The influence of vaccine-critical websites on perceiving vaccination risks

A Cross-Sectional Analysis of Community Perceptions of Flu and COVID-19 Vaccines at Turtle Creek Primary Care Center

BACKGROUND

Influenza (flu) and COVID-19 vaccination rates are subpar across the US, especially in racial and/or socioeconomic minority groups who are understudied in public health literature.

OBJECTIVE

The objective of this mixed-methods study was to elucidate attitudes of patients at the Turtle Creek Primary Care Center, a clinic that cares for ∼70% non-white patients, towards flu and COVID-19 vaccines, with the goal of establishing vaccine education gaps and increasing vaccine uptake in minority communities.

DESIGN/PATIENTS

This study was conducted as a cross-sectional analysis. Authors completed 123 patient phone surveys of patients cared for at the Turtle Creek clinic inquiring about flu and COVID-19 infection status and vaccination uptake (August 26-October 10, 2021).

APPROACH/KEY RESULTS

We found that rates of vaccination were subpar in the Turtle Creek community, with only 54% having received the COVID-19 vaccine and only 44% receiving the flu vaccine regularly. There was a strong association between COVID-19 and flu vaccine acceptance and a notable correlation between vaccine acceptance and age. When assessing how vaccine acceptance was influenced by trusted sources of information, those who cited trusting "medical professionals" and "word of mouth" had higher odds of COVID-19 vaccine acceptance but those who cited trusting "social media" had decreased odds of acceptance. Finally, we uncovered 14 common factors for either vaccine acceptance or refusal that clustered into four overarching themes of trust, need, safety, and availability.

CONCLUSION

These data highlight the necessity of improved vaccine education and reveal targetable populations and approaches for disseminating vaccine information.

Exploring social media influences on vaccine decision-making in parents: a netnography

Background

Immunization is one of the most significant health initiatives of recent times. Despite this, vaccine hesitancy is increasing and was listed as one of the top 10 threats to global health by the World Health Organization in 2019. A major factor associated with vaccine hesitancy is thought to be the viral spread of misinformation by a small but active anti-vaccination movement.

Objectives

The purpose of this study was to explore the influences of social media on vaccine decision-making in parents.

Design

This study is part of a larger body of research that explored vaccine decision-making in parents. Other methods included were an online survey and semi-structured interviews. This study investigated the influence of cyberculture on parents in an online environment.

Method

This study employed netnography, a form of qualitative inquiry with its roots in ethnography as methodology and a purpose-designed Facebook page as the means of exploring a purpose-designed online community with a particular focus on the culture, belief systems and influences present. Both manual and computer-assisted thematic analyses were used to analyse the data obtained.

Results

Three key themes were identified in this study. These included vaccine safety concerns, the emotional debate and COVID-19-specific issues. The results indicated the presence of strong anti-vaccination sentiment combined with an 'infodemic' of conspiracy theories, misinformation and vitriol with the potential to negatively impact parents seeking immunization information.

Conclusion

Given the popularity and accessibility of social media and the ready access to misinformation present online, it is evident that parental vaccine decision-making may be impacted adversely. Therefore, it is important that healthcare professionals are aware of this and provide adequate and timely education prior to parents seeking information on social media.

Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study

BACKGROUND

Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention.

OBJECTIVE

This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians.

METHODS

We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter.

RESULTS

In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively.

CONCLUSIONS

Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially "filling the vacuum" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects.

A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis

BACKGROUND

Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services).

OBJECTIVE

This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube.

METHODS

Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a "snapshot" of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations.

RESULTS

A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions.

CONCLUSIONS

Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities.

Timing of preventive behavior in the case of a new and evolving health risk: the case of COVID-19 vaccination

BACKGROUND

Time preferences for preventive behavior under novel risks and uncertain contexts may differ from timing preferences related to familiar risks. Therefore, it is crucial to examine drivers of preventative health behavior timing in light of new health risks. Using the case of COVID-19, we examine factors affecting vaccination timing plans when vaccines were widely available in the European Union (EU).

METHODS

We use data from the Flash Eurobarometer 494 survey (May 21-26, 2021), which collected information on EU residents' attitudes towards COVID-19 vaccinations. We also use the 'Our World in Data' vaccination database for country-level COVID-19 vaccination rates. Probit regressions were conducted to determine how local vaccination rates, trust in information sources, social norms, vaccine safety beliefs, and risk understanding affected the probability of COVID-19 vaccination delay.

RESULTS

Of total participants (n = 26,106), 9,063 (34.7%) were vaccinated, 7,114 (27.3%) wanted to get vaccinated as soon as possible, 5,168 (19.8%) wanted to delay vaccination and 2,962 (11.4%) resisted vaccination. Participants were more likely to delay COVID-19 vaccination if they lived in a country with lower vaccination prevalence, trusted online social networks, family, friends, and colleagues for vaccination information, were eager to follow vaccination-related social norms, expressed vaccine safety concerns, and understood the risk of catching COVID-19 without a vaccine to be lower.

CONCLUSIONS

Results from the study contribute to understanding important factors that predict timing of vaccination plans. These findings can also contribute to the wider knowledge base about timing of preventive behavior uptake in novel risk contexts.

The Double Democratic Bind: Challenges to Enacting Mandates and Combating Misinformation

CONTEXT

Wealthy countries vary considerably in terms of how well they have been able to inoculate their populations against COVID-19. In particular, democracies have been constrained in their abilities to implement vaccine mandates, given enshrined protections of civil liberties and individual freedom in such regimes. While scholars have begun addressing the democratic constraint on vaccine mandates, less attention has been paid to the additional challenges democracies face in constraining the spread of vaccine misinformation-particularly misinformation that spreads online.

METHODS

This study combines large-N cross-country analysis with a case study of Germany to illustrate the "double bind" that democracies face when it comes to containing both the spread of disease and the spread of misinformation through social media.

FINDINGS

The cross-national analysis confirms that democracies have been less likely to enact vaccine mandates, and they have also been relatively more hesitant to restrict what people can see and share online. The case study of Germany highlights the normative and the procedural constraints underlying such decisions.

CONCLUSIONS

These findings show that resources are often not the binding constraint on effective disease control, raising questions regarding the ability of high-income democracies to respond effectively to future public health emergencies.

Predictors of young people's anti-vaccine attitudes in the context of the COVID-19 pandemic

The objective of this research was to explore how attitudes to science and scientists may be related to anti-vax positions and whether the psychological trait known as Need for Closure may influence the relationship between any or all of these attitudes. A questionnaire was administered to a sample of 1128 young people aged 18-25 living in Italy during the COVID-19 health crisis. Based on the results of exploratory and confirmatory factor analyses, which allowed the extraction of a three-factor solution (scepticism about science, unrealistic expectations about science and anti-vax postures), we tested our hypotheses by means of a structural equation model. We found that anti-vax positions are strongly correlated with sceptical views of science, while unrealistic expectations about science affect attitudes to vaccination only indirectly. Either way, Need for Closure emerged as a key variable in our model, as it significantly moderates the effect of both factors on anti-vax positions.

Psychological Distance to Science as a Predictor of Science Skepticism Across Domains

This article presents and tests psychological distance to science (PSYDISC) as a domain-general predictor of science skepticism. Drawing on the concept of psychological distance, PSYDISC reflects the extent to which individuals perceive science as a tangible undertaking conducted by people similar to oneself (social), with effects in the here (spatial) and now (temporal), and as useful and applicable in the real world (hypothetical distance). In six studies (two preregistered; total N = 1,630) and two countries, we developed and established the factor structure and validity of a scale measuring PSYDISC. Crucially, higher PSYDISC predicted skepticism beyond established predictors, across science domains. A final study showed that PSYDISC shapes real-world behavior (COVID-19 vaccination uptake). This work thus provides a novel tool to predict science skepticism, as well as a construct that can help to further develop a unifying framework to understand science skepticism across domains.

Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review

BACKGROUND

Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs.

OBJECTIVE

This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children.

METHODS

The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12).

CONCLUSIONS

The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination.

Behavioral interventions for vaccination uptake: A systematic review and meta-analysis

BACKGROUND

Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries.

METHODS

We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately.

FINDINGS

Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes.

INTERPRETATION

Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.

Social media trust predicts lower COVID-19 vaccination rates and higher excess mortality over 2 years

Trust plays a crucial role in implementing public health interventions against the COVID-19 pandemic. We examined the prospective associations of interpersonal, institutional, and media trust with vaccination rates and excess mortality over time in two multinational studies. In study 1, we investigated the country-level relationships between interpersonal trust, vaccination rates, and excess mortality across 54 countries. Interpersonal trust at the country level was calculated by aggregating data of 80,317 participants from the World Values Survey in 2017-20. Data on vaccination rates and excess mortality were obtained from the World Health Organization. Our findings indicated that higher levels of interpersonal trust were linked to higher vaccination rates and lower excess mortality rates in both 2020 and 2021. In study 2, we collected data from 18,171 adults in 35 countries/societies, stratified by age, gender, and region of residence. At the country/society level, interpersonal trust and trust in local healthcare facilities, local healthcare services, and healthcare professionals were associated with higher vaccination rates and lower excess mortality, whereas social media trust was associated with lower vaccination rates and higher excess mortality across three time points over 2 years. Our findings are robust when controlling for country-level covariates of the government stringency index, population density, and medical resources (i.e. critical care beds) in both studies.

Russian Troll Vaccine Misinformation Dissemination on Twitter: The Role of Political Partisanship

Although vaccine misinformation has been a longstanding problem, the growth of social media and divides based on political ideology have raised novel concerns. One noteworthy example involves the Russian Internet Research Agency's deployment of operatives on Twitter (i.e., trolls) working to sow discord among the American public. We examine 1,959 tweets made by trolls between 2015 and 2017 about vaccination to better understand their efforts to spread vaccine misinformation. Our results indicate that misinformation was more likely to be perpetuated by left and right trolls than nonpartisan trolls. There was, however, relatively little user engagement with vaccine tweets containing misinformation and no differences in engagement with misinformation shared by partisan and nonpartisan trolls. Trends in the psycholinguistic properties of language in trolls' vaccine tweets suggest that right and left trolls were more likely to include cognitive process words (i.e., insight, causation, discrepancy, certainty, differentiation, and tentativeness) than were nonpartisan trolls.

Do social media interventions increase vaccine uptake?

Introduction

The Italian mass COVID-19 vaccination campaign has included children aged 5-11 years as part of the target population since December 2021. One of the biggest challenges to vaccine uptake was vaccine hesitancy among parents and children's caregivers. Primary care pediatricians (PCPs), as the first point of contact between the National Health Service (NHS) and parents/caretakers, initiated various communication strategies to tackle this hesitancy. This study aims to evaluate the impact of a PCP-led social media intervention and a digital reminder service (DRS) on parental hesitancy regarding vaccinating their 5-11-year-old children against COVID-19.

Methods

A prospective cohort study was designed, and the chosen target populations were parents and caretakers of children aged 5-11 years. Two PCP cohorts were recruited. The first group received a social media intervention and a DRS; while the second group did not. Both cohorts had access to traditional face-to-face and telephone-based counseling. The vaccination coverage rate in the two groups was evaluated.

Results

A total of 600 children were enrolled. The exposed cohort (277 patients) received social media intervention, DRS, and counseling options (face-to-face and telephone-based), whereas the non-exposed cohort (323 patients) received only counseling options. In total, 89 patients from the exposed cohort did not receive any dose of the COVID-19 vaccine (32.5%), 165 were fully immunized (59.5%), and 23 received only one dose (8.5%). A total of 150 non-exposed patients did not receive any dose of the COVID-19 vaccine (47%), 147 were fully immunized (45.5%), and 24 only received one dose (7.4%). The difference between the two groups was statistically significant (chi square = 11.5016; p = 0.0006).

Conclusion

Social media and DRS interventions had a positive impact on vaccine uptake and may be helpful in tackling vaccine hesitancy. Better-designed studies are needed to corroborate these findings.

Evaluating COVID-19 vaccination intentions and vaccine hesitancy among parents of children with autism spectrum disorder

As the global vaccination mass campaign against COVID-19 extended to children aged 5 to 11 years, some parents remained hesitant about their children being administered the vaccine despite data supporting its safety. Parent vaccine hesitancy (PVH) may have predisposed certain groups of children, particularly those with autism spectrum disorder (ASD), to COVID-19 when other neurotypical children would have been vaccinated. We investigated the current PVH in 243 parents of children with ASD and 245 controls using the Parent Attitudes about Childhood Vaccines (PACV) scale. The study was conducted in Qatar from May to October 2022. Overall, 15.0% [95% CI 11.7%; 18.3%] of parents were vaccine-hesitant, with no difference (p = 0.054) between groups (ASD children [18.2%] vs. controls [11.7%]). The only sociodemographic factor associated with higher vaccine hesitancy was being a mother (as compared to being a father). The COVID-19 vaccine receipt rate at the time of the study did not differ between ASD (24.3%) and non-ASD groups (27.8%). Around two-thirds of parents of children with ASD refused or were unsure about vaccinating their children against COVID-19. We found that the intent to vaccinate against COVID-19 was higher in parents who were married and in those with a lower PACV total score. Continued public health efforts are needed to address vaccine hesitancy among parents.

Tracking the Influence of Misinformation on Elderly People's Perceptions and Intention to Accept COVID-19 Vaccines

In this study, we surveyed low-income elderly people in Hong Kong and their family or friends to test a dual-path model with which we identified how misinformation in the media reached elderly people and how the elderly people's perception and acceptance of coronavirus disease 2019 (COVID-19) vaccines were influenced. The findings suggest that elderly people's own exposure to erroneous information regarding vaccines and COVID-19 in the media was positively associated with their misperceptions. In addition, their family or friends, who also received misinformation from the media, were found to relay the misleading or erroneous information to the elderly people, indicating a two-step flow of media influence. While previous studies have predominantly focused on the direct influence of misinformation in the media, our study suggests that social influence can also mediate the influence of misinformation in the media and negatively impacts elderly people's perceptions of COVID-19 vaccines.

Is the COVID-19 bad news game good news? Testing whether creating and disseminating fake news about vaccines in a computer game reduces people's belief in anti-vaccine arguments

Improving vaccination eagerness is crucial, especially during the ongoing COVID-19 pandemic and establishing new procedures to achieve that goal is highly important. Previous research (Roozenbeek & van der Linden, 2019a, 2019b) has indicated that playing the "Bad News" game, in which a player spreads fake news to gain followers, reduces people's belief in fake news. The goal of the present paper was to test an analogous new game called "COVID-19 Bad News (CBN)" to improve one's eagerness to vaccinate against coronavirus. CBN was constructed to examine whether creating and disseminating fake news focused on vaccinations and the COVID-19 pandemic has a similar effect and improves people's attitudes toward vaccination. Two experiments were conducted where participants played CBN or Tetris and afterwards evaluated the credibility of statements about vaccines against COVID-19 and finally filled out a questionnaire concerning their attitudes toward vaccination. The results show that playing CBN does not reduce evaluations of the credibility of all statements that are unfavorable to vaccines (false as well as true). Additionally, it does not enhance readiness to vaccinate. Future research and limitations are discussed.

HPV vaccine narratives on Twitter during the COVID-19 pandemic: a social network, thematic, and sentiment analysis

INTRODUCTION

The COVID-19 pandemic has increased online interactions and the spread of misinformation. Some researchers anticipate benefits stemming from improved public awareness of the value of vaccines while others worry concerns around vaccine development and public health mandates may have damaged public trust. There is a need to understand whether the COVID-19 pandemic, vaccine development, and vaccine mandates have influenced HPV vaccine attitudes and sentiments to inform health communication strategies.

METHODS

We collected 596,987 global English-language tweets from January 2019-May 2021 using Twitter's Academic Research Product track. We determined vaccine confident and hesitant networks discussing HPV immunization using social network analysis. Then, we used a neural network approach to natural language processing to measure narratives and sentiment pertaining to HPV immunization.

RESULTS

Most of the tweets in the vaccine hesitant network were negative in tone (54.9%) and focused on safety concerns surrounding the HPV vaccine while most of the tweets in the vaccine confident network were neutral (51.6%) and emphasized the health benefits of vaccination. Growth in negative sentiment among the vaccine hesitant network corresponded with legislative efforts in the State of New York to mandate HPV vaccination for public school students in 2019 and the WHO declaration of COVID-19 as a Global Health Emergency in 2020. In the vaccine confident network, the number of tweets concerning the HPV vaccine decreased during the COVID-19 pandemic but in both vaccine hesitant and confident networks, the sentiments, and themes of tweets about HPV vaccine were unchanged.

CONCLUSIONS

Although we did not observe a difference in narratives or sentiments surrounding the HPV vaccine during the COVID-19 pandemic, we observed a decreased focus on the HPV vaccine among vaccine confident groups. As routine vaccine catch-up programs restart, there is a need to invest in health communication online to raise awareness about the benefits and safety of the HPV vaccine.

Social Media Sentiment about COVID-19 Vaccination Predicts Vaccine Acceptance among Peruvian Social Media Users the Next Day

Drawing upon theories of risk and decision making, we present a theoretical framework for how the emotional attributes of social media content influence risk behaviors. We apply our framework to understanding how COVID-19 vaccination Twitter posts influence acceptance of the vaccine in Peru, the country with the highest relative number of COVID-19 excess deaths. By employing computational methods, topic modeling, and vector autoregressive time series analysis, we show that the prominence of expressed emotions about COVID-19 vaccination in social media content is associated with the daily percentage of Peruvian social media survey respondents who are vaccine-accepting over 231 days. Our findings show that net (positive) sentiment and trust emotions expressed in tweets about COVID-19 are positively associated with vaccine acceptance among survey respondents one day after the post occurs. This study demonstrates that the emotional attributes of social media content, besides veracity or informational attributes, may influence vaccine acceptance for better or worse based on its valence.

Halal or Haram? The COVID-19 Vaccine Discussion Among Twitter users in Malaysia

Vaccine hesitancy is gaining attention due to the increasing spread of the COVID-19 pandemic in Malaysia. Malaysia is a majority Muslim country and religion has a significant influence on the acceptance or rejection of vaccines. This is clearly seen through the disagreement over the  halal status of vaccines. Social media has become a platform for discussion and dissemination of information and dis-information on vaccines. Thus, it has had a relatively significant influence on vaccine hesitancy among social media users. By analysing tweets from February 2020 to February 2021 using Twitter API, this paper highlights the discussion of COVID-19 vaccines' halal status on Twitter. This study focuses on the analysis of vaccination reluctancy among the Twitter users in Malaysia and found that the most prevalent theme from the discussion is the constructed religious narratives to justify scientifically misleading and false claims concerning vaccination represented on social media. This finding also calls for a deeper understanding of society's constructed knowledge concerning contemporary issues in the digital age on social media.

Understanding barriers and motivations to Papillomavirus vaccination in a middle school in Reunion Island

BACKGROUND

In Reunion Island, papillomavirus (HPV) vaccination coverage is low. A study encouraging vaccination in middle school showed low rate of participation. The main objective of the study was to understand barriers and motivations to HPV vaccination in populations yet sensitized to its benefits.

METHODS

The study focused on population around the intervention school where a health promotion program was conducted during school year 2020-2021. Semi-structured face-to-face interviews among children, children's parents, school staff, general practitioners (GP) and association members were conducted. A qualitative study was adopted using a grounded theory approach to obtain an in-depth understanding of issues pertaining to HPV vaccination.

FINDINGS

A total of 19 school staff members, 20 parents of middle school children, 39 children, 5 GPs and 3 association members were interviewed in May 2021. Anti-vaccination attitudes included: fear of serious adverse effects (such as fertility) due to poor knowledge, fear of encouraging sexuality among teenagers, mistrust towards scientists and the pharmaceutical industry and the negative impact from social networks. However, we found that the influence of the school, GP's and 'story-telling' study testimonials were crucial to invert the balance and motivate children's vaccination.

INTERPRETATION

Reproductive adverse events related to the HPV vaccine may be strongly perceived amongst our population, either regarding fertility or negative fetal effects; though Reunion island has 5% of pregnancies among teenagers. It is crucial to lift this taboo related to sexuality and encourage dialogue between children and their close social network. This better understanding of barriers and motivations will help us increase the impact of school-based HPV vaccination, which will be introduced in September 2023 in whole France.

Attitudes of Swedish Language Twitter Users Toward COVID-19 Vaccination: Exploratory Qualitative Study

Background

Social media have played an important role in shaping COVID-19 vaccine choices during the pandemic. Understanding people’s attitudes toward the vaccine as expressed on social media can help address the concerns of vaccine-hesitant individuals.

Objective

The aim of this study was to understand the attitudes of Swedish-speaking Twitter users toward COVID-19 vaccines.

Methods

This was an exploratory qualitative study that used a social media–listening approach. Between January and March 2022, a total of 2877 publicly available tweets in Swedish were systematically extracted from Twitter. A deductive thematic analysis was conducted using the World Health Organization’s 3C model (confidence, complacency, and convenience).

Results

Confidence in the safety and effectiveness of the COVID-19 vaccine appeared to be a major concern expressed on Twitter. Unclear governmental strategies in managing the pandemic in Sweden and the belief in conspiracy theories have further influenced negative attitudes toward vaccines. Complacency—the perceived risk of COVID-19 was low and booster vaccination was unnecessary; many expressed trust in natural immunity. Convenience—in terms of accessing the right information and the vaccine—highlighted a knowledge gap about the benefits and necessity of the vaccine, as well as complaints about the quality of vaccination services.

Conclusions

Swedish-speaking Twitter users in this study had negative attitudes toward COVID-19 vaccines, particularly booster vaccines. We identified attitudes toward vaccines and misinformation, indicating that social media monitoring can help policy makers respond by developing proactive health communication interventions.

Do Socioeconomic Disparities Matter? Unraveling the Impacts of Online Vaccine Misinformation on Vaccination Intention During the COVID-19 Pandemic in China

Concerns have been raised about whether and how groups at high risk of COVID-19 are more likely affected by online vaccine misinformation during the pandemic. This study examined the associations between exposure to online vaccine misinformation and vaccination intention through vaccination perceptions and investigated the moderating role of individuals' socioeconomic status. eHealth literacy was also investigated as a protective factor that mediated the effect of socioeconomic status. A survey of 1,700 Chinese netizens revealed that increased exposure to online COVID-19 vaccine misinformation predicted lower vaccination intention, which was mediated by negative attitudes, lowered subjective norms, lowered perceived benefits, and higher perceived barriers toward vaccination. Socio-economic status (i.e. education, income, and residence), in general, did not guarantee individuals against the negative impacts of vaccine misinformation. eHealth literacy is critical in reducing susceptibility to vaccine misinformation during the COVID-19 pandemic.

Political Partisanship, Trust, and Attitudes toward COVID-19 Vaccines in Indonesia

CONTEXT

This study examines the extent to which political partisanship-measured as support for either the incumbent candidate for Indonesia's presidency, Joko Widodo (popularly known as Jokowi), or for Jokowi's challenger, Prabowo-affects individuals' risk perception of COVID-19 and COVID-19 vaccine hesitancy and refusal as well as beliefs about the safety and efficacy of the COVID-19 vaccine.

METHODS

The authors performed multinomial logistic and ordinary least squares regression analyses on a nationally representative sample of a national survey on public trust in COVID-19 vaccines and vaccinations that was conducted in December 2020.

FINDINGS

Individuals who voted for Prabowo in the 2019 presidential election were more likely to have a lower level of willingness and a higher level of hesitancy to get the COVID-19 vaccine than those who cast their ballot for Jokowi as the Indonesian president.

CONCLUSIONS

Political partisanship does matter in shaping individuals' hesitancy or refusal to receive the COVID-19 vaccine in Indonesia. The effect of partisanship is also significant in shaping individuals' trust in the efficacy and safety of the COVID-19 vaccine, but it is not significantly associated with individuals' risk perceptions.

The effect of emotion regulation strategies on decision-making about the maternal pertussis vaccination among pregnant women in the Netherlands: an experimental study

OBJECTIVE

To assess whether cognitive reappraisal and acceptance are effective emotion regulation strategies to decrease the influence of negative affect on intention to accept maternal pertussis vaccination (MPV) among pregnant women in the Netherlands.

METHODS

An experimental study with baseline and two follow-up measurements was conducted. Participants selected after baseline (N = 382) were randomized into two experimental groups (cognitive reappraisal, acceptance) and a control group. The effect of the experimental manipulations on negative affect was examined with multilevel analyses. A moderation analysis was performed to examine whether the manipulations moderated the association between negative affect and intention.

RESULTS

All groups showed a decrease in negative affect (all p's < 0.001), with no differences between groups. A small decrease in the influence of negative affect on intention was found among those who used acceptance.

CONCLUSION

No additional value of the emotion regulation strategies was found compared to the control group. However, exploratory analyses showed that acceptance seemed a promising strategy to decrease the influence of negative affect on intention to accept MPV.

PRACTICE IMPLICATIONS

This study stressed the relevance for communication strategies to consider the emotions pregnant women experience during the decision-making process about the MPV.

Informiert = Geimpft? Das Informationsverhalten und die COVID-19-Impfentscheidung bei Studierenden

Eine zu geringe Impfbereitschaft zählt zu den größten globalen Gesundheitsgefahren und war in der COVID-19-Pandemie auch in Deutschland eine der großen Herausforderungen der öffentlichen Gesundheit. Die Identifikation potenzieller Einflussfaktoren auf das Impfverhalten ist deshalb für eine zielgruppengerechte Gesundheitskommunikation von großer Bedeutung. Studierende sind eine besonders wichtige Zielgruppe der Prävention und Gesundheitsförderung. Der Beitrag geht mit Hilfe einer Online-Befragung der Studierenden einer westdeutschen Universität (n = 1398) im Sommersemester 2021 den Fragen nach, inwieweit sich geimpfte und ungeimpfte Studierende mit hoher bzw. niedrigerer Impfintention hinsichtlich a) ihrer Medien- und Informationsnutzung und b) ihres Vertrauens in Medien und Informationsquellen in der COVID-19-Pandemie unterschieden. Die Ergebnisse zeigen z. T. deutliche Differenzen. Während geimpfte Studierende sich intensiver informierten und hierfür auch stärker auf klassische Medienangebote zurückgriifen, vertrauten insbesondere ungeimpfte Studierende mit niedrigerer Impfintention u. a. mehr auf alternative Nachrichtenseiten und Blogs.

COVID-19 vaccine and booster hesitation around the world: A literature review

The development of COVID-19 vaccines has helped limit the extent of the pandemic, which over the past 2 years has claimed the lived of millions of people. The Moderna and Pfizer COVID-19 vaccines were the first to be manufactured using mRNA technology. Since then, other manufacturers have built their own vaccines which utilize adenovirus vector, whole inactivated coronavirus, and protein subunit methods. Given the continued mutation of the SARS-CoV-2 virus, a booster of the COVID-19 vaccine offers additional protection for citizens, especially those with comorbid conditions. However, uptake of the vaccine and booster has faced hurdles. This literature review aims to analyze the acceptance of the COVID-19 booster among different populations throughout the world. Keywords searched include "COVID-19 vaccine rates OR COVID-19 booster rates," "COVID-19 vaccine hesitancy," "COVID-19 booster hesitancy," "reasons against COVID-19 vaccine," "reasons for COVID-19 vaccine," and "COVID-19 vaccine acceptance" (for each country). Research articles indexed in PubMed, University of Illinois Urbana-Champaign Library, and Google Scholar were included. Despite the proven effectiveness of the COVID-19 booster, vaccine hesitancy is still causing suboptimal compliance to the primary vaccine and booster, thus slowing down control of the pandemic. Reasons for vaccine hesitancy differ by country and acceptance is affected by misinformation, political circumstances, and cultural values. Among the most common reasons found are distrust in the government, a lack of safety information, and fear of side effects. Uptake of the COVID-19 vaccine has also been delayed in low and middle income countries due to resource allocation and as a result, these countries have fallen behind vaccination benchmarks. The future of COVID-19 vaccination is unknown, but vaccine mandates and additional booster doses are a possibility. Determining the ethical impact that these policies could have will allow for the best implementation.

How was the coronavirus vaccine accepted on Twitter? A computational analysis using big data in Japan

Purpose

This study aims to reveal how the COVID-19 vaccine was accepted in the Japanese Twitter-sphere. This study explores how the topics related to the vaccine promotion project changed on Twitter and how the topics that were likely to spread changed during the vaccine promotion project.

Design/methodology/approach

The computational social science methodology was adopted. This study collected all tweets containing the word “vaccine” using the Twitter API from March to October 2021 and conducted the following analysis: analyzing frequent words and identifying topics likely to spread through the cosine similarity and Tobit model.

Findings

First, vaccine hesitancy–related words were frequently mentioned during the vaccine introduction and dissemination periods and had diffusing power only during the former period. Second, vaccine administration–related words were frequently mentioned and diffused through April to May and had diffusing power throughout the period. The background to these findings is that the sentiment of longing for vaccines outweighed that of hesitancy toward vaccines during this period.

Originality/value

This study finds that the timing of the rise in vaccine hesitation sentiment and the timing of the start of vaccine supply were misaligned. This is one of the reasons that Japan, which originally exhibited strong vaccine hesitancy, did not face vaccine hesitancy in the COVID-19 vaccine promotion project.

Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic

BACKGROUND

Vaccine hesitancy presents an obstacle to the campaign to control COVID-19. It has previously been found to be associated with youth, female gender, low income, low education, low medical trust, minority ethnic group membership, low perceived risk from COVID-19, use of certain social media platforms and conspiracy beliefs. However, it is unclear which of these predictors might explain variance associated with others.

METHODS

An online survey was conducted with a representative sample of 4343 UK residents, aged 18-75, between 21 November and 21 December 2020. Predictors of vaccine hesitancy were assessed using linear rank-order models.

RESULTS

Coronavirus vaccine hesitancy is associated with youth, female gender, low income, low education, high informational reliance on social media, low informational reliance on print and broadcast media, membership of other than white ethnic groups, low perceived risk from COVID-19 and low trust in scientists and medics, as well as (to a much lesser extent) low trust in government. Coronavirus conspiracy suspicions and general vaccine attitudes appear uniquely predictive, jointly explaining 35% of variance. Following controls for these variables, effects associated with trust, ethnicity and social media reliance largely or completely disappear, whereas the effect associated with education is reversed.

CONCLUSIONS

Strengthening positive attitudes to vaccination and reducing conspiracy suspicions with regards to the coronavirus may have a positive effect on vaccine uptake, especially among ethnic groups with heightened vaccine hesitancy. However, vaccine hesitancy associated with age and gender does not appear to be explained by other predictor variables tested here.

Social media use and COVID-19 vaccine status among a nationally representative population sample in Uganda

Objectives

The effect of social media on COVID-19 vaccination behavior is sub-Saharan Africa is unclear. We conducted a study to determine social media use among a random nationally representative sample of adults in Uganda and assessed the association between recent social media use and COVID-19 vaccination uptake.

Methods

We used data from the 2020 general population survey in Uganda, the Population-based HIV Impact Assessment Survey, to identify a probability sample for a mobile phone survey and included nonphone owners in the phone survey by asking phone owners to pass the phone.

Results

In March 2022, of the 1022 survey participants, 213 (20%) did not own a mobile phone, 842 (80%) owned a mobile phone, of whom 199 (24%) indicated social media use, and 643 (76%) of whom did not use social media. Among all participants, the most frequent source of COVID-19 vaccine information was radio. Overall, 62% reported receiving the COVID-19 vaccination. The multivariable logistic regression model found that social media use was not associated with vaccination status.

Conclusion

Social media users in this population sample from Uganda-who were mainly young, urban residents with higher educational attainment-continue to utilize TV, radio and health care workers for public health messages, thus the Government of Uganda should continue to conduct public health communication through these mediums.

Do Social Norms Influence Young People's Willingness to Take the COVID-19 Vaccine?

Although young adults are not at great risk of becoming severely ill with COVID-19, their willingness to get vaccinated affects the whole community. Vaccine hesitancy has increased during recent years, and more research is needed on its situational determinants. This paper reports a preregistered experiment (N = 654) that examined whether communicating descriptive social norms - information about what most people do - is an effective way of influencing young people's intentions and reducing their hesitancy to take the COVID-19 vaccine. We found weak support for our main hypothesis that conveying strong (compared to weak) norms leads to reduced hesitancy and stronger intentions. Furthermore, norms did not produce significantly different effects compared to standard vaccine information from the authorities. Moreover, no support was found for the hypothesis that young people are more strongly influenced by norms when the norm reference group consists of other young individuals rather than people in general. These findings suggest that the practical usefulness of signaling descriptive norms is rather limited, and may not be more effective than standard appeals in the quest of encouraging young adults to trust and accept a new vaccine.

Using conditional inference to quantify interaction effects of socio-demographic covariates of US COVID-19 vaccine hesitancy

COVID-19 vaccine hesitancy has become a major issue in the U.S. as vaccine supply has outstripped demand and vaccination rates slow down. At least one recent global survey has sought to study the covariates of vaccine acceptance, but an inferential model that makes simultaneous use of several socio-demographic variables has been lacking. This study has two objectives. First, we quantify the associations between common socio-demographic variables (including, but not limited to, age, ethnicity, and income) and vaccine acceptance in the U.S. Second, we use a conditional inference tree to quantify and visualize the interaction and conditional effects of relevant socio-demographic variables, known to be important correlates of vaccine acceptance in the U.S., on vaccine acceptance. We conduct a retrospective analysis on a COVID-19 cross-sectional Gallup survey data administered to a representative sample of U.S.-based respondents. Our univariate regression results indicate that most socio-demographic variables, such as age, education, level of household income and education, have significant association with vaccine acceptance, although there are key points of disagreement with the global survey. Similarly, our conditional inference tree model shows that trust in the (former) Trump administration, age and ethnicity are the most important covariates for predicting vaccine hesitancy. Our model also highlights the interdependencies between these variables using a tree-like visualization.

Healthcare University Courses Fail to Improve Opinions, Knowledge, and Attitudes toward Vaccines among Healthcare Students: A Southern Italy Cross-Sectional Study

(1) Background: Healthcare providers have a crucial role in contrasting vaccine hesitancy (VH). We aimed to investigate opinions, knowledge, and attitudes toward vaccines in healthcare students (HS) at the University of Catania (Italy). (2) Methods: A survey was conducted from 1 October 2019 to 31 January 2020. Data on the opinions, knowledge, and attitudes of HS toward vaccinations were collected using an anonymous self-administered questionnaire. The opinion answers were added to calculate the VH index (<18 = low, 19−22 = medium, >23 = high). Data were summarized by the VH index, degree, year of study, and sex differences, using descriptive statistics. (3) Results: A total of 1275 students (53.7% females) participated in the study, with a median (IQR) age of 21 (19−22) years. The median level of VH was 20 (17−23), with slightly higher values in males. We found an inverse trend between VH and opinions, knowledge, and attitudes toward vaccines. The same trend was confirmed in all study courses. Furthermore, the comparison between sexes revealed a higher level of knowledge in women. (4) Conclusions: The results highlight a lack of knowledge about vaccines, as well as contrasting opinions and attitudes among future health professionals. Therefore, future interventions on these topics in the preparation of future healthcare providers are needed.

A Descriptive Analysis of the Relationship between Social Media Use and Vaccine Hesitancy among a Sample of Unvaccinated Adults in Canada

Both traditional and social media information sources have disseminated information on the COVID-19 pandemic. The content shared may influence public opinion on different mitigation strategies, including vaccination. Misinformation can alter risk perception and increase vaccine hesitancy. This study aimed to explore the impact of using social media as the primary information source about the COVID-19 vaccine on COVID-19 vaccine hesitancy among people living in Canada. Secondary objectives identified other predictors of vaccine hesitancy and distinguished the effects of using traditional and social media sources. We used quota sampling of adults in Canada [N = 985] to conduct an online survey on the Pollfish survey platform between 21st and 28th May 2021. We then used bivariate chi-squared tests and multivariable logistic regression modeling to explore the associations between using social media as one's primary source of information about the COVID-19 vaccine and vaccine hesitancy. We further analyzed the association between specific types of channels of information and vaccine hesitancy. After controlling for covariates such as age, sex, race, and ethnicity, individuals reporting social media as their primary source of COVID-19 vaccine information versus those who had not used social media as their primary source of COVID-19 vaccine information had 50% higher odds of vaccine hesitancy. Among different channels of information, we found that information from television was associated with a 40% lower odds ratio for vaccine hesitancy. Since social media platforms play an essential role in influencing hesitancy in taking the COVID-19 vaccination, it is necessary to improve the quality of social media information sources and raise people's trust in information. Meanwhile, traditional media channels, such as television, are still crucial for promoting vaccination programs.

Balanced Reporting and Boomerang Effect: An Analysis of Croatian Online News Sites Vaccination Coverage and User Comments during the COVID-19 Pandemic

The purpose of this paper was to explore online media coverage of COVID-19 vaccination and user reactions to the different types of coverage. The authors aimed to investigate possible boomerang effects that arise when COVID-19 media coverage is assertive and confident, and to determine the effects of balanced reporting. A two-stage random sample comprised a total of 300 articles published in three Croatian online news sites during a period from 1 February 2020, through 15 January 2022. The data were categorized using human coding content analysis, while reliability of coding was checked by using two coders and calculating reliability coefficients. The data were analyzed by means of negative binomial regression analysis. The results revealed that COVID-19 reporting was mainly consensual, i.e., it provided largely affirmative information about vaccines. However, user comments were highly polarized and mostly negative, with the majority of anti-vaccination tropes linked to the "corrupt elites". Based on the user comments, the negative influence of balanced reporting on COVID-19 vaccines and the existence of boomerang effect in cases of the overtly persuasive affirmative reporting was also established. The boomerang effect did not depend on the context, i.e., on the type of reporting. This study extends previous research on balanced reporting and boomerang effects by analyzing online comments as a potentially good parallelism of the offline discursive strategies of the pro-vaccination and anti-vaccination communication. The results of the study can be used for the adjustment of strategic communication targeting the vaccine hesitant audience. Based on the study results, it is recommended that relativization and politicization of science should be prevented by not equating scientific consensus with absolute epistemological certainty and by addressing legitimate concerns of vaccine hesitant persons without putting explicit blame on them.

Parents' Attitudes toward Childhood Vaccines and COVID-19 Vaccines in a Turkish Pediatric Outpatient Population

Vaccination hesitancy (VH) is an important public health issue. The determinants of parental decisions on whether to vaccinate their children are multidimensional and need to be carefully considered in the COVID-19 era. Our study aims to investigate the prevalence of VH among parents, parents’ use of social media, and their attitudes toward the COVID-19 vaccine upon vaccine refusal. Materials and methods: Our participants were the parents of children admitted to hospitals in three different cities in Turkey between September 2021 and December 2021. The parents were asked to complete sociodemographic data and their attitudes toward COVID-19 diseases, the Parental Attitudes Toward Childhood Vaccines (PACV) scale, and the Attitudes Toward COVID-19 Vaccine (ATV-COVID-19) scale. Participants were categorized as “non-hesitant”, with a score of <50, and “hesitant”, with a score of ≥50. Results: A total of 1087 parents with a mean age of 33.66 (SD 9.1) years old participated in the study. VH was noted in 102 (9.38%) parents. Age, gender, education, and income levels did not significantly differ from one another, according to the PACV; however, parents who delayed vaccinating their children and indicated that social media had an impact on vaccination decisions were more hesitant. Parents who were male and had a family member diagnosed with COVID-19 showed more positive attitudes in the ATV-COVID-19. Parents who were hesitant about childhood vaccinations had lower positive attitudes toward the COVID-19 vaccine (2.84 ± 0.97) than parents who were not hesitant (3.77 ± 0.9). A total of 761 (70.14%) parents need more information about childhood immunizations. Conclusion: Parents who are hesitant about childhood immunization programs in Turkey have a less positive attitude toward COVID-19 vaccines and are affected by social media. Parents need information about vaccines, and because the controversy surrounding COVID-19 vaccines can diminish parents’ confidence in routine childhood immunizations, understanding the complex causes behind vaccination hesitancy can help public health policy break through barriers and increase immunization rates.

Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study

BACKGROUND

The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy.

OBJECTIVE

The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none.

METHODS

This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone.

RESULTS

The majority of participants were male (n=974, 59.3%), White (n=1347, 82.0%), and non-Hispanic (n=1518, 92.4%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95% CI 1.04-1.06), other race (AOR 0.47, 95% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95% CI 2.42-5.73), self-efficacy (AOR 1.75, 95% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs.

CONCLUSIONS

Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted.

Digital Media Exposure and Health Beliefs Influencing Influenza Vaccination Intentions: An Empirical Research in China

The purpose of this study was to investigate whether/how digital media exposure influences people's intention to influenza vaccination. Through an anonymous online survey, we collected data on Chinese people's exposure to influenza and influenza vaccine information on digital media platforms and their attitudes toward influenza vaccines (N = 600). The structural equation model analysis results strongly support to the research hypotheses and the proposed model. The findings reveal three major themes: (1) digital media exposure significantly influence the susceptibility and severity of influenza. (2) After exposure to digital media, it is helpful to understand the vaccine's benefits, reduce the barriers to vaccination, and finally improve the intention to vaccination. (3) Users receive cues to action from digital media, and their vaccination intention tends to be positive. These findings explore how digital media exposure influences influenza vaccination intention and may provide insights into vaccine promotion efforts in countries. Research has shown that digital media exposure contributes to getting vaccinated against influenza.

[Health information behaviour and health literacy on COVID-19 vaccination of the general population in Germany-findings from the CoSiD study]

BACKGROUND

Although COVID-19 vaccination reduces severe disease progression as well as hospitalisations and deaths, every fourth to fifth person in Germany is not vaccinated against COVID-19. Effective information and communication measures are needed to reach these people. For this, it is important to know the information behaviour as well as the health competences in the area of COVID-19 vaccination, especially of previously unvaccinated people.

METHODS

The third representative population survey (November/December 2021; n = 4366) of the CoSiD study (Corona vaccination in Germany) was conducted as a combined telephone and online survey. Bivariate correlations between reported information behaviour, subjective health literacy and vaccination status and intention are investigated. In addition, multivariate correlations of socio-demographic characteristics and subjective health literacy are analysed.

RESULTS

Undecided people and people that are more likely to vaccinate were overall less likely to report a good subjective level of information (46.1%; 41.1%) and competences in evaluating information about COVID-19 vaccination (36.5%; 38.8%) as well as decision making (39.0%; 35.9%). Unvaccinated people without vaccination intentions are more likely to report observing information rated as untrustworthy or wrong (60.3%). People with a lower level of education, younger people and people with a migration background report lower levels of heath literacy.

DISCUSSION

Communication measures to promote health literacy should specifically address people with uncertain vaccination intentions as well as younger people, people with lower levels of education and people with a migration background.

Determinants of university students' COVID-19 vaccination intentions and behavior

Vaccination hesitancy has been a major challenge for health authorities and societies during the COVID-19 pandemic. The general determinants of vaccination intentions and behavior include sociodemographic and health-related, psychological, and communication-related factors, with varying relevance for different types of vaccinations, countries, and target groups. The predictors of university students' COVID-19 vaccination behavior have not been sufficiently studied. Using a German university as an example and based on an online survey of 1398 university students, we investigated factors related to (a) the likelihood of vaccination against COVID-19 and (b) vaccination intention among those who had not been vaccinated by summer of 2021. Psychological factors showed high relevance. Field of study, trust in, and use of certain media and information channels were found to be important determinants of students' vaccination decision. Our findings can help better understand university students' vaccination behavior to develop and implement tailored strategies and campaigns.

Understanding the influence of online information, misinformation, disinformation and reinformation on COVID-19 vaccine acceptance: Protocol for a multicomponent study

Background

The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended vaccination for themselves or their children.

Objective

The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines.

Methods

Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature.

Results

As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months.

Conclusions

The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them.

International Registered Report Identifier (IRRID)

DERR1-10.2196/41012

Understanding the Role of Psychosocial Factors in Pakistani Parents' Hesitancy to Vaccinate Their Kids: The Mediating Role of Knowledge and Mistrust of Science about the COVID-19 Vaccine

Vaccination is a vital component in the battle against outbreaks of infectious diseases. Recognizing parents’ reluctance to vaccinate their children is even more critical now, given the ongoing threat of a COVID-19 pandemic. Conspiracy theories, vaccination safety concerns, parental efficacy and risk perception, and a lack of confidence in science all influence intention. To investigate how these variables interact with vaccination behavior against COVID-19, we developed a model with psychosocial factors serving as the predictor and mistrust in science and vaccine knowledge serving as the mediator. In order to validate the model, the parents’ intentions regarding their children’s vaccination with COVID-19 were used. The study included 454 Pakistani parents who completed an online questionnaire assessing their intention to vaccinate their children. We analyzed the data using structural equation modeling (SEM). A significant level of vaccine hesitation is due to belief in vaccine conspiracy theories, and vaccine safety concerns were investigated. A surprising correlation exists between risk perception and vaccination intentions, followed by parental self-efficacy. It is significant to note that vaccine knowledge mediated conspiracy beliefs, risk perceptions, and intentions fully but partially mediated parental self-efficacy. Conspiracy theories were mediated by a mistrust in science, while perceptions of risk and vaccine safety were partially mediated. The findings of this research were used to develop sensible policy reforms and public health campaigns to encourage vaccination against both common infections such as measles, human papillomaviruses, or pertussis, and novel diseases such as COVID-19.

COVID-19 Vaccination Intent and Belief that Vaccination Will End the Pandemic

High vaccination coverage is considered to be key in dealing with the coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy can limit uptake. We examined the specific coronavirus beliefs that persons have regarding COVID-19 and COVID-19 vaccines and to what extent these beliefs explain COVID-19 vaccination intentions. We conducted a survey among 4,033 residents of the Netherlands that examined COVID-19 vaccination intentions and various beliefs. Random forest regression analysis explained 76% of the variance in vaccination intentions. The strongest determinant in the model was the belief the COVID-19 crisis will only end if many persons get vaccinated. Other strong determinants were beliefs about safety of vaccines, specifically in relation to vaccine development and approval process; (social) benefits of vaccination; social norms regarding vaccination behavior; and effectiveness of vaccines. We propose to address these specific beliefs in communications about COVID-19 vaccinations to stimulate vaccine uptake.

Attitudes toward COVID-19 Vaccination on Social Media: A Cross-Platform Analysis

During the COVID-19 pandemic, social media content analysis allowed for tracking attitudes toward newly introduced vaccines. However, current evidence is limited to single social media platforms. Our objective was to compare arguments used by anti-vaxxers in the context of COVID-19 vaccines across Facebook, Twitter, Instagram, and TikTok. We obtained the data set of 53,671 comments regarding COVID-19 vaccination published between August 2021 and February 2022. After that, we established categories of anti-vaccine content, manually classified comments, and compared the frequency of occurrence of the categories between social media platforms. We found that anti-vaxxers on social media use 14 categories of arguments against COVID-19 vaccines. The frequency of these categories varies across different social media platforms. The anti-vaxxers' activity on Facebook and Twitter is similar, focusing mainly on distrust of government and allegations regarding vaccination safety and effectiveness. Anti-vaxxers on TikTok mainly focus on personal freedom, while Instagram users encouraging vaccination often face criticism suggesting that vaccination is a private matter that should not be shared. Due to the differences in vaccine sentiment among users of different social media platforms, future research and educational campaigns should consider these distinctions, focusing more on the platforms popular among adolescents (i.e., Instagram and TikTok).

The Relationship between Sources of COVID-19 Vaccine Information and Willingness to Be Vaccinated: An Internet-Based Cross-Sectional Study in Japan

Despite considerable interest in the Japanese population in receiving the vaccine for COVID-19 when it first became available, a sizable percentage of people remain unwilling or hesitant to be vaccinated. Concerns among both the vaccinated and the unwilling center on the vaccine’s efficacy and its safety. Thus, this study aimed to identify whether the willingness to receive COVID-19 vaccination is related to the sources of information people use to learn about the vaccine. A cross-sectional study was conducted on 800 participants registered in an Internet research panel across Japan who completed a questionnaire on their sources of information about the vaccine, demographics, and vaccination status. Vaccine willingness/hesitancy and refusal were set as dependent variables in the logistic regression analysis, with sources of vaccine information and other socio-demographic variables set as independent variables. The results of the analysis found that the information sources significantly associated with willingness to vaccinate were TV (AOR 2.44 vs. vaccine refusal/hesitation), summary websites of COVID-19 by non-experts (AOR 0.21, vs. vaccine refusal/hesitation), Internet video sites (AOR 0.33, vs. vaccine refusal/hesitation), and the personal websites of doctors (AOR 0.16, vs. vaccine refusal/hesitation). Given the likelihood of misinformation in non-traditional sources of information, it is important that health communications be accurate and persuasive.

Canine and feline core vaccinations: US veterinarians’ concerns and perceived impact of COVID-19 antivaccination views on veterinary medicine

OBJECTIVE

Assess US veterinarians’ perceptions regarding vaccine concerns (their own and owners’) and the association between owners’ vaccine concerns and COVID-19 antivaccination sentiments.

SAMPLE

Members of the Veterinary Information Network.

PROCEDURES

An electronic survey distributed via the Veterinary Information Network data collection portal.

RESULTS

1,341 US veterinarians completed the survey. Top veterinarian concerns for vaccinating a healthy adult dog were anaphylaxis, soreness at injection site, and lethargy; for cats, these concerns included vaccine-associated sarcoma, lethargy, and soreness at injection site. Veterinarians reported that the most common concerns mentioned by owners included that the pet does not go outside, that vaccinations are unnecessary, that vaccinations can lead to chronic or severe illness, and cost. Veterinarians reported an increased number of dog and cat owners reluctant about or resistant to the idea of rabies vaccines and core vaccines since the time that COVID-19 vaccines became widely available. There was an association between veterinarians’ perceptions of local COVID-19 antivaccination sentiments and the increase in the number of vaccine-resistant or -concerned clients.

CLINICAL RELEVANCE

There appears to be little overlap between veterinarians’ primary concerns related to vaccinations and their perception of dog and cat owners’ primary concerns. The fact that the number of resistant clients is positively associated with the presence of veterinarians’ perceptions of a local COVID-19 antivaccination sentiment suggests that human antivaccination sentiments impact pet owners’ views of companion animal vaccinations. A better understanding of the cognitive biases that impact owners’ vaccine decisions can help veterinarians better communicate with vaccine-reluctant clients and increase vaccination compliance rates.

Mass Media Use to Learn About COVID-19 and the Non-intention to Be Vaccinated Against COVID-19 in Latin America and Caribbean Countries

Background

The Latin American and Caribbean (LAC) region has been one of the regions most affected by the COVID-19 pandemic, with countries presenting some of the highest numbers of cases and deaths from this disease in the world. Despite this, vaccination intention is not homogeneous in the region, and no study has evaluated the influence of the mass media on vaccination intention. The objective of this study was to evaluate the association between the use of mass media to learn about COVID-19 and the non-intention of vaccination against COVID-19 in LAC countries.

Methods

An analysis of secondary data from a Massachusetts Institute of Technology (MIT) survey was conducted in collaboration with Facebook on people's beliefs, behaviors, and norms regarding COVID-19. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI) were calculated to evaluate the association between the use of mass media and non-vaccination intention using generalized linear models of the Poisson family with logarithmic link.

Results

A total of 350,322 Facebook users over the age of 18 from LAC countries were included. 50.0% were men, 28.4% were between 18 and 30 years old, 41.4% had a high school education level, 86.1% lived in the city and 34.4% reported good health condition. The prevalence of using the mass media to learn about COVID-19 was mostly through mixed media (65.8%). The non-intention of vaccination was 10.8%. A higher prevalence of not intending to be vaccinated against COVID-19 was found in those who used traditional media (aPR = 1.36; 95%CI: 1.29–1.44; p &lt; 0.001) and digital media (aPR = 1.70; 95%CI: 1.24–2.33; p = 0.003) compared to those using mixed media.

Conclusion

We found an association between the type of mass media used to learn about COVID-19 and the non-intention of vaccination. The use of only traditional or digital information sources were associated with a higher probability of non-intention to vaccinate compared to the use of both sources.

Statewide evaluation of COVID-19 vaccine hesitancy in Rhode Island

BACKGROUND

Vaccines are effective in preventing Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy defined as delay of acceptance or refusal of the vaccine is a major barrier to effective implementation.

METHODS

Participants were recruited statewide through an English and Spanish social media marketing campaign conducted by a local news station during a one-month period as vaccines were becoming available in Rhode Island (from December 21, 2020 to January 22, 2021). Participants completed an online survey about COVID-19 vaccines and vaccine hesitancy with constructs and items adopted from the Health Belief Model.

RESULTS

A total of 2,007 individuals completed the survey. Eight percent (n = 161) reported vaccine hesitancy. The sample had a median age of 58 years (interquartile range [IQR]: 45, 67), were majority female (78%), White (96%), Non-Hispanic (94%), employed (58%), and reported an annual individual income of $50,000 (59%). COVID-19 vaccine hesitancy was associated with attitudes and behaviors related to COVID-19. A one unit increase in concern about COVID-19 was associated with a 69% (Adjusted Odds Ratio: 0.31, 95% CI: 0.26-0.37) decrease in vaccine hesitancy. A one-level increase in the likelihood of getting influenza vaccine was associated with a 55% (AOR: 0.45 95% CI: 0.41-0.50) decrease in vaccine hesitancy.

CONCLUSIONS

COVID-19 vaccine hesitancy was relatively low in a state-wide survey in Rhode Island. Future research is needed to better understand and tailor messaging related to vaccine hesitancy.

Development of a patient decision aid for COVID-19 vaccination with the Comirnaty vaccine

BACKGROUND

SARS-CoV-2 has been responsible for a pandemic since the beginning of 2020. Vaccine arrival brings a concrete solution to fight the virus. However, vaccine hesitancy is high. In France, the first available vaccine was Comirnaty from Pfizer-BioNTech. Shared decision-making, based on tools such as patient decision aids (PtDAs), can help patients make an informed choice about vaccination with Comirnaty.

OBJECTIVE

The French College of Teachers in General Practice (CNGE) aimed to create a PtDA for people who have to decide whether they will receive the Comirnaty vaccine.

METHODS

Development of the PtDA was performed according to the International Patient Decision Aids Standards (IPDAS). The initial design was based on a literature review and semistructured interviews with 17 patients to explore and clarify patients' expectations. A first draft of the PtDA was then alpha tested by a patient expert group and a physician expert group. The PtDA was finally beta tested in 14 prevaccine consultations. A steering group was consulted throughout the work. Patient support, community groups and the French National Authority for Health (HAS) were involved in the development process.

RESULTS

A literature review identified one randomized trial on Comirnaty efficacy and safety. The first part of the PtDA allows patients to identify their own risk factors. The second part of the PtDA provides information on vaccination: benefits and risks, unknown data, and technical explanations about the mRNA vaccine.

CONCLUSIONS

We developed a PtDA to be used in primary care settings for shared decision-making regarding vaccination with Comirnaty.

HPV Vaccination: An Underused Strategy for the Prevention of Cancer

Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world’s cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.