists in immunization programs, their educational gap should be addressed in order to significantly improve and enhance the protection of the public health.

Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative

The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.