A systematic review of communication interventions for countering vaccine misinformation

Enhanced influenza vaccination for older adults in Europe: a review of the current situation and expert recommendations for the future

INTRODUCTION

Influenza causes considerable morbidity and mortality in Europe, particularly among older adults due to comorbidities, as well as immunosenescence and inflammaging, which contribute to a diminished immune response. Vaccination remains the most effective way to prevent poor outcomes; however, uptake is suboptimal and many countries recommend standard vaccines despite evidence supporting better protection with enhanced (adjuvanted and high-dose) vaccines.

AREAS COVERED

A multidisciplinary group of experts reviewed the burden of influenza in Europe and evaluated data on enhanced vaccines, providing recommendations for their use in older adults. The group discussed barriers to vaccination and strategies to increase uptake.

EXPERT OPINION

Improving protection of older adults against influenza relies upon increasing vaccine uptake and ensuring access to vaccines that overcome age-related immunological decline. Achieving higher uptake requires national policies that facilitate equitable access and clear communication about vaccine eligibility. Based on available evidence, enhanced vaccines offer better protection than standard vaccines against hospitalization and complications in older adults. National recommendations should prioritize the use of enhanced influenza vaccines over standard vaccines in older adults. Limitations to interpretation of evidence include discrepancies in reporting of influenza-related medical encounters and underreporting of influenza-related complications.

Exploring health locus of control among vaccine-hesitant parents: a scoping review

OBJECTIVES

This scoping review aimed to explore the relationship between health locus of control (HLOC) and vaccine hesitancy among parents of children aged 0-18 years, focusing on the tools and methods used to assess these constructs.

DESIGN

The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and adhered to established methodologies for scoping reviews, including systematic searches across four electronic databases.

DATA SOURCES

PubMed, PsycINFO, Web of Science and CINAHL were searched using a comprehensive search strategy to identify relevant studies on 24 September 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they examined HLOC and vaccine hesitancy in parents, measured these constructs with validated tools and focused on childhood vaccination.

DATA EXTRACTION AND SYNTHESIS

Data were extracted into a structured table capturing study characteristics, HLOC and vaccine hesitancy measurements, and key findings. Results were synthesised narratively to highlight associations and patterns.

RESULTS

Five studies involving a total of 11 758 parents and caregivers of children aged 0-18 years met inclusion criteria. Higher internal HLOC was consistently associated with lower vaccine hesitancy and higher compliance, while lower chance HLOC correlated with greater hesitancy. Powerful others HLOC (ie, trust in healthcare professionals) emerged as a key predictor of better vaccine adherence.

CONCLUSIONS

The findings suggest that internal HLOC and trust in healthcare providers are predictors of vaccine acceptance among parents. However, standardised tools and longitudinal studies are needed to further elucidate these relationships and inform targeted interventions to reduce vaccine hesitancy.

Generative AI for vaccine misbelief correction: Insights from targeting extraversion and pseudoscientific beliefs

BACKGROUND

Misinformation about vaccines is a significant barrier to public health, fueling hesitancy and resistance. Generative AI offers a scalable tool for assisting public health communicators in crafting targeted correction messages tailored to audience characteristics. This study investigates the effectiveness of AI-generated messages targeting extraversion and pseudoscientific beliefs compared to high-quality generic and non-vaccine-related messages.

METHOD

In a between-subjects experiment, 1435 U.S. adults were randomly assigned to one of four conditions: control, generic correction, extraversion-targeting correction, or pseudoscientific-belief-targeting correction. Participants rated their agreement with vaccine misbelief statements before and after exposure to a correction message. AI was used to generate the targeted correction messages, while the generic and control messages were sourced from real-world examples.

RESULTS

Extraversion-targeting messages significantly reduced vaccine misbeliefs, performing comparably to high-quality generic messages, particularly among participants with higher extraversion levels. However, these effects did not extend to general vaccination attitudes. Pseudoscientific-belief-targeting messages were ineffective and, in some cases, backfired, reinforcing negative attitudes among individuals with strong pseudoscientific beliefs.

CONCLUSION

This study demonstrates the potential of AI-assisted message generation for crafting effective correction messages, particularly when targeting personality traits like extraversion. However, the findings suggest that certain AI-generated messages may be less effective or even counterproductive when targeting entrenched beliefs, underscoring the need for human oversight in refining AI-generated messages. Future research should explore additional audience characteristics and optimize human-AI collaboration to enhance the effectiveness of AI-generated correction messages in public health communication.

The Role of Internet Information on Anti-HPV Vaccines: A Comprehensive Overview of a Double-Edged Sword

Cervical cancer (CC) is the only cancer that has the possibility of primary and secondary prevention. Despite this, it is one of the leading causes of cancer death among women, especially in developing countries. The World Health Organization has set the ambitious goal of eliminating CC by 2030 by suggesting specific types of intervention. Unfortunately, to date, we are very far from this goal at a global level, including developed countries. Implementing vaccination coverage among the target population is one of the strategies to be pursued in this area. Achieving this goal should include combating misinformation about the HPV vaccine, which is one of the main reasons for vaccination hesitancy. Such conspiracy theories are prevalent on social media, one of the primary sources of information for adults and adolescents today. In this regard, the Internet plays a significant role in disseminating information about the HPV vaccine, both positively and negatively. The Internet provides easy access to information about the HPV vaccine, including its safety, efficacy, recommended dosing schedule, and potential side effects. It may promote vaccine advocacy and debunking vaccine myths. On the other hand, the Internet may be the place for disseminating misinformation and influencing vaccine decision making. It is a double-edged sword in shaping public discourse and perceptions about the HPV vaccine. This overview aims to assess the literature on this topic in depth to promote evidence-based information, analyze the social channels through which misinformation spreads, and leverage digital health interventions essential for promoting HPV vaccination and reducing the burden of HPV-related diseases.

[Barriers to vaccination - parents' attitudes towards HPV vaccination]

BACKGROUND

Although HPV vaccination substantially reduces the risk of HPV-related cancer, vaccination coverage in Germany is still too low among girls and boys aged 9 to 14 years. To increase HPV vaccination coverage, it is essential to assess the attitudes of parents or guardians of children of recommended vaccination age.

METHODS

A representative cross-sectional survey of parents or guardians of children aged 9 to 15 years was conducted (31 May-19 July 2023). Of particular interest were the attitudes of those parents who had not (yet) had their child vaccinated against HPV (primary target group). A combined telephone and online survey was conducted in which a total of 1439 parents were interviewed, including 1000 parents of unvaccinated children.

RESULTS

A portion of the parents is still undecided about the HPV vaccination or tend to be reluctant to have their child vaccinated against HPV (21% and 8%, respectively). 5% are opposed to the vaccination, 23% feel rather or very poorly informed about the HPV vaccination, and 22% feel neither well nor poorly informed. By far the most trusted source of information on HPV vaccination are doctors (85%). The most frequently cited reasons against HPV vaccination are a lack of public education (59%), no perceived need for vaccination at this time (46%), fear of possible side effects (40%), and the statement that the child should decide for themselves about vaccination later (39%).

DISCUSSION

The suitability of communication measures for HPV vaccination should be continuously reviewed and adjusted if necessary. Doctors are highly trusted and should be supported in providing information on HPV vaccination through materials and specific training.

Pregnant women's experiences of and attitudes toward COVID-19 vaccination: A qualitative descriptive study

INTRODUCTION

This study aimed to understand the experiences of and attitudes toward pregnant women regarding COVID-19 vaccination during pregnancy.

MATERIAL AND METHODS

A qualitative descriptive study was conducted between April and June 2022 with 25 pregnant women in South Korea through seven focus group interviews via Zoom™. Data were analyzed using a content analysis approach.

RESULTS

Participants ranged in age from 27 to 41 years, with an average of 33.40 (±3.84) years. Gestational ages ranging from 15 to 35 weeks, with 13 women (52.0 %) in their second trimester, and 12 women (48.0 %) in their third trimester. All participants were college graduates. Forty percent completed three doses, while 40 % received two, 12 % one, and 8 % none. Three key themes emerged: (a) COVID-19 vaccine acceptance, (b) COVID-19 vaccine hesitancy, and (c) needs for quality maternal care. Participants who accepted vaccination trusted the vaccines and viewed healthcare providers' recommendations and government policies, such as the "vaccine pass," positively. Hesitant participants cited safety concerns, past medical history, and incomplete vaccination as reasons for reluctance. Additionally, there was a need for enhanced information on the vaccine and supportive, individualized maternal care.

CONCLUSIONS

The findings highlight the importance of tailored educational interventions and supportive care that leverages trust in healthcare providers to promote COVID-19 vaccination among pregnant women. There is a need to address information gaps and hesitancy among pregnant women related to their concerns regarding safety or past medical history. Future research should focus on strategies to ensure comprehensive care and information dissemination in this population in order to increase vaccination rates during pandemics.

Experiences of Public Health Professionals Regarding Crisis Communication During the COVID-19 Pandemic: Systematic Review of Qualitative Studies

BACKGROUND

The COVID-19 pandemic emerged in the digital age and has been called the first "data-driven pandemic" in human history. The global response demonstrated that many countries had failed to effectively prepare for such an event. Learning through experience in a crisis is one way to improve the crisis management process. As the world has returned to normal after the pandemic, questions about crisis management have been raised in several countries and require careful consideration.

OBJECTIVE

This review aimed to collect and organize public health professionals' experiences in crisis communication to the public during the COVID-19 pandemic.

METHODS

We searched PubMed, MEDLINE, CINAHL, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, and Communication Abstracts in February 2024 to locate English-language articles that qualitatively investigated the difficulties and needs experienced by health professionals in their communication activities during the COVID-19 pandemic.

RESULTS

This review included 17 studies. Our analysis identified 7 themes and 20 subthemes. The 7 themes were difficulties in pandemic communication, difficulties caused by the "infodemic," difficulties in partnerships within or outside of public health, difficulties in community engagement, difficulties in effective communication, burnout among communicators, and the need to train communication specialists and establish a permanent organization specializing in communication.

CONCLUSIONS

This review identified the gaps between existing crisis communication guidelines and real-world crisis communication in the digital environment and clarified the difficulties and needs that arose from these gaps. Crisis communication strategies and guidelines should be updated with reference to the themes revealed in this review to effectively respond to subsequent public health crises.

TRIAL REGISTRATION

PROSPERO CRD42024528975; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=528975.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/58040.

Role of Individual, Social and Health Factors as Determinants of COVID-19 Vaccine Hesitancy: Results from the Second Phase of the Italian EPICOVID19 Web-Based Survey

BACKGROUND

Despite scientific breakthroughs in vaccine development, some people remain reluctant to accept the anti-SARS-CoV-2 vaccine. This study evaluates attitudes and behaviours towards the vaccine and factors associated with refusal/hesitancy at the start of Italy's vaccination campaign.

METHODS

EPICOVID19 is a two-phase observational web-based study where adult volunteers completed questionnaires in April-June 2020 and January-February 2021. Refusal/hesitancy towards the vaccine was assessed among those not yet vaccinated. We analysed factors associated with refusal/hesitancy by applying multivariate multinomial logistic regression models.

RESULTS

Among 36,820 survey participants (mean age of 51 years, 59.7% women, 63.6% highly educated), 2449 (6.7%) were against or hesitant, 4468 (12.1%) were inclined but unsure, and 29,903 (81.2%) were willing to be vaccinated. Factors positively associated with refusal/hesitancy included female sex, middle age, at-risk occupations, medium and low education, deprived status, being underweight, previous SARS-CoV-2 positivity, poor perceived health, no fear of contracting SARS-CoV-2, the fear of contaminated food and natural disasters, and low trust in science, media, government, or institutions. Low hesitancy was associated with student and retired status, overweight and obesity, moderate and high alcohol consumption, no concern about economic and working conditions, and sensitivity to climate change/environmental pollution and epidemics.

CONCLUSIONS

This survey showed that, during the first month of Italy's vaccination campaign, some individuals were reluctant to receive the anti-SARS-CoV-2 vaccine. This study highlights potential target groups for tailored communication and prevention campaigns.

COVID-19 pediatric vaccine Hesitancy: Themes and interactions with verified twitter accounts

BACKGROUND

Though vaccine hesitancy and misinformation has been pervasive online, via platforms such as Twitter, little is known about the characteristics of pediatric-specific vaccine hesitancy and how online users interact with verified user accounts that may hold larger influence. Identifying specific COVID-19 pediatric vaccine hesitancy themes and online user interaction and sentiment may help inform health promotion that addresses vaccine hesitancy more effectively among parents and caregivers of pediatric populations.

METHODS

Keywords were used to query the public streaming twitter application programming interface to collect tweets associated with COVID-19 pediatric vaccines. From this corpus of tweets, we used topic modeling to output 20 topic clusters of tweet content and examined the 10 most retweeted tweets from each cluster to classify for relevance to pediatric COVID-19 vaccine hesitancy topics. Tweets were inductively coded to identify specific themes. Publicly available user metadata were assessed to identify verified accounts and self-reporting of racial or ethnic identity, and parental status. Replies to tweets were coded for user sentiment. A chi-squared test was used to determine the proportion of users agreeing with misinformation tweets RESULTS: 863,007 tweets were collected between October 2020-October 2021. The 230 top tweets reviewed after outputting topic clusters accounted for 236,121 tweets and retweets. 84 unique tweets were identified as related to pediatric COVID-19 vaccine topics by verified users. Twenty three tweets (generating 44,509 retweets) contained misinformation-related themes. Seventy-one percent (n = 742) of user replies agreed with misinformation sentiment of the parent tweet. Main themes identified included vaccine development conspiracy, vaccine is experimental, and vaccine as a control tactic discussions. This study found that users who interacted with misinformation posted by verified accounts were more likely to agree than disagree with misinformation sentiment.

Assessing routine childhood vaccination acceptance, hesitancy and refusal in Cape Town, Western Cape, South Africa: a mixed-method study protocol

INTRODUCTION

Vaccines have proven to be one of the most effective ways to prevent infections. Since the introduction of the Expanded Programme on Immunisation worldwide by WHO in 1974, vaccines have saved more than 150 million lives and prevented countless illnesses and disabilities. In South Africa, vaccination has contributed substantially to the decline in under-five childhood deaths from 89 418 in 2005 to 47 409 in 2013. However, the country still has limitations in achieving optimal uptake of vaccines.

METHODS

This study will use a mixed-methods design to identify the factors associated with acceptance, hesitancy and refusal of childhood vaccines in three subdistricts of the Cape Town Metropolitan Health District in South Africa. In phase I of the study, we aim to estimate the uptake of childhood vaccines and assess the factors associated with uptake among a representative sample of at least 236 caregivers of children aged 0-2 years in a cross-sectional study. For phase II of the study, we will explore the behavioural and social drivers of childhood vaccination from the perspective of caregivers of children aged 0-2 years using a purposively selected sample of 20-25 participants from phase I. Finally, for phase III of the study, we will explore the behavioural and social drivers of childhood vaccination from the perspective of 20-25 healthcare workers providing vaccinations to children aged 0-2 years purposively sampled from primary healthcare facilities.

ETHICS AND DISSEMINATION

Ethical approval was obtained from Stellenbosch University (S23/10/232). Various steps will be taken to ensure the anonymity and confidentiality of participants. Findings of the study will be shared with various healthcare stakeholders through conferences and presentations at relevant meetings.

CONCLUSION

Evidence from several studies conducted in South Africa shows a significant increase in vaccine hesitancy within the country. The findings of this study will provide insight into the characteristics associated with vaccine acceptance, hesitancy and refusal in Cape Town. The results will help inform the development of evidence-based interventions that can be implemented to improve vaccination coverage.

Vaccine Knowledge and Acceptance Among Hadzabe Hunter-Gatherers in Tanzania

OBJECTIVES

Vaccines are highly successful in preventing disease, but misinformation has fueled vaccine hesitancy globally, thereby reducing immunization rates and weakening herd immunity. Vaccine knowledge and hesitancy among hunter-gatherers is a crucial area of research and intervention, as their mobile lifestyle exacerbates other challenges, such as marginalization and medical mistrust.

METHODS

In our exploratory study, we surveyed 91 Hadzabe adults across six camps (mean age = 39, 46% female) about their knowledge of vaccines and their safety and efficacy. Differences between sexes and camps were tested using Fisher's exact tests.

RESULTS

Half of participants reported not knowing what a vaccine is, while one-third described vaccines as protecting health or preventing disease. About 32% were unsure about vaccine safety, while most Hadzabe adults strongly agreed vaccines are effective (65.3%). A majority (72%) agreed vaccines are important for children, yet only one-third strongly agreed on their importance for adults. More females than males expressed uncertainty about the importance of adult vaccines (p = 0.03). Participants in our sample perceived vaccines as less effective and more safe than the general Tanzanian population, based on 2018 Wellcome data.

DISCUSSION

In our sample, results indicate that while Hadzabe participants generally agree that vaccines are important, particularly for children, important gaps in vaccine knowledge remain. There is a clear need to communicate vaccine information to the Hadzabe community in a culturally appropriate manner. Such efforts are critical in safeguarding the health of Indigenous populations experiencing greater market integration, thereby supporting access to vaccines against diseases.

Vaccine hesitancy as indecision: Creation and evaluation of the Unidimensional Vaccine Hesitancy Scale

BACKGROUND

Several authors have argued that vaccine hesitancy should be conceptualized as indecision in the vaccination decision-making process, but no established measure with support for its psychometric properties and validity has been created from this operational definition.

AIMS

To resolve this tension, this article undergoes a four-study scale development process to create the 4-item Unidimensional Vaccine Hesitancy Scale (UVHS).

MATERIALS AND METHODS

We conduct four survey studies utilizing a total sample size of 884.

RESULTS

In Studies 1 (n = 297) and 2 (n = 298), we provide psychometric support for the measure via exploratory and confirmatory factor analysis. In Studies 3 (n = 193) and 4 (n = 106), we support the concurrent and discriminant validity of the measure by assessing its relations with relevant constructs, such as vaccination readiness and acceptance, and we also provide initial indicators of the scale's possible predictive qualities by testing its time-separated effects with vaccination willingness, receipt and word-of-mouth.

DISCUSSION

We leverage these results to provide a number of theoretical insights and suggestions for future practice. Of note, we highlight that different conceptualizations and operationalizations for the same construct can produce notably differing empirical findings, and vaccine hesitancy is no different.

CONCLUSION

Our cumulative efforts indicate that the UVHS is an appropriate measure to assess vaccine hesitancy as indecision.

A study of Facebook comments regarding amber teething necklaces: insights into public perception

PURPOSE

To qualitatively analyse English-language Facebook comments pertaining to amber necklaces, aiming to explore user experiences, perceptions, and beliefs.

METHODS

A sample of 1000 comments, totalling 2309 sentences, was collected via CrowdTangle. Sociodemographic details and the time elapsed since comment were also recorded. Using QDAMiner software, a single investigator manually performed deductive content analysis, categorising each sentence based on a predefined list from the "Seeking Health-Related Information Online" model. WordStat software was employed to assess word clouds and cluster analyses.

RESULTS

The majority of comments originated from white users (88.5%), females (92%), and residents of the United Kingdom (35.8%). Key terms included "teething," "amber," "baby," and "love," with "teething" central in four identified clusters on the main map. Predominantly, sentences were categorised as "information is useful or potentially useful" (25.29%) and "positive experiences from using the amber necklace" (17.11%). Over time, there was an increase in comments categorised as "receiver's doubts related to information" and "acquisition or intention to acquire the necklace." Conversely, comments related to safety concerns, fear of accidents, dentist contraindication, and information quality decreased.

CONCLUSION

Facebook users actively engage with amber necklace content, frequently sharing positive experiences and recommending its use to other parents. Notably, concerns about associated risks appeared to diminish over time.

"Fear of the unknown": Health, disability, and stakeholder perspectives on the behavioral and social drivers of vaccination in children with disability in Fiji

Vaccinating children with disability in low- and middle-income countries, such as Fiji, is a key priority for equity. This study aimed to understand the social and behavioral drivers of vaccine uptake among children with disability in Fiji, from the perspectives of health, disability, and community stakeholders. Five qualitative focus groups were conducted with 22 stakeholders, including healthcare workers, disability service providers and advocates, and community and faith leaders (female n = 17, 77%). Data were collected and analyzed using reflexive thematic analysis and applied the World Health Organization's Behavioral and Social Drivers of Vaccination framework. Numerous drivers were reported to impact vaccination for children with disability. These included (1) Thinking and feeling: lack of reliable information about vaccine benefits and safety for children with disability; (2) Social processes: disability stigma and discrimination impacted families of children with disability engaging with healthcare services; lack of tailored vaccination communication and engagement strategies; and, need for improved disability and health service collaboration; (3) Motivation: lack of awareness and support for parents of children with disability to have their children vaccinated, and religious beliefs negatively impacted motivation; (4) Practical issues: long waiting times and lack of suitable waiting areas for children with disability; financial and time barriers; and, lack of healthcare worker knowledge and confidence in providing vaccines to children with disability, impacted patient-provider trust. The findings from this study can inform strategic actions to overcome barriers to vaccination for children with disability, including strengthening existing vaccination programs, promoting greater equity in vaccination for children with disability in Fiji. This will reduce the burden of vaccine-preventable diseases in this priority group.

A thematic analysis of UK COVID-19 vaccine hesitancy discussions on Twitter

BACKGROUND

Following UK approval of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on 2/12/20 and 30/12/20 respectively, discussions about them emerged on the social media platform Twitter, (now 'X'). Previous research has shown that Twitter/ X is used by the UK public to engage with public health announcements and that social media influences public opinions of vaccines, including COVID-19 vaccines, globally. This study explored discussions on Twitter posted in response to the UK government's posts introducing the Pfizer-BioNTech and Oxford-AstraZeneca vaccines. The aim was to investigate vaccine hesitant views, and thereby identify barriers and facilitators to COVID-19 vaccine uptake in the UK.

METHODS

Online ethnography was used to collect responses ('tweet replies') to 14 Twitter posts published by officials or departments of the UK government on the dates the Pfizer-BioNTech and Oxford-AstraZeneca vaccines received approval from the Medicines and Healthcare products Regulatory Agency (2/12/20 and 30/12/20, respectively). 16,508 responses were collected and those expressing vaccine hesitancy were analysed using reflexive thematic analysis.

RESULTS

Three themes that underpinned Twitter posters' vaccine hesitancy were identified: (1) Concerns about vaccine development and safety, (2) Information, misinformation and disinformation, (3) Distrust: Politics and 'Big Pharma'. From these themes, eight barriers and eight facilitators to UK COVID-19 vaccine uptake were identified.

CONCLUSION

This paper highlights key obstacles to COVID-19 vaccine acceptance in the UK based on views from Twitter and contributes to the emerging literature on the relationship between social media and the public response to COVID-19 vaccines. In so doing, this analysis offers insights that are useful for the development of vaccine communication strategies more broadly, both in and beyond future pandemics, to ensure that public concerns are addressed, and misinformation and disinformation are appropriately countered.

Bringing Pandemic Science to the Classroom: Building Public Health Capacity at a Rural Kentucky High School

In response to the COVID-19 pandemic, a multidisciplinary team at the University of Kentucky developed an interdisciplinary science, technology, engineering, and mathematics and environmental health unit-the Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology (WACKIEST) Unit-for high school students in summer 2022. This case study outlines the WACKIEST Unit, which focused on wastewater surveillance and COVID-19, the obstacles faced during development and recruitment, and implementation of the WACKIEST Unit in conjunction with a rural wastewater surveillance initiative. The unit was implemented in spring 2023 at a rural high school in Kentucky, spanning 12 days and engaging 190 students. Lessons emphasized the importance of wastewater testing in public health decision-making, particularly in the context of COVID-19. A mobile laboratory provided students with hands-on experience in conducting preliminary analyses of wastewater, and a field trip to the local wastewater treatment plant allowed them to observe real-world wastewater management practices. At the unit's conclusion, students created a public health report aligned with the Evidence-Informed Decision Making in Public Health model, reinforcing the goal of fostering community health resilience. The initiative's success-measured by the unit's completion and positive feedback from students and teachers-supports the creation of online modules for broader dissemination. This case study demonstrates how adaptable interdisciplinary approaches can integrate real-world scientific issues into secondary education, offering valuable insights for future efforts in public health education.

Understanding the features and effectiveness of randomized controlled trials in reducing COVID-19 misinformation: a systematic review

This systematic review aimed to assess the features and effectiveness of individual-level randomized controlled trials targeting COVID-19 misinformation. The selection process included rigorous criteria, resulting in the inclusion of 24 individual studies from 21 papers. The majority of studies were conducted in high-income countries, with the accuracy/credibility of information as the primary outcome. Debunking and boosting interventions were the most common interventions while nudging and content labeling interventions were examined in a few studies. This study highlights that further research is needed to enhance the effectiveness of boosting strategies and to explore the impact of combined interventions. Addressing bias concerns and standardizing intervention assessment measures will contribute to the development of evidence-based approaches in this critical area.

Vaccination Promotion Strategies in the Elderly: Systematic Review and Meta-Analysis

Background: The World Health Organization estimates that currently available vaccines prevent 2 to 3 million deaths worldwide each year. Preventing infectious diseases is an important public health priority to ensure healthy ageing and improve quality of life. This study's aim is to identify the best strategies to increase vaccination coverage in the elderly. Methods: A systematic review and meta-analysis were carried out, including a bibliographic search in the PubMed and Scopus databases. Studies in older people (60 years or older) on any type of intervention aimed at increasing vaccination coverage were included. The effect of the intervention was measured using the odds ratio (OR). Results: After applying the selection criteria, 20 studies were identified: 17 on influenza vaccines and 3 on other vaccines. Educational strategies obtained an OR = 1.63 (95% CI: 1.22-2.19, I2 = 0.59). Medical counselling obtained an OR = 3.13 (95% CI: 0.60-16.37, I2 = 0.95). Writing strategies obtained an OR = 1.14 (95% CI: 0.99-1.32, I2 = 0.93). Few studies reported the effect of free vaccination. Conclusions: The educational strategies proved to be more effective than the others in this study. Free vaccination and age may have important roles. Further studies are needed as research in this area remains limited.

The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation

BACKGROUND

Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation.

OBJECTIVE

This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination.

METHODS

We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general.

RESULTS

The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (χ21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style (χ21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups.

CONCLUSIONS

Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/41012.

Contributions and Impact of Health Communication Research to Vaccination Efforts and Acceptance

Vaccines (a medical product) and vaccination recommendations (expert advice on who should receive, when, and how often) have grown in importance and prominence in the past 15 years, including because of a recent COVID-19 pandemic. This essay highlights contributions from vaccine and vaccination-related health communication research since 2010. This research has had significant impacts - that is, visible and discernible positive effects - on the ways health communication is undertaken broadly (e.g. at the campaign level) and at the health care provider-patient level (e.g. conversations with parents and patients regarding vaccine benefits, risks, and safety). As this essay illustrates, health communication research has resulted in greater use of formative research to guide vaccination campaign and education efforts, better identification and understanding of the factors behind vaccination delay and declination, and greater recognition that communication efforts can fail to achieve desired outcomes or generate unintended consequences. Health communication research has also documented the powerful influence of healthcare provider communication on parent and patient understanding and compliance with immunization recommendations. Importantly, this research has also shown the characteristics of provider-patient communication matter much. Healthcare providers must have or establish a high degree of trust, be well-versed in vaccine efficacy and safety, and be adept at using their personal experiences, information tailoring/personalization, and evidence-based communication strategies to increase the likelihood of success.

Conspiracy narratives and vaccine hesitancy: a scoping review of prevalence, impact, and interventions

Believing conspiracy narratives is frequently assumed to be a major cause of vaccine hesitancy, i.e., the tendency to forgo vaccination despite its availability. In this scoping review, we synthesise and critically evaluate studies that assess i) the occurrence of vaccine-related conspiracy narratives on the internet, ii) the prevalence of belief in vaccine-related conspiracy narratives, iii) the relationship between belief in conspiracy narratives and vaccination intention or vaccination uptake, and iv) interventions that reduce the impact of conspiracy narratives on vaccination intention.In July 2022, we conducted a literature search using three databases: PubMed, PsychInfo, and Web of Science. Following the PRISMA approach, of the 500 initially identified articles, 205 were eligible and analysed.The majority of identified studies were conducted in Europe and North America, were published in 2021 and 2022, and investigated conspiracy narratives around the COVID-19 vaccination. The prevalence of belief in various vaccine-related conspiracy narratives varied greatly across studies, from 2 to 77%. We identified seven experimental studies investigating the effect of exposure to conspiracy narratives on vaccination intentions, of which six indicated a small negative effect. These findings are complemented by the evidence from over 100 correlative studies showing a significant negative relationship between conspiracy beliefs and vaccination intention or uptake. Additionally, the review identified interventions (e.g., social norm feedback, fact-checking labels, or prebunking) that decreased beliefs in vaccine-related conspiracy narratives and, in some cases, also increased vaccination intentions. Yet, these interventions had only small effects.In summary, the review revealed that vaccine-related conspiracy narratives have spread to varying degrees and can influence vaccination decisions. Causal relationships between conspiracy beliefs and vaccination intentions remain underexplored. Further, the review identified a need for more research on interventions that can reduce the impact of conspiracy narratives.

Information needed for optimal immunization related to medical advice: an observational prospective cohort study protocol (INFORMed)

Introduction

Today, accessing information on health issues is easier than ever. However, the flood of information can make decision-making difficult. Information can influence the intention for an action, yet the action often remains unpredictable. It is unclear if there is a relationship between the intention behavior gap and the wish for medical advice in parents of newborns as they have to deal with a number of vaccinations more than any other group of people. According to survey data, vaccine-hesitant people have less interest in vaccine advice.

Methods and design

This study aimed to validate and elaborate this finding in a specific population and in a prospective observational manner. This study protocol was registered: https://drks.de/search/en/trial/DRKS00030716, DRKS00030716. The specific objectives include a primary endpoint focused on the wish for advice among hesitant and non-hesitant parents. Secondary endpoints involve comparing parents in terms of their respective information needs, which will be assessed based on: (a) vaccination attitudes at 6 weeks, (b) actual action taken at 12 weeks, and (c) the consistency of their attitudes and decisions. Parents of infants up to 6-week-old will be recruited and asked before the first recommended vaccination period and thereafter when the infant is 12 weeks old. Participants will receive an online questionnaire focusing on the information and advice they would like to receive and have received. Vaccination attitudes will be assessed using the C7C questionnaire at 6 weeks and the actual action of taking the first vaccine at 12 weeks.

Discussion

INFORMed will provide data on information needs and wishes of young parents depending on their attitude toward vaccination. Based on the results, health literacy in parents can be improved and information strategies can be adapted.

Strategies and bottlenecks to tackle infodemic in public health: a scoping review

Background

The World Health Organization defines "infodemic" as the phenomenon of an uncontrolled spread of information in digital and physical environments during a disease outbreak, causing confusion and risk-taking behaviors that can harm health. The aim of this scoping review is to examine international evidence and identify strategies and bottlenecks to tackle health-related fake news.

Methods

We performed a scoping review of the literature from 1 January 2018 to 26 January 2023 on PubMed, Web of Science, and Scopus electronic databases. We also performed a search of grey literature on institutional websites. The research question has been defined according to the PCC (population, concept, and context) mnemonic for constructing research questions in scoping reviews.

Results

The overall research in the scientific databases yielded a total of 5,516 records. After removing duplicates, and screening the titles, abstracts, and full texts, we included 21 articles from scientific literature. Moreover, 5 documents were retrieved from institutional websites. Based on their content, we decided to group recommendations and bottlenecks into five different and well-defined areas of intervention, which we called strategies: "foster proper communication through the collaboration between science and social media companies and users," "institutional and regulatory interventions," "check and debunking," "increase health literacy," and "surveillance and monitoring through new digital tools."

Conclusion

The multidisciplinary creation of standardized toolkits that collect recommendations from the literature and institutions can provide a valid solution to limit the infodemic, increasing the health education of both citizens and health professionals, providing the knowledge to recognize fake news, as well as supporting the creation and validation of AI tools aimed at prebunking and debunking.

COVID-19 and influenza vaccine-hesitancy subgroups

Health communicators are faced with the challenge that people can hesitate vaccines for different reasons. Our aim was to identify and describe the qualities of distinct COVID-19 and influenza vaccine-hesitancy subgroups to facilitate the development of tailored vaccine-hesitancy communication. In two studies, we used agglomerative hierarchical cluster analysis to identify COVID-19 (N = 554) and influenza (N = 539) vaccine-hesitancy subgroups in the general population based on nine vaccine hesitancy-related variables (intent to get vaccinated, perceived vaccine safety, perceived vaccine efficacy, perceived disease threat, perceived vaccination responsibility, perceived vaccination convenience, distrust in authorities, conspiracy mentality, and reliance on anecdotal testimonies). We identified and described six distinct COVID-19 vaccine-hesitancy subgroups (the Vaccination Positive, the Ambivalent, the Fearing Skeptic, the Unconvinced, the Constrained Skeptic, and the Vaccination Opponent), and three influenza vaccine-hesitancy subgroups (the Vaccination Positive, the Complacent, and the Vaccination Opponent), with different levels of hesitancy. We discuss the implications of the results for health communicators. Our results shed light on the (dis)similarities between people who hesitate COVID-19 and influenza vaccines and suggest that there is greater variety in hesitancy concerning COVID-19 vaccinations than influenza vaccinations. These findings can be used to design and test tailored vaccination messages.

Do conspiracy beliefs fuel support for reactionary social movements? Effects of misbeliefs on actions to oppose lockdown and to "stop the steal"

Pundits have speculated that the spread of conspiracies and misinformation (termed "misbeliefs") is leading to a resurgence of right-wing, reactionary movements. However, the current empirical picture regarding the relationship between misbeliefs and collective action is mixed. We help clarify these associations by using two waves of data collected during the COVID-19 Pandemic (in Australia, N = 519, and the United States, N = 510) and democratic elections (in New Zealand N = 603, and the United States N = 609) to examine the effects of misbeliefs on support for reactionary movements (e.g., anti-lockdown protests, Study 1; anti-election protests, Study 2). Results reveal that within-person changes in misbeliefs correlate positively with support for reactionary collective action both directly (Studies 1-2) and indirectly by shaping the legitimacy of the authority (Study 1b). The relationship between misbelief and legitimacy is, however, conditioned by the stance of the authority in question: the association is positive when authorities endorse misbeliefs (Study 1a) and negative when they do not (Study 1b). Thus, the relationship between conspiracy beliefs and action hinges upon the alignment of the content of the conspiracy and the goals of the collective action.

Increasing the use of telemedicine: A field experiment

Patients are reluctant to use telemedicine health services, compared to its substitute in-person visits. One reason is that telemedicine can be accurately evaluated and compared to its substitute only after the product has been adopted and experienced. As such, an intervention that increases the probability of a first experience can have lasting effects. This article reports the results of a randomized field experiment conducted in collaboration with a health insurance company. During the intervention, half of the households out of 3,469 in the sample received periodic e-mails with information about the available services. It effectively increased the take-up and demand for telemedicine. Within the first 8 months of the experiment, patients assigned to the treatment group were 6 percentage points more likely to have used the service at least once (and had about five times the odds of using telemedicine compared to those in the control group). Eight months after the start of the intervention, the number of virtual consultations by the treatment group was six times larger than that of the control group. These results, even if limited by the sample and context in which the intervention took place, provide additional evidence about how information interventions can increase technological take-up within the health sector and could serve as the stepping stone for evaluating the impact of telemedicine on health outcomes causally.

Experiences of Governments and Public Health Agencies Regarding Crisis Communication During the COVID-19 Pandemic in the Digital Age: Protocol for a Systematic Review of Qualitative Studies

BACKGROUND

Governments and public health agencies worldwide experienced difficulties with social media-mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies.

OBJECTIVE

This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises.

METHODS

We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data-based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review.

RESULTS

The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024.

CONCLUSIONS

To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public.

TRIAL REGISTRATION

PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/58040.

A culture shift to support public involvement and engagement in research

The need to empower people to understand their health and well-being has never been greater. However, current research culture does not necessarily prioritize public involvement and engagement, and many scientists are left under-equipped to reap its benefits. Here, we outline both the positive need for purposeful public involvement and engagement in biomedical research and major systemic challenges. While some of our examples stem from the UK, we believe the learnings from them have global significance.

Makkah healthcare cluster response, challenges, and interventions during COVID-19 pandemic: A qualitative study

BACKGROUND

The global COVID-19 crisis has underscored the critical role of effective decision-making in healthcare systems. Saudi Arabia has shown resilience by implementing comprehensive testing, tracing, and vaccination measures. Given the unique cultural and religious characteristics of Makkah, specific challenges have prompted efforts to uncover local pandemic responses. This qualitative assessment aims to delineate the challenges faced by decision-makers during COVID-19 in Makkah and identify key interventions implemented by the Makkah healthcare cluster to manage and coordinate care.

METHOD

Utilizing a purposive sampling approach, executive leaders within the Makkah Healthcare Cluster were invited for semi-structured interviews during the COVID-19 period. Thematic analysis was carried out in five steps, ensuring rigor and trustworthiness through multiple checks, and employing a critical and collaborative approach.

RESULT

Throughout the COVID-19 outbreak in Makkah, participants revealed Several factors that have hindered healthcare organizations' ability to effectively manage the pandemic, including testing difficulties, resource shortages, vaccination misconceptions, continuity of care issues, infections among healthcare workers, and the need for consistent protocols. The participant leaders in Makkah's healthcare cluster specified implemented strategies that helped in overcoming the encountered challenges, such as adopting new technologies, enhancing communication, managing supply and demand, and improving workforce adaptability and development. Their experience in managing Hajj and Umrah provided valuable insights for handling the pandemic effectively.

CONCLUSION

The study emphasizes the significance of technology adoption, effective communication, supply management, workforce development, and lessons from managing religious events. Its findings have implications for healthcare systems globally, emphasizing the importance of preparedness, response, and resilience in diverse cultural contexts.

Courage in Decision Making: A Mixed-Methods Study of COVID-19 Vaccine Uptake in Women of Reproductive Age in the U.K

COVID-19 vaccination rates are lower in women of reproductive age (WRA), including pregnant/postpartum women, despite their poorer COVID-19-related outcomes. We evaluated the vaccination experiences of 3568 U.K. WRA, including 1983 women (55.6%) experiencing a pandemic pregnancy, recruited through the ZOE COVID Symptom Study app. Two staggered online questionnaires (Oct-Dec 2021: 3453 responders; Aug-Sept 2022: 2129 responders) assessed reproductive status, COVID-19 status, vaccination, and attitudes for/against vaccination. Descriptive analyses included vaccination type(s), timing relative to age-based eligibility and reproductive status, vaccination delay (first vaccination >28 days from eligibility), and rationale, with content analysis of free-text comments. Most responders (3392/3453, 98.2%) were vaccinated by Dec 2021, motivated by altruism, vaccination supportiveness in general, low risk, and COVID-19 concerns. Few declined vaccination (by Sept/2022: 20/2129, 1.0%), citing risks (pregnancy-specific and longer-term), pre-existing immunity, and personal/philosophical reasons. Few women delayed vaccination, although pregnant/postpartum women (vs. other WRA) received vaccination later (median 3 vs. 0 days after eligibility, p < 0.0001). Despite high uptake, concerns included adverse effects, misinformation (including from healthcare providers), ever-changing government advice, and complex decision making. In summary, most women in this large WRA cohort were promptly vaccinated, including pregnant/post-partum women. Altruism and community benefit superseded personal benefit as reasons for vaccination. Nevertheless, responders experienced angst and received vaccine-related misinformation and discouragement. These findings should inform vaccination strategies in WRA.

User correction

This paper reviews the existing literature on user correction to consider its value for combating misinformation on social media. We discuss the effectiveness of user correction in reducing misperceptions, and synthesize best practices, highlighting the dual audiences for public correction on social media. We outline how often user correction occurs across contexts, countries, and social media platforms. We pay special attention to the methodological constraints in existing research, emphasizing the need for using diverse and interdisciplinary methods, including longitudinal surveys and experiments, computational methods, realistic simulated environments, and qualitative methods. We call for a more comprehensive understanding of user correction in terms of its long-term and downstream effects on social media platforms.

An effective COVID-19 vaccine hesitancy intervention focused on the relative risks of vaccination and infection

We designed the Relative Risk Tool (RRT) to help people assess the relative risks associated with COVID-19 vaccination and infection. In May 2022 (N = 400) and November 2022 (N = 615), U.S. residents participated in a survey that included questions about the risks of vaccination and infection. In both cohorts, we found an association between relative risk perception and vaccine hesitancy. Participants in the May cohort were randomly assigned an intervention: to see information from the RRT or the Centers for Disease Control and Prevention (CDC). After the intervention, participants answered the same questions about risk perception and vaccination intent again. The RRT was more effective than the CDC at changing risk perception and increasing vaccination intent. In November, the survey structure was the same, but the RRT was the only intervention included, and we confirmed that the RRT was effective at changing opinions in this new sample. Importantly, the RRT provided accurate information about the risks of serious adverse outcomes to vaccination and still increased vaccination intent. Our work suggests that the RRT helps people assess relative risk, which can in turn help empower them to make informed decisions and ultimately reduce vaccine hesitancy.

How older adults manage misinformation and information overload - A qualitative study

BACKGROUND

The COVID-19 pandemic was characterized by an abundance of information, some of it reliable and some of it misinformation. Evidence-based data on the impact of misinformation on attitudes and behaviours remains limited. Studies indicate that older adults are more likely to embrace and disseminate misinformation than other population groups, making them vulnerable to misinformation. The purpose of this article is to explore the effects of misinformation and information overload on older adults, and to present the management strategies put in place to deal with such effects, in the context of COVID-19.

METHODS

A qualitative exploratory approach was adopted to conduct this research. A total of 36 semi-structured interviews were conducted with older adults living in Quebec, Canada. The interviews were fully transcribed and subjected to a thematic content analysis.

RESULTS

Participants said they could easily spot misinformation online. Despite this, misinformation and its treatment by the media could generate fear, stress and anxiety. Moreover, the polarization induced by misinformation resulted in tensions and even friendship breakdowns. Participants also denounced the information overload produced largely by the media. To this end, the participants set up information routines targeting the sources of information and the times at which they consulted the information.

CONCLUSIONS

This article questions the concept of vulnerability to misinformation by highlighting older adults' agency in managing misinformation and information overload. Furthermore, this study invites us to rethink communication strategies by distinguishing between information overload and misinformation.

Do both anticipated relief and anticipated regret predict decisions about influenza vaccination?

OBJECTIVE

Anticipated regret has been found to predict vaccination intentions and behaviours. We examined whether anticipated relief also predicts seasonal influenza vaccination intentions and behaviour. Given claims about differences in their antecedents and function, we distinguished between counterfactual relief (relief that a worse outcome did not obtain) and temporal relief (relief that an unpleasant experience is over).

DESIGN

Cross-sectional.

METHODS

Unvaccinated participants (N = 295) were recruited online in November 2020. Participants completed measures of anticipated regret, anticipated counterfactual relief, and anticipated temporal relief and measures of theory of planned behaviour constructs (attitudes, norms, perceived control, and intentions). One month later, the same participants were re-surveyed and asked to report their vaccination status.

RESULTS

Although all anticipated emotion measures were associated with intentions and behaviour, only anticipated counterfactual relief and regret independently predicted vaccination intentions in regression analyses. Mediation analysis showed both anticipated counterfactual relief and regret were indirectly, via intentions, associated with behaviour.

CONCLUSIONS

Results suggest that, regardless of valence, counterfactual emotions predict vaccination intention and, indirectly, behaviour. Furthermore, participants may differ in their sensitivity to the anticipation of positive versus negative counterfactual emotions. These findings may permit more precise targeting of interventions to increase vaccine uptake.

Italian oncologists and vaccinations against infectious diseases: Results of a survey of the Italian Association of Medical Oncology

BACKGROUND

Patients with cancer present a higher risk of vaccine-preventable diseases. Recommended vaccinations are the most cost-effective measure to reduce the risk of transmission and related complications. Nevertheless, vaccination rates are inadequate. Oncologists have a central role in tailored vaccine communication to their patients. We present the results of a survey conducted by AIOM in 2022, focusing on the perception of the problem by oncologists.

MATERIALS AND METHODS

An anonymous 31-item online questionnaire was shared on 15 September 2022 on the AIOM website. The objectives of this survey were to examine the perception of Italian oncologists on vaccine-preventable diseases and the main available vaccines, their attitude towards recommending vaccines and the COVID-19 pandemic impact on their habits regarding vaccine-preventable diseases.

RESULTS

Between September 2022 and January 2023, 114 medical oncologists (5% of the members) completed the anonymous questionnaire. At the first oncological visit, only 30% of respondents usually propose a vaccination schedule to all their patient, 41% do not usually discuss vaccinations at the first visit and 29% recommend vaccines exclusively to specific categories of patients. For 56% of respondents, patients are more aware of the benefits of vaccines, whereas 36% reported that patients are worried of receiving too many vaccines.

CONCLUSION

This is the first survey conducted among Italian oncologists to better understand the perception and attitudes towards the vaccination. It highlights the urgent issues of educating and training oncologists in vaccine-preventable diseases and vaccine awareness and the need to build (or implement) a network of multidisciplinary collaborations.

Are we saying it right? Communication strategies for fighting vaccine hesitancy

Vaccine hesitancy is a multi-faceted phenomenon, deeply rooted in cultural, socioeconomic and personal background. Communication is deemed fundamental in fighting vaccine hesitancy. Medical communication should be accessible, relying both on an emotional approach and accurate information. Trained professionals should curate communication with the public.

The Worrying Phenomenon of COVID-19 Vaccine Hesitancy and Its Negative Impact on Pandemic Control Efforts: Common Themes that Emerged in the Middle East and North Africa (MENA) Region

Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, intensive measures were taken to mitigate its negative health, psychological, social, and economic impact. COVID-19 continues to pose serious threats globally, with vaccination as the central safe strategy to control the pandemic. However, COVID-19 vaccine hesitancy is a major concern, especially in the Middle East and North Africa (MENA). Concerns regarding vaccine safety, efficacy, and misinformation contribute to vaccine hesitancy. Addressing these concerns and providing accurate information is crucial for increasing COVID-19 vaccine acceptance and uptake in this region, where the coverage is low. Variable rates of COVID-19 vaccine hesitancy were found in the numerous studies conducted in the region. Complex factors contributed to vaccination hesitancy in the region including concerns about COVID-19 vaccine safety and efficacy, low trust in healthcare systems, complacency toward the risks of COVID-19, constraints hindering access to COVID-19 vaccination services, as well as the circulation of misinformation and conspiracy beliefs about COVID-19 and its vaccination. Effective approaches to address COVID-19 vaccine hesitancy in the MENA region rely on developing evidence-based communication strategies that are recommended to build trust in vaccination, highlight the disease risks, and counter COVID-19 vaccine-related misinformation. Ensuring COVID-19 vaccine affordability is also necessary besides the cautious consideration of implementing COVID-19 vaccine mandates. Based on the preceding discussion, this chapter aims to identify the common themes of COVID-19 vaccine hesitancy in the MENA region. In addition, the chapter highlights the importance of understanding the root causes of COVID-19 vaccination hesitancy and its associated determinants to develop effective strategies for promoting COVID-19 vaccine acceptance and uptake in the MENA region. To build community trust, promote community education and awareness, and counter misinformation for better COVID-19 vaccine coverage in the region, it is recommended to involve healthcare professionals and policymakers.

Ethical Challenges of Advances in Vaccine Delivery Technologies

Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin-patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved delivery technologies for which such a careful approach should be developed in order to increase vaccine uptake. Defusing fears and conspiracy mongering must be a key part of their rollout.

A descriptive review on the real-world impact of Moderna, Inc. COVID-19 vaccines

INTRODUCTION

Since the original COVID-19 vaccines were developed, abundant clinical trial and real-world evidence evaluating the efficacy, effectiveness, and safety of COVID-19 vaccines has been collected. Knowledge of the relative benefits and risks of COVID-19 vaccines is essential for building trust within target populations, ensuring they remain effectively and safely protected against an enduring infectious threat.

AREAS COVERED

This descriptive review discusses the benefits and risks associated with marketed Moderna, Inc. mRNA-based COVID-19 vaccines, focusing on their real-world effectiveness and safety profiles in various age groups. Adverse events of interest and potential benefits of vaccination are reviewed, including reduced risk for severe COVID-19 and long-term health outcomes, reduced economic and societal costs, and reduced risk for SARS-CoV-2 transmission.

EXPERT OPINION

Post-marketing safety and real-world data for Moderna, Inc. COVID-19 mRNA vaccines strongly support a positive benefit - risk profile favoring vaccination across all age groups. Although COVID-19 is no longer considered a global health pandemic, health risks associated with SARS-CoV-2 infection remain high. Concerted efforts are required to engage communities and maintain protection through vaccination. Continued surveillance of emerging variants and monitoring of vaccine safety and effectiveness are crucial for ensuring sustained protection against SARS-CoV-2.

Unraveling the association between vaccine attitude, vaccine conspiracies and self-reported side effects following COVID-19 vaccination among nurses and physicians in Jordan

BACKGROUND

The negative impact of vaccine conspiracies is linked with negative health behavior. The aim of the current study was to examine the association between attitudes toward booster COVID-19, influenza, and monkeypox (mpox) vaccinations with post-COVID-19 vaccine side effects, vaccine conspiracies, and attitude towards mandatory vaccination among nurses and physicians in Jordan.

METHODS

A structured closed-ended questionnaire was used to collect data on demographics, COVID-19 history, COVID-19 vaccine type and doses received, self-reported side effects post-COVID-19 vaccination, acceptance of booster COVID-19, seasonal influenza, and mpox vaccinations, attitudes towards mandatory vaccination, and beliefs in vaccine conspiracies.

RESULTS

The study sample comprised a total of 341 participants. Acceptance of yearly booster COVID-19 vaccination was expressed by 46.6% of the sample, while 73.3% accepted seasonal influenza vaccination, and only 37.0% accepted mpox vaccination. A higher frequency of self-reported side effects following the first COVID-19 vaccine dose was associated with embrace of vaccine conspiracies and vaccine type. For the second vaccine dose, a higher frequency of self-reported side effects was associated with the embrace of vaccine conspiracies, older age, and affiliation to private sector. In multinomial logistic regression analyses, the lower embrace of vaccine conspiracies was associated with lower odds of reporting side effects post-COVID-19 vaccination. The lower embrace of vaccine conspiracies and favorable attitude towards mandatory vaccination were associated with the willingness to get COVID-19, influenza, and mpox vaccinations.

CONCLUSION

The study findings highlighted the negative impact of embracing vaccine conspiracies on health-seeking behavior among nurses and physicians. The findings indicated that the willingness to get vaccinated was associated with lower endorsement of vaccine conspiracies. Additionally, the lower embrace of vaccine conspiracies was associated with a lower frequency of self-reported side effects following COVID-19 vaccination. These results emphasize the importance of addressing vaccine misinformation and promoting accurate information to ensure optimal vaccine uptake and public health outcomes.

Effective Vaccination and Education Strategies for Emerging Infectious Diseases Such as COVID-19

Social isolation and control owing to coronavirus disease 2019 (COVID-19) are easing; however, concerns regarding new infectious diseases have not disappeared. Given epidemic experiences such as severe acute respiratory syndrome (SARS), the influenza pandemic, Middle East respiratory syndrome (MERS), and COVID-19, it is necessary to prepare for the outbreak of new infectious diseases and situations in which large-scale vaccinations are required. Although the development of vaccines against COVID-19 has contributed greatly to overcoming the pandemic, concerning vaccine side effects from the general public, including medical personnel, and decreased confidence in vaccine efficacy and side effects, present many challenges in promoting and educating vaccinations for new infectious diseases in the future. In addition to plans to develop vaccines for the outbreak of new infectious diseases, education and promotion plans are necessary to administer the latest developments of vaccines to the general public. Moreover, efforts are needed to secure the necessity, legitimacy, and evidence for rapid vaccination on a large scale at the national level. It is also necessary to carefully prepare scientific bases and explanatory statements so that the general public can easily understand them. This study aimed to establish vaccine strategies and vaccination education plans for new infectious diseases that may occur in the future. Many ways to promote vaccination to the general public and healthcare workers should be prepared to ensure that the latest vaccines against new infectious diseases are administered safely. Thus, education and promotion of vaccine efficacy and safety based on specific data from clinical studies are necessary.

Measuring Motivation for COVID-19 Vaccination: An Application of the Transtheoretical Model

PURPOSE

In the United States (US), individuals vary widely in their readiness to get vaccinated for COVID-19. The present study developed measures based on the transtheoretical model (TTM) to better understand readiness, decisional balance (DCBL; pros and cons), self-efficacy (SE), as well as other motivators for change such as myths and barriers for COVID-19 vaccination.

DESIGN

Cross-sectional measurement development.

SETTING

Online survey.

SAMPLE

528 US adults ages 18-75.

MEASURES

Demographics, stage of change (SOC), DCBL, SE, myths, and barriers.

ANALYSIS

The sample was randomly split into halves for exploratory factor analysis using principal components analysis (EFA/PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Correlation matrices were assessed and multivariate analyses examined relationships between constructs and sub-constructs.

RESULTS

For DCBL, EFA/PCA revealed three correlated factors (one pros, two cons) (n1 = 8, α = .97; n2 = 5, α = .93; n3 = 4, α = .84). For SE, two correlated factors were revealed (n1 = 12, α = .96; n2 = 3, α = .89). Single-factor solutions for Myths (n = 13, α = .94) and Barriers (n = 6, α = .82) were revealed. CFA confirmed models from EFAs/PCAs. Follow-up analyses of variance aligned with past theoretical predictions of the relationships between SOC, pros, cons, and SE, and the predicted relationships with myths and barriers.

CONCLUSION

This study produced reliable and valid measures of TTM constructs, myths, and barriers to understand motivation to receive COVID-19 vaccination that can be used in future research.

"The problem is not lack of information": A qualitative study of parents and school nurses' perceptions of barriers and potential solutions for HPV vaccination in schools

BACKGROUND

HPV vaccination has been offered in school programs for over a decade in Quebec, Canada, but the vaccine coverages are not reaching the target coverage in several regions. This qualitative study aimed to describe barriers and enabling conditions of HPV vaccination as perceived by parents and school nurses and identify potential solutions to improve HPV vaccine uptake rates and acceptance in school-based programs.

METHODS

Three focus group discussions were conducted with parents of children in Grades 2 or 3 who were unsure or unwilling to vaccinate. Individual interviews were conducted with 24 school nurses. A thematic content analysis was performed using N'Vivo.

RESULTS

The main parental questions and concerns regarding the HPV vaccination were the children's young age, the possible side effects, the rationale behind boys' vaccination and the possible interaction with COVID-19 vaccination. Except for interaction with COVID-19 vaccination, these concerns remain similar to those identified before the pandemic. Interviews highlighted that the information on HPV vaccination provided by the public was not well understood by parents. Parents suggested different tools to access information tailored to their concerns and situation. From the nurses' perspective, HPV vaccination promotion tools such as decision-aids and social media communication campaigns were needed and could reduce their work.

CONCLUSION

COVID-19 may have disrupted the acceptance of the vaccines. While strategies to catch up on missed doses and reduce access barriers to vaccines are urgently needed, our findings highlight that a shift in attitudes toward routine vaccines may pose further challenges even if HPV vaccine coverage appears to have returned to pre-pandemic levels.

"In the beginning, I said I wouldn't get it.": Hesitant adoption of the COVID-19 vaccine in remote Alaska between November 2020 and 2021

Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by 'hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context.

Effect of digital messages from health professionals on COVID-19-related outcomes: A systematic review of randomized controlled trials

Effectiveness of health professionals' messages via digital tools on COVID-19-related outcomes remains unknown. In this systematic review, we examined this issue by searching randomized controlled trials in six databases until August, 2022 (PROSPERO, CRD 42022350788). Risk of bias was assessed using revised Cochrane risk-of-bias tool. Primary outcomes were COVID-19 infections, preventive behaviors, and factors that support behavioral change. Seven trials with 16 reports (some reported two or more outcomes) were included. One trial showed that physician videos distributed by Facebook ads significantly reduced COVID-19 infections. Five of 6 reports showed that interventions can promote non-pharmaceutical preventive behaviors, vaccination, or information-seeking behaviors and half of the results were significant. Interventions improved the factors that support behavioral change. 14 reports had some concerns of bias risk and 2 had high risk of bias. Our findings suggest that digital messages by health professionals may help reduce COVID-19 infections through promoting behavioral change.

Social media users' perceptions about health mis- and disinformation on social media

This study used recently released nationally representative data with new measures on health information seeking to estimate the prevalence and predictors of adult social media users' perceptions of health mis- and disinformation on social media. Most adults who use social media perceive some (46%) or a lot (36%) of false or misleading health information on social media, but nearly one-fifth reported either none or a little (18%). More than two-thirds of participants reported that they were unable to assess social media information as true or false (67%). Our study identified certain population groups that might be a focus of future intervention work, such as participants who use social media to make decisions. The perception by social media users that false and misleading health information on social media is highly prevalent may lend greater urgency to mitigate the spread of false or misleading health information that harms public health.

Addressing vaccine hesitancy: experimental evidence from nine high-income countries during the COVID-19 pandemic

We study the impact of public health messages on intentions to vaccinate and vaccination uptakes, especially among hesitant groups. We performed an experiment comparing the effects of egoistic and altruistic messages on COVID-19 vaccine intentions and behaviour. We administered different messages at random in a survey of 6379 adults in December 2020, following up with participants in the nationally representative survey Citizens' Attitudes Under COVID-19 Project covering nine high-income countries (Australia, Austria, France, Germany, Italy, New Zealand, Sweden, the UK and the USA). Four alternative interventions were tested, based on narratives of (1) self-protection, (2) protecting others, (3) reducing health risks and (4) economic protection. We measure vaccination intentions in the December 2020 survey and elicit actual vaccination behaviour by respondents in the June/July 2021 survey. Messages conveying self-protection had no effect on vaccine intentions but altruistic messages, emphasising protecting other individuals (0.022, 95% CI -0.004 to 0.048), population health (0.030, 95% CI 0.003 to 0.056) and the economy (0.038, 95% CI 0.013 to 0.064) had substantially stronger effects. These effects were stronger in countries experiencing high COVID-19 mortality (Austria, France, Italy, Sweden, the UK and the USA), where health risks may have been more salient, but weaker and, in several cases, not significant where mortality was low (Australia, Germany and New Zealand). On follow-up at 6 months, these brief communication interventions corresponded to substantially higher vaccination uptake. Our experiments found that commonly employed narratives around self-protection had no effect. However, altruistic messages about protecting individuals, population health and the economy had substantially positive and enduring effects on increasing vaccination intentions. Our results can help structure communication campaigns during pandemics and are likely to generalise to other vaccine-preventable epidemics.

Benefits of near-universal vaccination and treatment access to manage COVID-19 burden in the United States

BACKGROUND

As we continue the fourth year of the COVID-19 epidemic, SARS-CoV-2 infections still cause high morbidity and mortality in the United States. During 2020-2022, COVID-19 was one of the leading causes of death in the United States and by far the leading cause among infectious diseases. Vaccination uptake remains low despite this being an effective burden reducing intervention. The development of COVID-19 therapeutics provides hope for mitigating severe clinical outcomes. This modeling study examines combined strategies of vaccination and treatment to reduce the burden of COVID-19 epidemics over the next decade.

METHODS

We use a validated mathematical model to evaluate the reduction of incident cases, hospitalized cases, and deaths in the United States through 2033 under various levels of vaccination and treatment coverage. We assume that future seasonal transmission patterns for COVID-19 will be similar to those of influenza virus and account for the waning of infection-induced immunity and vaccine-induced immunity in a future with stable COVID-19 dynamics. Due to uncertainty in the duration of immunity following vaccination or infection, we consider three exponentially distributed waning rates, with means of 365 days (1 year), 548 days (1.5 years), and 730 days (2 years). We also consider treatment failure, including rebound frequency, as a possible treatment outcome.

RESULTS

As expected, universal vaccination is projected to eliminate transmission and mortality. Under current treatment coverage (13.7%) and vaccination coverage (49%), averages of 81,000-164,600 annual reported deaths, depending on duration of immunity, are expected by the end of this decade. Annual mortality in the United States can be reduced below 50,000 per year with 52-80% annual vaccination coverage and below 10,000 annual deaths with 59-83% annual vaccination coverage, depending on duration of immunity. Universal treatment reduces hospitalizations by 88.6% and deaths by 93.1% under current vaccination coverage. A reduction in vaccination coverage requires a comparatively larger increase in treatment coverage in order for hospitalization and mortality levels to remain unchanged.

CONCLUSIONS

Adopting universal vaccination and universal treatment goals in the United States will likely lead to a COVID-19 mortality burden below 50,000 deaths per year, a burden comparable to that of influenza virus.