What Determines Vaccine Hesitancy: Recommendations from Childhood Vaccine Hesitancy to Address COVID-19 Vaccine Hesitancy

Conflicting and complementary notions of responsibility in caregiver's and health care workers' vaccination narratives in the Philippines

Background

Vaccine hesitancy (VH) continues to pose a public health threat globally. Understanding the attitudes and perceptions about vaccination of key stakeholders in vaccine decision-making (such as health care workers (HCWs) and caregivers) about vaccination can pave the way toward novel approaches to bolster vaccine confidence. In this study, we explored the role of notions of responsibilities among HCWs and caregivers in shaping vaccination interactions and decision-making in the Philippines.

Methods

We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with 44 vaccine-hesitant caregivers, seven HCWs, and 20 community health workers (barangay health workers) in the Philippines between August 2020 and March 2021. The interviews and focus groups were conducted online, transcribed verbatim, and analysed through the reflexive thematic analysis approach.

Results

Caregivers highlighted responsibility in terms of being a good caregiver, managing risk to one's own child, and seeking and validating information. Meanwhile, HCWs highlighted responsibility as: being a good HCW, managing risk to children and to the community, and providing and transforming information. Our findings suggest that responsibility manifests differently in HCWs' and caregivers' narratives, and that these notions can be both conflicting and complementary, shaping the interaction between stakeholders and, ultimately, their vaccine decision-making. We also found that fostering a good relationship between HCWs and caregivers through communication techniques such as motivational interviewing could help bridge the gap created by mistrust in vaccinations. HCWs sharing their own experiences as parents who vaccinate their own children also resonate with caregivers.

Conclusions

Notions of responsibility can underpin collaborative and divisive interactions between HCWs and caregivers. Public health messaging and interventions related to vaccination must consider strategies that align with these notions to address VH.

Factors Influencing the Healthcare Workers' Willingness to Receive the COVID-19 Booster Dose in Tuscany (Italy)

BACKGROUND

The World Health Organization has defined vaccine hesitancy as behavior influenced by several factors, including trust in the vaccine itself or its provider or the perceived need for vaccination. The aim of this study was to investigate the factors influencing the willingness to receive the COVID-19 vaccine among the employees and healthcare professionals of the Central Tuscany Local Health Authority (CT-LHA) in Italy.

METHODS

From July to October 2022, a cross-sectional study was conducted. An online questionnaire was administered to 7000 employees of the CT-LHA. The questionnaire analyzed the factors that influenced receiving the booster dose of the COVID-19 vaccine. The sample was stratified by gender, age, type of occupation (healthcare or non-healthcare workers), and seniority. Incomplete questionnaires were excluded. A chi-squared test was performed through STATA. The significance level was set at 95%.

RESULTS

Of the questionnaires administered, 1885 (26.9%) questionnaires were eligible for the study. In the previous vaccination campaign, the healthcare workers (HCWs) considered the vaccine used by CT-LHA as safe, in contrast to non-healthcare workers (N-HCWs), who considered it less secure (p < 0.05). The HCWs showed a higher propensity for vaccine safety to receive the booster dose than N-HCWs. N-HCWs appeared to be less affected by an updated booster dose than HCWs (p < 0.05).

CONCLUSIONS

The factors studied appear to influence HCWs differently from N-HCWs. Both HCWs and N-HCWs would choose an upgraded mRNA vaccine for the booster dose.

COVID-19 vaccine hesitancy worldwide and its associated factors: a systematic review and meta-analysis

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has taken a toll on humans, and the development of effective vaccines has been a promising tool to end the pandemic. However, for a vaccination program to be successful, a considerable proportion of the community must be vaccinated. Hence, public acceptance of coronavirus disease 2019 (COVID-19) vaccines has become the key to controlling the pandemic. Recent studies have shown vaccine hesitancy increasing over time. This systematic review aims to evaluate the COVID-19 vaccine hesitancy rate and related factors in different communities.

Method

A comprehensive search was performed in MEDLINE (via PubMed), Scopus, and Web of Science from January 1, 2019 to January 31, 2022. All relevant descriptive and observational studies (cross-sectional and longitudinal) on vaccine hesitancy and acceptance were included in this systematic review. In the meta-analysis, odds ratio (OR) was used to assess the effects of population characteristics on vaccine hesitancy, and event rate (acceptance rate) was the effect measure for overall acceptance. Publication bias was assessed using the funnel plot, Egger's test, and trim-and-fill methods.

Result

A total of 135 out of 6,417 studies were included after screening. A meta-analysis of 114 studies, including 849,911 participants, showed an overall acceptance rate of 63.1%. In addition, men, married individuals, educated people, those with a history of flu vaccination, those with higher income levels, those with comorbidities, and people living in urban areas were less hesitant.

Conclusion

Increasing public awareness of the importance of COVID-19 vaccines in overcoming the pandemic is crucial. Being men, living in an urban region, being married or educated, having a history of influenza vaccination, having a higher level of income status, and having a history of comorbidities are associated with higher COVID-19 vaccine acceptance.

Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal

Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral science to immunization programs in Nepal is nascent. Through the Behavioral Science Immunization Network, JSI, UNICEF Nepal, and Dhulikhel Hospital-Kathmandu University School of Medical Sciences established a Behavioral Science Center to engage a diverse group of stakeholders in increasing the capacity of practitioners to use behavioral science in immunization programming. As a result of the engagement during formative research, government stakeholders requested and applied tools from behavioral science to solve different immunization challenges. Of particular value was the use of the Journey to Health and Immunization framework, which helped stakeholders identify behavioral and social drivers of zero-dose communities in Kathmandu. Our experience in Nepal demonstrates that there is strong demand for approaches and tools from behavioral science to use in relation to immunization and that this type of engagement model is effective for generating demand for and strengthening capacity to use behavioral science approaches.

Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan

Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.

A Qualitative Analysis of Social-Ecological Factors Shaping Childhood Immunisation Hesitancy and Delay in the Eastern Province of Saudi Arabia

(1) Background: Immunisation is a crucial and effective method for preventing infectious diseases, with its success dependent on high immunisation rates to protect under-immunised individuals and promote herd immunity. This qualitative descriptive study is part of a larger explanatory sequential mixed method design that aims to explore factors influencing parents' decision making to complete childhood immunisation in the Eastern Province of Saudi Arabia, a country experiencing disparities in immunisation coverage across its population. (2) Methods: The sample consisted of a subset of participants from the initial quantitative phase, which included a survey on the immunisation attitudes of parents living in Qatif. This initial phase included n = 350 participants, who were over 18, had access to one of the 27 Primary Health Care (PHC) Centres in Qatif, and had a child under 24 months. This paper presents the qualitative-descriptive phase, which used a qualitative survey to gain open-ended responses from parents (n = 20) and analysed using thematic analysis. (3) Results: Participants identified certain vaccines, particularly MMR, as influencing their immunisation practices. Specific factors identified as deterring parents from immunising their children included fear of autism and other developmental delays, concerns about risks and side effects, mistrust in vaccine efficacy, and discouraging information from the media. Parents' immunisation decisions were evidently affected by policy compliance, family and friends, and social networking sites. These factors are explained through the socio-ecological model. Moreover, the COVID-19 pandemic influenced parents' decisions on vaccine completion in terms of perceived barriers, perceived benefits, and perceived trust. (4) Conclusions: By examining the social-ecological factors shaping parents' decisions to immunise their children in the Eastern Province of Saudi Arabia, this research contributes to the literature and informs the Saudi National Childhood Immunisation Programme about factors contributing to childhood immunisation hesitancy, helping to address a critical healthcare issue.

Parents' and Health Professionals' Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age-A Qualitative Thematic Analysis Embedded in a Randomized Trial

Declining levels and duration of passively acquired maternal antibodies prompted a Danish trial to test the feasibility of advancing administration of the first measles, mumps, and rubella vaccine (MMR1) from 15 to 6 months of age. A trial-embedded qualitative study aimed to understand parents' (N = 24) and health professionals' (N = 11) attitudes about the measles, mumps, and rubella vaccine (MMR) in general and about advancing MMR1 administration. Overly positive parent attitudes were contrasted by members of a vaccine-skeptical organization including parents considering that their child was seriously vaccine-injured long ago. Parents' attitudes to advancing MMR1 mirrored their attitudes about the MMR vaccine in general, with four positions along a continuum of trust in the healthcare system: unquestioning trust, acceptance after careful consideration, challenging indecisiveness, and defensive rejection. Low tolerance was identified between vaccine supporters and vaccine opponents. Parents of children with perceived serious vaccine-related injuries described lifelong unresolved feelings of guilt. Supporters of advanced MMR1 saw it as a timely and convenient administration of a well-known vaccine, whereas opponents feared it would disturb the children's immature immune systems and emphasized difficulties in recognizing side effects so early in life. Health professionals were supportive of advancing the MMR1 vaccine and they carefully challenged the parents. Current MMR vaccine supporters show readiness to advance MMR1 administration.

COVID-19 Pediatric Vaccination Attitudes Among Parents in Ohio

INTRODUCTION

This study aimed to examine factors associated with parental intention to vaccinate children against COVID-19 in Ohio following pediatric vaccine approval in October 2021.

METHOD

Online anonymous surveys were distributed between November 2021 and January 2022 to parents in Ohio.

RESULTS

Surveys were completed by 581 parents of whom 43.5% reported they intended to vaccinate their children against COVID-19, whereas 56.5% did not intend to vaccinate their children. Perceiving a lack of support by health care providers was significantly associated with not intending to vaccinate children against COVID-19 (p < .001).

DISCUSSION

Survey results from parents in Ohio indicate that perceived health care provider support and parents' attitudes about pediatric COVID-19 vaccination influenced their intent to vaccinate their children. Hence, health care providers working with families need to focus on educating parents regarding the importance and safety of vaccination.

Social Vulnerability and COVID-19 Vaccine in Spain

Different analyses show that the design of vaccination policies should especially protect the most vulnerable social groups, since the level of acceptance is determined by the population's knowledge, attitude and concerns about the safety and efficacy of vaccines. The objective of this work will be to detect the most socially vulnerable groups with respect to COVID-19 and to analyze the factors that influence predisposition to vaccination. This is a cross-sectional study using data from the Centro de Investigaciones Sociológicas (CIS) on the Effects and Consequences of Coronavirus (Study 3346 of December 2021). Sociodemographic variables (sex, age, employment status, studies and subjective class identification) were extracted, as well as the answers to the questions indicating the attitude towards vaccination, corresponding to questions 7,8,10 and 11 of the study. The most vulnerable group was lower class women (self-perceived), under 45 years of age with lower educational level, unemployed or performing unpaid work in the home. Most of them are not predisposed to vaccinate only because of the obligation to do so, mainly due to lack of belief in the power and efficacy of vaccines, as well as fear of health risks/collateral side effects. The lower vaccine uptake in this vulnerable population group may be due to a lack of awareness and lower trust in the authorities, as well as the benefits of the vaccine, which could be related to a lack of policy targeting the most socially vulnerable populations.

The Multidimensional Vaccine Hesitancy Scale: A Validation Study

Vaccination hesitancy (VH) is a phenomenon which increases the occurrence of vaccine-preventable diseases. The study tests the validity of the Multidimensional Vaccine Hesitancy Scale (MVHS) in the case of a sample of Romanian adults (n = 528; Meanage = 30.57). The latter filled in an online cross-sectional survey. The construct validity of MVHS was assessed by using confirmatory factor analysis (CFA), the reliability was calculated by using the internal consistency, and the convergent and discriminant validity was assessed by using the composite reliability (CR), and average variance extracted (AVE). The obtained model was invariant across gender. The structural equation model was designed for predictive validity by using the partial least square method (PLS-SEM) which analyses the relation between the MVHS dimensions and the vaccination willingness. The results show support for the 8-factor structure of the scale (χ2/df = 2.48; CFI = 0.95; RMSEA = 0.053). The Cronbach’s coefficients α > 0.70; McDonald’s ω > 0.70 and CR > 0.80 have very good values. The structural equation model shows that there are more dimensions of the scale which predict vaccination hesitancy in various types of vaccines—the main predictors remain the dimensions of health risk and healthy condition. The study’s conclusion led to the idea that the MVHS is suitable for medical practice and for research on the analysis of vaccination behaviours and intentions.

Global Predictors of COVID-19 Vaccine Hesitancy: A Systematic Review

Background: vaccine hesitancy is defined as a delay in the acceptance or refusal of vaccination, even though immunisation is a determinant in reducing the mortality and morbidity associated with Coronavirus Disease 2019 (COVID-19). Aim: to identify and analyse the predictors of COVID-19 vaccine acceptance and/or hesitancy. Methods: a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Keywords: vaccine and (COVID or SARS) and (acceptance or acceptability or willingness or hesitancy or refusal) and (multivariate or regression) and (questionnaire or survey) and national. Databases/resources: PubMed, DOAJ, SciELO and b-on. Timeframe: March 2020–2022. Inclusion criteria: general population, questionnaire-based, calculation of a multivariate regression model and national studies. Quality assessment: application of the National Heart, Lung, and Blood institute (NHLBI) tool. Results: a total of 37 studies were selected, whose overall rate was fair. The most predominant predictors of vaccine hesitancy were a lower perceived risk of getting infected, a lower level of institutional trust, not being vaccinated against influenza, lower levels of perceived severity of COVID-19, or stronger beliefs that the vaccination would cause side effects or be unsafe. Discussion and conclusion: the identified predictors can be used to design tailored health policies and/or public health interventions, or to evaluate subjects’ vaccine hesitancy.

Vaccination against COVID-19 in Europe: A Typology Based on Cluster Analysis

This study aims to identify a general typology for the EU27, and subsequently in Romania, regarding the hesitation, acceptance and refusal of vaccination against COVID-19. The analysis we propose below is based on the information contained in Eurobarometer 94.3, the data of which were collected at the beginning of most of the national vaccination campaigns in Europe. Based on the attitudes and opinions expressed by the respondents of the European states (EU27), we constructed with the help of the cluster k-means (SPSS) statistical analysis a typology with four categories on the subject of vaccination against COVID-19. Our study proposes a matrix with five items/scenarios on a scale from total agreement to total disagreement. We chose a typology with four attitudinal types (clusters). We subsequently compared the results of the general European analysis with the cluster typology resulting from the same Eurobarometer, the same set of questions, only for the case of Romania, to see if this analysis sheds a specific light on the fact that Romania had a very low vaccination rate compared to other EU Member States.