Perceived threat of COVID-19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK

COVID-19 vaccine hesitancy in Chinese residents: A national cross-sectional survey in the community setting

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine hesitancy is associated with community aggregation, inducing low vaccine coverage and potentially more frequent community-level outbreak. Addressing vaccine hesitancy in community settings should be a priority for healthcare providers. A cross-sectional online questionnaire survey was conducted during June and July 2022. Ten sites were set up in eastern, central, and western China, from where residents were recruited in a community setting. In total, 7,241 residents from 71 communities were included. Of the residents, 7.0% had refusal administration, 30.4% had delayed administration, and community clustering accounted for 2.4-3.7% and 8.5-9.6% of the variation, respectively. The reasons for primary-dose refusal were diseases, pregnancy, or lactation, whereas the main reasons for booster-dose refusal were diseases during the vaccination period, no time to vaccinate, and felt unnecessary to vaccinate. Younger age (under 40), female, residing in urban settings and having self-reported diseases were sociodemographic indicators of risk for refusal. In the health belief model of refusing to vaccinate, perceived barriers had a positive impact on refusal (β = 0.08), while perceived benefits had a negative impact (β = -0.09). In conclusion, this study underscores the population heterogeneity and community clustering of SARS-CoV-2 vaccine hesitancy. Targeted interventions for these high-risk groups are crucial to enhance vaccination coverage and prevent outbreaks. Public health strategies should address vaccine hesitancy at different stages and doses, while considering both individual beliefs and community dynamics.

Modifiable risk factors of vaccine hesitancy: insights from a mixed methods multiple population study combining machine learning and thematic analysis during the COVID-19 pandemic

BACKGROUND

Vaccine hesitancy, the delay in acceptance or reluctance to vaccinate, ranks among the top threats to global health. Identifying modifiable factors contributing to vaccine hesitancy is crucial for developing targeted interventions to increase vaccination uptake.

METHODS

This mixed-methods multiple population study utilized gradient boosting machines and thematic analysis to identify modifiable predictors of vaccine hesitancy during the COVID-19 pandemic. Predictors of vaccine hesitancy were investigated in 2926 Norwegian adults (Mage = 37.91, 79.69% female), before the predictive utility of these variables was investigated in an independent sample of 734 adults in the UK (Mage = 40.34, 57.08% female). Two independent teams of authors conducted the machine learning and thematic analyses, blind to each other's analytic procedures and results.

RESULTS

The machine learning model performed well in discerning vaccine hesitant (n = 248, 8.48% and n = 109, 14.85%, Norway and UK, respectively) from vaccine uptaking individuals (n = 2678, 91.52% and n = 625, 85.15%), achieving an AUC of 0.94 (AUPRC: 0.72; balanced accuracy: 86%; sensitivity = 0.81; specificity = 0.98) in the Norwegian sample, and an AUC of 0.98 (AUPRC: 0.89; balanced accuracy: 89%; sensitivity = 0.83; specificity = 0.97) in the out-of-sample replication in the UK. The mixed methods investigation identified five categories of modifiable risk tied to vaccine hesitancy, including illusion of invulnerability, doubts about vaccine efficacy, mistrust in official entities, minimization of the societal impact of COVID-19, and health-related fears tied to vaccination. The portrayal of rare incidents across alternative media platforms as fear amplifiers, and the mainstream media's stigmatizing presentation of unvaccinated individuals, were provided as additional motives underlying vaccine reluctance and polarization. The thematic analysis further revealed information overload, fear of needles, previous negative vaccination experiences, fear of not getting healthcare follow-up after vaccination if needed, and vaccine aversion due to underlying (psychiatric) illness (e.g., eating disorders) as motives underlying vaccine hesitance.

CONCLUSIONS

The identified influential predictors were consistent across two European samples, highlighting their generalizability across European populations. These predictors offer insights about modifiable factors that could be adapted by public health campaigns in mitigating misconceptions and fears related to vaccination toward increasing vaccine uptake. Moreover, the results highlight the media's responsibility, as mediators of the public perception of vaccines, to minimize polarization and provide accurate portrayals of rare vaccine-related incidents, reducing the risk aggravating fear and reactance to vaccination.

Effects of Government Mistrust and Group-Based Medical Mistrust on COVID-19 Vaccine Hesitancy Among a Sample of African Americans

BACKGROUND

Despite the demonstrated efficacy of coronavirus disease (COVID-19) vaccines, higher rates of vaccine hesitancy among African Americans remain concerning. As determinants of vaccine hesitancy, the simultaneous roles of government mistrust and group-based medical mistrust have not been examined via from a cognitive information perspective among African Americans.

PURPOSE

We examined the direct and indirect effects of government mistrust and group-based medical mistrust on COVID-19 vaccine hesitancy in a sample of African Americans.

METHODS

We obtained data from 382 African Americans in South-East Michigan via an online survey. We assessed demographic variables, government mistrust, group-based medical mistrust, COVID risk and COVID worry, and positive and negative beliefs regarding the COVID-19 vaccine (i.e., vaccine pros and cons), and vaccine hesitancy. We examined our hypotheses with path analyses.

RESULTS

Results indicated significant direct effects of government mistrust on vaccine hesitancy; however, despite a significant correlation, there was no direct effect of group-based medical mistrust on vaccine hesitancy. The effect of group-based medical mistrust was fully mediated by both vaccine pros and cons, whereas the effect of government mistrust was partially mediated by vaccine pros. COVID risk and COVID worry did not mediate the effects of mistrust to vaccine hesitancy.

CONCLUSION

Negative effects of group-based medical mistrust on COVID-19 vaccine hesitancy among African Americans may be amenable to interventions that focus on beliefs about the vaccine rather than beliefs about vulnerability to the virus. However, given its direct effect, it may be necessary to focus directly on government mistrust to diminish its effects on COVID-19 vaccine hesitancy.

Vaccine hesitancy: a structured review from a behavioral perspective (2015-2022)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

Psychometric validation of the Vaccination Attitudes Examination (VAX) scale in German pre-pandemic and mid-pandemic samples

Despite the public health value of immunizations, vaccine hesitancy is a widespread phenomenon and received special attention during the global COVID-19 pandemic. The Vaccination Attitudes Examination (VAX) Scale aims to identify anti-vaccination attitudes for understanding vaccine hesitancy. The present study is the validation of the German version of the VAX scale in pre-/mid-pandemic samples. All individuals completed an online-survey assessing prior and expected future vaccination behaviors, further constructs associated with vaccine hesitancy, as well as anti-vaccination attitudes using the translated VAX scale among others. In a first study, 297 individuals were surveyed before the COVID-19 pandemic. A second study included 260 individuals recruited during the COVID-19 pandemic. For validation, two confirmatory factor analyses have been conducted. Reliability measures (internal consistency, test-retest-correlation) were determined. The four subscales were confirmed by Confirmation Factor Analysis with a very good to excellent fit. The subscales showed good to excellent reliability and convergent validity determinants. Average VAX values significantly distinguished between individuals who had previously received or refused immunization and predicted expected vaccination behavior. The German translation of the VAX scale is effective in identifying anti-vaccination attitudes and can be used for further research on anti-vaccination attitudes and vaccine hesitancy.

Exploring stigma, shame, and safety behaviours in social anxiety and paranoia amongst people diagnosed with schizophrenia

BACKGROUND

Social anxiety and paranoia are connected by a shared suspicion framework. Based on cognitive-behavioural approaches, there is evidence for treating social anxiety and psychosis. However, mechanisms underlying the relationship between social anxiety and paranoia remain unclear.

AIMS

To investigate mediators between social anxiety and paranoia in schizophrenia such as negative social appraisals (i.e. stigma or shame; Hypothesis 1), and safety behaviours (i.e. anxious avoidance or in situ safety behaviours; Hypothesis 2).

METHOD

A cross-sectional study was conducted among Asian out-patients with schizophrenia (January-April 2020). Data on social anxiety, paranoia, depression, shame, stigma, anxious avoidance, and in situ behaviours were collected. Associations between social anxiety and paranoia were investigated using linear regressions. Mediation analysis via 10,000 bias-corrected bootstrap samples with 95% confidence intervals (CI) was used to test the indirect effects (ab) of mediators.

RESULTS

Participants (n=113, 59.3% male) with a mean age of 44.2 years were recruited. A linear relationship between social anxiety and paranoia was found. In multiple mediation analyses (co-varying for depression), stigma and shame (Hypothesis 1) did not show any significant indirect effects with ab=.004 (95%CI=-.013, .031) and -.003 (-.023, .017), respectively, whereas in situ behaviours (Hypothesis 2) showed a significant effect with ab=.110 (.038, .201) through the social anxiety-paranoia relationship.

CONCLUSIONS

Social anxiety and paranoia are positively correlated. In situ safety behaviours fully mediated the social anxiety and paranoia relationship. Targeted interventions focusing on safety behaviours could help reduce paranoia in psychosis. Symptom severity should be measured to help characterise the participants' characteristics.

Using health belief model constructs to understand the role of perceived disease threat and resilience in responding to COVID-19 among people who use drugs: a cluster analysis

Introduction

The Health Belief Model (HBM) has been successfully applied to understanding adherence to COVID-19 prevention practices. It has not, however, been used to understand behavior in people who use drugs (PWUD). The aim of this study was to use the HBM to better understand COVID-19 perceptions among PWUD and understand how resiliency affects those perceptions.

Materials and methods

A cross-sectional survey was completed from September to December 2021 with PWUD (n = 75) who utilize services at a large harm reduction organization in Philadelphia. Segmentation analysis was done using a k-means clustering approach. Two clusters emerged based on perceived COVID-19 personal impact and resiliency (Less COVID impact/High resilience (NoCOV/HR) and High COVID impact/Low resilience (COV/LR). Differences in responses by cluster to perceptions of COVID-19 and individual pandemic response grouped by HBM constructs were assessed using Student's t-test and chi squares.

Results

Significant differences in HBM constructs were seen between clusters. Those in the COV/LR cluster were more likely to think they were susceptible to getting COVID-19 and less likely to believe they knew how to protect themselves. The NoCOV/HR cluster believed they were able to protect themselves from COVID-19 and that they were able to easily understand messages about protecting themselves.

Conclusion

Understanding how PWUD conceptualize disease threat and using HBM can better inform interventions to improve future pandemic response. Findings suggest that resilience is key to protecting PWUD from future infectious disease outbreaks. Interventions aimed at increasing resiliency among PWUD may improve preventative behavior and decrease disease burden in this vulnerable population.

Willingness to receive COVID-19 vaccines, associated factors and reasons for not taking a vaccine: a cross sectional study among persons aged 13-80 years in Wakiso, Central Uganda

BACKGROUND

Vaccination has been recommended as one of the approaches for the control of COVID-19 pandemic. However, adequate vaccine coverage is critical to the effectiveness of the vaccine at population level. Data on acceptability of the vaccine in Ugandan urban areas are limited. This study examined the prevalence, factors associated with willingness to accept COVID-19 vaccine including reasons for not taking COVID-19 vaccine in a predominantly urban population of Wakiso, central Uganda.

METHODS

Data were obtained from a cross-sectional study conducted between March 1st, 2021 and September 30th, 2021 in the urban population-based cohort of the Africa Medical and behavioral Sciences Organization (AMBSO). A Multivariable modified Poisson regression analysis was used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals of willingness to accept the COVID-19 vaccine.

RESULTS

A total of 1,903 participants were enrolled in this study; 61% of whom were females. About 63% of participants indicated their willingness to accept the COVID-19 vaccine. Persons aged 13-19 years (aPR = 0.79; [95% CI: 0.74, 0.84]) or 20-29years (aPR = 0.93; [95% CI: 0.88, 0.98]) were less likely to accept the vaccine compared to persons aged 40-49 years. Persons with post-primary level of education (aPR = 1.05; [95% CI: 1.02, 1.09]) were more likely to accept the vaccine compared to persons with primary level of education. Additionally, students or individuals working in government (aPR = 1.13; [95% CI: 1.04, 1.23]) were more likely to accept the vaccine compared to individuals doing construction and Mechanic work as their main occupation. Reported reasons for not taking a COVID-19 vaccine included; concerns about side effects of the vaccine 154(57.0%), 64(23.7%) did not think the vaccines were effective, while 32(11.9%) did not like the vaccines.

CONCLUSION

A substantial proportion of individuals were not willing to accept the COVID-19 vaccine. Health education campaigns on vaccination within urban communities could help reduce COVID-19 vaccine misconceptions in the urban populations more especially the young and persons with low levels of formal education.

COVID-19 vaccine acceptance: A comparative longitudinal analysis of the association between risk perception, confidence, and the acceptance of a COVID-19 vaccine

Following the outbreak of COVID-19, scientists rushed to develop vaccines to protect individuals and ferry the world out of the pandemic. Unfortunately, vaccine hesitancy is a major threat to the success of vaccination campaigns. Research on previous pandemics highlighted the centrality of perceived risk and confidence as core determinants of vaccine acceptance. Research on COVID-19 is less conclusive, and frequently it relies on one-country, cross-sectional data, thus making it hard to generalize results across contexts and observe these relationships over time. To bridge these gaps, in this article, we analyzed the association between perceived risk, confidence, and vaccine acceptance cross-sectionally at individual and country levels. Then, we longitudinally explored whether a within-country variation in perceived risk and confidence was correlated with a variation in vaccine acceptance. We used data from a large-scale survey of individuals in 23 countries and 19 time-points between June 2020 and March 2021 and comparative longitudinal multilevel models to estimate the associations at different levels of analysis simultaneously. Results show the existence of cross-sectional relationships at the individual and country levels but no significant associations within countries over time. This article contributes to our understanding of the roles of risk perception and confidence in COVID-19 vaccines' acceptance by underlining that these relationships might differ at diverse levels of analysis. To foster vaccine uptake, it might be important to address individual concerns and persisting contextual characteristics, but increasing levels of perceived risk and confidence might not be a sufficient strategy to increase vaccine acceptance rates.

A situational test of the health belief model: How perceived susceptibility mediates the effects of the environment on behavioral intentions

OBJECTIVE

Existing evidence regarding the role of perceived susceptibility in shaping preventative health behavior is mixed for the Health Belief Model (HBM). To clarify whether and under which conditions perceived susceptibility affects preventative behavior, this study aims to better understand how situational environmental factors affect perceived susceptibility, thereby shaping health decisions, and whether this mediation relationship is conditioned by other HBM cognitions, namely perceived benefits and severity.

METHODS

Therefore, we employed a scenario-based experiment in a large, representative sample of the German population (N = 4,802) in April 2022. Respondents were presented with a fictional invitation to a social gathering, which mimicked a post in a messenger group chat. The invitation included five experimentally manipulated scenarios: no COVID-19 preventative measure implemented, a COVID-19 test is required; either testing negative, being vaccinated, or being recovered from COVID-19 is required (known as 3G in the German context); reduced number of attendees; or the social gathering occurred outside. Moreover, perceived susceptibility to contract COVID-19 at the social gathering and perceived severity and benefits (independent of the scenario) were measured.

RESULTS

We found evidence that perceived susceptibility mediates the relationship between each implemented preventative measure and willingness to attend the social gathering. The effect of the preventative measures on perceived susceptibility and the indirect effect of the preventative measure on attendance via perceived susceptibility were moderated by perceived benefits. However, there is lack of robust evidence that perceived severity moderates the effect of perceived susceptibility on attendance.

CONCLUSION

In summary, our study provides evidence that individuals perceive and adapt their perceptions and behavior to preventive measures in a given situation, which speaks to the dynamic nature of the cognition perceived susceptibility. Moreover, our findings suggest a promising avenue forward for the HBM is to examine how the cognitions and the environment together shape preventative health behavior.

Predicting individuals' behaviors during a pandemic: why we might have acted as we did during the COVID-19 pandemic

BACKGROUND

This study examined individual differences in how people behave in response to a pandemic - more specifically, the current coronavirus pandemic.

PARTICIPANTS AND PROCEDURE

A sample of 420 participants was recruited through the online data collection platform MTurk. Participants were directed via an online link to a Qualtrics survey. This survey was composed of several demographic questions and self-report personality and belief scales, followed by a set of outcome measures designed to measure specific behaviors relating to avoidant behavior, protective behavior, and impulsive buying which the participants might, or might not, have engaged in during the COVID-19 pandemic.

RESULTS

The results showed that locus of control was the best personality-related predictor of peoples' pandemic-relevant behavior, such that externally oriented people were more likely to report both protective behavior and impulsive buying behavior. In addition, perceived threat was significantly associated with all three types of pandemic-relevant behaviors (avoidant, protective, and impulsive buying).

CONCLUSIONS

Individuals' personality traits and beliefs clearly play a major role in determining their behavior during health crises. In the case of the current COVID-19 crisis, some people adopt behaviors that ensure their safety and the safety of others, whereas other people display careless behaviors that contribute to spreading the infection. Because individual differences in this situation matter, it is important to determine which variables accurately predict which behaviors.

Trends in primary, booster, and updated COVID-19 vaccine readiness in the United States, January 2021-April 2023: Implications for 2023-2024 updated COVID-19 vaccines

OBJECTIVE

COVID-19 vaccines have mitigated the severity of COVID-19 and its sequelae. The emergence of new SARS-CoV-2 variants and waning immunity conferred by COVID-19 vaccination have necessitated booster and updated COVID-19 vaccines. This study examined trends in vaccine readiness-a composite measure of intention and uptake-for the primary, booster, and 2022-2023 updated (bivalent) COVID-19 vaccines among U.S. adults.

METHODS

Data from the nationally-representative U.S. Department of Health and Human Services' COVID-19 Monthly Outcome Survey from January 2021 to April 2023 were analyzed (N = 140,180). We conducted pairwise comparisons (weighted t-tests) to assess for significant between-month differences in the proportion of participants in each vaccine-readiness category (vaccine ready, wait and see, and no vaccine intention) for the following outcomes: (1) primary; (2) booster; and (3) updated COVID-19 vaccine readiness.

RESULTS

From January 2021 to April 2023, significant increases in the primary vaccine ready group were accompanied by decreases in the wait and see and no vaccine intention groups (p < 0.001). From January to September 2022, the no booster intention group notably increased (p < 0.001), whereas the booster ready group decreased (p < 0.001), and the wait and see group remained stable (p = 0.116). From October 2022 to April 2023, the no updated vaccine intention group increased (p < 0.001), the wait and see group decreased (p < 0.01), and the updated vaccine ready group remained unchanged (p = 0.357).

CONCLUSIONS

Findings show decreased vaccine readiness for the booster and 2022-2023 updated (bivalent) COVID-19 vaccines relative to the primary COVID-19 vaccines. Implications for the 2023-2024 updated COVID-19 vaccines are discussed.

Determinants of Non-Acceptance of the COVID-19 Vaccine During Pregnancy in Pregnant and Postpartum Women: A Descriptive Cross-Sectional Study

Objective

The rate of COVID-19 vaccination hesitation among Iranian pregnant women is around 50%. The objective of the present study was to determine the reasons for the refusal of COVID-19 vaccination among pregnant and postpartum women.

Materials and methods

This descriptive cross-sectional study was performed on 304 pregnant and postpartum women in the comprehensive health centers of Yazd, Iran, between October 2022 and April 2023. Researchers collected the data of unvaccinated women through phone calls using a validated questionnaire. Data was collected using a questionnaire consisting of baseline characteristics and reasons for refusing vaccination. Descriptive statistics were used to analyze the data using SPSS version 22.

Results

The mean age of the pregnant and postpartum women participating in this study was 28.31 ± 6.47 years. The most common reasons for refusing the COVID-19 vaccine included fear of harming the fetus (32.2%), fear of side effects in the mother (25.7%), disbelief in COVID-19 disease and vaccine (13.8%), lack of information about the vaccine (12.8%), and negative opinions of the media and society (12.8%). Less common reasons included husband's disagreement (8.2%), history of COVID-19 infection (6.9%), gynecologists' disagreement (6.3%), history of infertility (5.9%), and underlying disease (3.3%). Astonishingly, among participants who did not inject a booster dose of the vaccine, 76% reported they didn't receive any training and recommendation on booster dose injection from health providers.

Conclusion

Findings highlight that the most common reasons for refusing the COVID-19 vaccine were fear of harming the fetus and fear of side effects in the mother.

COVID-19 and EQ-5D-5L health state valuation

BACKGROUND

We investigate whether and how general population health state values were influenced by the initial stages of the COVID-19 pandemic. Changes could have important implications, as general population values are used in health resource allocation.

DATA

In Spring 2020, participants in a UK general population survey rated 2 EQ-5D-5L states, 11111 and 55555, as well as dead, using a visual analogue scale (VAS) from 100 = best imaginable health to 0 = worst imaginable health. Participants answered questions about their pandemic experiences, including COVID-19's effect on their health and quality of life, and their subjective risk/worry about infection.

ANALYSIS

VAS ratings for 55555 were transformed to the full health = 1, dead = 0 scale. Tobit models were used to analyse VAS responses, as well as multinomial propensity score matching (MNPS) to create samples balanced according to participant characteristics.

RESULTS

Of 3021 respondents, 2599 were used for analysis. There were statistically significant, but complex associations between experiences of COVID-19 and VAS ratings. For example, in the MNPS analysis, greater subjective risk of infection implied higher VAS ratings for dead, yet worry about infection implied lower ratings. In the Tobit analysis, people whose health was affected by COVID-19 rated 55555 higher, whether the effect on health was positive or negative.

CONCLUSION

The results complement previous findings that the onset of the COVID-19 pandemic may have impacted EQ-5D-5L health state valuation, and different aspects of the pandemic had different effects.

Extracting factors associated with vaccination from Twitter data and mapping to behavioral models

Social media platform, particularly Twitter, is a rich data source that allows monitoring of public opinions and attitudes toward vaccines.Established behavioral models like the 5C psychological antecedents model and the Health Belief Model (HBM) provide a well-structured framework for analyzing shifts in vaccine-related behavior. This study examines if the extracted data from Twitter contains valuable insights regarding public attitudes toward vaccines and can be mapped to two behavioral models. This study focuses on the Arab population, and a search was carried out on Twitter using: ' تلقيحي OR تطعيم OR تطعيمات OR لقاح OR لقاحات' for two years from January 2020 to January 2022. Then, BERTopicmodeling was applied, and several topics were extracted. Finally, the topics were manually mapped to the factors of the 5C model and HBM. 1,068,466 unique users posted 3,368,258 vaccine-related tweets in Arabic. Topic modeling generated 25 topics, which were mapped to the 15 factors of the 5C model and HBM. Among the users, 32.87%were male, and 18.06% were female. A significant 55.77% of the users were from the MENA (Middle East and North Africa) region. Twitter users were more inclined to accept vaccines when they trusted vaccine safety and effectiveness, but vaccine hesitancy increased due to conspiracy theories and misinformation. The association of topics with these theoretical frameworks reveals the availability and diversity of Twitter data that can predict behavioral change toward vaccines. It allows the preparation of timely and effective interventions for vaccination programs compared to traditional methods.

Longitudinal assessment of COVID-19 vaccine uptake: A two-wave survey of a nationally representative U.S. sample

Understanding factors that influence those who are initially COVID-19 vaccine hesitant to accept vaccination is valuable for the development of vaccine promotion strategies. Using Ipsos KnowledgePanel®, we conducted a national survey of adults aged 18 and older in the United States. We created a questionnaire to examine factors associated with COVID-19 vaccine uptake over a longitudinal period ("Wave 1" in April 2021 and "Wave 2" in February 2022), and utilized weighted data provided by Ipsos to make the data nationally representative. Overall, 1189 individuals participated in the Wave 1 survey, and 843 participants completed the Wave 2 survey (71.6% retention rate). Those who intended to be vaccinated as soon as possible ("ASAP") were overwhelmingly vaccinated by Wave 2 (96%, 95% CI: 92% to 100%). Of those who initially wished to delay vaccination until there was more experience with it ("Wait and See"), 57% (95% CI: 47% to 67%) were vaccinated at Wave 2. Within the "Wait and See" cohort, those with income <$50,000 and those who had never received the influenza vaccine were significantly less likely to be vaccinated at Wave 2. Among those who initially indicated that they would not receive a COVID-19 vaccine ("Non-Acceptors"), 28% (95% CI: 21% to 36%) were vaccinated at Wave 2. Those who believed COVID-19 was not a major problem in their community were significantly less likely to be vaccinated, while those with more favorable attitudes toward vaccines in general and public health strategies to decrease the impact of COVID-19 were significantly more likely to be vaccinated. Overall, barriers to vaccine uptake for the "Wait and See" cohort appear to be more practical, whereas barriers for the "Non-Acceptor" cohort seem to be more ideological. These findings will help target interventions to improve uptake of COVID-19 boosters and future novel vaccines.

One year of COVID-19 in dental health services in Norway: psychological impact, risk perceptions and vaccination status

BACKGROUND

Increased psychological pressure on oral healthcare professionals (OHP) due to COVID-19 has been shown, yet little is known about the long-term psychological impacts. We aimed to study the psychological impact of COVID-19 and associated factors including perceived risk and preparedness and vaccination status among OHP in the first year after the lockdown period in Norway.

METHODS

A structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired experiences and perceptions during the second year following the outbreak in Norway. The questionnaire comprised a COVID-19 fear scale and questions about risk perception, preparedness and vaccination status. Exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used to assess psychological impact, perception of risk and preparedness according to vaccination status of the respondents.

RESULTS

The majority of the 708 respondents were female (92.8%), had ten or more years of work experience (67.1%), and worked in public dental clinics (95.9%). Fears and concerns related to COVID-19 were common, 72.6% feared getting infected and 85.4% feared infecting others. Of the 642 respondents who agreed that their workplaces handled the situation well, 55.6% were fully vaccinated. Three factors were retrieved from EFA: Insecurity, Instability and Infection. SEM showed that females were more concerned with Infection, and respondents with long clinical experience were less likely to express fear about Instability. Fully vaccinated individuals felt more insecure about becoming infected, and those agreeing that their workplaces handled the current situation well were concerned with Insecurity.

CONCLUSIONS

Despite widespread perception of adequate preparedness and high vaccine coverage, a considerable psychological impact and high levels of fear of COVID-19 were observed among the majority of OHP. Fully vaccinated individuals had a larger psychological burden than not fully vaccinated and those with unknown vaccination status. These findings can inform means and interventions to reduce negative impacts of fear in populations with a high psychological burden.

Social media and COVID-19 vaccination hesitancy during pregnancy: a mixed methods analysis

OBJECTIVE

To evaluate the reasons for COVID-19 vaccine hesitancy during pregnancy.

DESIGN

We used regular expressions to identify publicly available social media posts from pregnant people expressing at least one reason for their decision not to accept COVID-19 vaccine.

SETTING

Two social media platforms - WhatToExpect and Twitter.

SAMPLE

A total of 945 pregnant people in WhatToExpect (1017 posts) and 345 pregnant people in Twitter (435 tweets).

METHODS

Two annotators manually coded posts according to the Scientific Advisory Group for Emergencies (SAGE) working group's 3Cs vaccine hesitancy model (confidence, complacency and convenience barriers). Within each 3Cs we created subthemes that emerged from the data.

MAIN OUTCOME MEASURES

Subthemes were derived according to the people's posting own words.

RESULTS

Safety concerns were most common and largely linked to the perceived speed at which the vaccine was created and the lack of data about its safety in pregnancy. This led to a preference to wait until after the baby was born or to take other precautions instead. Complacency surrounded a belief that they are young and healthy or already had COVID-19. Misinformation led to false safety and efficacy allegations, or even conspiracy theories, and fed into creating confidence and complacency barriers. Convenience barriers (such as availability) were uncommon.

CONCLUSION

The information in this study can be used to highlight the questions, fears and hesitations pregnant people have about the COVID-19 vaccine. Highlighting these hesitations can help public health campaigns and improve communication between healthcare professionals and patients.

"I'm luckier than everybody else!": Optimistic bias, COVID-19 conspiracy beliefs, vaccination status, and the link with the time spent online, anticipated regret, and the perceived threat

The catastrophic wave in the fall of 2021 drove Romania to the top of the list of dangerous COVID-19 infections, with the highest mortality rate in Europe. At the same time, Romania had one of the lowest vaccination rates. In this context, the present research aimed to explore the link between vaccination intention/status, optimistic bias, COVID-19 conspiracy beliefs, the time spent online, and vaccination (anticipated) regret. Our convenience sample was formed by 408 adults aged 18-63 years (M = 22.11, SD = 6.18, 69.9 % females), who were distributed into four groups: (1) non-vaccinated who definitely refused COVID-19 vaccination, (2) non-vaccinated who considered COVID-19 vaccination, (3) non-vaccinated who reported their absolute willingness to COVID-19 vaccination, and (4) people who were COVID-19 vaccinated. We conducted our analyses separately, depending on these groups (i.e., vaccination intentions/status). Data were collected using an online questionnaire between November 10, 2021, and January 03, 2022. In our cross-sectional approach, following correlation and ANOVA analyses, among the observed patterns were (1) the significant negative relation between optimism bias and the perceived COVID-19 threat; (2) the positive link between anticipated regret, post-vaccination regret, age, and conspiracy beliefs. We discuss our findings considering their contribution to health policies and practices.

Exposure to Misinformation, Risk Perception, and Confidence towards the Government as Factors Influencing Negative Attitudes towards COVID-19 Vaccination in Malaysia

INTRODUCTION

This study explored exposure to misinformation, COVID-19 risk perception, and confidence towards the government as predictors of negative attitudes toward the COVID-19 vaccine.

METHODS

A cross-sectional survey was carried out from 30 June to 30 August 2021 involving 775 respondents. The survey instrument for the questionnaire was an adaptation from various different studies consisting of five main variables: (1) misinformation about vaccination; (2) risk perception toward COVID-19; (3) attitudes toward the vaccination programme; (4) intention to get vaccinated; and (5) public confidence in the government in executing the vaccination programme.

RESULTS

The results of this study indicate that higher exposure to misinformation led to higher levels of negative attitudes toward the COVID-19 vaccine. When the perceived risk of COVID-19 infection was high, mistrust of vaccine benefits was low but there were also higher worries about the future effects of the vaccine. Confidence in the government was associated with lower negative attitudes toward the COVID-19 vaccine.

CONCLUSION

The results of this study may help develop an understanding of negative attitudes toward vaccinations in Malaysia and its contributing factors.

A multinational Delphi consensus to end the COVID-19 public health threat

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Identifying the determinants of non-injection of covid-19 vaccine: A qualitative study in Urmia, Iran

Objective

Extensive vaccination coverage is one of the most effective ways to control COVID-19 vaccine, but the tendency to inject the vaccine is always hampered and there are various determinants of non-injection. Hence, the present study was done with the aim of identifying the determinants of non-injection of COVID-19 vaccine with a qualitative approach in the city of Urmia in Iran.

Methods

The present study was conducted with a qualitative approach and conventional content analysis method among 36 people who refused to be vaccinated. Access to participants and data collection was done in person (28 interviews) and online (8 interviews) through targeted sampling and snowball method and semi-structured interviews. Data management was performed using MAXQDA-2018 software and its analysis was performed by Graneheim and Lundman method. Also, Guba and Lincoln criteria were observed to improve the quality of results.

Results

After analyzing the data, 3 main categories and 11 subcategories were obtained including (1) Individual factors (fear of short-term side effects of vaccine, personality traits, distrust of vaccines and pharmaceutical companies), (2) Socio-cultural factors (conspiracy theory, social learning, misconceptions about COVID-19, fatalism), legal and managerial factors (incomplete information, difficult and irregular access to vaccination centers, lack of restrictions and compulsion to be vaccinated, lack of incentives to be vaccinated).

Conclusion

The results showed that various determinants were involved in the non-injection of COVID-19 vaccine. Therefore, efforts to increase vaccination coverage require comprehensive measures at different levels and cross-sectoral cooperation between governmental and non-governmental institutions and organizations.