Factors associated with COVID-19 Vaccine Hesitancy in Thai Seniors

Effectiveness and impact of covid-19 response and vaccination challenges in Namibia: A systematic review

Namibia, as with many countries around the world is experiencing devastating impact of Covid-19 disease on the economy, psycho-social interactions, and well-being of the populace. These countries implemented several measures to limit the spread of the virus responsible for the severe acute respiratory syndrome (SARS-CoV-2). Namibia also put measures in place to curtail the spread and fatalities due to the virus. However, the nature and implementation strategies of Public Health regulations seriously have impact on preventing the spread and curtailing fatalities arising from the virus. This article presents a report on the effectiveness and impact of Public Health measures instituted by the Health Authority towards curtailing the scourge of covid-19 on the general populace. Elements of the PRISMA protocol was utilised in the review which enabled the synthesis of data on focused area. Multifaceted databases on covid-19 such as Scopus, Science Direct, Google Scholar, World Health Organisation and the Ministry of Health and Social Services of Namibia (MoHSS) among others was used. A steady increase in covid-19 infection at an average rate of eleven (11) per day was noted in the country up till June 2021. Highest rate was linked to densely populated regions of Erongo and Khomas. Control measures for infection prevention and vaccination drive was ineffective majorly as a result of misinformation. A paradigm shift of enhanced interaction with local populace for effective information dissemination is required towards limiting the scourge of the virus and hence, saving of lives.

Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China

Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.

Immunogenicity and Reactogenicity of Messenger RNA Coronavirus Disease 2019 Vaccine Booster Administered by Intradermal or Intramuscular Route in Thai Older Adults

BACKGROUND

Intradermal (ID) vaccination may alleviate COVID-19 vaccine shortages and vaccine hesitancy.

METHODS

Persons aged ≥65 years who were vaccinated with 2-dose ChAdOx1 12-24 weeks earlier were randomized to receive a booster vaccination by either ID (20 µg mRNA-1273 or 10 µg BNT162b2) or intramuscular (IM) (100 µg mRNA-1273 or 30 µg BNT162b2) route. Anti-receptor-binding domain (RBD) immunoglobulin G (IgG), neutralizing antibody (NAb), and interferon gamma (IFN-γ)-producing cells were measured at 2-4 weeks following vaccination.

RESULTS

Of 210 participants enrolled, 70.5% were female and median age was 77.5 (interquartile range, 71-84) years. Following booster dose, both ID vaccinations induced 37% lower levels of anti-RBD IgG compared with IM vaccination of the same vaccine. NAb titers against ancestral and Omicron BA.1 were highest following IM mRNA-1273 (geometric mean, 1718 and 617), followed by ID mRNA-1273 (1212 and 318), IM BNT162b2 (713 and 230), and ID BNT162b2 (587 and 148), respectively. Spike-specific IFN-γ responses were similar or higher in the ID groups compared with IM groups. ID route tended to have fewer systemic adverse events (AEs), although more local AEs were reported in the ID mRNA-1273 group.

CONCLUSIONS

Fractional ID vaccination induced lower humoral but comparable cellular immunity compared to IM and may be an alternative for older people.

CLINICAL TRIALS REGISTRATION

TCTR20220112002.

COVID-19 vaccine hesitancy among older adult Thai Muslim people: A case-control study

The highest death toll during the COVID-19 pandemic in Thailand was among unvaccinated older adults. Deaths among older adults in Narathiwat Province were related to a lower COVID-19 vaccination rate. This study explored the factors influencing COVID-19 vaccination hesitancy in a Muslim community with low vaccination rates. A case-control study was conducted with participants assigned to the unvaccinated "case" group and the vaccinated "control" group. The sample was Thai older adults who practiced Islam and lived in Narathiwat Province. Purposive sampling was conducted by selecting a case house and finding the control around the case house in a 1:2 ratio. This study included 141 participants with a median age of 67 years (interquartile range [IQR], 8). More than 80% of both groups were retired and lived with their extended relatives. More participants in the vaccinated group believed that vaccines could prevent death from COVID-19 than in the unvaccinated group. In the multivariable analysis, factors related to the low perceived importance of the COVID-19 vaccination (odds ratio [OR] = 2.63) and a lack of vaccine recommendation from religious leaders (OR = 4.67) significantly influenced COVID-19 vaccination refusal. The COVID-19 guidance from religious leaders and the perceived importance of COVID-19 vaccination influence vaccination uptake among Muslim older adults in Thailand.

Melioidosis Vaccines (MeVa): Attitudes to vaccines, melioidosis and clinical trials in key stakeholders in Ubon Ratchathani, Thailand

Background: Melioidosis is a bacterial infection which kills an estimated 89,000 people per year in tropical and sub-tropical regions, chiefly affecting the poorest. Diabetes is the primary risk factor, conferring a 12-fold increase in risk. Despite limited funding compared to other neglected tropical diseases, melioidosis vaccine development has generated several candidates for clinical development. CPS-CRM 197/Hcp1 is a promising vaccine candidate developed at the University of Nevada, Reno which is due to enter a Phase I clinical trial in Oxford, UK in 2024. As we move closer to the possibility of field trials of a melioidosis vaccine, it is critical to work in parallel to understand perceptions toward a vaccine among those living where melioidosis rates are high. Reasons for vaccine acceptance versus hesitancy are complex, and include perceived risk of the target disease, concern about side effects, and above all trust in government, scientists, the pharmaceutical industry and other authorities. Methods: We will carry out a qualitative study in Ubon Ratchathani, Thailand, an endemic region for melioidosis, as groundwork for a potential future melioidosis vaccine efficacy study, and in the longer-term vaccine introduction. This study seeks to explore knowledge and attitudes in three main areas; 1) melioidosis disease, 2) vaccines, and 3) participation in clinical vaccine trials. In-depth interviews and focus group discussions will take place in five participant groups of different risks and exposure to melioidosis. Purposive, convenience sampling will be used, also snowball sampling to reach some participant groups. Sample size will be based on participant's experience, to inform the line of enquiries of study, or until data saturation, expecting 66-90 participants across all groups. Discussion: The findings of this study will be written up and published in an open access journal, and will be valuable to inform future design of clinical trials as well as engagement and communications associated with future vaccine rollout.

Anxiety, Optimism, and COVID-19 Vaccine Hesitancy among Students in a University in Southern Thailand during the 2021 Academic Year

This study examined the prevalence of COVID-19 vaccine hesitancy and its associated factors, including anxiety and optimism, surrounding the COVID-19 pandemic among Thai university students. An online observational cross-sectional study was conducted between November and December 2021. Descriptive analyses and logistic regression were performed using R. In total, 409 university students participated in the study. Most reported high anxiety levels (69.4%), while more than half also expressed high levels of optimism associated with the COVID-19 pandemic (51.1%). Only 4.4% were unvaccinated, among whom 50% were hesitant to receive vaccination (2.2%). Per statistical analysis, those who perceived the available vaccines as low safety were significantly associated with a higher risk of vaccine hesitancy (p = 0.03). In contrast, those who reported that they would likely to receive the COVID-19 vaccine if recommended to by their doctors or pharmacists were significantly associated with lower vaccine hesitancy (p = 0.048). However, both anxiety and optimism regarding the COVID-19 pandemic were not associated with vaccine hesitancy. Thus, healthcare workers play an important role in COVID-19 vaccination counseling to prevent transmission. Health education during the pandemic should focus on COVID-19 infection as well as COVID-19 vaccines, including their safety and their adverse effects.

Social-political and vaccine related determinants of COVID-19 vaccine hesitancy in Tanzania: A qualitative inquiry

Vaccines have played a critical role in the response to the COVID-19 pandemic globally, and Tanzania has made significant efforts to make them available to the public in addition to sensitizing them on its benefit. However, vaccine hesitancy remains a concern. It may prevent optimal uptake of this promising tool in many communities. This study aims to explore opinions and perceptions on vaccine hesitancy to better understand local attitudes towards vaccine hesitancy in both rural and urban Tanzania. The study employed cross-sectional semi-structured interviews with 42 participants. The data were collected in October 2021. Men and women aged between 18 and 70 years were purposefully sampled from Dar es Salaam and Tabora regions. Thematic content analysis was used to categorize data inductively and deductively. We found that COVID-19 vaccine hesitancy exists and is shaped by multiple socio-political and vaccine related factors. Vaccine related factors included worries over vaccine safety (e.g., death, infertility, and zombie), limited knowledge about the vaccines and fear of the vaccine's impact on pre-existing conditions. Participants also found it paradoxical that mask and hygiene mandates are expected even after vaccination, which further exacerbated their doubts about vaccine efficacy and their hesitancy. Participants possessed a range of questions regarding COVID-19 vaccines that they wanted answered by the government. Social factors included preference for traditional and home remedies and influence from others. Political factors included inconsistent messages on COVID-19 from the community and political leaders; and doubts about the existence of COVID-19 and the vaccine. Our findings suggest that the COVID-19 vaccine is beyond a medical intervention, it carries with it a variety of expectations and myths that need to be addressed in order to build trust and acceptance within communities. Health promotion messages need to respond to heterogeneous questions, misinformation, doubts, and concerns over safety issues. An understanding of country-specific perspectives toward COVID-19 vaccines can greatly inform the development of localized strategies for meaningful uptake in Tanzania.

Scale Development for COVID-19 Vaccine Hesitancy by Integration of Socio-Demographic and Psychological Factors

Vaccination is the most cost-effective way to maintain population health. However, it can only be effective if widespread acceptance is held. The efficacy of COVID-19 vaccines depends on their favor. When countries start to vaccinate their citizens, there is a certain level of skepticism about the effectiveness of the vaccines. The hesitancy study on vaccines has gained momentum following the pandemic. However, few studies have examined the link between the psychological and sociodemographic factors influencing the fit. This paper proposes integrating the concepts of the information systems success and stimulus-organism-response into a cognitive fit theory framework to explore the integration of psychological and sociodemographic factors in the receivers' reactions (n = 1510). This study analyses the factors that influence the hesitancy of vaccines and the public's refusal in Asia and Europe. Receivers' reactions were assessed to various stimuli and we explored the link between psychological and sociodemographic elements and the concept of fit. Two surveys were conducted following the scale development of Mackenzie. The first was to develop the fit scale, while the second was to validate the fit scale. The results of the second survey were analyzed using structural equation modelling. The results indicate that the scale's fit development is valid and reliable. The quality of the vaccine information, the psychological characteristics of the vaccine system, and vaccine receivers' satisfaction are also beneficial factors for emotional and cognitive fit. Maintaining the vaccines' quality and efficiency can help improve the fit between sociodemographic and psychological characteristics. It can also enhance receivers' satisfaction and encourage continued vaccine administration. This study is regarded as one of the first to examine and develop an emotional and cognitive fit scale for practitioners and researchers.

Addressing Unmet Needs in Vaccination for Older Adults in the Asia Pacific: Insights from the COVID-19 Pandemic

The impact of vaccinating the older population against vaccine-preventable diseases in terms of health, social and economic benefits has been increasingly recognised. However, there is a gap in the utilisation of vaccines worldwide. The population is ageing at an unprecedented pace in the Asia-Pacific (APAC) region, with the number of persons older than 65 years set to double by 2050 to around 1.3 billion. More than 18% of the population in Japan, Hong Kong, and China is over the age of 65 years. This highlights the importance of prioritising resources to address societal obligations toward the needs of the ageing generation. This review provides an overview of the challenges to adult vaccination in APAC, drivers to increase vaccination coverage, vaccination insights gained through the COVID-19 pandemic, and potential measures to increase the uptake of adult vaccines in the region.

Effectiveness of chatbots on COVID vaccine confidence and acceptance in Thailand, Hong Kong, and Singapore

Chatbots have become an increasingly popular tool in the field of health services and communications. Despite chatbots' significance amid the COVID-19 pandemic, few studies have performed a rigorous evaluation of the effectiveness of chatbots in improving vaccine confidence and acceptance. In Thailand, Hong Kong, and Singapore, from February 11th to June 30th, 2022, we conducted multisite randomised controlled trials (RCT) on 2,045 adult guardians of children and seniors who were unvaccinated or had delayed vaccinations. After a week of using COVID-19 vaccine chatbots, the differences in vaccine confidence and acceptance were compared between the intervention and control groups. Compared to non-users, fewer chatbot users reported decreased confidence in vaccine effectiveness in the Thailand child group [Intervention: 4.3 % vs. Control: 17%, P = 0.023]. However, more chatbot users reported decreased vaccine acceptance [26% vs. 12%, P = 0.028] in Hong Kong child group and decreased vaccine confidence in safety [29% vs. 10%, P = 0.041] in Singapore child group. There was no statistically significant change in vaccine confidence or acceptance in the Hong Kong senior group. Employing the RE-AIM framework, process evaluation indicated strong acceptance and implementation support for vaccine chatbots from stakeholders, with high levels of sustainability and scalability. This multisite, parallel RCT study on vaccine chatbots found mixed success in improving vaccine confidence and acceptance among unvaccinated Asian subpopulations. Further studies that link chatbot usage and real-world vaccine uptake are needed to augment evidence for employing vaccine chatbots to advance vaccine confidence and acceptance.

Perceptions and Intentions around Uptake of the COVID-19 Vaccination among Older People: A Mixed-Methods Study in Phuket Province, Thailand

BACKGROUND

A 70% vaccination rate against COVID-19 in the general population was required for re-opening Phuket tourist industry. However, prior to this research, 39.61% of older people remained unvaccinated. This study aimed to examine perceptions and intentions around COVID-19 vaccination amongst older people and to explore the reasons and factors influencing their decisions to receive or refuse vaccination.

METHODS

This was a mixed-methods approach with a sequential explanatory design. We conducted an online survey and semi-structured qualitative interview with a subsample. Multinomial logistic regression was applied and thematic content analysis was conducted.

RESULTS

92.4% of participants reported intention to receive the vaccine. Multinomial regression analysis revealed that perceived barriers (AdjOR = 0.032; 95% CI: 0.17-0.59), perceived benefit (AdjOR = 2.65; 95% CI: 1.49-4.71), good health (AdjOR = 3.51; 95% CI: 1.01-12.12) and health not good (AdjOR = 0.10; 95% CI: 0.02-0.49) were predictors of vaccine uptake. In the qualitative interviews, four key influences on up-take for the 28 vaccinated participants were: prevention and protection, convenience, fear of death from COVID-19, and trust in the vaccine. Four key influences on refusal of vaccination in the eight unvaccinated participants were: rarely leaving the house, fear of vaccine side-effects, fear of death after getting the vaccine, and not enough information for decision-making.

CONCLUSION

Intervention and campaigns addressing COVID-19 vaccination should employ strategies, including the widespread use of social and other popular media to increase older people's perceived benefit of vaccination on their current and future health status, while decreasing perceived barriers to receiving the vaccine.

Covid-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-Sectional Survey via Social Media

BACKGROUND

The third, most severe COVID-19 wave in mid-2021 coincided with dual challenges of limited vaccine supply and lagging acceptance in Bangkok, Thailand. Understanding of persistent vaccine hesitancy during the "608" campaign to vaccinate the over 60 years and eight medical risk groups was needed. On-the ground surveys place further demands on resources and are scale-limited. We leveraged the University of Maryland COVID-19 Trends and Impact Survey (UMD-CTIS) - a digital health survey conducted among daily Facebook user samples - in this this densely populated, high-transmission region with high Facebook social media use to fill this need and inform regional vaccine roll-out policy.

OBJECTIVE

The aims of this study were to characterize COVID-19 vaccine hesitancy, frequent reasons for hesitancy, mitigating risk behaviors, and most trusted sources of COVID-19 information through which to combat vaccine hesitancy in Bangkok, Thailand during the "608" vaccine campaign.

METHODS

UMD-CTIS is an online, cross-sectional survey conducted among daily, statistical samples of the Facebook active user base. We analyzed 34,423 Bangkok UMD-CTIS surveys conducted June-October 2021 coinciding with the third COVID-19 wave. Sampling consistency and representativeness of the UMD-CTIS respondents were evaluated by comparing distributions of demographics, 608 priority groups, and vaccine uptake over time with source population benchmark data. Estimates of vaccine hesitancy in Bangkok and 608 priority groups were tracked over time. Frequently cited hesitancy reasons and trusted information sources were identified by 608 group and degree of hesitancy. Kendall's Tau was used to test statistical associations between vaccine acceptance and vaccine hesitancy.

RESULTS

UMD-CTIS Bangkok respondents had similar demographics over weekly samples and compared to the Bangkok source population. Respondents self-reported fewer pre-existing health conditions such as chronic kidney disease and cardiovascular disease compared to census but had similar prevalence of the important COVID-19 risk factor diabetes. UMD-CTIS vaccine uptake rose in parallel with national vaccination statistics, while vaccine hesitancy and degree of hesitancy declined [-7% hesitant per week]. Concerns about vaccination side effects (63%) and wanting to wait and see (62%) were selected most frequently, while "not liking vaccines" (7%) and "religious objections'' (1%" least so, regardless of risk group, time period, or level of vaccine acceptance. Greater vaccine acceptance was associated positively with wanting to "Wait and See'' and negatively with "Don't Believe I Need [the vaccine]" (Kendall's Tau 0.21 and -0.22, respectively, adjusted P values <0.001). Scientists and health experts were most frequently cited as trusted COVID-19 information sources (97%), even within the "Probably Not" and "Definitely Not" groups.

CONCLUSIONS

These findings provide policy and health experts with evidence that vaccine hesitancy was declining, albeit slowly, over the study timeframe. Hesitancy and trust analyses among the unvaccinated support Bangkok policy measures to address vaccine safety and efficacy concerns through health experts, rather than government or religious officials. Large-scale surveys enabled by existing, widespread digital networks, offer an insightful, minimal-infrastructure resource for informing region-specific health policy needs.

CLINICALTRIAL

Why I Have Not Taken the COVID-19 Vaccine" a Descriptive Qualitative Study of Older Adults' Perceived Views of COVID-19 Vaccine Uptake in Nigeria

Globally, the COVID-19 vaccine uptake is increasing, but slowly among older adults residing in lower and middle-income countries, including Nigeria. Following this, we explored the perceived views of older adults on the uptake of the COVID-19 vaccine in Nigeria. We adopted a qualitative descriptive study design and purposively selected and interviewed 16 retirees of older adults. Data were analyzed using conventional content analysis. Findings show that older adults' willingness to receive the COVID-19 vaccine was dissuaded by their past experiences with the government, religion, and Western media, including affordability and accessibility problems related to vaccination campaigns. Findings also show that the uncertainty about the COVID-19 virus existence and perceptions about COVID-19 vaccine risks influence older adults' decisions regarding vaccine uptake. Finally, older adults' views on getting vaccinated for COVID-19 were positively influenced by the trust they placed in their physicians and other members of their healthcare system. The government should incentivize healthcare workers to serve as a nudge to increase COVID-19 vaccine uptake among older adults in Nigeria.

Cost-Effectiveness Analysis of COVID-19 Vaccine Booster Dose in the Thai Setting during the Period of Omicron Variant Predominance

The Thai government implemented COVID-19 booster vaccines to prevent morbidity and mortality during the spreading of the Omicron variant. However, little is known about which types of vaccine should be invested in as the booster dose for the Thai population. This study aims to investigate the most cost-effective COVID-19 vaccine for a booster shot as empirical evidence for Thai policymakers. This study applied a stochastic simulation based on a compartmental susceptible-exposed-infectious-recovered model and included system dynamics in the model. We evaluated three scenarios: (1) No booster, (2) A viral vector vaccine as the booster dose, (3) An mRNA vaccine as the booster dose. The incremental cost-effectiveness ratio (ICER) was calculated based on provider perspectives. We found the number of cases in scenarios with viral vector and mRNA booster doses to be lower than in the non-booster group. Likewise, the number of deaths in the viral vector and the mRNA booster scenarios was threefold lower than in the no-booster scenario. Moreover, the estimated grand cost for the no-booster scenario was over 100 billion baht, while viral vector and mRNA scenario costs were 70 and 64.7 billion baht, respectively. ICER shows that viral vector and mRNA scenarios are more cost-effective than the no-booster scenario. Viral vector booster shot appeared to be slightly more cost-effective than mRNA booster shot in terms of death aversion. However, being boosted by an mRNA vaccine seemed slightly more cost-effective than a viral vector vaccine concerning case aversion. In conclusion, policies to promote COVID-19 booster shots in the Thai population by either mRNA or viral vector vaccines are likely to be worthwhile for both economic and public health reasons.

Increasing pneumococcal vaccine uptake in older adults: a scoping review of interventions in high-income countries

BACKGROUND

There is low uptake of the pneumococcal vaccination in eligible older adults, even in high-income countries that offer routine and universal vaccination programs.

OBJECTIVE

To systematically characterize interventions aimed at improving pneumococcal vaccine uptake in older adults.

DESIGN

We conducted a scoping review following PRISMA-SCr guidelines of five interdisciplinary databases: Medline-Ovid, Embase, CINAHL, PsychInfo, and Cochrane Library. Databases were searched from January 2015 until April 2020. The interventions were summarized into three pillars according to the European Union Conceptional Framework for Action: information campaigns, prioritization of vaccination schemes, and primary care interventions.

RESULTS

Our scoping review included 39 studies that summarized interventions related to pneumococcal vaccine uptake for older adults, encompassing 2,481,887 study participants (945 healthcare providers and 2,480,942 older adults) across seven countries. Examples of interventions that were associated with increased pneumococcal vaccination rate included periodic health examinations, reminders and decision-making tools built into electronic medical records, inpatient vaccination protocols, preventative health checklists, and multimodal educational interventions. When comparing the three pillars, prioiritization of vaccination schemes had the highest evidence for improved rates of vaccination (n = 14 studies), followed by primary care interventions (n = 8 studies), then information campaigns (n = 5 studies).

CONCLUSION

Several promising interventions were associated with improved outcomes related to vaccine uptake, although controlled study designs are needed to determine which interventions are most effective.

Changes on local travel behaviors under travel reduction-related interventions during COVID-19 pandemic: a case study in Hong Kong

The emerging Omicron variant poses a serious threat to human health. Public transports play a critical role in infection spread. Based on the data of nearly 4 billion smartcard uses, between January 1, 2019 and January 31, 2021 from the Mass Transit Railway Corporation of Hong Kong, we analyzed the subway travel behavior of different population groups (adults, children, students and senior citizens) due to the COVID-19 pandemic and human travel behavior under different interventions (e.g. work suspension, school closure). Due to the pandemic, the number of MTR passengers (the daily number of passengers in close proximity in subway carriages) decreased by 37.4% (40.8%) for adults, 80.3% (78.5%) for children, 71.6% (71.6%) for students, and 33.5% (36.1%) for senior citizens. Due to work from home (school suspension), the number of contacted adults (students/children) in the same carriage during the rush hours decreased by 39.6% (38.6%/43.2%). If all workers, students, and children were encouraged to commute avoiding rush hours, the possible repeated contacts during rush hour of adults, children and students decreased by 73.3%, 77.9% and 79.5%, respectively. Since adults accounted for 87.3% of the total number of subway passengers during the pandemic, work from home and staggered shift pattern of workers can reduce the infection risk effectively. Our objective is to find the changes of local travel behavior due to the pandemic. From the perspective of public transports, the results provide a scientific support for COVID-19 prevention and control in cities.

Perspectives of Older Adults on COVID-19 and Influenza Vaccination in Ontario, Canada

INTRODUCTION/OBJECTIVES

Addressing vaccine hesitancy has become an increasingly important public health priority in recent years. There is a paucity of studies that have focused on vaccine hesitancy among older adults, who are known to be at greater risk of complications from infections such as COVID-19. We aim to explore the attitudes and beliefs of older adults regarding COVID-19 and influenza vaccines in Toronto, Ontario.

METHODS

Older adults enrolled in the Student Senior Isolation Prevention Partnership (SSIPP) program at the University of Toronto were contacted to participate in a phone survey and semi-structured interview. Survey data was analyzed descriptively, and attitude toward vaccination was compared between sociodemographic groups by using Fisher's exact test. Interview audio files were transcribed verbatim and analyzed inductively for themes and sub-themes.

RESULTS

All thirty-three (100%) older adults reported that they had received the first and second doses of the COVID-19 vaccine. Twenty-six (78.8%) participants reported intent to get vaccinated against influenza or had already received the influenza vaccine that year. Notably, only 2 out 7 (28.6%) individuals who did not plan to get vaccinated against influenza believed that vaccines offered by health providers are beneficial and only 3 out of 7 (42.9%) agreed that getting vaccines is a good way to protect oneself from disease. No other significant differences in attitudes among participants were found when compared by gender, ethnicity, or education level. The qualitative data analysis of interview transcripts identified 5 themes that impact vaccine decision making: safety, trust, mistrust, healthcare experience, and information dissemination and education.

CONCLUSIONS

Our data showed that older adults in the SSIPP program generally had positive views toward vaccination, especially toward the COVID-19 vaccines. However, several concerns regarding the effectiveness of the vaccines were brought up in interviews, such as the speed at which the vaccines were produced and the inconsistency in government messaging.

Factors associated with reluctancy to acquire COVID-19 vaccination: A cross-sectional study in Shiraz, Iran, 2022

BACKGROUND

Vaccination is a crucial action that can end the COVID-19 pandemic and reduce its detrimental effect on public health. Despite the availability of various vaccines, this study was conducted to better understand the factors behind individuals refusing to get vaccinated.

METHOD

The current cross-sectional study was conducted with individuals above 18 years of age in Shiraz, Iran, who were eligible but refused to receive the COVID-19 vaccination. Demographic features and factors related to their hesitancy and willingness to participate in the vaccination program were recorded in a questionnaire.

RESULT

Out of 801 participants in the current study, 427 (53.3%) were men, with a mean age of 37.92 years (± 14.16). The findings revealed that 350 (43.7%) participants claimed the side effects of the vaccine outweigh the benefits as one reason for their reluctance toward COVID-19 vaccination, followed by the unknown efficacy of vaccines (40.4%) and a lack of trust in vaccine companies (32.8%). Ensuring the safety of the vaccine (43.7%) and verifying its effectiveness (34.5%) were the most prevalent factors behind participating in the vaccination program. Those who reported their socio-economic status as low were significantly reluctant toward vaccination because of a self-presumption of high immunity (p-value < 0.001), the unclear efficacy of vaccines (p-value < 0.001), the side effects outweighing the benefits of vaccines (p-value < 0.001), distrust of vaccine companies (p-value < 0.001), usage of mask, gloves, and sanitizers (p-value < 0.001), contradictory speech of health authorities regarding vaccines (p-value = 0.041), and the unavailability of trusted vaccines (p-value = 0.002). It should also be noted that participants reported a greater likelihood to obtain information about vaccination reluctance from family and friends (p-value <0.001) and complementary medicine professionals (p-value <0.001).

CONCLUSION

Avoiding vaccination is an undeniable public and individual health concern in Iran, as demonstrated in the current study. Concern about vaccine efficacy and side effects is the most reported cause of vaccination reluctance among individuals, which could be altered by emphasizing mass education and averting an infodemic by forming dedicated multidisciplinary organizations.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Prevalence and Factors Associated with Caregivers’ Hesitancy in Immunizing Dependent Older Adults with COVID-19 Vaccines: A Cross-Sectional Survey

Background: Coronavirus disease 2019 (COVID-19) vaccinations have been proven to prevent hospitalization and mortality. However, some caregivers may be hesitant to authorize COVID-19 vaccination of people under their care. Our study aimed to evaluate factors associated with caregiver hesitancy to authorize vaccination of dependent older adults. Method: We conducted a cross-sectional telephone survey of vaccine hesitancy among caregivers of dependent older patients in the geriatric clinic of Ramathibodi Hospital. Caregivers were contacted and interviewed by trained interviewers from 20 June to 25 July 2021. Results: The study enrolled 318 participants with a mean age of 55.9 years. The majority of the participants were the patients’ children (86.5%). In total, 39.9% of participants were hesitant to authorize COVID-19 vaccination of the older adults under their care. Factors associated with caregiver vaccine hesitation were uneasiness, anxiety, agitation, sadness, and worry in association with social distancing, refusal to receive a COVID-19 vaccine, and concern about vaccine manufacturers. Conclusion: The prevalence of caregiver hesitancy to allow older adults to undergo COVID-19 vaccination was relatively high, and several factors associated with this vaccine hesitancy were identified. These findings may aid efforts toward COVID-19 vaccination of dependent older adults.

Temporal Trend of COVID-19 Vaccine Acceptance and Factors Influencing International Travellers

The COVID-19 pandemic has seen disrupted international travel due to travel restrictions and public health measures aimed at containing the spread of the virus. With increasing evidence of the COVID-19 vaccines' ability to mitigate disease severity, reopening tourism is desirable to promote the recovery of the global economy. However, the COVID-19 vaccine and vaccination passport for international travellers remains an ongoing debate. Little is known of the acceptance of these and the influencing factors among this population group. Therefore, this study sought to determine the temporal trend in COVID-19 vaccine acceptance and influencing factors among international travellers. A cross-sectional study was conducted using a self-administered questionnaire among international travellers who visited the Thai Travel Clinic, Hospital for Tropical Diseases, Mahidol University, Thailand from June 2021 to December 2021 (3 different variants dominated during this period). Study data were analyzed using SPSS software, version 23. Chi-square was used to demonstrate associations. Binary logistic regression was used to evaluate the magnitude of effect, demonstrated by odds ratio with 95% confidence interval. All significant variables were included in a multinomial logistic regression model to estimate adjusted odds ratios. The study enrolled 1068 travellers, 719 (67.3%) Thai and 349 (32.7%) foreign travellers. Most travellers were female (55.4%) and aged 18-30 years. The three main purposes for visiting the clinic were: for study, visiting friends and relatives, and returning to their home country. The overall COVID-19 vaccine acceptance rate among the travellers was 96.2%. The temporal trend of acceptance among Thai and non-Thai travelers varied from 93-99% and 93-100%, respectively. Vaccine efficacy, protective duration of the vaccine, risk of infection, and travel plan were factors strongly associated with COVID-19 vaccine acceptance. In conclusion, the COVID-19 vaccine acceptance rate among these international travellers was very high. The safe and effective reopening of tourism to international travellers will facilitate economic recovery.

Factors associated with routine vaccination card retention among children aged 0–59 months in Yaounde-Cameroon: A cross-sectional survey

Background

The routine vaccination card is an important health record for children, but recent findings suggest that vaccination card retention in Cameroon is low, varying from 29%-53%. The aim of this study was to assess factors associated with children’s routine vaccination card retention in Cameroon.

Methods

This cross-sectional survey was conducted in Yaoundé in November 2021, targeting children aged 0–59 months. Participants were selected using a 2-stage systematic cluster sampling in which households were selected by a restricted sampling technique. Data were collected by interviewing the children’s parents/guardians, and a vaccination card was said to be retained if it was presented to the interviewer by the interviewees. Data were analysed using multiple logistics regression with R version 4.1.0 (2021-05-18).

Findings

A total of 529 households were assessed with 361 children aged 0–59 months enrolled: 51% girls and 49% boys. Children aged 0–11 months represented 24.4% of all participants, and children aged 12–59 months were 74.6%. Vaccination card retention was 24% (87), and positive predictors of card retention included: girl child (adjusted Odds Ratio = 1.34, p-value = 0.0269), the respondent being one of the biological parents of the child: mother (adjusted Odds Ratio = 5.97, p-value = 0.0034) or father(adjusted Odds Ratio = 4.69, p-value = 0.0067), and living in a richer household (adjusted Odds Ratio = 1.56, p-value = 0.038). On the other hand, negative predictors of card retention were: child aged 12–23 months (adjusted Odds Ratio = 0.44, p-value = 0.0209) or aged 24-59months (adjusted Odds Ratio = 0.13, p-value = 0.0000), and having an employed mother (adjusted Odds Ratio = 0.34, p-value = 0.0066).

Conclusion

Vaccination card retention in children aged 0–59 months in Yaoundé is low when compared with findings reported by studies from other locations in Cameroon. Besides, the poor and older children have lower odds of keeping routine vaccination cards. There is a need to design interventions to improve vaccination card retention, which considers household wealth and the age of the child.

Factors Contributing to SARS-CoV-2 Vaccine Hesitancy of Hispanic Population in Rio Grande Valley

Hispanic communities have been disproportionately affected by economic disparities. These inequalities have put Hispanics at an increased risk for preventable health conditions. In addition, the CDC reports Hispanics to have 1.5× COVID-19 infection rates and low vaccination rates. This study aims to identify the driving factors for COVID-19 vaccine hesitancy of Hispanic survey participants in the Rio Grande Valley. Our analysis used machine learning methods to identify significant associations between medical, economic, and social factors impacting the uptake and willingness to receive the COVID-19 vaccine. A combination of three classification methods (i.e., logistic regression, decision trees, and support vector machines) was used to classify observations based on the value of the targeted responses received and extract a robust subset of factors. Our analysis revealed different medical, economic, and social associations that correlate to other target population groups (i.e., males and females). According to the analysis performed on males, the Matthews correlation coefficient (MCC) value was 0.972. An MCC score of 0.805 was achieved by analyzing females, while the analysis of males and females achieved 0.797. Specifically, several medical, economic factors, and sociodemographic characteristics are more prevalent in vaccine-hesitant groups, such as asthma, hypertension, mental health problems, financial strain due to COVID-19, gender, lack of health insurance plans, and limited test availability.

Attitudes toward Receiving COVID-19 Booster Dose in the Middle East and North Africa (MENA) Region: A Cross-Sectional Study of 3041 Fully Vaccinated Participants

COVID-19 vaccines are crucial to control the pandemic and avoid COVID-19 severe infections. The rapid evolution of COVID-19 variants such as B.1.1.529 is alarming, especially with the gradual decrease in serum antibody levels in vaccinated individuals. Middle Eastern countries were less likely to accept the initial doses of vaccines. This study was directed to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in the MENA region to attain public herd immunity. We conducted an online survey in five countries (Egypt, Iraq, Palestine, Saudi Arabia, and Sudan) in November and December 2021. The questionnaire included self-reported information about the vaccine type, side effects, fear level, and several demographic factors. Kruskal−Wallis ANOVA was used to associate the fear level with the type of COVID-19 vaccine. Logistic regression was performed to confirm the results and reported as odds ratios (ORs) and 95% confidence intervals. The final analysis included 3041 fully vaccinated participants. Overall, 60.2% of the respondents reported willingness to receive the COVID-19 booster dose, while 20.4% were hesitant. Safety uncertainties and opinions that the booster dose is not necessary were the primary reasons for refusing the booster dose. The willingness to receive the booster dose was in a triangular relationship with the side effects of first and second doses and the fear (p < 0.0001). Females, individuals with normal body mass index, history of COVID-19 infection, and influenza-unvaccinated individuals were significantly associated with declining the booster dose. Higher fear levels were observed in females, rural citizens, and chronic and immunosuppressed patients. Our results suggest that vaccine hesitancy and fear in several highlighted groups continue to be challenges for healthcare providers, necessitating public health intervention, prioritizing the need for targeted awareness campaigns, and facilitating the spread of evidence-based scientific communication.

Using the Health Belief Model to Predict Vaccination Intention Among COVID-19 Unvaccinated People in Thai Communities

Background

The coronavirus disease 2019 (COVID-19) pandemic has become one of the biggest challenges to individual health and the public health system worldwide. COVID-19 morbidity and mortality are increasing, impacting almost every country including Thailand. This study used the Health Belief Model (HBM) as a framework to examine the intention of unvaccinated people living in northern Thailand to receive COVID-19 vaccines.

Methods

This cross-sectional study was conducted during October and November 2021. A total of 1,024 participants who are currently living in four northern provinces of Thailand, Chiang Mai, Chiang Rai, Lamphun, and Phayao, were recruited to participate in the study. The questionnaire was developed using an HBM structure to obtain information about the perceived severity, perceived susceptibility, self-efficacy, perceived benefits and barriers, cues to action, and preventive behaviors relating to COVID-19 vaccination and the decision to become vaccinated. Multiple linear regression was used to analyze the data.

Results

The unvaccinated participants were an average of 44.45 ± 16.63 years of age and more than half were women (54.5%). The COVID-19 preventive behavior score used perceived severity (B = 0.26), self-efficacy (B = 0.51), perceived benefits and barriers (B = 0.11), and cues to action (B = 0.18) after adjusting for age, underlying disease, and body mass index (R² = 42.5%). The COVID-19 vaccination decision score was positively correlated with perceived severity (B = 0.13), perceived susceptibility (B = 0.25), perceived benefits and barriers (B = 0.21), and cues to action (B = 0.27) after adjusting for underlying disease (R² = 38.7%).

Discussion

The results demonstrated the usefulness of using the HBM structure to understand individual intention to receive a COVID-19 vaccine. Communities should consider a COVID-19 health campaign and programs that use the HBM model as a framework for altering perceptions and beliefs about the COVID-19 vaccine and improving vaccination rates among unvaccinated people in rural northern Thailand.

Can Thailand achieve COVID‐19 herd immunity?

The COVID‐19 outbreak has had a great impact on the social, economic, and health systems of Thailand. A variety of measures to curb the spread of the disease were implemented since the beginning of the pandemic, including a strict national lockdown protocol. The Thai government aimed to achieve herd immunity through an efficient vaccination programme. Initially, vaccine supply shortage and a lack of vaccine options plagued the health system, but this has since been improved. Continuous monitoring of the situation through research is being carried out to assess the level of immunity among the population whereby the current general recommendation is presently a fourth booster dose for adults. Hurdles towards achieving herd immunity remain. One such issue is the low level of vaccine literacy among those that are unvaccinated or inadequately vaccinated. Another obstacle is the sizeable rate of hesitancy towards getting booster doses. Achieving herd immunity in the Thai population would require multilateral cooperation, improved health promotion to target population groups, such as older adults, and a developed distribution system for those with limited access, such as those in the rural areas.

Two-Tailed Dogs, Social Unrest and COVID-19 Vaccination: Politics, Hesitancy and Vaccine Choice in Hungary and Thailand

Background: A long tradition of research has shown an association between political orientation and vaccine uptake. However, we know little about political preferences and the choice of specific vaccines. Methods: We conducted two national surveys, in Hungary (Study 1, online, n = 1130) and Thailand (Study 2, on the street survey: n = 1052), testing associations between political allegiance, trust in government, vaccine willingness, and vaccine choice. Results: In Hungary, those supporting the government or on the political right were more willing to be vaccinated, with this association strongest for government approved vaccines. These respondents were also more likely to accept Chinese and Russian vaccines and reject the Moderna vaccine. In Thailand, vaccinated respondents reported greater trust in the government, with preference for AstraZeneca associated with support for pro-government political parties and preference for Pfizer with anti-government attitudes. Conclusions: Vaccine campaigns need to recognise the role of political loyalties not only in vaccine willingness, but in vaccine choice, especially given the mixing of vaccines across doses.

Willingness to receive the COVID-19 vaccine and associated factors among residents of Southwestern Ethiopia: A cross-sectional study

Introduction

The COVID-19 vaccine is a key intervention toward containing the pandemic. Vaccines are thought to be a form of defense. One of the major challenges to managing the COVID-19 pandemic is the uncertainty or willingness to accept vaccinations. Our study aimed willingness to get the COVID-19 vaccine and the factors that influence it in Mettu Woreda, Ilu Ababor Zone, Ethiopia.

Methodology

Cross-sectional study design was conducted from August 1, 2021, to September 1, 2021, among rural residents of Mettu woreda's of Ilu Ababor Zone, Oromia, Ethiopia. The semi-structured data collection format was prepared to assess the magnitude of the communities' acceptance of the COVID-19 vaccine. A multivariable logistic regression analysis was used to determine the predictors of communities' acceptance of the COVID-19 vaccine at 95% CI.

Results

Of 350 participants from the study area, 59% of them were males and 41% females. Less than one-third (29.8%) of participants were willing to accept the COVID-19 vaccine. The results multivariable logistic regression revealed that the age group of ≥50 years (OR=0.29; 95% CI: -3.1-0.34) as compare with the 18-29 years, low monthly income (OR=0.85; 95% CI: -0.74-2.33), low perception level (OR=0.35; 95% CI: -2.03-0.24), government unemployed (OR=0.86; 95% CI: -0.72-0.1), low Level of acceptance (OR=0.72; 95% CI: -0.67, 0.08) and unwillingness to test COVID-19 (OR=0.13; 95% CI: -4.47, 0.58) were predictors of willingness to receive COVID-19 vaccine.

Conclusion

Less than one-third of the study, participants were willing to accept the COVID-19 vaccine. The likelihood of Willingness to accept the COVID-19 vaccine was low in the study area. Overall; low education, low vaccination perception, low income, jobless occupation, older age, and unwillingness to test for COVID-19 were associated with greater willingness to take the COVID-19 vaccine and are significantly associated with willingness to get the COVID-19 immunization.

The Effect of Message Framing on COVID-19 Vaccination Intentions among the Younger Age Population Groups: Results from an Experimental Study in the Italian Context

The coronavirus pandemic has been recognized as a major threat to public health. Widespread acceptance of COVID-19 vaccines is crucial for achieving adequate immunization coverage to end the global pandemic. However, to date, there are still hesitant people, especially among the younger population groups. For this reason, it is essential to identify the psychological variables that may affect vaccination intention among these “at risk groups” and to select possible successful communication frames in order to increase vaccination rates. An online cross-sectional survey was carried out on 208 Italian citizens younger than 50 years old, to explore message framing effects on their intention to receive the vaccination and to understand the psychological factors influencing it. Results showed that depending on the goal (stimulate vaccination intention, vaccination trust, or vaccine attitude), not all the communication stimuli are equally effective on this target population. Furthermore, the study showed that sociodemographic variables do not help to explain the vaccination intention of the younger population groups, while the psychological variables have been found to have a stronger impact on such attitude. Trust and attitudes towards vaccines, concern about the pandemic and concern about infecting others have been found to be the most effective predictive variables of people vaccination intention. The study results underline the importance of understanding the psychological roots behind vaccine hesitancy to shape sensitization actions and vaccination campaigns targeting this population group.

Understanding Factors to COVID-19 Vaccine Adoption in Gujarat, India

The COVID-19 pandemic has posed threats to human life across the globe, including India. Vaccinating is an effective means of addressing the pandemic threat. The government of India has implemented a massive vaccination drive to save its citizens from the deadly virus. However, the effort has faced multiple challenges, including vaccine hesitancy. This research understands respondents' perspectives on factors contributing to the lower vaccination uptake in Gujarat, India. Forty-four semi-structured interviews were conducted through convenience sampling representing different demographic backgrounds. Factors influencing vaccine adoption included religious leadership, political leadership and the government, and fear of side effects, especially among children and those with co-morbidities, resulting primarily from fake news and misinformation circulated through social media. Compared with nine countries from across the world, the study found similarities to vaccine hesitancy from misinformation and the fear of side effects among children. In contrast, the role of government and the influence of religious and political leaders was considered positive. The study recommends strategies to overcome people's apprehensions about the adoption of vaccination. These include offering incentives, providing positive peer-to-peer communication, recruiting influencers such as religious and community leaders and early adopters such as the elderly population to endorse vaccination, targeting youth through social media, and reaching rural sections by involving NGOs and social service groups.

Cyberchondria, but not preventive behavior, mediates the relationship between fear of COVID-19 and somatic burden: Evidence from Russia

BACKGROUND

There is extensive available research on the relationship between fear of COVID-19 pandemic and physical symptoms. This study was the first to examine the cyberchondria and COVID-19 preventive behavior as mediators of this relationship.

METHODS

A cross-sectional study was conducted from October to December 2021, during the fourth wave of the COVID-19 pandemic in Russia. The participants were 2,011 Russian-speaking volunteers aged 18 years and older. They completed questionnaires on somatic burden, cyberchondria, COVID-19 preventive behavior, and fear of COVID-19 pandemic. Mediation analysis was used to explore the mediating roles of cyberchondria and preventive behavior in the relationship between fear of COVID-19 and somatic burden.

RESULTS

Fear of COVID-19 positively predicted somatic burden, cyberchondria, and COVID-19 preventive behavior. Mediation analysis showed that the relationship between fear of COVID-19 pandemic and somatic burden was mediated by cyberchondria (effect = 0.08, bootstrapping SE = 0.01, bootstrapping 95% CI [0.08, 0.12]), but not COVID-19 preventive behavior (effect = 0.02, bootstrapping SE = 0.01, bootstrapping 95% CI [0.00, 0.05]).

CONCLUSION

The findings suggest that cyberchondria had negative effects on somatic burden during the COVID-19 pandemic. The knowledge of the mediating role of cyberchondria may be used by health care workers when consulting persons with physical health complaints and psychosomatic disorders.

COVID-19 Vaccine Hesitancy among the Younger Generation in Japan

Japan has vaccinated its older population; a mass vaccination program for younger citizens is underway. Accordingly, this study investigated vaccine hesitancy among younger Japanese citizens. We used online panel survey data from the Hiroshima Institute of Health Economics Research of Hiroshima University and applied probit regression models. Our study found that vaccine hesitancy among younger people was significantly higher than among older people. Moreover, vaccine hesitancy was significantly higher among younger women than younger men and inter-age-group differences in vaccine hesitancy were higher for younger men than for younger women. Regression demonstrated that subjective health status and anxiety about the future were significantly associated with vaccine hesitancy among younger women and younger men of all ages, respectively. Furthermore, marital status, university degree, anxiety about the future, and myopic view of the future had specific associations with vaccine hesitancy among younger women of different ages, while subjective health status, university degree, having children, financial literacy, household income and assets, and myopic view about the future had specific associations with vaccine hesitancy among younger men of varying ages. Therefore, these results suggest that policymakers should consider the diversity among the younger generation while developing effective, tailored communication strategies to reduce their vaccine hesitancy.