People's Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis

Patient safety discourse in a pandemic: a Twitter hashtag analysis study on #PatientSafety

Background

The digitalization of medicine is becoming a transformative force in modern healthcare systems. This study aims to investigate discussions regarding patient safety, as well as summarize perceived approaches to mitigating risks of adverse events expressed through the #PatientSafety Twitter hashtag during the COVID-19 pandemic.

Methods

This research is grounded in the analysis of data extracted from Twitter under the hashtag #PatientSafety between December 1, 2019 and February 1, 2023. Symplur Signals, which represents a tool offering a method to monitor tweets containing hashtags registered with the Symplur Healthcare Hashtag Project, was used for analyzing the tweets shared in the study period. For text analytics of the relevant data, we further used the word cloud generator MonkeyLearn, and VOSviewer.

Results

The analysis encompasses 358'809 tweets that were shared by 90'079 Twitter users, generating a total of 1'183'384'757 impressions. Physicians contributed to 18.65% of all tweets, followed by other healthcare professionals (14.31%), and health-focused individuals (10.91%). Geographically, more than a third of tweets (60.90%) were published in the United States. Canada and India followed in second and third positions, respectively. Blocks of trending terms of greater interest to the global Twitter community within the hashtag #PatientSafety were determined to be: "Patient," "Practical doctors," and "Health Care Safety Management." The findings demonstrate the engagement of the Twitter community with COVID-19 and problems related to the training, experience of doctors and patients during a pandemic, communication, the vaccine safety and effectiveness, and potential use of off-label drugs. Noteworthy, in the field of pharmacovigilance, Twitter has the possibility of identifying adverse reactions associated with the use of drugs, including vaccines. The issue of medical errors has been also discussed by Twitter users using the hashtag #PatientSafety.

Conclusion

It is clear that various stakeholders, including students, medical practitioners, health organizations, pharmaceutical companies, and regulatory bodies, leverage Twitter to rapidly exchange medical information, data on the disease symptoms, and the drug effects. Consequently, there is a need to further integrate Twitter-derived data into the operational routines of healthcare organizations.

The Correlation Among COVID-19 Vaccine Acceptance, the Ability to Detect Fake News, and e-Health Literacy

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has seen a rise in the spread of misleading and deceptive information, leading to a negative impact on the acceptance of the COVID-19 vaccine and public opinion. To address this issue, the importance of public e-Health literacy cannot be overstated. It empowers individuals to effectively utilize information technology and combat the dissemination of inaccurate narratives.

OBJECTIVE

This study aimed to investigate the relationship between the ability to identify disingenuous news, electronic health literacy, and the inclination to receive the COVID-19 immunization.

METHODS

In this descriptive-analytical cross-sectional study conducted during summer 2021 in Isfahan, Iran, 522 individuals older than age 18 years, seeking medical attention at health centers, were surveyed. The participants were selected through a meticulous multistage cluster sampling process from the pool of individuals referred to these health centers. Along with demographic information, data collection instruments included the standard e-Health literacy questionnaire and a researcher-developed questionnaire designed to identify misinformation. The collected questionnaires were entered into SPSS 24 for statistical analysis, which included the Kruskal-Wallis test, the Chi-square test, the Spearman test, and logistic regression models.

KEY RESULTS

The study findings revealed a statistically significant relationship between acceptance of the COVID-19 vaccine and the ability to identify deceptive news. An increase of one unit in the score for recognizing misinformation led to a 24% and 32% reduction in vaccine hesitancy and the intention to remain unvaccinated, respectively. Furthermore, a significant correlation was found between the intention to receive the vaccine and e-Health literacy, where an increase of one unit in e-Health literacy score corresponded to a 6% decrease in the intention to remain unvaccinated. Additionally, the study found a notable association between the ability to detect false and misleading information and e-Health literacy. Each additional point in e-Health literacy was associated with a 0.33% increase in the capacity to identify fake news (Spearman's Rho = 0.333, p < .001).

CONCLUSION

The study outcomes demonstrate a positive correlation between the COVID-19 vaccine acceptance, the ability to identify counterfeit news, and proficiency in electronic health literacy. These findings provide a strong foundation for policymakers and health care practitioners to develop and implement strategies that counter the dissemination of spurious and deceitful information related to COVID-19 and COVID-19 immunization. [HLRP: Health Literacy Research and Practice. 2023;7(3):e130-e138.].

Impact of the COVID-19 Pandemic on Attitudes toward Vaccination: Representative Study of Polish Society

The study explored the association between individuals' attitudes toward vaccination and their actual vaccination behavior. We also examined the impact of the coronavirus disease 2019 (COVID-19) pandemic and the ongoing vaccination debate on changing attitudes towards vaccination, specifically within different demographic groups. The survey was conducted among a representative sample of Poles (N = 805) using computer-assisted web interview (CAWI) technology. As demonstrated, those who identified themselves as strong vaccine supporters were statistically significantly more frequently to be vaccinated with COVID-19 booster doses, to follow a physician's recommendation on any vaccine without hesitation, and to be strengthened in their confidence in vaccines during the COVID-19 pandemic (p < 0.001 for all). However, over half of the responders declared themselves as moderate vaccine supporters/opponents, the groups whose further attitudes are likely to be affected by (mis)communication. Importantly, more than half of moderate vaccine supporters declared that their vaccine confidence was weakened during the COVID-19 pandemic, while 43% were not vaccinated against COVID-19. In addition, the study demonstrated that older and better-educated individuals were more likely to be COVID-19-vaccinated (p < 0.001 and p = 0.013, respectively). The results of this study imply that, in order to improve vaccine acceptance, it is essential to strengthen public health communication and avoid communication errors conducted during the COVID-19 pandemic.

Stress, Anxiety, and Depression Levels among University Students: Three Years from the Beginning of the Pandemic

BACKGROUND

Three years after the outbreak of the COVID-19 pandemic, psychological distress among college students remains increased. This study assesses stress, anxiety, and depression levels among students of the Aristotle University of Thessaloniki by the end of the third year of the pandemic (November 2022), revealing demographic characteristics and probable stressors.

METHODS

A questionnaire was distributed in November 2022 via the academic students' e-mails. The evaluation was performed with the DASS21 survey tool. The correlation analysis and the effect size calculation were performed with the t-test.

RESULTS

The majority of participants were undergraduates, on their first or second academic year, female students (67%), age of 18 to 21, unmarried or single (91%), and vaccinated against COVID-19 infection (83.4%). Severely increased levels of stress, anxiety, and depression (21.3%, 23.3%, and 25.1%, respectively) were measured. The normal and mild levels of stress, anxiety, and depression were 64.0%, 66.5%, and 57.2%, respectively. Female and younger students were at a higher risk of extremely severe stress, anxiety and depression prevalence (ORs up to 2.07, p-Values < 0.00001). Participants who were receiving psychological or psychiatric treatment exhibited severe stress, anxiety, and depression levels (ORs above 2.9, p-Values < 0.00001).

CONCLUSIONS

Despite the undeniable withdrawal of the COVID-19 pandemic, the community of the Aristotle University of Thessaloniki presents high stress, anxiety, and depression levels, similar to those reported during the first year of the pandemic (November 2020). Stressors and risk factors were according to the reported literature and previous studies on Greek students. Academic psychological support offices should consider the students' "profile" in order to evaluate properly the potential risk for emotional and psychological distress. Evidence suggest that new technology (virtual reality, tele-psychiatry or tele-support apps and sessions) should also be implemented in universities.

Perception of COVID-19 vaccination among Indian Twitter users: computational approach

Vaccination has been a hot topic in the present COVID-19 context. The government, public health stakeholders and media are all concerned about how to get the people vaccinated. The study was intended to explore the perception and emotions of the Indians citizens toward COVID-19 vaccine from Twitter messages. The tweets were collected for the period of 6 months, from mid-January to June, 2021 using hash-tags and keywords specific to India. Topics and emotions from the tweets were extracted using Latent Dirichlet Allocation (LDA) method and National Research Council (NRC) Lexicon, respectively. Theme, sentiment and emotion wise engagement and reachability metrics were assessed. Hash-tag frequency of COVID-19 vaccine brands were also identified and evaluated. Information regarding 'Co-WIN app and availability of vaccine' was widely discussed and also received highest engagement and reachability among Twitter users. Among the various emotions, trust was expressed the most, which highlights the acceptance of vaccines among the Indian citizens. The hash-tags frequency of vaccine brands shows that Covishield was popular in the month of March 2021, and Covaxin in April 2021. The results from the study will help stakeholders to efficiently use social media to disseminate COVID-19 vaccine information on popular concerns. This in turn will encourage citizens to be vaccinated and achieve herd immunity. Similar methodology can be adopted in future to understand the perceptions and concerns of people in emergency situations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42001-023-00203-0.

"Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19

Background

Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic.

Methods

The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset.

Results

We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay.

Conclusions

"Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.

Ethical principles for infodemiology and infoveillance studies concerning infodemic management on social media

Big data originating from user interactions on social media play an essential role in infodemiology and infoveillance outcomes, supporting the planning and implementation of public health actions. Notably, the extrapolation of these data requires an awareness of different ethical elements. Previous studies have investigated and discussed the adoption of conventional ethical approaches in the contemporary public health digital surveillance space. However, there is a lack of specific ethical guidelines to orient infodemiology and infoveillance studies concerning infodemic on social media, making it challenging to design digital strategies to combat this phenomenon. Hence, it is necessary to explore if traditional ethical pillars can support digital purposes or whether new ones must be proposed since we are confronted with a complex online misinformation scenario. Therefore, this perspective provides an overview of the current scenario of ethics-related issues of infodemiology and infoveillance on social media for infodemic studies.

The International Natural Product Sciences Taskforce (INPST) and the power of Twitter networking exemplified through #INPST hashtag analysis

BACKGROUND

The development of digital technologies and the evolution of open innovation approaches have enabled the creation of diverse virtual organizations and enterprises coordinating their activities primarily online. The open innovation platform titled "International Natural Product Sciences Taskforce" (INPST) was established in 2018, to bring together in collaborative environment individuals and organizations interested in natural product scientific research, and to empower their interactions by using digital communication tools.

METHODS

In this work, we present a general overview of INPST activities and showcase the specific use of Twitter as a powerful networking tool that was used to host a one-week "2021 INPST Twitter Networking Event" (spanning from 31st May 2021 to 6th June 2021) based on the application of the Twitter hashtag #INPST.

RESULTS AND CONCLUSION

The use of this hashtag during the networking event period was analyzed with Symplur Signals (https://www.symplur.com/), revealing a total of 6,036 tweets, shared by 686 users, which generated a total of 65,004,773 impressions (views of the respective tweets). This networking event's achieved high visibility and participation rate showcases a convincing example of how this social media platform can be used as a highly effective tool to host virtual Twitter-based international biomedical research events.

Factors impacting COVID-19 vaccine decision making in older adults and people with underlying conditions in Victoria, Australia: A cross-sectional survey

Australia's COVID-19 vaccine rollout included prioritizing older adults and those with underlying conditions. However, little was known around the factors impacting their decision to accept the vaccine. This study aimed to assess vaccine intentions, information needs, and preferences of people prioritized to receive the COVID-19 vaccine at the start of the Australian vaccine rollout. A cross-sectional online survey of people aged ≥70 years or 18-69 with chronic or underlying conditions was conducted between 12 February and 26 March 2021 in Victoria, Australia. The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework and items informed the survey design and framing of results. Bivariate logistic regression was used to investigate the association between intention to accept a COVID-19 vaccine and demographic characteristics. In total, 1828 eligible people completed the survey. Intention to vaccinate was highest among those ≥70 years (89.6%, n = 824/920) versus those aged 18-69 years (83.8%, n = 761/908), with 91% (n = 1641/1803) of respondents agreeing that getting a COVID-19 vaccine was important to their health. Reported vaccine safety (aOR 1.4, 95% CI 1.1 to 1.8) and efficacy (aOR 1.9, 95% CI 1.5 to 2.3) were associated with intention to accept a COVID-19 vaccine. Concerns around serious illness, long-term effects, and insufficient vaccine testing were factors for not accepting a COVID-19 vaccine. Preferred communication methods included discussion with healthcare providers, with primary care providers identified as the most trusted information source. This study identified factors influencing the prioritized public's COVID-19 vaccine decision-making, including information preferences. These details can support future vaccination rollouts.

The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis

Background

Vaccination is one of the most successful public health interventions for the prevention of COVID-19. Toward the end of April 2021, UNICEF (United Nations International Children’s Emergency Fund), alongside other organizations, were promoting the hashtag #VaccinesWork.

Objective

The aim of this paper is to analyze the #VaccinesWork hashtag on Twitter in the context of the COVID-19 pandemic, analyzing the main messages shared and the organizations involved.

Methods

The data set used in this study consists of 11,085 tweets containing the #VaccinesWork hashtag from the 29th to the 30th of April 2021. The data set includes tweets that may not have the hashtag but were replies or mentions in those tweets. The data were retrieved using NodeXL, and the network graph was laid out using the Harel-Koren fast multiscale layout algorithm.

Results

The study found that organizations such as the World Health Organization, UNICEF, and Gavi were the key opinion leaders and had a big influence on the spread of information among users. Furthermore, the most shared URLs belonged to academic journals with a high impact factor. Provaccination users had other vaccination-promoting hashtags in common, not only in the COVID-19 scenario.

Conclusions

This study investigated the discussions surrounding the #VaccinesWork hashtag. Social media networks containing conspiracy theories tend to contain dubious accounts leading the discussions and are often linked to unverified information. This kind of analysis can be useful to detect the optimal moment for launching health campaigns on Twitter.

Stroke and TIA Survivors' Perceptions of the COVID-19 Vaccine and Influences on Its Uptake: Cross Sectional Survey

BACKGROUND

People who have experienced a stroke or transient ischaemic attack (TIA) have greater risks of complications from COVID-19. Therefore, vaccine uptake in this vulnerable population is important. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals' views on the vaccine.

OBJECTIVES

We aimed to explore perspectives of the COVID-19 vaccine and influences on its uptake from people who have experienced a stroke or TIA.

METHOD

A cross-sectional, electronic survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke/TIA in the UK/Ireland.

RESULTS

The survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine dose or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/377) had not been offered the vaccine despite being eligible. Some people expressed concerns around the safety of the vaccine (particularly risk of blood clots and stroke) and some were hesitant to have the second vaccine. Societal and personal benefits were motivations for vaccine uptake. There was uncertainty and lack of information about risk of COVID-19 related complications specifically for people who have experienced a stroke or TIA.

CONCLUSION

Despite high uptake of the first vaccine, some people with stroke and TIA have legitimate concerns and information needs that should be addressed. Our findings can be used to identify targets for behaviour change to improve vaccine uptake specific to stroke/TIA patients.

The influence of supply chain immunity perceptions on COVID-19 vaccine willingness in supply chain professionals

Purpose

This study examines the lack of confidence in the actions of the government and pharmaceutical companies during vaccine deployment. The authors introduce the concept of supply chain immunity. The authors test whether the perception of higher vaccine supply chain immunity leads to higher willingness to be vaccinated within the supply chain community.

Design/methodology/approach

The authors utilize factor analysis and item response theory methods to develop a scale for measuring supply chain immunity. The original and psychometrically sound scale is tested via a structural equation model (SEM). Factor analysis and SEM use survey responses from two samples of 125 supply chain executives.

Findings

SEM suggests that supply chain immunity perceptions are a strong predictor of overall supply chain confidence for COVID vaccines. Further, these perceptions, through supply chain confidence, indirectly impact individuals' self-reported willingness to personally accept a vaccine themselves.

Originality/value

This paper presents the concept of supply chain immunity perceptions that have not been used in the medical supply chain literature. This paper presents a first-of-a-kind scale for supply chain immunity perceptions utilizing nascent methods and demonstrates the constructs impact on vaccine program confidence and public willingness to participate.

Long-term Behavioral Changes During the COVID-19 Pandemic and Impact of Vaccination in Patients With Inflammatory Rheumatic Diseases

OBJECTIVE

To explore anxiety and self-isolation in patients with inflammatory rheumatic disease (IRD)15 months into the coronavirus disease 2019 (COVID-19) pandemic, including attitudes toward and effects of SARS-CoV-2 vaccination.

METHODS

A nationwide online survey was conducted at 3 timepoints: May 2020, November 2020, and May 2021. Patients with IRD followed in the Danish Rheumatology Quality Registry (DANBIO) were asked about the effects of the pandemic, including SARS-CoV-2 infection and their behavior, anxiety, and concerns. The May 2021 survey included attitudes toward SARS-CoV-2 and influenza vaccination. Characteristics associated with self-isolation in May 2021 were explored with adjusted logistic regression analyses that included patient characteristics and SARS-CoV-2 vaccination status.

RESULTS

Respondents to surveys 1, 2, and 3 included 12,789; 14,755; and 13,921 patients, respectively; 64% had rheumatoid arthritis and 63% were female. Anxiety and concerns were highest in May 2020 and decreased to stable levels in November 2020 and May 2021; 86%, 50%, and 52% of respondents reported self-isolation, respectively. In May 2021, 4% of respondents self-reported previous SARS-CoV-2 infection. The SARS-CoV-2 vaccine acceptance rate was 86%, and the proportion of patients vaccinated against influenza had increased from 50% in winter 2019-2020 to 64% in winter 2020-2021. The proportion of patients with anxiety appeared similar among those vaccinated and unvaccinated against SARS-CoV-2. In multivariable analyses, being unvaccinated, female gender, receiving biologic drugs, and poor quality of life were independently associated with self-isolation.

CONCLUSION

Levels of anxiety and self-isolation decreased after the initial lockdown period in patients with IRD. Half of the patients reported self-isolation in May 2021, a phase that included widespread reopening of society and large-scale vaccination. The lack of prepandemic data prevented a full understanding of the long-term effects of the pandemic on anxiety and self-isolation in patients with IRD.

Twitter-based crowdsourcing: What kind of measures can help to end the COVID-19 pandemic faster?

Background

Crowdsourcing is a low-cost, adaptable, and innovative method to collect ideas from numerous contributors with diverse backgrounds. Crowdsourcing from social media like Twitter can be used for generating ideas in a noticeably brief time based on contributions from globally distributed users. The world has been challenged by the COVID-19 pandemic in the last several years. Measures to combat the pandemic continue to evolve worldwide, and ideas and opinions on optimal counteraction strategies are of high interest.

Objective

This study aimed to validate the use of Twitter as a crowdsourcing platform in order to gain an understanding of public opinion on what measures can help to end the COVID-19 pandemic faster.

Methods

This cross-sectional study was conducted during the period from December 22, 2021, to February 4, 2022. Tweets were posted by accounts operated by the authors, asking “How to faster end the COVID-19 pandemic?” and encouraging the viewers to comment on measures that they perceive would be effective to achieve this goal. The ideas from the users' comments were collected and categorized into two major themes – personal and institutional measures. In the final stage of the campaign, a Twitter poll was conducted to get additional comments and to estimate which of the two groups of measures were perceived to be important amongst Twitter users.

Results

The crowdsourcing campaign generated seventeen suggested measures categorized into two major themes (personal and institutional) that received a total of 1,727 endorsements (supporting comments, retweets, and likes). The poll received a total of 325 votes with 58% of votes underscoring the importance of both personal and institutional measures, 20% favoring personal measures, 11% favoring institutional measures, and 11% of the votes given just out of curiosity to see the vote results.

Conclusions

Twitter was utilized successfully for crowdsourcing ideas on strategies how to end the COVID-19 pandemic faster. The results indicate that the Twitter community highly values the significance of both personal responsibility and institutional measures to counteract the pandemic. This study validates the use of Twitter as a primary tool that could be used for crowdsourcing ideas with healthcare significance.

Twitter Poll as a Medium for Questionnaire-Based Health Survey: An Experience of a Pilot Study on the Preference of Systems of Medicine for Various Health Conditions

Background

The easy accessibility of smartphones and internet connections enables people to stay virtually connected to communities via social media. However, social media is also being explored for health care education and dissemination of health-related information. Twitter (Twitter, Inc., San Francisco, California) is one of the popular social media used for spreading health-related information. Twitter enables users to create polls to get opinions from their users. The Twitter poll is a less-explored avenue for health surveys.

Objective

In this pilot study, we aimed to explore the feasibility of conducting a questionnaire-based health survey (on the preference of different systems of medicine for the treatment of various health problems) as a Twitter poll.

Methods

This observational study was conducted on Twitter for five consecutive days starting from May 31, 2021. We posted five Twitter polls, one poll each day, for five days in a #INPST unique Twitter campaign. Preferences on the use of modern medicine, traditional medicine, a combination of these two systems, and self-medication were collected on five health conditions. We collected the data from the landing poll page and Tweet Analytics (insight about the engagement of tweets provided free by Twitter). The Chi-square test, binomial test, and one-way Analysis of Variance were used to compare data, and Spearman's rank correlation coefficient was used to find a correlation between categorical variables.

Results

We had a mean 4358.6±590.3 poll reach with the engagement of 108.2±36.87 Twitter users and 67.6±28.06 votes. Most of the responses were received on the first day of posting the poll. The participation then gradually decreased. Modern medicine was the first choice for emergency medical care (85.1%, P <0.0001), treatment of cancer (43.6%, P <0.0001), and sexual disorder or transmitted diseases (48.9%, P <0.0001). Traditional medicine was the first choice (37.5%, P = 0.63) for the treatment of common illnesses, and a combination of modern and traditional medicine was the first choice (37.5%, P = 0.01) for the treatment of chronic diseases.

Conclusion

A medical survey with short questions with a maximum of four response options can be conducted on Twitter. Survey results can be obtained without any third-party analytic service. The response rate is highest on the first day and participation may decrease when multiple polls are posted within a Twitter campaign. Preference for systems of medicine found in this study can be used for designing large-scale surveys in the future.

Time-Series Associations between Public Interest in COVID-19 Variants and National Vaccination Rate: A Google Trends Analysis

The emergence of a constantly mutating novel virus has led to considerable public anxiety amid the COVID-19 pandemic. Information seeking is a common strategy to cope with pandemic anxiety. Using Google Trends analysis, this study investigated public interest in COVID-19 variants and its temporal associations with the disease-prevention measure of vaccination during the initial COVID-19 vaccine rollout period (13 December 2020 to 25 September 2021). Public interest was operationalized as the relative search volume of online queries of variant-related terms in the countries first affected by the Alpha, Beta, and Delta variants: the UK, South Africa, and India, respectively. The results show that public interest in COVID-19 variants was greater during the Delta-variant-predominant period than before this period. The time-series cross-correlation analysis revealed positive temporal associations (i.e., greater such public interest was accompanied by an increase in national vaccination rate) tended to occur more frequently and at earlier time lags than the negative temporal associations. This study yielded new findings regarding the temporal changes in public interest in COVID-19 variants, and the between-country variations in these public interest changes can be explained by differences in the rate and pace of vaccination among the countries of interest.

The Roles of Health and e-Health Literacy, Conspiracy Beliefs and Political Sympathy in the Adherence to Preventive Measures Recommended during the Pandemic

Adherence to preventive measures is of the utmost importance for limiting the spreading of the coronavirus. Many predictors of adopting preventive behaviors have been analyzed in different countries during the COVID-19 pandemic. Objectives: The study’s main aim was to assess the roles of health (HL) and e-health literacy (eHL), conspiracy beliefs, political sympathy, and religious practices in the adherence to COVID-19 preventive measures after adjusting for sociodemographic factors. The analysis was based on the data obtained from a survey conducted among 2410 adult Internet users in Poland in October 2020. The survey was performed with a computer-assisted web-based interviewing technique. Survey data were analyzed through uni- and multivariable linear regression models. The multivariable regression model revealed that after adjusting for sociodemographic variables, the preventive measures score (PMS) was significantly associated with HL (B = 0.04, p < 0.001), eHL (B = 0.03, p < 0.001) and the COVID-19-related conspiracy beliefs score (C19CBS) (B = −0.24, p < 0.001). There was also a significant statistical relationship between PMS and political sympathies and religious practices. HL and eHL are key factors eligible for modification through appropriate interventions and showing positive effects in compliance with preventive measures. Conspiracy beliefs, political sympathy and religious beliefs are independently associated with the adherence.

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.

The Effect of Fear of Infection and Sufficient Vaccine Reservation Information on Rapid COVID-19 Vaccination in Japan: Evidence From a Retrospective Twitter Analysis

BACKGROUND

The global public health and socioeconomic impacts of the COVID-19 pandemic have been substantial, rendering herd immunity by COVID-19 vaccination an important factor for protecting people and retrieving the economy. Among all the countries, Japan became one of the countries with the highest COVID-19 vaccination rates in several months, although vaccine confidence in Japan is the lowest worldwide.

OBJECTIVE

We attempted to find the reasons for rapid COVID-19 vaccination in Japan given its lowest vaccine confidence levels worldwide, through Twitter analysis.

METHODS

We downloaded COVID-19-related Japanese tweets from a large-scale public COVID-19 Twitter chatter data set within the timeline of February 1 and September 30, 2021. The daily number of vaccination cases was collected from the official website of the Prime Minister's Office of Japan. After preprocessing, we applied unigram and bigram token analysis and then calculated the cross-correlation and Pearson correlation coefficient (r) between the term frequency and daily vaccination cases. We then identified vaccine sentiments and emotions of tweets and used the topic modeling to look deeper into the dominant emotions.

RESULTS

We selected 190,697 vaccine-related tweets after filtering. Through n-gram token analysis, we discovered the top unigrams and bigrams over the whole period. In all the combinations of the top 6 unigrams, tweets with both keywords "reserve" and "venue" showed the largest correlation with daily vaccination cases (r=0.912; P<.001). On sentiment analysis, negative sentiment overwhelmed positive sentiment, and fear was the dominant emotion across the period. For the latent Dirichlet allocation model on tweets with fear emotion, the two topics were identified as "infect" and "vaccine confidence." The expectation of the number of tweets generated from topic "infect" was larger than that generated from topic "vaccine confidence."

CONCLUSIONS

Our work indicates that awareness of the danger of COVID-19 might increase the willingness to get vaccinated. With a sufficient vaccine supply, effective delivery of vaccine reservation information may be an important factor for people to get vaccinated. We did not find evidence for increased vaccine confidence in Japan during the period of our study. We recommend policy makers to share accurate and prompt information about the infectious diseases and vaccination and to make efforts on smoother delivery of vaccine reservation information.

Monitoring Mentions of COVID-19 Vaccine Side Effects from Japanese and Indonesian Twitter: Infodemiological Study (Preprint)

Background

The year 2021 was marked by vaccinations against COVID-19, which spurred wider discussion among the general population, with some in favor and some against vaccination. Twitter, a popular social media platform, was instrumental in providing information about the COVID-19 vaccine and has been effective in observing public reactions. We focused on tweets from Japan and Indonesia, 2 countries with a large Twitter-using population, where concerns about side effects were consistently stated as a strong reason for vaccine hesitancy.

Objective

This study aimed to investigate how Twitter was used to report vaccine-related side effects and to compare the mentions of these side effects from 2 messenger RNA (mRNA) vaccine types developed by Pfizer and Moderna, in Japan and Indonesia.

Methods

We obtained tweet data from Twitter using Japanese and Indonesian keywords related to COVID-19 vaccines and their side effects from January 1, 2021, to December 31, 2021. We then removed users with a high frequency of tweets and merged the tweets from multiple users as a single sentence to focus on user-level analysis, resulting in a total of 214,165 users (Japan) and 12,289 users (Indonesia). Then, we filtered the data to select tweets mentioning Pfizer or Moderna only and removed tweets mentioning both. We compared the side effect counts to the public reports released by Pfizer and Moderna. Afterward, logistic regression models were used to compare the side effects for the Pfizer and Moderna vaccines for each country.

Results

We observed some differences in the ratio of side effects between the public reports and tweets. Specifically, fever was mentioned much more frequently in tweets than would be expected based on the public reports. We also observed differences in side effects reported between Pfizer and Moderna vaccines from Japan and Indonesia, with more side effects reported for the Pfizer vaccine in Japanese tweets and more side effects with the Moderna vaccine reported in Indonesian tweets.

Conclusions

We note the possible consequences of vaccine side effect surveillance on Twitter and information dissemination, in that fever appears to be over-represented. This could be due to fever possibly having a higher severity or measurability, and further implications are discussed.

What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany

Background

Vaccination against COVID-19 has been available in Germany since December 2020. However, about 30% of the population report not wanting to be vaccinated. In order to increase the willingness of the population to get vaccinated, data on the acceptance of vaccination and its influencing factors are necessary. Little is known about why individuals refuse the COVID-19 vaccination. The aim of this study was to investigate the reasons leading to rejecting vaccination, based on posts from three social media sites.

Methods

The German-language versions of Instagram, Twitter and YouTube were searched regarding negative attitudes towards COVID-19 vaccination. Data was extracted until a saturation effect could be observed. The data included posts created from January 20, 2020 to May 2, 2021. This time frame roughly covers the period from the first reports of the spread of SARS-CoV-2 up to the general availability of vaccines against COVID-19 in Germany. We used an interpretive thematic approach to analyze the data and to inductively generate codes, subcategories and categories.

Results

Based on 333 posts written by 323 contributing users, we identified six main categories of reasons for refusing a COVID-19 vaccination: Low perceived benefit of vaccination, low perceived risk of contracting COVID-19, health concerns, lack of information, systemic mistrust and spiritual or religious reasons. The analysis reveals a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination.

Conclusions

The study emphasizes the relevance of providing trustworthy and quality-assured information on COVID-19 and COVID-19 vaccination to all population groups. In addition, vaccinations should be easily accessible in order to promote the population’s willingness to be vaccinated.

Construction of COVID-19 Epidemic Prevention and Control and Public Health Emergency Response System Based on Discrete Stochastic Mathematical Model

This research was aimed at exploring the construction and evaluation method of the comprehensive emergency response system for public health emergencies under the COVID-19 (coronavirus disease 2019) epidemic situation based on discrete stochastic mathematical model. The response of the Centers for Disease Control and Prevention (CDCP) of Taiyuan city in the COVID-19 epidemic situation was taken as an example. A new discrete stochastic COVID-19 epidemic spread mathematical model which integrated public health intervention and input cases was proposed. The model was parameterized by multisource data, and the impact of different flow patterns on the risk of secondary outbreak was analyzed. The advantages and disadvantages of its emergency system construction were analyzed. Additionally, the improvement measures and suggestions for the existing problems were proposed. Results suggested that there was only one specialized disease prevention and control institution in Taiyuan, and there were only 11 centers for disease prevention and control, accounting for 6.2% (11/177) of the total in Shanxi Province. Through the analysis, it was found that the current public health emergency response system in Taiyuan city had imperfect management coordination mechanism, incomplete plan type, serious shortage of public health personnel, poor information communication efficiency, insufficient early warning efficiency of the epidemic detection system, and weak logistics material security links. Therefore, it was proposed to establish a sound coordination system of emergency health management and vigorously promote the construction of emergency health management institutions. Thus, a public health emergency management system integrating management coordination system, plan system, emergency team building system, material reserve management, and other functions was formed. The application of discrete stochastic mathematical model suggests that intermittent population flow and effective isolation of infected people in transient population can effectively reduce the risk of secondary outbreak. The system analysis here also provides theoretical basis for improving the construction of public health emergency response system in Taiyuan.

Systematic review on the association of COVID-19-related conspiracy belief with infection-preventive behavior and vaccination willingness

BACKGROUND

In times of a pandemic, not only infections but also conspiracy narratives spread among people. These have the potential to influence the course of the pandemic. Here we summarize and critically evaluate studies from the first year of the pandemic presenting findings on the association between COVID-19-related conspiracy belief and infection-preventive behavior and vaccination willingness.

METHOD

A systematic literature search was conducted using the databases COVID-19 Data Portal, APA PsycArticles, Psychology and Behavioral Sciences, Scopus, and PubMed. After removing duplicates, studies meeting the previously defined inclusion and exclusion criteria were subjected to title and abstract screening and content reviewed and analyzed subsequently.

RESULTS AND CONCLUSION

The systematic literature search yielded 17 studies meeting our pre-specified inclusion criteria. Twelve studies examined infection-preventive behavior (N = 16,485), and ten studies vaccination willingness (N = 20,210). In summary, belief in COVID-19-related conspiracy narratives was negatively associated with vaccination willingness and infection-preventive behavior. The results point to the importance of the content of the conspiracy narratives. Various explanatory approaches and possible moderator variables are discussed, referencing the state of research on conspiracy beliefs and health-related preventive behavior after the first year of the pandemic. We argue that future studies should strive for a consistent operationalization and use of the term conspiracy belief.

Acceptance and Factors Influencing Acceptance of COVID-19 Vaccine in a Romanian Population

COVID-19 vaccination has been recognized as one of the most effective ways to overcome the current SARS-CoV-2 pandemic. However, the success of this effort relies on national vaccination programmes. In May 2021, we surveyed 1552 people from Romania to determine acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 39.2% of participants reported that they were vaccinated and 25.6% desired vaccination; nonetheless, 29.5% expressed opposition to vaccination. Concerning vaccination refusal, the top justification given by respondents is that the vaccine is insufficiently safe and there is a risk of serious side effects (84.4%). A higher rate of vaccination refusal was observed among female gender, younger age, and lower educational level. Refusal was also associated with unemployment, being in a relationship, and having a decrease in income during the pandemic. People who are constantly informed by specialized medical staff have a statistically significant higher vaccination rate, while people who choose to get information from friends, family, and co-workers have the strongest intention of avoiding the vaccine. Current levels of vaccine are insufficient to achieve herd immunity of 67%. It is mandatory to understand the aspects that define and establish confidence and to craft nationwide interventions appropriately.

Assessment of Attitudes, Main Concerns and Sources of Knowledge Regarding COVID-19 Vaccination in Poland in the Unvaccinated Individuals-A Nationwide Survey

Vaccination is the most effective tool to combat the COVID-19 pandemic. However, it is ineffective without appropriate public acceptance. In Poland, 53% of the country's population is vaccinated, which puts us in the last position among the EU countries. Therefore, this study aims to assess the main concerns regarding vaccination in the unvaccinated population of Poland. The study was based on an original questionnaire that was distributed online. There were three phases of the study: Phase 1-before the preventive vaccination plan, Phase 2-2 months after implementation of the programme, Phase 3-after 4 months when the immunisation rate in Poland was 42%. A total of 4459 individuals participated in the study. As many as 1943 participants were excluded from the analysis due to lack of consent (30 subjects) or COVID-19 vaccination (1913 subjects). Out of the remaining 2516 unvaccinated individuals, 463 were participants in the first phase of the study, 1137 in the second phase of the study, and 916 in the third phase. As the preventive vaccination plan in Poland continued, concerns about vaccine adverse events, safety and efficacy were raised. The only lower concern was that about the vaccine transportation rules. Moreover, as the vaccination programme continued, there was an increase in the percentage of individuals declaring their full reluctance towards vaccination against COVID-19. Conclusions: The Internet is the main source of knowledge about the COVID-19 vaccination, so it should be focused on during vaccination campaigns. The public is primarily concerned about adverse events of vaccines and the lack of appropriate tests of the products used. Therefore, it is advisable to popularise the current state of knowledge and promote reliable information concerning the COVID-19 vaccination.

Tracking Public Attitudes toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-based Sentiment Analysis

Background

The development and approval of COVID-19 vaccines have generated optimism for the end of the COVID-19 pandemic and a return to normalcy. However, vaccine hesitancy, often fueled by misinformation, poses a major barrier to achieving herd immunity.

Objective

We aim to investigate Twitter users’ attitudes toward COVID-19 vaccination in Canada after vaccine rollout.

Methods

We applied a weakly supervised aspect-based sentiment analysis (ABSA) technique, which involves the human-in-the-loop system, on COVID-19 vaccination–related tweets in Canada. Automatically generated aspect and opinion terms were manually corrected by public health experts to ensure the accuracy of the terms and make them more domain-specific. Then, based on these manually corrected terms, the system inferred sentiments toward the aspects. We observed sentiments toward key aspects related to COVID-19 vaccination, and investigated how sentiments toward “vaccination” changed over time. In addition, we analyzed the most retweeted or liked tweets by observing most frequent nouns and sentiments toward key aspects.

Results

After applying the ABSA system, we obtained 170 aspect terms (eg, “immunity” and “pfizer”) and 6775 opinion terms (eg, “trustworthy” for the positive sentiment and “jeopardize” for the negative sentiment). While manually verifying or editing these terms, our public health experts selected 20 key aspects related to COVID-19 vaccination for analysis. The sentiment analysis results for the 20 key aspects revealed negative sentiments related to “vaccine distribution,” “side effects,” “allergy,” “reactions,” and “anti-vaxxer,” and positive sentiments related to “vaccine campaign,” “vaccine candidates,” and “immune response.” These results indicate that the Twitter users express concerns about the safety of vaccines but still consider vaccines as the option to end the pandemic. In addition, compared to the sentiment of the remaining tweets, the most retweeted or liked tweets showed more positive sentiment overall toward key aspects (P<.001), especially vaccines (P<.001) and vaccination (P=.009). Further investigation of the most retweeted or liked tweets revealed two opposing trends in Twitter users who showed negative sentiments toward vaccines: the “anti-vaxxer” population that used negative sentiments as a means to discourage vaccination and the “Covid Zero” population that used negative sentiments to encourage vaccinations while critiquing the public health response.

Conclusions

Our study examined public sentiments toward COVID-19 vaccination on tweets over an extended period in Canada. Our findings could inform public health agencies to design and implement interventions to promote vaccination.

Determinants of COVID-19 Vaccine Acceptance and Hesitancy: A Health Care Student-Based Online Survey in Northwest China

Background: With the spread of COVID-19 around the world, herd immunity through vaccination became a key measure to control the pandemic, but high uptake of vaccine is not guaranteed. Moreover, the actual acceptance of COVID-19 vaccination and associated factors remain uncertain among health care students in Northwest China. Methods: A cross-sectional survey of a sample of 631 health care students was performed using a questionnaire developed through Wen Juan Xing survey platform to collect information regarding their attitudes, beliefs, and acceptance of COVID-19 vaccination. Binary logistic regression analyses were performed to identify the association between vaccination willingness and demographics, attitudes, and beliefs to determine the factors that actually effect acceptance and hesitancy of COVID-19 vaccine among health care students. Results: Overall, 491 (77.81%) students actually received the COVID-19 vaccine, and of the 140 unvaccinated, 69 were hesitant and 71 rejected. Binary logistic regression analysis showed that the actually vaccinated individuals were those who mostly believed in the effectiveness of the COVID-19 vaccine (OR = 2.94, 95%CI: 1.37, 6.29), those who mostly felt it is their responsibility to receive the vaccine to protect others from infection (OR = 2.75, 95%CI: 1.45, 5.23), with less previous experience about other vaccines (OR = 1.70, 95%CI: 1.06, 2.72), students who mostly thought COVID-19 to be very severe (OR = 1.77, 95%CI: 1.07, 2.93), and students who mostly thought the COVID-19 vaccine was one of the best protection measures (OR = 1.68, 95%CI: 1.03, 2.76). Concerns about side effects of vaccines (OR = 0.30, 95%CI: 0.18, 0.51) and the use of personal protective behavior as an alternative to the COVID-19 vaccination (OR = 0.16, 95%CI: 0.06, 0.39) hindered the vaccine acceptance. Conclusions: Our study showed higher COVID-19 vaccine acceptance among healthcare students. However, the individuals with vaccine hesitancy and rejection were still worrying. Vaccine safety and effectiveness issues continue to be a major factor affecting students' acceptance. To expand vaccine coverage in response to the COVID-19 pandemic, appropriate vaccination strategies and immunization programs are essential, especially for those with negative attitudes and beliefs.

Examining Public Sentiments and Attitudes Toward COVID-19 Vaccination: Infoveillance Study Using Twitter Posts

Background

A global rollout of vaccinations is currently underway to mitigate and protect people from the COVID-19 pandemic. Several individuals have been using social media platforms such as Twitter as an outlet to express their feelings, concerns, and opinions about COVID-19 vaccines and vaccination programs. This study examined COVID-19 vaccine–related tweets from January 1, 2020, to April 30, 2021, to uncover the topics, themes, and variations in sentiments of public Twitter users.

Objective

The aim of this study was to examine key themes and topics from COVID-19 vaccine–related English tweets posted by individuals, and to explore the trends and variations in public opinions and sentiments.

Methods

We gathered and assessed a corpus of 2.94 million COVID-19 vaccine–related tweets made by 1.2 million individuals. We used CoreX topic modeling to explore the themes and topics underlying the tweets, and used VADER sentiment analysis to compute sentiment scores and examine weekly trends. We also performed qualitative content analysis of the top three topics pertaining to COVID-19 vaccination.

Results

Topic modeling yielded 16 topics that were grouped into 6 broader themes underlying the COVID-19 vaccination tweets. The most tweeted topic about COVID-19 vaccination was related to vaccination policy, specifically whether vaccines needed to be mandated or optional (13.94%), followed by vaccine hesitancy (12.63%) and postvaccination symptoms and effects (10.44%) Average compound sentiment scores were negative throughout the 16 weeks for the topics postvaccination symptoms and side effects and hoax/conspiracy. However, consistent positive sentiment scores were observed for the topics vaccination disclosure, vaccine efficacy, clinical trials and approvals, affordability, regulation, distribution and shortage, travel, appointment and scheduling, vaccination sites, advocacy, opinion leaders and endorsement, and gratitude toward health care workers. Reversal in sentiment scores in a few weeks was observed for the topics vaccination eligibility and hesitancy.

Conclusions

Identification of dominant themes, topics, sentiments, and changing trends about COVID-19 vaccination can aid governments and health care agencies to frame appropriate vaccination programs, policies, and rollouts.

Online Public Attention of COVID-19 Vaccination in Mainland China

With the approval of the vaccine in mainland China, concerns over its safety and efficacy emerged. Since the Chinese vaccine has been promoted by the Chinese government for months and got emergency approval from the World Health Organization. The Chinese vaccination program is yet to be identified from the perspective of local populations. The COVID-19 vaccine-related keywords for the period from January 2019 to April 2021 were examined and queried from the Baidu search index. The searching popularity, searching trend, demographic distributions and users’ demand were analyzed. The first vaccine enquiry emerged on 25th January 2020, and 17 vaccination keywords were retrieved and with a total BSI value of 13,708,853. The average monthly searching trend growth is 21.05% (p < 0.05) and was led by people aged 20–29 (39.22%) years old. Over 54.93% of the demand term search were pandemic relevant, and the summed vaccine demand ratio was 44.79%. With the rising search population in COVID-19 vaccination, education programs and materials should be designed for teens and people above the 40 s. Also, vaccine-related birth safety should be alerted and further investigated.

Does the COVID-19 Vaccine Still Work That "Most of the Confirmed Cases Had Been Vaccinated"? A Content Analysis of Vaccine Effectiveness Discussion on Sina Weibo during the Outbreak of COVID-19 in Nanjing

In July 2021, breakthrough cases were reported in the outbreak of COVID-19 in Nanjing, sparking concern and discussion about the vaccine's effectiveness and becoming a trending topic on Sina Weibo. In order to explore public attitudes towards the COVID-19 vaccine and their emotional orientations, we collected 1542 posts under the trending topic through data mining. We set up four categories of attitudes towards COVID-19 vaccines, and used a big data analysis tool to code and manually checked the coding results to complete the content analysis. The results showed that 45.14% of the Weibo posts (n = 1542) supported the COVID-19 vaccine, 12.97% were neutral, and 7.26% were doubtful, which indicated that the public did not question the vaccine's effectiveness due to the breakthrough cases in Nanjing. There were 66.47% posts that reflected significant negative emotions. Among these, 50.44% of posts with negative emotions were directed towards the media, 25.07% towards the posting users, and 11.51% towards the public, which indicated that the negative emotions were not directed towards the COVID-19 vaccine. External sources outside the vaccine might cause vaccine hesitancy. Public opinions expressed in online media reflect the public's cognition and attitude towards vaccines and their core needs in terms of information. Therefore, online public opinion monitoring could be an essential way to understand the opinions and attitudes towards public health issues.

Mandatory vaccination against COVID-19: A Twitter poll analysis on public health opinion (Preprint)

Background

On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19.

Objective

The purpose of this study was to better understand the public’s perception of mandatory COVID-19 vaccination in real time using Twitter polls.

Methods

Two Twitter polls were developed (in the English language) to seek the public’s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform’s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience.

Results

Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ.

Conclusions

Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the “echo chamber effect,” the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity.

Expectations, concerns and experiences of rehabilitation patients during the COVID-19 pandemic in Germany: a qualitative analysis of online forum posts

Background

The COVID-19 pandemic, as well as efforts to prevent its spread, have had a strong impact on the delivery of rehabilitative services in Germany. While several studies have addressed the impact of these developments on health service providers and COVID-19 patients, little is known about its impact on patients in need of rehabilitative treatment because of other conditions. This study aims to identify expectations, concerns and experiences of rehabilitation patients related to service delivery in this situation.

Methods

Using a qualitative study design, user posts from six German online forums between March and Mid-November 2020 were systematically searched with respect to experiences, concerns and expectations of health care users toward receiving rehabilitative treatment. We used qualitative content analysis with inductive coding as our methodological approach.

Results

Users fearing physical or psychological impairment were concerned about not receiving timely or effective treatment due to closed hospitals, reduced treatments and limited admissions. In contrast, patients more concerned about getting infected with COVID-19 worried about the effectiveness of protective measures and being denied postponement of treatment by the funding bodies. During their stay, some patients reported feeling isolated due to contact restrictions and did not feel their treatment was effective, while others reported being satisfied and praised hospitals for their efforts to ensure the safety of the patients. Many patients reported communication problems before and during their treatment, including concerns about the safety and effectiveness of their treatment, as well as financial concerns and worries about future treatments. Several users felt that their concerns were disregarded by the hospitals and the funding bodies, leaving them feeling distressed, insecure and dissatisfied.

Conclusions

While some users report only minor concerns related to the pandemic and its impact on rehabilitation, others report strong concerns relating not only to their own health and safety, but also to financial aspects and their ability to work. Many users feel ignored and disregarded, showing a strong need for more coordinated strategies and improved communication specifically with funding bodies like health insurance companies and the German pension funds.

The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study

BACKGROUND

The ongoing COVID-19 pandemic has brought unprecedented challenges to every country worldwide. A call for global vaccination for COVID-19 plays a pivotal role in the fight against this virus. With the development of COVID-19 vaccines, public willingness to get vaccinated has become an important public health concern, considering the vaccine hesitancy observed worldwide. Social media is powerful in monitoring public attitudes and assess the dissemination, which would provide valuable information for policy makers.

OBJECTIVE

This study aimed to investigate the responses of vaccine positivity on social media when major public events (major outbreaks) or major adverse events related to vaccination (COVID-19 or other similar vaccines) were reported.

METHODS

A total of 340,783 vaccine-related posts were captured with the poster's information on Weibo, the largest social platform in China. After data cleaning, 156,223 posts were included in the subsequent analysis. Using pandas and SnowNLP Python libraries, posts were classified into 2 categories, positive and negative. After model training and sentiment analysis, the proportion of positive posts was computed to measure the public positivity toward the COVID-19 vaccine.

RESULTS

The positivity toward COVID-19 vaccines in China tends to fluctuate over time in the range of 45.7% to 77.0% and is intuitively correlated with public health events. In terms of gender, males were more positive (70.0% of the time) than females. In terms of region, when regional epidemics arose, not only the region with the epidemic and surrounding regions but also the whole country showed more positive attitudes to varying degrees. When the epidemic subsided temporarily, positivity decreased with varying degrees in each region.

CONCLUSIONS

In China, public positivity toward COVID-19 vaccines fluctuates over time and a regional epidemic or news on social media may cause significant variations in willingness to accept a vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. It is crucial for policy makers to adjust their policies through the use of positive incentives with prompt responses to pandemic-related news to promote vaccination acceptance.

Natural Products for the Management of Castration-Resistant Prostate Cancer: Special Focus on Nanoparticles Based Studies

Prostate cancer is the most common type of cancer among men and the second most frequent cause of cancer-related mortality around the world. The progression of advanced prostate cancer to castration-resistant prostate cancer (CRPC) plays a major role in disease-associated morbidity and mortality, posing a significant therapeutic challenge. Resistance has been associated with the activation of androgen receptors via several mechanisms, including alternative dehydroepiandrosterone biosynthetic pathways, other androgen receptor activator molecules, oncogenes, and carcinogenic signaling pathways. Tumor microenvironment plays a critical role not only in the cancer progression but also in the drug resistance. Numerous natural products have shown major potential against particular or multiple resistance pathways as shown by in vitro and in vivo studies. However, their efficacy in clinical trials has been undermined by their unfavorable pharmacological properties (hydrophobic molecules, instability, low pharmacokinetic profile, poor water solubility, and high excretion rate). Nanoparticle formulations can provide a way out of the stalemate, employing targeted drug delivery, improved pharmacokinetic drug profile, and transportation of diagnostic and therapeutic agents via otherwise impermeable biological barriers. This review compiles the available evidence regarding the use of natural products for the management of CRPC with a focus on nanoparticle formulations. PubMed and Google Scholar search engines were used for preclinical studies, while ClinicalTrials.gov and PubMed were searched for clinical studies. The results of our study suggest the efficacy of natural compounds such as curcumin, resveratrol, apigenin, quercetin, fisetin, luteolin, kaempferol, genistein, berberine, ursolic acid, eugenol, gingerol, and ellagic acid against several mechanisms leading to castration resistance in preclinical studies, but fail to set the disease under control in clinical studies. Nanoparticle formulations of curcumin and quercetin seem to increase their potential in clinical settings. Using nanoparticles based on betulinic acid, capsaicin, sintokamide A, niphatenones A and B, as well as atraric acid seems promising but needs to be verified with preclinical and clinical studies.

Public perception of COVID-19 vaccines from the digital footprints left on Twitter: analyzing positive, neutral and negative sentiments of Twitterati

Purpose

Twitter is gaining popularity as a microblogging and social networking service to discuss various social issues. Coronavirus disease 2019 (COVID-19) has become a global pandemic and is discussed worldwide. Social media is an instant platform to deliberate various dimensions of COVID-19. The purpose of the study is to explore and analyze the public sentiments related to COVID-19 vaccines across the Twitter messages (positive, neutral, and negative) and the impact tweets make across digital social circles.

Design/methodology/approach

To fetch the vaccine-related posts, a manual examination of randomly selected 500 tweets was carried out to identify the popular hashtags relevant to the vaccine conversation. It was found that the hashtags “covid19vaccine” and “coronavirusvaccine” were the two popular hashtags used to discuss the communications related to COVID-19 vaccines. 23,575 global tweets available in public domain were retrieved through “Twitter Application Programming Interface” (API), using “Orange Software”, an open-source machine learning, data visualization and data mining toolkit. The study was confined to the tweets posted in English language only. The default data cleaning and preprocessing techniques available in the “Orange Software” were applied to the dataset, which include “transformation”, “tokenization” and “filtering”. The “Valence Aware Dictionary for sEntiment Reasoning” (VADER) tool was used for classification of tweets to determine the tweet sentiments (positive, neutral and negative) as well as the degree of sentiments (compound score also known as sentiment score). To assess the influence/impact of tweets account wise (verified and unverified) and sentiment wise (positive, neutral, and negative), the retweets and likes, which offer a sort of reward or acknowledgment of tweets, were used.

Findings

A gradual decline in the number of tweets over the time is observed. Majority (11,205; 47.52%) of tweets express positive sentiments, followed by neutral (7,948; 33.71%) and negative sentiments (4,422; 18.75%), respectively. The study also signifies a substantial difference between the impact of tweets tweeted by verified and unverified users. The tweets related to verified users have a higher impact both in terms of retweets (65.91%) and likes (84.62%) compared to the tweets tweeted by unverified users. Tweets expressing positive sentiments have the highest impact both in terms of likes (mean = 10.48) and retweets (mean = 3.07) compared to those that express neutral or negative sentiments.

Research limitations/implications

The main limitation of the study is that the sentiments of the people expressed over one single social platform, that is, Twitter have been studied which cannot generalize the global public perceptions. There can be a variation in the results when the datasets from other social media platforms will be studied.

Practical implications

The study will help to know the people's sentiments and beliefs toward the COVID-19 vaccines. Sentiments that people hold about the COVID-19 vaccines are studied, which will help health policymakers understand the polarity (positive, negative, and neutral) of the tweets and thus see the public reaction and reflect the types of information people are exposed to about vaccines. The study can aid the health sectors to intensify positive messages and eliminate negative messages for an enhanced vaccination uptake. The research can also help design more operative vaccine-advocating communication by customizing messages using the obtained knowledge from the sentiments and opinions about the vaccines.

Originality/value

The paper focuses on an essential aspect of COVID-19 vaccines and how people express themselves (positively, neutrally and negatively) on Twitter.

Vaccination intentions generate racial disparities in the societal persistence of COVID-19

We combined survey, mobility, and infections data in greater Boston, MA to simulate the effects of racial disparities in the inclination to become vaccinated on continued infection rates and the attainment of herd immunity. The simulation projected marked inequities, with communities of color experiencing infection rates 3 times higher than predominantly White communities and reaching herd immunity 45 days later on average. Persuasion of individuals uncertain about vaccination was crucial to preventing the worst inequities but could only narrow them so far because 1/5th of Black and Latinx individuals said that they would never vaccinate. The results point to a need for well-crafted, compassionate messaging that reaches out to those most resistant to the vaccine.

Attitudes and Intentions toward COVID-19 Vaccination among Spanish Adults: A Descriptive Cross-Sectional Study

Vaccination against SARS-CoV-2 is postulated as the most effective measure to control the COVID-19 pandemic. However, the use of other protection measures is necessary to efficiently combat the spread of the virus. The aim of the present study was to determine the attitudes and intentions toward COVID-19 vaccination among non-regular social media users in Spain and to analyze how these factors could condition the acceptance of other personal protective measures once an individual has received the COVID-19 vaccine. A cross-sectional design was used in this work. In total, 719 subjects, ≥18 years old and of both sexes, were recruited from primary public healthcare centers to self-complete a questionnaire between March and April 2021. The majority of participants had a positive attitude toward vaccination and showed high levels of intention to be vaccinated. Likewise, except those participants who considered the vaccine to be the most effective measure to fight the COVID-19 pandemic, the rest of the participants highlighted the importance of continuing to limit social interactions and/or wearing masks even after being vaccinated. Since vaccination can create a perception of total immunity against SARS-CoV-2, it is necessary that healthcare staff organize effective awareness campaigns on the importance of maintaining personal protective measures until vaccination coverage is greater.

Prevalence of complementary and alternative medicine despite limited perceived efficacy in patients with rheumatic diseases in Mexico: Cross-sectional study

INTRODUCTION

Complementary and alternative medicine (CAM) is frequently used by patients with rheumatic diseases (RD) to improve their symptoms; however, its diversity and availability have increased notably while scientific support for its effectiveness and adverse effects is still scarce.

OBJECTIVE

To describe the prevalence and diversity of CAM in patients with RD in Chihuahua, Mexico.

METHODS

A cross-sectional study was conducted in 500 patients with RD who were interviewed about the use of CAM to treat their disease. The interview included sociodemographic aspects, characteristics of the disease, as well as a description of CAM use, including type, frequency of use, perception of the benefit, communication with the rheumatologist, among others.

RESULTS

The prevalence of CAM use was reported by 59.2% of patients, which informed a total of 155 different therapies. The herbal CAM group was the most used (31.4%) and included more than 50 different therapies. The use of menthol-based and arnica ointments was highly prevalent (35%). Most patients (62.3%) reported very little or no improvement in their symptoms. Only a fourth of the patients informed the rheumatologist of the use of CAM. The use of CAM was influenced by female sex, university degree, diagnosis delay, lack adherence to the rheumatologist's treatment, family history of RD, and orthopedic devices.

CONCLUSION

The use of CAM in our population is highly prevalent and similar to reports in different populations suggesting a widespread use in many different societies. We found high use of herbal remedies; however, there were many different types suggesting a lack of significant effect. Patients continue using CAM despite a perception of no-effectiveness. Recurrent use of CAM is explained by factors other than its efficacy.

COVID-19 Vaccine and Social Media in the U.S.: Exploring Emotions and Discussions on Twitter

The understanding of the public response to COVID-19 vaccines is the key success factor to control the COVID-19 pandemic. To understand the public response, there is a need to explore public opinion. Traditional surveys are expensive and time-consuming, address limited health topics, and obtain small-scale data. Twitter can provide a great opportunity to understand public opinion regarding COVID-19 vaccines. The current study proposes an approach using computational and human coding methods to collect and analyze a large number of tweets to provide a wider perspective on the COVID-19 vaccine. This study identifies the sentiment of tweets using a machine learning rule-based approach, discovers major topics, explores temporal trend and compares topics of negative and non-negative tweets using statistical tests, and discloses top topics of tweets having negative and non-negative sentiment. Our findings show that the negative sentiment regarding the COVID-19 vaccine had a decreasing trend between November 2020 and February 2021. We found Twitter users have discussed a wide range of topics from vaccination sites to the 2020 U.S. election between November 2020 and February 2021. The findings show that there was a significant difference between tweets having negative and non-negative sentiment regarding the weight of most topics. Our results also indicate that the negative and non-negative tweets had different topic priorities and focuses. This research illustrates that Twitter data can be used to explore public opinion regarding the COVID-19 vaccine.

Preparedness of current and future Saudi Pediatricians to face vaccine hesitancy: Cross-sectional study within the capital city of Saudi Arabia, Riyadh

BACKGROUND

Vaccines have helped in eradicating many communicable diseases. They are considered major players in preserving children's health. However, concerns about vaccines' ingredients and safety became hot topics globally. With doubt, some parents became hesitant to vaccinate their children. A recent study documented high prevalence of vaccine hesitancy among Saudi parents.

OBJECTIVES

This study aims to explore preparedness of current and future pediatricians to face vaccine hesitancy, a growing public health issue in Saudi Arabia.

METHODS

This study adopted non-interventional cross-sectional online questionnaire specifically designed to encompass general vaccine hesitancy related questions including Covid-19's vaccines.

RESULTS

The study recruited 119 participants form three main tertiary centers in Riyadh. Trainees were the majority with pediatric consultants representing 22%. Females were more than half of total participants (53%). Although familiarity with the term "vaccine hesitancy" was common, it was affected by training level. Among participants, 66% heard about it from social media. Furthermore, only 32% received designated training. Knowledge was suboptimal among all levels except for those who received formal training. Despite 80% encountered vaccine hesitancy, only 55% consider it a common public health issue. Attitude toward vaccine hesitant parents was negative among male physicians (odds ratio of 2.3, P value 0.045). Additionally, majority consider it a form of child neglect (95%). In regard to COVID19's vaccine, 31% were reluctant to get vaccinated themselves.

CONCLUSION

Pediatric workforce in Saudi Arabia commonly encounters vaccine hesitancy. The strong stand against vaccine hesitant parents might affect rapport with families. Sub-optimal knowledge, negative attitude and emerging COVID19 vaccine hesitancy might negatively impact future efforts. Tailored training and innovative educational platforms are essentials to address vaccine hesitancy in Saudi Arabia.

Public Perceptions of COVID-19 Vaccines: Policy Implications from US Spatiotemporal Sentiment Analytics

There is a compelling and pressing need to better understand the temporal dynamics of public sentiment towards COVID-19 vaccines in the US on a national and state-wise level for facilitating appropriate public policy applications. Our analysis of social media data from early February and late March 2021 shows that, despite the overall strength of positive sentiment and despite the increasing numbers of Americans being fully vaccinated, negative sentiment towards COVID-19 vaccines still persists among segments of people who are hesitant towards the vaccine. In this study, we perform sentiment analytics on vaccine tweets, monitor changes in public sentiment over time, contrast vaccination sentiment scores with actual vaccination data from the US CDC and the Household Pulse Survey (HPS), explore the influence of maturity of Twitter user-accounts and generate geographic mapping of tweet sentiments. We observe that fear sentiment remained unchanged in populous states, whereas trust sentiment declined slightly in these same states. Changes in sentiments were more notable among less populous states in the central sections of the US. Furthermore, we leverage the emotion polarity based Public Sentiment Scenarios (PSS) framework, which was developed for COVID-19 sentiment analytics, to systematically posit implications for public policy processes with the aim of improving the positioning, messaging, and administration of vaccines. These insights are expected to contribute to policies that can expedite the vaccination program and move the nation closer to the cherished herd immunity goal.

Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach

BACKGROUND

COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines.

OBJECTIVE

This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context.

METHODS

We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups.

RESULTS

Laypeople are more prevailing in the COVID-19 vaccine-related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the "safety of Chinese-made vaccine" topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference.

CONCLUSIONS

Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as "qualitatively different" in perspective rather than "quantitatively different" in scientific knowledge. Among those questions closely associated with medical expertise, the "qualitatively different" characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively.

Role of Information Technology in COVID-19 Vaccination Drive: An Analysis of the COVID-19 Global Beliefs, Behaviors, and Norms Survey

With the onset of the COVID-19 pandemic, information technology has played a critical role in healthcare. A broad spectrum of information technology tools and applications played an essential role to create awareness of the COVID-19 vaccination drive and its health benefits. Research conducted by Massachusetts Institute of Technology (MIT) in collaboration with information technology platforms like Facebook with inputs from World Health Organization (WHO), John Hopkins University (JHU), and Global Outbreak Alert and Response Network (GOARN) shows that 65.06% of people all over the globe are willing to get vaccinated. Vaccine acceptance depends upon social norms and human behavior. These organizations conducted the global survey in over 60 countries with a sample size of 437,236 responses. The international survey was organized using a pre-registered randomized experiment demonstrating the role of technology in reaching out to people based in diverse communities and evaluating their beliefs, behavior, and social norms. The study shows that vaccine acceptance can vary due to descriptive norms. All the respondents in the study were adults with access to the internet. Moreover, a large proportion of the population thinks that the COVID-19 pandemic is a viable threat to the community and preventive measures need to be taken including vaccination drives to eradicate the menace. The survey consisted of five blocks involving questions related to healthcare, demographics, vaccines, knowledge, and information exposure. Sampling and weighting were done using a pool of 3,000 respondents over two weeks, and weights were provided per respondent to represent the target population as a whole. It reduces the representation error and minimizes non-response biases.

Mapping of the Covid-19 Vaccine Uptake Determinants From Mining Twitter Data

Opinion polls on vaccine uptake clearly show that Covid-19 vaccine hesitancy is increasing worldwide. Thus, reaching herd immunity not only depends on the efficacy of the vaccine itself, but also on overcoming this hesitancy of uptake in the population. In this study, we revealed the determinants regarding vaccination directly from people's opinions on Twitter, based on the framework of the 6As taxonomy. Covid-19 vaccine acceptance depends mostly on the characteristics of new vaccines (i.e. their safety, side effects, effectiveness, etc.), and the national vaccination strategy (i.e. immunization schedules, quantities of vaccination points and their localization, etc.), which should focus on increasing citizens' awareness, among various other factors. The results of this study point to areas for potentially improving mass campaigns of Covid-19 immunization to increase vaccine uptake and its coverage and also provide insight into possible directions of future research.

The Impact of Social Media on the Acceptance of the COVID-19 Vaccine: A Cross-Sectional Study from Saudi Arabia

INTRODUCTION

Social media platforms are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination.

PURPOSE

The objective of this study is to understand the influence of social media on the attitudes and willingness of the general public of the Aseer region of Saudi Arabia to receive COVID-19 vaccination.

MATERIALS AND METHODS

A cross-sectional self-administrated online survey was conducted in Saudi Arabia Aseer region, where 613 persons willingly took part in the survey in April and May 2021. Residents of Aseer in Saudi Arabia, who are over the age of 18 (eligible for COVID-19 vaccination) and willing to participate in the survey, were included in the study.

RESULTS

Overall, 74.6% agreed that the COVID-19 vaccine was misrepresented via social media. However, 37% of those respondents strongly agreed that social media had increased their willingness to get the COVID-19 vaccine. In addition, employees reported (21.8%) or strongly agreed (28%) that the quantity and quality of information on social media has a detrimental impact on their psychological well-being. Additionally, participants also agreed (21.8%) or strongly agreed (28%) that social media had a negative effect on their psychological condition.

CONCLUSION

The study provides that there was a high degree of awareness indicated among Aseer population regarding misleading information about COVID-19 vaccination via social media. Thus, social media that can share up-to-date scientific information about vaccination must be utilized optimally by the government to assist people in making decisions about accepting vaccinations.