Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021

Considering the impact of vaccine communication in the COVID-19 pandemic among adults in Canada: A qualitative study of lessons learned for future vaccine campaigns

We aimed to understand how experiences with vaccine-related information and communication challenges during the COVID-19 pandemic impacted motivations and behaviors among Canadian adults regarding future vaccines. Semi-structured interviews were conducted with participants purposively selected to ensure diversity in age, sex at birth, self-identified gender, and region. Data were analyzed using thematic analysis; findings were mapped to the Information-Motivation-Behavioral Skills Model focusing on factors affecting vaccine hesitancy and uptake. Of 62 interviews completed, most were with woman (n = 32, 51.6%) and residents of Ontario (n = 36, 58.1%); the median age was 43.5 yr (interquartile range 23.3 yr). Themes included: 1) accessibility of information, 2) ability to assess information accuracy and validity, 3) trust in communications from practitioners and decision-makers, and 4) information seeking behaviors. Participants expressed various concerns about vaccines, including fears about potential side effects, particularly regarding the long-term effects of novel vaccinations. These concerns may reflect broader societal anxieties, which have been intensified by widespread misinformation and an overload of vaccine information. Moreover, participants highlighted a lack of trust in the information provided by government agencies and pharmaceutical companies, primarily driven by concerns regarding their underlying motives. Concerns about COVID-19 vaccine safety and effectiveness negatively impacted future vaccine attitudes and behaviors. Vaccine hesitancy studies should consider how individuals receive, perceive, and seek information within social contexts and risk profiles.

A cross-sectional study assessing Pro-VC-Be short-form questionnaire in Canada; measuring psychosocial determinants of vaccination behavior in Canadian healthcare professionals

Vaccine hesitancy poses a significant challenge to worldwide public health and has been exacerbated by the COVID-19 pandemic, leading to heightened polarization and the spread of misinformation. Addressing vaccine hesitancy requires multifaceted strategies in which healthcare professionals (HCPs) play a critical role. Nonetheless, HCPs may also be hesitant toward vaccination. The 31-item original Pro-VC-Be tool, designed to measure the psychosocial determinants of vaccine attitudes in HCPs, was first validated in France, French-speaking Belgian regions, and Quebec (Canada). The validity of a short-form version was evaluated and found to be comparable to that of the long-form. Given differing vaccination recommendations and the changing pandemic context, assessing the tool's stability among diverse Canadian HCPs is crucial. Relying on the original short version of the Pro-VC-Be tool, a cross-sectional online survey was conducted among various Canadian HCPs (N = 544) to explore the psychosocial determinants that impact vaccination-related behaviors (frequency of general vaccination activity, vaccine recommendations activity, and willingness to recommend vaccines). The findings underscore three crucial dimensions - vaccine confidence, proactive efficacy, and trust in authorities - as robust predictors of positive professional practice and attitudes, and thus globally support the results obtained in previous studies using the Pro-VC-Be tool. HCPs with higher vaccine confidence, high proactive efficacy, and higher trust in authorities were 80% and 180% more likely to recommend vaccines to their patients and 80% more likely to have received a COVID-19 vaccine than other HCPs, respectively. By identifying the root causes of vaccine hesitancy among HCPs, adapted strategies can be developed.

Using positive imagination to reduce negativity in information processing and hesitant attitudes towards childhood COVID-19 vaccinations in parents: A randomized controlled trial

OBJECTIVES

We aim to investigate the impact of negative information processing on parental vaccine hesitancy in Hong Kong and design an intervention to reduce negativity in pandemic and vaccine-related information processing.

DESIGN

Six hundred and forty-seven parents were recruited for baseline assessment. One week later, participants were randomly assigned to either the positive imagination simulation (PIS) intervention group or the neutral recall simulation (NRS) control group. Participants completed outcome assessments immediately and 2 weeks after the intervention.

METHODS

We first examined whether affective response to pandemic and vaccine-related news mediated the association between parents' distress and acceptance of childhood COVID-19 vaccination using baseline data. The PIS intervention leveraged positive psychology and personalized imagery techniques to enhance positive affect. To test intervention effectiveness, ANCOVAs were conducted to examine whether PIS versus NRS could reduce negative affective response to pandemic and vaccine-related news (immediate effect) and COVID-19 vaccine-hesitant attitudes (effect at the 2-week post-intervention point).

RESULTS

The baseline assessment showed that greater distress was linked to a more negative affective response to pandemic and vaccine-related news, which was associated with lower acceptance for childhood COVID-19 vaccination. The intervention positively impacted valence rating (F(1, 627) = 8.46, p = .004) and affective state rating (F(1, 627) = 4.88, p = .028) on pandemic and vaccine-related news. This improved positivity spilled over to significantly enhance parents' trust in COVID-19 vaccine-related information and alleviate their vaccine safety concerns 2 weeks post-intervention.

CONCLUSIONS

Our study highlights the promising impact of positive affect priming in increasing positivity in information processing and, consequently, reducing vaccine-hesitant attitudes that are modifiable through positive information processing.

Does Policy Uncertainty Boost Vaccine Hesitancy? Political Controversy, the FDA, and COVID-19 Vaccine Hesitancy in Fall 2020

CONTEXT

Vaccine hesitancy is associated with political and institutional distrust, but there is little research on how people's trust responds to political events. The authors revisit the fall of 2020, when evaluation of new COVID-19 vaccines collided with an impending US national election. Drawing on a "political Bayesian" perspective, the authors assess abrupt changes in attention to political events and test hypotheses on how subpopulation responses may differ in accordance with partisanship, educational attainment, and race/ethnicity.

METHODS

The authors analyze daily changes in US news reporting and social media use in 2020, combined with detailed analysis of two-large scale surveys fielded at the time, focusing on questions of COVID-19 vaccine hesitancy and safety concerns about COVID-19 vaccines.

FINDINGS

Vaccine hesitancy spiked in the United States from late August to early October 2020. The authors identify several plausible triggers for this spike, all pertaining to the Food and Drug Administration and electoral politics. Heightened vaccine hesitancy occurred among Democrats, Asian citizens, Black citizens, and college-educated respondents. Turbulence mainly affected those who were initially most trusting in government and vaccines. Asian American vaccine confidence recovered; that of Black Americans did not.

CONCLUSIONS

Electoral politics may destabilize citizen assumptions about vaccine authorization and boost uncertainty, thereby undermining public willingness to take approved vaccines.

"Not Only a Matter of Personal Interest"-Vaccination Narratives and the Model of Moral Motives in China and Germany

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

Evaluating the effects of a multisectoral dialogue-based COVID-19 awareness-raising intervention in a limited-resource setting: A quasi-experimental study in Senegal

BACKGROUND

Sustainable and effective strategies to increase disease awareness and vaccination willingness are crucial in limited-resource settings for the prevention of infectious diseases such as COVID-19. Yet, in the region of sub-Saharan Africa COVID-19 vaccination rates remain considerably lower than in other world regions. This study aims to assess the effects of a multisectoral dialogue-based COVID-19 awareness-raising intervention implemented in the Jaxaay-Parcelles commune in Dakar Metropolitan Area, Senegal.

METHODS

This study adopted a quasi-experimental design. The STOP COVID-19 intervention was developed through a multisectoral collaboration involving academia, non-governmental organisations, local authorities and active community engagement initiatives. Community volunteers delivered the awareness-raising sessions through household visits. Data on the outcomes were collected through population-based repeated cross-sectional surveys, prior to the intervention (n = 863) and post-intervention (n = 737). A difference-in-difference analysis with propensity score weighting was used to explore changes in community awareness and attitudes towards COVID-19 and vaccination against the disease between the intervention and control groups before and after the STOP COVID-19 campaign.

RESULTS

From August to November 2021, 124 awareness-raising sessions were organized. Difference-in-difference analysis showed a significant relative decrease in the proportion of insufficiently informed individuals about COVID-19 vaccination in the intervention site (DID = -0.10, CI 95 %: -0.21, -0.003). The intervention was associated with a less pronounced increase in COVID-19 vaccine hesitancy (DID = -0.11, CI 95 %: -0.21, -0.01) and did not affect the attitudes towards paediatric vaccination (DID = 0.02, CI 95 %: -0.07, 0.11).

CONCLUSIONS

Our results suggest that our multisectoral dialogue-based intervention conceptualised and implemented through active community engagement can be effective in limited-resource settings to enhance population awareness about COVID-19 and vaccination against the disease. The insights gained from the intervention can be used to inform future vaccination campaigns and other public health interventions in similar settings.

Pro-Vax, Anti-Vax, or Shades of Gray? Segmenting Consumers Based on Attitudes to Vaccination

Vaccination hesitancy remains a prominent global health concern, as recognized by the World Health Organization (WHO). This quantitative study, conducted on a representative sample of the Belgian population (n = 1,030), explores consumer segmentation concerning vaccination attitudes during the COVID-19 pandemic in 2021, identifying five distinct clusters. While 39.6% of the surveyed consumers broadly accepted the COVID-19 vaccine (Convinced Pro-Vaxxers), our analysis revealed that 17.1% were skeptical (Skeptics), 12.7% were fearful of the inoculation procedure (Fearful Doubters), and 7.1% were fully opposed to vaccination (Anti-Vaxxers). Nearly one in four participants (Indifferent Pro-Vaxxers) showed little interest in the pandemic yet remained largely favorable toward vaccination. The variation in cluster size, attitudes, beliefs, and sociodemographic traits highlights the complexity of vaccine hesitancy, indicating it is not a binary issue. These findings underscore the importance of tailored health communication and vaccination campaigns to address hesitancy and improve vaccine uptake.

The long term benefits of the measles vaccine in Mexico

We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes "immune amnesia", leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.

Considerations for mRNA Product Development, Regulation and Deployment Across the Lifecycle

With the successful deployment of several mRNA vaccines against SARS-CoV-2, an mRNA vaccine against RSV (respiratory syncytial virus) and a large pipeline of mRNA products against other infectious diseases, cancers and rare diseases, it is important to examine the whole product lifecycle. mRNA technology enables product design, testing and manufacturing systems to be rapidly developed, but these advantages can be lost if other factors that determine public access are not closely considered. This review analyzes key aspects of the mRNA product lifecycle including candidate design, manufacturing, quality systems and product safety and storage. Regulatory thinking is well advanced in some countries but not others, but more thought on the regulation of mRNA vaccines outside of a pandemic situation as well as mRNA therapeutics including individual neoantigen therapies and rare disease treatments is needed. Consumer acceptance-the "social license to operate" around mRNA products-is critical for their uptake, particularly outside of a pandemic.

The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study

Background

Social norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior.

Objective

We aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy.

Methods

A total of 44,339 participants aged 18 years and older were enrolled from 28 different countries between 2020 and 2022. We used the Vaccine Confidence Index (3 items related to evaluation of importance, effectiveness, and safety) with a 5-point Likert scale to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence.

Results

Of the participants, 21,968 (50.2%) were male and 18,957 (43.3%) had an education level of university or above. Vietnam exhibited the highest level of confidence (mean 13.31, SD 1.71) on COVID-19 vaccine and Slovakia had the lowest level (mean 9.52, SD 0.14). The higher levels of cultural tightness were positively linked to greater vaccine confidence (β=1.94, 95% CI 1.72-2.15; P<.001) after controlling individual- and national- level variables. Individuals who were younger in age, female, had lower levels of educational level, or belonged to minority religious groups demonstrated a positive association with lower vaccine confidence. Hofstede's 5 cultural dimensions were not significantly associated with vaccine confidence. The level of vaccine confidence in 2021 (β=-0.54, 95% CI -0.67 to -0.37; P<.001) and 2022 (β=-0.23, 95% CI -0.34 to -0.10; P<.001) was lower than that observed in 2020.

Conclusions

Lower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy in different cultural tightness context.

Barriers and motivators associated with COVID-19 vaccination-a vaccine acceptance scoring system based on a population survey in southern Sweden

Low vaccination coverage against SARS-CoV-2 (COVID-19) is a public health concern. The aim of this study was to identify barriers and motivators associated with COVID-19 vaccination and develop a vaccine acceptance scoring system. From the overall population residing in Skåne county Sweden in 2022 (n = 1 384 531), 3600 randomly selected individuals (aged ≥18 years) received a survey. Questions were grouped into six domains reflecting trust in vaccines and institutions, benefit-risk balance, injunctive and descriptive norms and accessibility. Responses were scored as either assenting (1 p) or dissenting (0 p) in relation to its domain. A score between 1 and 5 p was constructed for each domain and a total vaccine acceptance score was analysed. Internal consistency overall and within domains was assessed with Cronbach's alpha. Associations with vaccination status and vaccine acceptance scores in relation to domains were modelled with logistic regression. 820 responses were received, 646 vaccinated (response rate 36%), and 174 unvaccinated (response rate 10%), with relatively high internal consistency overall (α = 0.76). Domains markedly associated with vaccination were injunctive norms OR 5.06 (95% CI 3.27, 7.83), descriptive norms OR 2.64 (1.63, 4.30) and trust in vaccines OR 1.66 (1.15, 2.40). Vaccine acceptance was measured with sufficient reliability in a Swedish population. Norms, in this context, general perceptions of acceptable/unacceptable behaviours and notion on actual performed behaviours, were together with trust in vaccines most strongly associated with vaccination. Future pandemic responses should consider these aspects in communication strategies and targeted interventions to increase and equalize vaccination uptake.

The role of health systems in shaping vaccine decisions: Insights from Italy, Mexico, the United Kingdom, and the United States

BACKGROUND

The demographic drivers of vaccine uptake and confidence have been well-documented in diverse contexts. However, the role of health systems in improving vaccine uptake and confidence has been less discussed particularly in the post-pandemic period.

METHODS

Using nationally representative surveys of adults conducted between December 2022 and April 2023 in Italy, Mexico, the United Kingdom (UK), and the United States (US), we examined demographic, health, and health system determinants of vaccine confidence and uptake of four vaccines for adult respondents or their children: COVID-19, influenza, human papillomavirus (HPV), and measles, mumps, and rubella (MMR). Logistic and linear regression models explored associations between predictors of interest and vaccine outcomes, with coefficients reported on the risk difference and risk ratio scales.

FINDINGS

A total of 5180 respondents were surveyed, one-third of whom had at least one child aged 1-18 years. Having received at least three other preventive health services in the last year was associated with COVID-19 and Flu vaccination in all countries (Risk ratio (RR) 1.04-1.54) and with vaccine confidence in the US (RR 1.10). Having at least three health care visits in the last year and having a regular health provider were also associated with a higher likelihood of vaccine uptake and confidence in some countries. Being confident in one's ability to obtain and afford quality care (i.e. "health security") had a positive association with at least one outcome in all countries except Mexico (RR 1.07-1.36) and with children COVID vaccination in multi-country regression. Having a regular provider was associated with a higher probability of HPV vaccination for children. Health system engagement and health security showed stronger associations with Flu than COVID-19 vaccination and with vaccine uptake compared to vaccine confidence, although these associations varied across countries. Trust in scientists and trusting the national public health agency were also strongly correlated with several vaccine outcomes.

INTERPRETATION

Our findings highlight the links between health system engagement, health security, and vaccination rates. Health system engagement may be particularly important to mitigate barriers to vaccination related to 'complacency' and 'convenience'.

Global perspectives on COVID-19 vaccination: Impacts on well-being and inequality

INTRODUCTION

This study aims to examine the relationship between COVID-19 vaccination and subjective well-being (SWB), as well as well-being inequality. It employs a conceptual framework that incorporates demographic characteristics, socioeconomic factors, health, and social support.

METHODS

Using data from the Gallup World Poll (2021-2022), which includes 131,910 respondents across 96 countries, we analyze the association between vaccination status and SWB. The Cantril ladder technique is employed to measure SWB, while regression analyses are conducted to estimate the conditional mean and variance of well-being, allowing for an assessment of well-being inequality.

RESULTS

Our findings indicate that vaccinated individuals report significantly higher levels of current SWB (p < .01) and lower well-being inequality (p < .01) than unvaccinated people. Specifically, vaccination is associated with a 0.04 standard deviation increase in SWB and a 0.06 standard deviation decrease in interpersonal well-being inequality. Moreover, those vaccinated exhibit greater optimism regarding their future well-being.

CONCLUSION

The results underscore the importance of COVID-19 vaccination in enhancing both current and expected future well-being while reducing well-being inequality. These findings suggest that public health policies should prioritize vaccine uptake and address underlying socioeconomic factors to promote overall mental health and well-being in the population.

[Digital innovations in vaccination communication]

Despite the significant success of vaccinations, increasing vaccine hesitancy poses a threat to public health, making effective vaccination communication essential. Both personalized, needs-based conversations between healthcare providers and patients and large-scale, standardized vaccination campaigns through traditional media are important tools for addressing patients' concerns, correcting misinformation, and conveying positive arguments for the benefits of vaccination. This article describes innovative digital solutions for vaccination communication that combine the strengths of these two approaches, potentially becoming vital components of vaccination communication in an increasingly digital society. We focus on four digital solutions: social media, smartphone apps, chatbots, and immersive technologies (particularly virtual reality). We describe the features of these media and technologies, potential target groups for their application, selected scientific evidence regarding their effectiveness in vaccination communication, and potential research gaps and opportunities. Finally, we offer suggestions for possible application areas of these digital solutions in vaccination communication. While research on the use of innovative digital solutions in vaccination communication is still in its early stages, we see great potential for integrating these technologies as complementary measures into comprehensive vaccination communication strategies to enhance the effectiveness of future vaccination campaigns and promote global health.

Cultural interplay shaping the well-being of Ghanaian migrants in Japan during the COVID-19 pandemic

Ghanaian migrants in Japan, who make up the second-largest population of African migrants in the country, may have faced heightened racial prejudice and challenges during the COVID-19 pandemic, impacting their well-being. This study explored cultural factors shaping the well-being of Ghanaians living in Japan during the COVID-19 pandemic through a qualitative study using the socioecological model. From June 2022 to August 2022, 18 in-depth interviews and 2 focus group discussions were conducted among Ghanaian migrants in Japan. Interviews were audio recorded and transcribed, and an inductive thematic approach was used to analyze the data. At the individual level, the internalized face mask culture, financial constraints, reluctance to access mental healthcare services, and hesitancy toward COVID-19 vaccine played major roles in the well-being of Ghanaian migrants. Adherence to social distancing and coping using religious and social circles influenced their well-being at the interpersonal level. At the community and societal levels, important influences on well-being were language barriers, discrimination and COVID-19-related stigma, and trust in Japan's healthcare system. In conclusion, while Ghanaian migrants in Japan faced challenges during the pandemic, affecting them physically and psychologically, they were able to cope through the religious and social ties from Ghana that they maintained.

Stakeholder perspective and sentiment in a rapidly growing United States adult vaccination environment

The United States adult vaccine landscape is rapidly expanding, raising critical questions about prioritizing vaccines. Through comprehensive market research involving healthcare providers, pharmacies, integrated delivery networks, policy influencers, and pharmaceutical leaders, this study identifies key barriers to vaccine uptake. Findings reveal significant trends including pharmacy-led vaccination, patient adherence challenges, misinformation influence, and operational constraints. Results underscore the need for coordinated efforts to improve vaccine accessibility, streamline processes, enhance public trust, and develop clearer guidelines. Insights provide actionable strategies for stakeholders to collaborate and ensure optimal uptake in an increasingly complex market.

Factors shaping Covid-19 vaccine acceptability among young people in South Africa and Nigeria: An exploratory qualitative study

Covid-19 vaccine hesitancy among young people can be seen as an acute - but not isolated - phenomenon within an alarming longer-term trend of broader vaccine distrust in Africa. Yet there are still considerable knowledge gaps in relation to the scope and drivers of low vaccine acceptability among young people. Moreover, better frameworks and tools are needed to conceptualise and better understand acceptability in this population group. We applied the recently published Accelerate Framework for Young People's Acceptability to guide qualitative research with young people living in South Africa and Nigeria. We aimed to investigate their overall acceptability of the Covid-19 vaccine, and explore factors shaping this acceptability and willingness to be vaccinated. In collaboration with seven community-based organisation partners, we conducted 12 in-person focus groups and 36 remote interviews with 163 individuals aged 15-24. Through a collaborative, iterative process we conducted thematic analysis, incorporating aspects of both deductive and inductive approaches. Our findings show how vaccine acceptability is shaped by a multiplicity of inter-related factors. They also provide a more in-depth perspective of some of these phenomena, their relative importance and their connections in this group of young people. Limited vaccine understanding, conflicting information and distrust, the influence of others, and fear of side effects were key inter-related drivers of low vaccine acceptability. Factors promoting Covid-19 vaccine acceptability were instead: positive perceptions of vaccine safety and efficacy, protection from disease, protection of others, and a desire to return to normal activity. We discuss implications of these findings for policy and practice, both to increase acceptability of Covid-19 vaccination among young people, and more broadly promote vaccination as a critical component of public health programs. Lastly, we reflect on this first application of theAccelerate Framework, and implications for its use in future studies.

Coronavirus disease 2019 (COVID-19) vaccine acceptability in Ghana: An urban-based population study

INTRODUCTION

Coronavirus disease 2019 (COVID-19) vaccine hesitancy is a complex health challenge characterized by a delay in the acceptance or refusal of the vaccination with context-specific determinants. Our study, therefore, assessed the COVID-19 vaccine acceptance among urban dwellers in the Central Region, of Ghana.

METHODS

A cross sectional study was conducted between September and November, 2022 using a multi-stage cluster sampling procedure among 377 participants. A modified World Health Organization pretested paper-based questionnaire was administered to study participants. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Descriptive and inferential statistics were carried out and results were summarized into frequencies, percentages, tables, and charts for clarity. A conventional p-value < 0.05 was considered statistically significant.

RESULTS

The study revealed that COVID-19 vaccine acceptance was 20.0% (76/377) and vaccine hesitancy was 80.0% (301/377). Out of the 377 participants, their socio-demographic characteristics showed that the majority were below 25 years 53.8% (203/377), [vaccine acceptance; 36.84% (28/76) vs vaccine hesitancy; 58.14% (175/301)], and females 50.1% (189/377), [vaccine acceptance; 56.58% (43/76) vs vaccine hesitancy; 48.50% (146/301)]. Common reasons for COVID-19 vaccine hesitancy included mistrust of the source of the vaccine, personal belief and experience, mistrust of the drug development process, mistrust in the health system, and mistrust of the pharmaceutical company. Age above 25 years, female, educational levels, senior high school and above, being employed, and hearing of new vaccine had a significance influence on COVID-19 vaccine acceptance.

CONCLUSION

COVID-19 vaccine acceptance was low with high vaccine hesitancy among participants. The study's findings highlights the importance of addressing vaccine hesitancy through building trust in the vaccine development processes, including the provision of accurate information about the vaccine safety and efficacy. Resolving concerns related to the source of the vaccine and the overall healthcare system are important to address vaccine hesitancy. Policy makers could adopt tailored interventions targeting specific demographic groups, such as the younger population and females to increase vaccine acceptance. Ghana's public health authorities could adopt the findings to re-strategize its urban COVID-19 vaccine campaigns to address misconceptions and misinformation to increase vaccine acceptance.

Study on SARS-CoV-2 infection in middle-aged and elderly population infected with hepatitis virus: a cohort study in a rural area of northeast China

Background

To investigate the symptoms, the level of antibody, the progression of liver disease after SARS-CoV-2 infection in middle-aged and elderly population infected with hepatitis virus.

Methods

The study was based on a cohort of high-risk liver cancer and the participants was recruited in April 2023. Blood sample were collected and information was obtained through questionnaires. Data on reinfection was obtained by follow-up until July 31, 2023. The SARS-CoV-2-specific neutralizing antibody and IgG were measured.

Results

A total of 599 participants infected with hepatitis virus were included and the mean age was 61.3 ± 7.4 years. The SARS-CoV-2 infection rate was 94.7%. Among the infected, 132 were asymptomatic, 435 were symptomatic, no severe cases occurred. Four months after infection, no difference was in liver function and aMAP score between the infected and uninfected. The infected had higher seropositivity rates of both antibodies than the uninfected (neutralizing antibody: uninfected: 93.7%, infected: 99.6%; IgG: uninfected: 59.4%, infected: 98.9%). The levels of both antibodies in the symptomatic were higher than those the asymptomatic and the uninfected (neutralizing antibody: uninfected: 0.75 AU/mL, asymptomatic: 15.46 AU/mL, symptomatic: 24.76 AU/mL; IgG: uninfected: 15.10 AU/mL, asymptomatic: 263.84 AU/mL, symptomatic: 291.83 AU/mL). By July 31, 2023, the incidence of reinfection was 17.5%.

Conclusions

Although the infection rate of SARS-CoV-2 was high, no severe cases occurred. Omicron infection may not aggravate progression of hepatitis. Four months after infection, the population showed high positivity rate in neutralizing antibody and IgG. Monitoring of virus mutations and targeted prevention and care strategies is crucial for vulnerable populations.

Epidemiological Transitions in Influenza Dynamics in the United States: Insights from Recent Pandemic Challenges

The SARS-CoV-2 pandemic has reshaped the epidemiological landscape of respiratory diseases, with profound implications for seasonal influenza. Nonpharmaceutical interventions implemented globally during the pandemic significantly altered human behavior and reduced the prevalence of respiratory pathogens, including influenza. However, the post-pandemic resurgence of influenza activity to pre-pandemic levels highlights the persistent challenges posed by this virus. During the 2023-2024 influenza season in the United States, an estimated 40 million individuals contracted influenza, resulting in 470,000 hospitalizations and 28,000 deaths, with the elderly disproportionately affected. Pediatric mortality was also notable, with 724 deaths reported among children. This study examines trends in influenza incidence, vaccination rates, and mortality in the United States from the 2018-2019 through to the 2023-2024 influenza seasons. Additionally, it evaluates the interplay between influenza and SARS-CoV-2 during the pandemic, considering the impact of disrupted air travel, public health measures, and altered virus circulation dynamics. By integrating these insights, the study underscores the critical need for sustained vaccination campaigns and innovative public health strategies to mitigate the dual burden of respiratory diseases. Findings from this analysis highlight the urgency of strengthening prevention and surveillance systems to enhance pandemic preparedness and reduce the impact of respiratory pathogens in an evolving epidemiological landscape.

COVID-19-related stress, anxiety and vaccine hesitancy among healthcare workers in a tertiary hospital in South-Western Nigeria

COVID-19 ranks as one of the major pandemics in recent history, with healthcare workers disproportionately burdened by the disease. Vaccination emerged as the most effective measure to curb the spread and reduce COVID-19 morbidity and mortality. However, vaccine hesitancy presents a challenge to achieving optimal vaccination coverage in Nigeria. This study assessed the level of COVID-19-related stress and anxiety as well as factors associated with vaccine hesitancy among healthcare workers. A descriptive, cross-sectional study was conducted among 849 health workers of a tertiary hospital. Vaccine hesitancy, COVID-19 related stress and anxiety were assessed using the Vaccine Hesitancy Scale (VHS) and SAVE-6 scale respectively. Also, the WHO-5 index was used to assess the perceived mental wellbeing among study participants. Data analysis was conducted using SPSS 25 at univariate, bivariate and multivariate levels. There were slightly more males (479; 56.4%) than females and about four-fifth (674; 79.4%) of respondents were married. About one-quarter of health workers were vaccine hesitant, 236 (27.8%) while 96 (11.3%) had high levels of stress and anxiety. Also, 38 (4.5%) of respondents had poor mental wellbeing. Females when compared to males, had significantly higher odds (OR 1.50; 95% CI 1.10-2.10; p = 0.023) of having vaccine hesitancy while those who were married compared to their single counterparts had significantly lesser odds (OR 0.60; 95% CI 0.36-0.94; p = 0.026). However, there was no significant association between COVID-19 related anxiety and vaccine hesitancy. COVID-19 vaccine hesitancy exists even among health professionals. This study highlights that gender and marital status significantly influence vaccine hesitancy among healthcare workers. Healthcare workers need to receive vaccines to protect themselves and others. Given their role in educating patients and community members about vaccination against infectious diseases like COVID-19, targeted interventions are needed to address hesitancy and optimize vaccine acceptance among healthcare professionals.

COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review

Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.

Does delivery matter? Examining pandemic vaccination preferences across time and countries using a discrete choice experiment

INTRODUCTION

After a pandemic outbreak, designing and implementing an effective vaccine supply chain is key. The last-mile vaccine delivery (LMVD) - the last stage of the vaccine supply chain - is of particular importance. LMVD design choices, such as the delivery mode (e.g., mobile team or PODs) and the number and locations of PODs, affect "operational attributes" like travel time and waiting time. This paper aims to understand how operational attributes of LMVD systems impact vaccination preferences across different priority groups, pandemic stages, and countries.

METHODS

Adults in The Netherlands (N=473 in May 2021 and N=385 in January 2023), Italy (N=302 in March 2023), and Poland (N=303 in March 2023) completed an online discrete-choice experiment. Participants chose between two hypothetical LMVD systems (and opt-out) with five attributes: appointment flexibility, appointment delay, in-facility waiting time, travel time, and familiarity with personnel. Mixed logit models were used to estimate coefficients, based on which relative importance (RI) and vaccine uptake percentages were calculated.

RESULTS

Operational attributes have a significant impact on estimated uptake. Travel time was the most important attribute in all four studies. Appointment delay and in-facility waiting consistently ranked second or third. The impact of the choice of an LMVD system on uptake varies over time and by country. In The Netherlands, it was strong in 2023 (23.4%) but moderate in 2021 (12.6%). Similarly, it was strong in Italy 2023 (21.8%) and moderate in Poland 2023 (11.4%). The estimated impact also varied by priority group, and was minor (6.1%) for the elderly with poor health in The Netherlands 2021 study.

CONCLUSION

Design choices for the LMVD system significantly impact vaccination preferences. Adapting these systems to different countries, time periods, and population groups is key for their effectiveness.

Association between COVID-19 anxiety syndrome and COVID-19 vaccine hesitancy in the postpandemic era: a cross-sectional study in Hong Kong

BACKGROUND

The COVID-19 pandemic has had profound psychophysiological and socioeconomic effects worldwide. COVID-19 anxiety syndrome (CAS) is a specific cluster of maladaptive coping strategies, including perseveration and avoidance behaviours, in response to the perceived threat and fear of COVID-19. CAS is distinct from general COVID-19 anxiety. The level of CAS in the postpandemic era remained unknown. Despite extensive research on general COVID-19 anxiety and COVID-19 vaccine hesitancy (CVH), few studies have investigated the association between CAS and CVH. The present study aimed to assess the level of CAS and the prevalence of CVH and explore the association between CAS and CVH in the general population of Hong Kong.

METHODS

This cross-sectional study was conducted in Hong Kong. Participants were recruited using convenience and snowball sampling methods and completed an online or a paper-based questionnaire comprising two well-validated instruments. The COVID-19 Anxiety Syndrome Scale (C-19ASS), which includes the C-19ASS-P and C-19ASS-A subscales, was used to evaluate CAS in terms of perseveration and avoidance behaviours. The COVID-19 Vaccine Hesitancy Scale (CVHS) was used to determine the presence of CVH.

RESULTS

This study included 389 participants. The median C-19ASS-P and C-19ASS-A scores were 8 (Interquartile range (IQR) 5-13) and 3 (IQR 0-6), respectively. The CVHS scores revealed a CVH prevalence of 68.1%. A significantly larger proportion of participants with CVH rated "hesitant" compared with those without CVH across all the CVHS items. Furthermore, the median C-19ASS-P and C-19ASS-A scores were significantly higher for participants without CVH than for those with CVH.

CONCLUSIONS

Our findings revealed that CAS persists and CVH is common in the postpandemic era and that CAS is associated with CVH. Comprehensive interventions addressing both informational and psychological aspects are needed to increase the rate of vaccine acceptance and to mitigate the effect of CAS on public health outcomes.

Socioeconomic status correlates with COVID-19 vaccination coverage among primary and secondary students in the most populated city of Chile

The burden of COVID-19 was heterogeneous, indicating that the effects of this disease are synergistic with both other non-communicable diseases and socioeconomic status (SES), highlighting its syndemic character. While the appearance of vaccines moderated the pandemic effects, their coverage was heterogeneous too, both when comparing different countries, and when comparing different populations within countries. Of note, once again SES appears to be a correlated factor. We analyzed publicly available data detailing the percentage of school-aged, vaccinated children in different municipalities belonging to the Metropolitan Area (MA) of Santiago, Chile. Vaccination data was compiled per school type, either public, state-subsidized, or private, at three different dates during the COVID-19 pandemic to cover the dispersion of Delta, Omicron, and its subvariants BA.4 and BA.5. We computed the median vaccination ratio for each municipality and school type and calculated their Spearman's rank correlation coefficient with each one of nine SES indices. The percentage of school-age children who received vaccinations against COVID-19 correlates with SES. This strong correlation is observed in public and state-subsidized schools, but not in private schools. Although inequity in vaccination coverage decreased over time, it remained higher among students enrolled either in public or state-subsidized schools compared to those of private schools. Although available data was insufficient to explore plausible causes behind lower vaccination coverage, it is likely that a combination of factors including the lack of proper information about the importance of vaccination, the lack of incentives for children's vaccination, low trust in the government, and limited access to vaccines for lower-income people, may all have contributed. These findings raise the need to design better strategies to overcome shortcomings in vaccination campaigns to confront future pandemics.

Factors influencing COVID-19 vaccine acceptability among household heads in northern Nigeria: a community-based cross-sectional study

OBJECTIVES

COVID-19 vaccine was rolled out for the public in August 2021 in Zamfara state, Northen Nigeria. We determined the factors influencing COVID-19 vaccine acceptance.

SETTINGS

We executed a community-based analytical cross-sectional study during the first 4 months of the second phase of the COVID-19 (Oxford/AstraZeneca) mass vaccination campaign in Zamfara state.

PARTICIPANTS

We used multistage sampling to select 910 household heads.

OUTCOME MEASURES

We used a semistructured electronic questionnaire to collect data on sociodemographic characteristics, uptake and acceptance of COVID-19 vaccine between 12 October and 20 December 2021. We calculated frequencies, proportions, adjusted ORs and 95% CIs for factors influencing COVID-19 vaccine acceptance using logistic regression.

RESULTS

Our respondents had a median age of 48 years (IQR: 37-55), 78.1% (711) were men, a majority more than 30 years, and only 8.9% (81) had received COVID-19 vaccine. Of the 829 unvaccinated respondents, 10.1% (84) accepted to take the vaccine, the current week of the interview while 12.2% (101) rejected the vaccine. Individuals aged 30 years and older (adjusted OR (aOR)=2.39, 95% CI 1.16 to 4.94, p=0.018), who owned a mobile phone (aOR=25.35, 95% CI 11.23 to 57.23, p<0.001) and a television (aOR=3.72, 95% CI 1.09 to 12.69, p=0.036), with medium-high levels of trust (aOR=7.41, 95% CI 3.10 to 17.74, p<0.001), and those with a medium-high (positive) levels of attitude (aOR=1.82, 95% CI 1.06 to 3.11, p=0.029) were more likely to accept the COVID-19 vaccine. Also, those who had been vaccinated with other vaccines (aOR=2.2, 95% CI 1.09 to 4.43, p=0.027) and those previously tested for COVID-19 (aOR=2.0, 95% CI 1.10 to 3.66, p=0.023) were also more likely to accept it.

CONCLUSION

COVID-19 vaccine had a poor uptake and acceptance. Factors such as age, awareness, trust and previous vaccination experience played a significant role in COVID-19 vaccine acceptance. We recommended targeted public health campaigns, improving community engagement and building trust in community leaders, healthcare providers and public health institutions.

Variation in the time to complete the primary COVID-19 vaccine series by race, ethnicity, and geography among older US adults

INTRODUCTION

Racial and ethnic disparities in COVID-19 vaccine access are well-documented; however, few studies have examined whether racial disparities are modified by other factors, including geographic location and area-level deprivation.

METHODS

We conducted an observational study using the COVVAXAGE database. Medicare beneficiaries who received the COVID-19 vaccine primary series (two doses) between 01/01/2021 and 12/31/2021 were included. Racial differences in the time between doses was assessed by urbanicity using g-formula methods.

RESULTS

We identified 11,924,990 beneficiaries (mean age = 75.4; 60 % female; 80 % White). Most beneficiaries (97.1 %) received their second vaccine on time. Delayed second doses were more common among beneficiaries who were Black (RRdelayed = 1.30, 95 %CI = 1.28-1.31) and rural (RRdelayed = 1.27, 95 %CI = 1.25-1.29) relative to White and urban beneficiaries. Racial disparities in delayed vaccinations varied in magnitude by degree of urbanicity.

CONCLUSIONS

Most beneficiaries received their second COVID-19 vaccine on time. Racial disparities were observed and shown to vary by geographic area.

Determinants of COVID-19 Vaccine Uptake Among People Living with Human Immunodeficiency Virus

BackgroundHuman immunodeficiency virus (HIV) cases are rising in Central Asia and Kazakhstan. People living with HIV (PLWH) in Kazakhstan are at heightened risk of severe COVID-19. We conducted a study to evaluate determinants of COVID-19 vaccine uptake among PLWH in Kazakhstan.MethodsIn this cross-sectional study, 196 PLWH were recruited from the Almaty City AIDS Center (July 2022-January 2023). We used logistic regression to evaluate how multilevel factors are associated with COVID-19 vaccine uptake among PLWH in Kazakhstan.ResultsCOVID-19 vaccine non-uptake was associated with higher HIV stigma scores (AOR = 1.08, 95%CI:1.02,1.16, P = 0.017), a lower level of education (AOR = 2.53, 95%CI: 1.04,6.17, P = 0.0412), and never receiving the flu vaccine (AOR = 15.64, 95%CI:3.66,66.89, P = 0.0002). Participants with at least mild anxiety symptoms (AOR = 0.15, 95%CI:0.03,0.64, P = 0.0107) and a positive attitude towards vaccination (AOR = 0.79, 95%CI: 0.73,0.86, P < 0.0001) were less likely to remain unvaccinated against COVID-19.ConclusionsCOVID-19 vaccination campaigns should be tailored for PLWH and incorporate stigma reduction interventions within healthcare settings.

The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

Factors influencing adverse events following COVID-19 vaccination

Various novel platform technologies have been used for the development of COVID-19 vaccines. In this nested cohort study among healthcare workers in Australia and Brazil who received three different COVID-19-specific vaccines, we (a) evaluated the incidence of adverse events following immunization (AEFI); (b) compared AEFI by vaccine type, dose and country; (c) identified factors influencing the incidence of AEFI; and (d) assessed the association between reactogenicity and vaccine anti-spike IgG antibody responses. Of 1302 participants who received homologous 2-dose regimens of ChAdOx1-S (Oxford-AstraZeneca), BNT162b2 (Pfizer-BioNTech) or CoronaVac (Sinovac), 1219 (94%) completed vaccine reaction questionnaires. Following the first vaccine dose, the incidence of any systemic reaction was higher in ChAdOx1-S recipients (374/806, 46%) compared with BNT162b2 (55/151, 36%; p = 0.02) or CoronaVac (26/262, 10%; p < 0.001) recipients. After the second vaccine dose, the incidence of any systemic reaction was higher in BNT162b2 recipients (66/151, 44%) compared with ChAdOx1-S (164/806, 20%; p < 0.001) or CoronaVac (23/262, 9%; p < 0.001) recipients. AEFI risk was higher in younger participants, females, participants in Australia, and varied by vaccine type and dose. Prior COVID-19 did not impact the risk of AEFI. Participants in Australia compared with Brazil reported a higher incidence of any local reaction (170/231, 74% vs 222/726, 31%, p < 0.001) and any systemic reaction (171/231, 74% vs 328/726, 45%, p < 0.001), regardless of vaccine type. Following a primary course of ChAdOx1-S or CoronaVac vaccination, participants who did not report AEFI seroconverted at a similar rate to those who reported local or systemic reactions. In conclusion, we found that the incidence of AEFI was influenced by participant age and COVID-19 vaccine type, and differed between participants in Australia and Brazil.

Development and validation of a COVID-19 vaccination prediction model based on self-reporting results in Chinese older adults from September 2022 to November 2022: A nationwide cross-sectional study

It was common to see that older adults were reluctant to be vaccinated for coronavirus disease 2019 (COVID-19) in China. There is a lack of practical prediction models to guide COVID-19 vaccination program. A nationwide, self-reported, cross-sectional survey was conducted from September 2022 to November 2022, including people aged 60 years or older. Stratified random sampling was used to divide the dataset into derivation, validation, and test datasets at a ratio of 6:2:2. Least absolute shrinkage and selection operator and multivariable logistic regression were used for variable screening and model construction. Discrimination and calibration were assessed primarily by area under the receiver operating characteristic curve (AUC) and calibration curve. A total of 35057 samples (53.65% males and mean age of 69.64 ± 7.24 years) were finally selected, which constitutes 93.73% of the valid samples. From 33 potential predictors, 19 variables were screened and included in the multivariable logistic regression model. The mean AUC in the validation dataset was 0.802, with sensitivity, specificity, and accuracy of 0.732, 0.718 and 0.729 respectively, which were similar to the parameters in the test dataset of 0.755, 0.715 and 0.720, respectively, and the mean AUC in the test dataset was 0.815. There were no significant differences between the model predicted values and the actual observed values for calibration in these groups. The prediction model based on self-reported characteristics of older adults was developed that could be useful for predicting the willingness for COVID-19 vaccines, as well as providing recommendations in improving vaccine acceptance.

Vaccine Intention, Uptake, and Hesitancy Among US Certified Food Producers: The National COVID-19 Organic Farmer Study

OBJECTIVE

To estimate COVID-19 vaccine intention, uptake, and hesitancy among essential workers.

METHODS

A cross-sectional survey of USDA-certified organic producers. An electronic survey was used for data collection. Analyses included descriptive statistics, χ2 tests, and ordinal logistic regressions.

RESULTS

The dataset consisted of 273 records. While 63% of respondents had received at least 1 dose of COVID-19 vaccine, only 17% had the recommended minimum of 2 doses. More than two-thirds of unvaccinated individuals indicated no plan to receive the vaccine, and limited perception of vaccine necessity. They indicated concerns about side effects and a distrust of the vaccines and the government. Age, education level, acreage, region, and health insurance status were variables significantly associated with the number of doses of vaccine received.

CONCLUSIONS

Interventions to encourage vaccination may target farmers who are less educated, live alone or just with one other person, lack health insurance, and run larger farms. Results also suggest focusing on enhancing trust in science and the government. Theory-based approaches that address low perception of risk and severity may be more likely to be effective with this population. Information on how US organic producers handled the COVID-19 pandemic is critical for emergency preparedness and food system stability.

Adult vaccination in India: A rapid review of current status & implementation challenges

Background & objectives The expanded programme on immunization launched in India in 1978, with its focus on preventing six diseases in children (tetanus, diphtheria, pertussis, poliomyelitis, typhoid, and childhood tuberculosis), was widened in its scope in 1985-86. This new avtaar, the Universal Immunization Programme (UIP), incorporated measles vaccine for children and rubella and adult diphtheria vaccines for pregnant women. We conducted this rapid review on adult immunization relevant for India, as recent COVID-19 experience revealed how newly emergent or re-emergent pathogens could have their onslaughts on the elderly and adults with comorbidities. Methods Three different bibliographic databases, namely PubMed, Scopus and Ovid were searched electronically to access the articles published in peer-reviewed journals. Relevant consensus guidelines by in-country professional groups were also collated. We conducted deduplication and screening of the outputs of these searches (1242 bibliographical records). Finally, 250 articles were found eligible for inclusion. As trials on the reduction of morbidities, mortalities and hospitalizations in adults due to proposed vaccines under Indian consensus guidelines were not available, no meta-analysis was conducted. Results Evidence from articles finally included in this synthesis were grouped under (i) preventing viral and bacterial infections in adults; (ii) adult vaccination and awareness tools; (iii) vaccine hesitancy/acceptance; and (iv) adult vaccination guidelines. In-country research revealed the need for introducing the Human Papilloma Virus (HPV) vaccine in adolescence or early-adulthood to prevent ano-genital cancers in elderly and later life. Importantly HPV prevalence among cervical cancer patients varied between 88 to 98 per cent in Andhra Pradesh, Odisha and Delhi. The importance of conducting regular surveillance of pneumococcal diseases and influenza, as well as tweaking the vaccines accordingly, was revealed in other articles. A poor uptake of influenza vaccine (≤2%) in adults (≥45 yr) was documented. The uptake of hepatitis B vaccine in Health Care Workers (HCWs) in Delhi and Mumbai was of concern and ranged from 55 to 64 per cent. The vulnerability of HCWs to rubella was investigated in a paediatric ophthalmic hospital in Madurai: a tenth of the selected HCWs were rubella seronegative and mounted good protective immunity following RA 27/3 vaccine administration. An outbreak of measles in college students in Pune emphasized the phenomenon of waning immunity. Similarly, a study in the infectious disease hospital in Kolkata and in-patients in Delhi revealed a lack of protective immunity against diphtheria and tetanus in adults. The researchers estimated the economic benefits of providing a typhoid vaccine to a household to be US$ 23 in a middle-income neighbourhood and US$ 14 in slum settings. The authors highlighted the importance of preventive strategies, finding that the cost of severe typhoid fever was US$ 119.1 in 18 centres across India. Both qualitative and quantitative investigations explored vaccine hesitancy, which was studied more during the COVID-19 pandemic than earlier. Interpretation & conclusions Vaccination programmes in India would require (i) increasing awareness around vaccine-preventable diseases among adults and HCWs; (ii) actively engaging health care systems and community-based organizations; and (iii) developing and producing affordable, safe, and country-appropriate vaccines. Effective communication strategies and tools will be the key to the success of such interventions.

Association Between County-Level Social Vulnerability and Vaccine-Related Attitudes and Hesitancy Toward COVID-19 Vaccination in the United States

BACKGROUND/OBJECTIVES

Understanding attitudes and behaviors related to vaccination is critical for enhancing COVID-19 vaccination acceptance and reducing disparities in vaccination coverage. This study examines disparities in vaccine-related attitudes and COVID-19 vaccine hesitancy in the United States in relation to community-level social vulnerability.

METHODS

This study analyzed cross-sectional national surveys conducted repeatedly between July 2020 and August 2021 (n = 6716). We assessed the association between county-level social vulnerability and general vaccine-related attitudes, as well as COVID-19 vaccine hesitancy. We developed Poisson models with robust variance estimation. The analysis also included the association of county social vulnerability with parental COVID-19 vaccine hesitancy.

RESULTS

Living in counties with high Socioeconomic Status vulnerability was associated with less vaccine support (adjusted Prevalence Ratio (aPR) 1.10; 95% CI 1.05-1.14) and residing in counties with high Household Characteristics vulnerability was associated with higher likelihood of COVID-19 vaccine hesitancy (aPR 1.13; 95% CI 1.07-1.20). In contrast, high vulnerability in the Racial and Ethnic Minority was associated with more positive attitudes toward vaccines (aPR 0.91; 95% CI 0.88-0.94) and lower COVID-19 vaccine hesitancy for both themselves (aPR 0.81; 95% CI 0.76-0.87) and children (aPR 0.84; 95% CI 0.75-0.94), after adjusting for sociodemographic factors.

CONCLUSIONS

Our study highlights the importance of addressing vulnerabilities related to socioeconomic status and household characteristics to reduce disparities in vaccine perceptions and hesitancy in socially vulnerable populations. The findings provide evidence for targeted public health interventions at the community level. They also demonstrate that the relationship between social vulnerability and vaccine attitudes varies across different vulnerability components.

Emerging global patterns of COVID-19 vaccine information fatigue in 23 countries in 2023

Vaccine information fatigue, exacerbated by the infodemic, misinformation, and cultural influences, hampers public responsiveness to the uptake of vaccines for COVID-19 and other vaccine-preventable diseases. This cross-sectional study of 23,000 respondents surveyed in 23 countries in October 2023 analyzed trust in information sources, perceptions of the pandemic's conclusion, and confidence in one's ability to discern false information from true and the association of these factors with willingness to pay attention to COVID-19 vaccine information, adjusting for sociodemographic characteristics. Results revealed that satisfaction with health authority communication was positively associated with individuals' willingness to pay attention to COVID-19 vaccine information in all 23 countries. Confidence in one's own capacity to distinguish true information from false was associated with willingness in 20 countries. Belief that the pandemic is over was associated with unwillingness to pay attention to COVID-19 vaccine information in 14 countries. These findings underscore the need for tailored communication strategies that build trust in information sources, combat complacency, and enhance discernment skills to address vaccine and pandemic fatigue, aiming to sustain public engagement with vaccine information and, ultimately, support vaccination efforts.

Trust in the science behind COVID-19 vaccines as a driver of vaccine acceptance in the United States, 2021-2023

Objectives

To evaluate changes in public trust in the science behind COVID-19 vaccines in the United States (US) from 2021 to 2023, and to assess how loss of a family member or close friend to COVID-19, influences this trust and vaccine acceptance.

Methods

Using stratified random sampling for key demographic variables, including age, gender, race/ethnicity, region, and education level, the study analyzes data from a series of cross-sectional surveys conducted in 2021, 2022 and 2023. Descriptive statistics were employed to summarize the socio-demographic characteristics of the respondents and their levels of trust in science and vaccine acceptance. Weighted logistic regression models were applied to assess the relationships between trust in science, vaccine acceptance, and socio-demographic factors. These models controlled for potential confounding variables and allowed for the estimation of adjusted odds ratios (aOR) and 95% confidence intervals (CI), highlighting the key predictors of vaccine acceptance and willingness to receive future recommended boosters.

Results

The results indicate that trust in science remained relatively stable over the study period and continued to be a strong predictor of vaccine acceptance, which was higher among male respondents, those with university degrees, and those with higher than median income. Notably, the experience of personal loss was significantly related to an individual's trust in science and vaccine acceptance.

Conclusions

Trust in the science behind COVID-19 vaccines appears to have been a crucial factor in US vaccine acceptance, with respondents who expressed higher trust being significantly more likely to accept the vaccine and express willingness to take future boosters. To maintain and enhance public trust in vaccination programs, trust in health communication from public sources, particularly the CDC, must be strengthened, as trust in the CDC was also found to be significantly correlated with both vaccine acceptance and future booster uptake. Personal experiences of loss due to COVID-19 were important predictors of trust in science and vaccine acceptance, highlighting the need for public health communications to be sensitive to the emotional impact of loss and grief along with the diverse socio-economic and educational backgrounds of the US population.

Vaccine Confidence Among Young Adults During COVID-19: A Cross-Sectional Study from Turkey

Purpose

A lack of confidence in vaccination is a threat to public health and undermines vaccine uptake at national and global levels. Unfortunately, COVID-19 vaccine confidence among Turkish young adults is poorly known. This study aims to understand COVID-19 vaccine confidence among Turkish young adults aged 18-29 and the barriers to and facilitators of vaccine uptake.

Methods

The present research is a cross-sectional study. Survey data were collected in May and June 2022 (n = 1066) during the COVID-19 vaccination campaign. Results were expressed in frequencies and percentages for dichotomous variables and mean with standard deviation for continuous variables. To assess COVID-19 vaccine confidence based on selected sociodemographic characteristics, a one-way ANOVA analysis and an independent-sample t-test were used.

Results

Almost half of the sample (43.9%) underestimated the risk of contracting COVID-19 disease. 65.9% of participants believed that getting vaccinated against COVID-19 was important, while 47.8% thought the vaccine was safe and not dangerous or harmful. Concerns about vaccine effectiveness (58.3%) were the primary reported reason for vaccination. The percentage of participants who reported barriers to vaccine access was generally low (8.7%). Importantly, 63.9% believed getting vaccinated is their responsibility to their community. 33.8% of participants reported encountering inaccurate, misleading, and unfavorable information about COVID-19 vaccines, while 22.9% said they were unsure.

Conclusion

Addressing concerns about COVID-19 vaccine safety and efficacy, emphasizing the role of vaccination in societal benefits, ensuring easy access to vaccines, and providing access to up-to-date and accurate information from reliable sources might help increase coverage among young adults. Perhaps the most crucial advice is to instill the correct comprehension of vaccination and make lifelong vaccination a reality before individuals develop false beliefs that are challenging to rectify.

Experiences and perceptions of migrant populations in South Africa on COVID-19 immunization: an interpretative phenomenological analysis

INTRODUCTION

Migrant populations (asylum seekers, permit holders, refugees, and undocumented migrants) living in South Africa face various individual, social, and physical circumstances that underpin their decisions, motivation, and ability to receive the COVID-19 vaccine. We conducted a qualitative study to explore the experiences and perceptions of migrant populations in South Africa on COVID-19 vaccines to inform recommendations for improved COVID-19 immunization.

METHODS

We conducted an Interpretative Phenomenological Analysis (IPA) with 20 asylum seekers, permit holders, refugees, and undocumented migrants living in South Africa. We applied a maximum variation purposive sampling approach to capture all three categories of migrants in South Africa. Semi-structured interviews were conducted and recorded electronically with consent and permission from the study participants. The recordings were transcribed and analyzed thematically following the IPA using Atlas.ti version 9.

RESULTS

Four major reflective themes emanated from the data analysis. (1) While some migrants perceived being excluded from the South African national immunization program at the level of advertisement and felt discriminated against at the immunization centers, others felt included in the program at all levels. (2) Skepticism, myths, and conspiracy theories around the origin of SARS-CoV-2 and the COVID-19 vaccine are pervasive among migrant populations in South Africa. (3) There is a continuum of COVID-19 vaccine acceptance/hesitancy ranging from being vaccinated through waiting for the chance to be vaccinated to refusal. (4) Accepting the vaccine or being hesitant follows the beliefs of the participant, knowledge of the vaccine's benefits, and lessons learned from others already vaccinated.

CONCLUSION

COVID-19 vaccine inclusiveness, awareness, and uptake should be enhanced through migrant-aware policies and actions such as community mobilization, healthcare professional training, and mass media campaigns.

Cross-country comparison of depressive symptoms and social-emotional aspects in university students from Brazil and Germany during the COVID-19 pandemic: results from two cross-sectional surveys

BACKGROUND

The COVID-19 pandemic negatively affected students' mental health, increasing pre-existing psychosocial vulnerabilities. University students worldwide have presented differences in their mental health status; however, cross-country studies comparing students' mental health during the pandemic are lacking.

AIMS

To investigate potential differences between university students from Brazil and those from Germany with respect to (a) depressive symptoms and alcohol and drug consumption, (b) social and emotional aspects (loneliness, self-efficacy, perceived stress, social support and resilience) and (c) attitudes towards vaccination.

METHOD

Two online cross-sectional studies were conducted with university students during the COVID-19 pandemic in Brazil (November 2021 to March 2022) and in Germany (April to May 2022). Depressive symptoms, alcohol consumption, loneliness, self-efficacy, perceived stress, social support, resilience, sociodemographic information and attitudes towards vaccination were assessed. Data were analysed using univariate and bivariate models.

RESULTS

The total sample comprised N = 7911 university students, with n = 2437 from Brazil and n = 5474 from Germany. Brazilian students presented significantly more depressive symptoms and suicidal thoughts, higher levels of perceived stress, higher frequency of drug or substance consumption, and lower levels of perceived social support and resilience than German students, whereas German students presented higher levels of loneliness than Brazilian students. A more favourable opinion towards vaccinations in general was found among Brazilian students compared with German students.

CONCLUSIONS

In both countries, low-threshold (online) counselling targeting university students is needed. The differences between the samples could indicate country and/or cultural differences which justify further research in this area.

Trust in institutions affects vaccination campaign outcomes

BACKGROUND

Trust is an important driver of various outcomes, but little is known about whether trust in institutions affects actual vaccination campaign outcomes rather than only beliefs and intentions.

METHODS

We used nationally representative, individual-level data for 114 countries and combined them with data on vaccination policies and rates. We measured the speed of the vaccination campaign for each country using the estimated growth rate of a Gompertz curve. We then performed country-level regressions in the global sample and explored heterogeneity across World Bank development groups.

RESULTS

Globally, higher trust in institutions significantly increased vaccination rates (p<0.01) and vaccination speed (p<0.01). The effect was strong in low- and middle-income countries but statistically not significant in high-income countries.

CONCLUSIONS

Our findings have implications for the design of vaccination campaigns for national governments and international organizations. The findings highlight the importance of trust in institutions when designing communication strategies around vaccination campaigns in low- and middle-income countries.

Factors influencing COVID-19 vaccination intentions and mediating effects among older adults in Southwest China

This study examines the factors influencing COVID-19 vaccination intentions among Chinese residents over the age of 60, with a focus on the mediating roles of Health Beliefs and Cues to Vaccination Action in the relationship between vaccine knowledge and vaccination intentions. We conducted a cross-sectional online survey involving 1,305 participants from Southwest China. Multiple logistic regression analysis identified potential determinants of vaccination intention, including socioeconomic characteristics, knowledge, health beliefs, and cues to vaccination action. Furthermore, mediation analysis using the causal mediation analysis method explored the mediating effects within the knowledge-to-intention pathway. Vaccination intention and its related factors: among the 1212 elderly people included in the study, 92.9% expressed willingness to receive the COVID-19 vaccine. Main factors influencing their vaccination willingness included Residency (urban vs. rural, OR = 0.47, p < 0.01), Age (75 + vs. others, OR = 0.41, p < 0.05), Marital status (OR = 0.36, p < 0.01), Occupation ( business/service vs. others, OR = 0.33, p < 0.05), Awareness of vaccine effectiveness (OR = 1.23, p < 0.01), Cues to vaccination action (OR = 1.31, p < 0.01) and COVID-19 related knowledge (OR = 1.06, p < 0.01). The analysis revealed two significant mediators-Health Beliefs and Cues to Vaccination Action. These mediators (p<0.05 for both natural indirect effect and natural direct effect) acted along two key pathways: (1) From Knowledge of COVID-19 to Health Beliefs to Vaccination Intention: Natural Direct Effects (NDE) ranged from 0.012 to 0.016, with Natural Indirect Effects (NIE) from 0.001 to 0.003, indicating that mediators accounted for 4% to 18% of the total effect. (2) From Knowledge of COVID-19 to Cues of Vaccination Action to Vaccination Intention: NDE ranged from 0.012 to 0.016 and NIE from 0.002 to 0.003, with mediators accounting for 9% to 20% of the effect. The intention to vaccinate against COVID-19 among older adults varies significantly based on socioeconomic and health belief factors. The study identifies health beliefs and cues to action not only as direct contributors but also as crucial mediators in the pathway from knowledge to vaccination intention among older individuals. These findings can extend our understanding of the impact of sociodemographic factors and health beliefs on the COVID-19 vaccination willingness among older adults.

Prevalence and Determinants of Vaccine ‎Hesitancy Among Students at King Faisal ‎University

Vaccination is a cornerstone of public health, providing immunity against various diseases. However, vaccine hesitancy, as defined by the World Health Organization (WHO), poses a significant challenge to global health efforts. This cross-sectional study explores the prevalence and determinants of vaccine hesitancy among 401 students at King Faisal University. The sample primarily comprises young individuals (97.4% aged 18-24) and predominantly female participants (79%), with 90.5% residing in Al-Ahsaa. Our findings indicate that 75.4% of students adhere to the vaccination schedule, and 55.8% recognize the health benefits of vaccines. Notably, while 1.5% express skepticism, 45.8% strongly agree on the safety of vaccines, and 47.3% acknowledge their effectiveness. Interestingly, only 30.4% feel well-informed about vaccination recommendations, and 47.1% recognize the media's influence on vaccine hesitancy. A significant majority (68.5%) demonstrate high awareness, mainly relying on healthcare professionals (63.4%) for information. Concerns regarding side effects (58.8%) and doubts about vaccine efficacy (21.2%) are prevalent among participants. In conclusion, while the majority of students exhibit high knowledge levels and low hesitancy, concerns about side effects and trust in vaccine efficacy remain critical barriers. Targeted interventions are essential to enhance vaccine uptake and effectively address the factors contributing to vaccine hesitancy.

Behaviorally informed digital campaigns and their association with social media engagement and COVID-19 vaccine uptake in Belize

BACKGROUND

Increasing vaccination coverage was key to curbing the COVID-19 pandemic globally. However, lack of trust in the vaccine and fear of side effects in regions like the Caribbean resulted in a low uptake despite enough vaccine supply.

METHODS

We conducted two correlational analyses and one experiment between five sequential behaviorally informed Facebook campaigns, social media performance outcomes, and district-level vaccination data. First, we ran multivariate linear regression models to estimate the mean differences between the campaigns in (i) social media performance ("Clicks" and "Engagement") and (ii) COVID-19 vaccination uptake at the district level. "Clicks" were measured by the number of people who clicked on the respective Facebook advert and visited the official vaccination site. "Engagements" were the number of people interacting with the advert through likes and emojis. Second, we took advantage of the experimental design during one of the campaigns to analyze the differential effect of messages conveying information about the number of people reporting vaccination side effects using words ("Few"/ "Majority) and numbers ("3 out of 100 ") on social media performance.

RESULTS

The correlational analysis showed that the number of "Clicks" and "Engagement" was similar among campaigns, except for the campaign focusing on vaccines' effectiveness, which had 14.65 less clicks and 19.52 less engagements per advert (including controls and district-fixed effects) compared to the base "It's safe" campaign. Vaccination rates were highest at times coinciding with campaigns focusing on vaccination safety and effectiveness. Our experimental results showed that informational messages related to side effects that were framed using words ("Majority did not report discomfort"/ "Few persons reported discomfort") were better at generating "Clicks" compared to those using numbers ("3 out of 100 reported discomforts").

CONCLUSIONS

Facebook adverts highlighting vaccine safety had a similar level of social media performance as other campaigns, except for adverts focusing on vaccine efficacy, which performed worse. Communicating side-effect information with words instead of numbers can expand social media interest in low-uptake regions like the Caribbean. Our results serve as preliminary evidence for public health officials to encourage vaccine uptake in high-hesitancy contexts.

Drivers of COVID-19 vaccine uptake among rural populations in Madagascar: a cross-sectional study

BACKGROUND

The WHO set the global immunisation threshold for COVID-19 at 70% to achieve worldwide protection against the disease. To date, global COVID-19 vaccine coverage is still below this threshold, in particular in several sub-Saharan African (SSA) countries, such as Madagascar. While factors influencing COVID-19 vaccine hesitancy have been widely explored in the past few years, research on drivers of COVID-19 vaccine uptake remains scarce. This study aimed at investigating drivers associated with COVID-19 vaccine uptake in the Boeny region of Madagascar.

METHODS

The study used a cross-sectional survey design to collect data on drivers of vaccine uptake from a sample of adults recruited from 12 healthcare facilities between November 2022 and February 2023. Relative and absolute frequencies were used to summarize participants' characteristics. Prevalence ratios were estimated by Poisson regression to identify and compare sociodemographic and motivational drivers of vaccine uptake among those who were willing to get vaccinated against COVID-19 with those who had already been vaccinated.

RESULTS

A total of 928 participants aged between 18 and 76 years were included in the study. Among those recruited, 44.9% (n = 417) had already been vaccinated and 55.1% (n = 511) were willing to receive their first dose of COVID-19 vaccine on the day of the interview. The proportions of those respondents who live in urban areas (56.5% vs. 43.8%) and who have high school or university education (46.6% vs. 35.8%) were higher for the uptake group, whereas the proportion of employed respondents (66.3% vs. 56.5%) was higher among those willing to get vaccinated. Vaccine being free of charge (aPR = 1.77 [CI 95%: 1.45-2.17]) and being able to travel again (aPR = 1.61 [CI 95%: 1.30-1.98]) were the drivers most strongly associated with higher vaccine uptake after adjustment for sociodemographic factors.

CONCLUSIONS

This study shows that actual COVID-19 vaccine uptake is influenced by a different set of factors than willingness to get vaccinated. Taking this difference in drivers into account can inform more tailored vaccination strategies to increase worldwide coverage.

Oxford Vaccine Hesitancy Scale (OVHS): a UK-based and US-based online mixed-methods psychometric development and validation study of an instrument to assess vaccine hesitancy

OBJECTIVES

To describe the development, validation and reliability of the Oxford Vaccine Hesitancy Scale (OVHS), a new instrument to assess vaccine hesitancy in the general population.

DESIGN

Cross-sectional validation study.

SETTING

Internet-based study with participants in the UK and USA.

PARTICIPANTS

Demographically representative (stratified by age, sex and race) samples from the UK and USA recruited through the Prolific Academic platform.

MAIN OUTCOME MEASURES

To demonstrate OVHS development, exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation on the UK sample was performed. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating goodness of fit statistics including the root mean squared error of approximation (RMSEA), standardised root mean squared residual (SRMR) and comparative fit index (CFI) was performed on the US sample. Reliability as internal consistency was assessed using McDonald's omega. Evidence in support of the predictive, convergent and discriminant validity of the scale was assessed using logistic regression ORs of association (OR) or Pearson correlation coefficients.

RESULTS

Data for factor analysis were obtained from 1004 respondents, 504 in the UK and 500 in the USA. A scree plot, minimum average partial correlation analysis and parallel analysis suggested a three-factor 13-item scale with domains of vaccine beliefs (seven items), pain (three items) and personal deliberation (three items). Responses were recorded on a Likert scale ranging from disagree completely to agree completely, with higher score reflecting greater hesitancy. Potential total scores ranged from 13 to 65. Goodness of fit was excellent, with RMSEA=0.044, SRMR=0.041 and CFI=0.977. Predictive validity for COVID-19 vaccination status was excellent, with logistic regression ORs of association (95% CI) of 0.07 (0.04, 0.13), p<0.0001 for the UK sample for each SD increase in OVHS score, suggesting a 93% decrease in the odds of being vaccinated against COVID-19 for each SD increase in OVHS score. Convergent validity between the OVHS score and the 5C short version scale demonstrated a correlation coefficient of 0.32 (p<0.0001). Discriminant validity with an unrelated desire to perform outdoor activities demonstrated an OR (95% CI) of 1.06 (0.88, 1.29), p=0.523 for the UK sample for each SD increase in OVHS score. McDonald's omega was 0.86 and 0.87 in the UK and US samples, respectively.

CONCLUSIONS

The OVHS is a feasible, valid and reliable scale for assessing vaccine hesitancy; further testing is warranted.

Effectiveness, acceptability, and potential of lay student vaccinators to improve vaccine delivery

SETTING

Task sharing can fill health workforce gaps, improve access to care, and enhance health equity by redistributing health services to providers with less training. We report learnings from a demonstration project designed to assess whether lay student vaccinators can support community immunizations.

INTERVENTION

Between July 2022 and February 2023, 27 undergraduate and graduate students were recruited from the University of Toronto Emergency First Responders organization and operated 11 immunization clinics under professional supervision. Medical directives, supported with online and in-person training, enabled lay providers to administer and document vaccinations when supervised by nurses, physicians, or pharmacists. Participants were invited to complete a voluntary online survey to comment on their experience.

OUTCOMES

Lay providers administered 293 influenza and COVID-19 vaccines without adverse events. A total of 141 participants (122 patients, 17 lay vaccinators, 1 nurse, and 1 physician) responded to our survey. More than 80% of patients strongly agreed to feeling safe and comfortable with lay providers administering vaccines under supervision, had no concerns with lay vaccinators, and would attend another lay vaccinator clinic. Content and thematic analysis of open-text responses revealed predominantly positive experiences, with themes about excellent vaccinators, organized and efficient clinics, and the importance of training, communication, and access to regulated professionals. The responding providers expressed comfort working in collaborative immunization teams.

IMPLICATIONS

Lay student providers can deliver vaccines safely under a medical directive while potentially improving patient experiences. Rather than redeploying scarce professionals, task sharing strategies could position trained lay vaccinators to support immunizations, improve access, and foster community engagement.

Perceptions of COVID-19 Vaccination Among Organ Transplant Recipients

BACKGROUND

Understanding COVID-19 vaccine hesitancy in organ transplant recipients (OTRs) is critical given clear-albeit attenuated-benefits from vaccination.

METHODS

Adult OTRs were surveyed regarding sociodemographic data, medical history, and vaccine-related values. A novel outcome variable called the Vaccine Acceptance Composite Score (VACS) was built as the average Likert score of seven domains of vaccine confidence. To examine its association with several factors and individual adherence to COVID-19 vaccine recommendations, univariable odds ratios and relative operating characteristic areas under the curve (AUC) values were calculated.

RESULTS

Of 46 OTRs included, 32.6% identified as female, 13.3% as Black, and 6.77% as Hispanic or Latino/a/x. The median age was 58 years old. 93.5% of patients were kidney transplant recipients, and 63.0% previously had COVID-19. Patients were most concerned about COVID-19 vaccine-associated risks (46.3%), its potential effect on allograft (47.6%), and motives of government officials involved with vaccine policy (55.6%). Politically conservative patients were likelier to have lower VACS, whereas those who lived with someone ≥65 years old were likelier to have higher VACS. The VACS was not significantly associated with race, income, religious beliefs, comorbidities, COVID-19 history, or influenza vaccination status. Higher VACS was associated with ≥3 and ≥4 COVID-19 immunizations.

CONCLUSIONS

This study highlighted political beliefs and elderly household members as correlates of vaccine acceptance among OTRs. The VACS may be a useful tool to help standardize multifaceted analyses in vaccination-focused behavioral research. In clinical practice, it could help identify individuals and groups at risk for vaccine hesitancy, who may benefit from tailored outreach and educational interventions.

SARS-CoV-2 Vaccination Coverage in Italian Children with Celiac Disease

Background: Celiac disease (CD) is the most common multisystemic autoimmune disorder affecting the pediatric population. However, little data is available regarding SARS-CoV-2 vaccination coverage in pediatric patients with CD. This study aims to evaluate the adherence to national recommendations for SARS-CoV-2 vaccination in children and adolescents with CD and its variation over time. Methods: We retrospectively analyzed medical charts and electronic registry records of SARS-CoV-2 vaccination of patients aged 0-19 years diagnosed with CD in a tertiary center. The vaccination coverage was evaluated according to age groups (young children, children, and adolescents), considering the patients' eligibility for vaccination at different times. Results: Among the 172 patients enrolled, 44.8% received at least one dose of the SARS-CoV-2 vaccine, showing no significant differences compared to the Italian population of similar age. Vaccination coverage demonstrated a progressive reduction after an initial peak (up to 65.5% in December 2021) concomitant with a gradual extension of vaccinable eligibility and falling SARS-CoV-2 infections. Histological diagnosis and the presence of other associated autoimmune diseases were associated with higher levels of adherence to vaccination. Conclusions: Adherence to the SARS-CoV-2 vaccination in young Italian children with CD was very low, while it was better in adolescents and patients with other associated autoimmune diseases. Vaccine hesitancy remains a concern, particularly among those diagnosed using the biopsy-sparing approach. Hesitancy increased during the pandemic period, suggesting the need for ongoing efforts to improve adherence to SARS-CoV-2 vaccination recommendations.

COVID-19 Vaccination and Vaccine Hesitancy in the Gaza Strip from a Cross-Sectional Survey in 2023: Prevalence, Risk Factors, and Associations with Health System Interventions

BACKGROUND

Preventing COVID-19 in Gaza is crucial due to the devastation of advanced health services infrastructure by war. Despite the high protection offered by COVID-19 vaccines against severe disease, a 2021 survey in Gaza found only half of the population was vaccinated, and one-third was vaccine-hesitant. This follow-up study conducted in March 2023 aimed to re-evaluate vaccination levels, hesitancy, exposure to vaccine promotion efforts, and other risk factors in Gaza.

METHODS

A community-based cross-sectional survey with multistage stratified sampling was used. Associations of primary exposures and other determinants with vaccine status and hesitancy were quantified using bivariate and multivariable logistic regression.

RESULTS

In 2023, 63.5% of adults received at least one vaccine dose compared to 49.1% in 2021 (p < 0.001). Vaccine hesitancy prevalence was 31.7% in 2023 versus 34.1% in 2021 (p = 0.395). Adjusted odds of vaccination were 4.2 times higher among those referred by health workers compared to those not referred. Adjusted odds of vaccine hesitancy among those who received information on the vaccine from health workers were 0.3 times that of people who did not receive information.

CONCLUSIONS

Results suggest health workers could play a crucial role in future vaccination strategies, as their vaccine promotion efforts were linked to better vaccine outcomes. Investing in the skills development of community health workers to contribute to these efforts is recommended.