The Importance of Mapping Determinants, Attitudes and Beliefs of Vaccine Hesitancy in the Great Challenge of Compulsory Childhood Vaccination Comment on "Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates"

A cross-sectional study assessing Pro-VC-Be short-form questionnaire in Canada; measuring psychosocial determinants of vaccination behavior in Canadian healthcare professionals

Vaccine hesitancy poses a significant challenge to worldwide public health and has been exacerbated by the COVID-19 pandemic, leading to heightened polarization and the spread of misinformation. Addressing vaccine hesitancy requires multifaceted strategies in which healthcare professionals (HCPs) play a critical role. Nonetheless, HCPs may also be hesitant toward vaccination. The 31-item original Pro-VC-Be tool, designed to measure the psychosocial determinants of vaccine attitudes in HCPs, was first validated in France, French-speaking Belgian regions, and Quebec (Canada). The validity of a short-form version was evaluated and found to be comparable to that of the long-form. Given differing vaccination recommendations and the changing pandemic context, assessing the tool's stability among diverse Canadian HCPs is crucial. Relying on the original short version of the Pro-VC-Be tool, a cross-sectional online survey was conducted among various Canadian HCPs (N = 544) to explore the psychosocial determinants that impact vaccination-related behaviors (frequency of general vaccination activity, vaccine recommendations activity, and willingness to recommend vaccines). The findings underscore three crucial dimensions - vaccine confidence, proactive efficacy, and trust in authorities - as robust predictors of positive professional practice and attitudes, and thus globally support the results obtained in previous studies using the Pro-VC-Be tool. HCPs with higher vaccine confidence, high proactive efficacy, and higher trust in authorities were 80% and 180% more likely to recommend vaccines to their patients and 80% more likely to have received a COVID-19 vaccine than other HCPs, respectively. By identifying the root causes of vaccine hesitancy among HCPs, adapted strategies can be developed.

Vaccination Coverage and Adherence to Scheduling in Children Aged 0 to 18 Months: Effects of COVID-19 and Age

Vaccination in Peru began 50 years ago as part of the Expanded Program on Immunization (EPI), which has proven effective in saving the lives of millions of children. This research aimed to determine the coverage and adherence to the vaccination schedule in children up to 18 months of age during the period 2018-2022, including the COVID-19 pandemic lockdown, in order to assess its influence.

MATERIALS AND METHODS

This was a secondary source study based on the Demographic and Family Health Survey (ENDES) of Peru, including a sample of 82,702 male and female children whose caregivers presented vaccination cards. Coverage and adherence indicators were calculated, and differences were evaluated between the pre-confinement, absolute confinement, and relative confinement periods using a chi-square test.

RESULTS

For almost all vaccines, coverage decreased from 2018 to 2022 (from 82.46% to 80.16% on average, p < 0.001). Coverage also decreased as the scheduled age increased (0-2 months: median 93%, 7-18 months: median 63%; p < 0.001). Average adherence rates also declined over time (2018: 65.82% to 2022: 61.77%). The most affected vaccine was the yellow fever vaccine. Coverage did not reach protective population levels, while adherence has averaged 85.06% since 2018.

CONCLUSIONS

COVID-19 negatively influenced compliance with the vaccination schedule and adherence.

Exploring reported causes of vaccine hesitancy among European adolescents and parents: results of a citizen science project

BACKGROUND

Progress in pediatric immunization is threatened by vaccine hesitancy. While recent estimates show 14-35% of European parents exhibit some degree of hesitancy, little is known about adolescents. We assessed vaccine hesitancy and associated factors in European adolescents and parents through the online Science4Pandemics platform.

METHODS

We conducted two cross-sectional surveys. One in individuals aged ≥ 12 and < 18 years, using a non-validated questionnaire adapted from the Parent Attitudes about Childhood Vaccines (PACV); and another using the PACV questionnaire in parents aged ≥ 18 years, who were not necessarily related to the adolescents.

RESULTS

1877 adolescents from Italy, Portugal, Poland and Spain were included. Of these, 45.9% were aged 12-14 years, and 54.1% were 15-17 years. The prevalence of hesitancy (adapted PACV score ≥ 50%) was 20.8% (390 individuals). Hesitancy prevalence varied between countries, from 12.5% in Spain to 31.6% in Poland (p < 0.001). Geographic region was the only associated factor for hesitancy [Odds Ratio (OR) for Polish adolescents: 3.20 (95%CI: 2.29, 4.51); OR for Italian adolescents: 2.28 (95%CI: 1.62, 3.24); OR for Portuguese adolescents: 1.13 (95%CI: 0.77, 1.66); all compared to Spanish adolescents]. Country remained the only associated factor in the multivariate logistic regression analysis. In contrast, 1135 parents of children under 18 were included, with hesitancy observed in 20.4% (232 individuals). The main associated factors for hesitancy, both in the univariate and multivariate analyses, were country of residence [OR for Italian parents: 2.34 (95%CI: 1.47, 3.80); OR for Polish parents: 2.69 (95%CI: 1.70, 4.36); OR for Portuguese parents: 2.26 (95%CI: 1.41, 3.68); all compared to Spanish parents], and age, with older parents being less hesitant (OR: 0.97, 95%CI: 0.96, 1.00). In both parents and adolescents, the main reasons for vaccine hesitancy were fear of vaccine side effects (56.1% in adolescents, 51.9% in parents) and lack of trust in government recommendations (21.9% in adolescents, 22.8% in parents).

CONCLUSIONS

Vaccine hesitancy in adolescents and parents in Europe is prevalent, with country of residence as a key influencing factor. Targeted strategies to educate both groups about immunization benefits and its side effects are essential, considering the heterogeneity across countries and reasons for hesitancy.

Exploring trends and determinants of basic childhood vaccination coverage: Empirical evidence over 41 years

Vaccination is widely considered to be one of the most important prevention measures as a health strategy. This paper examines trends in basic childhood vaccination coverage and which country and time-dependent determinants may have influenced childhood immunization rates (1-dose BCG, 1- and 3-dose DTP (diphtheria, tetanus, pertussis), 1-dose measles, and 3-dose polio) between 1980 and 2020 across 94 countries. We identify economic, inequality, demographic, health, education, labor market, environmental, and political stability factors of immunization. To do this, we use data from the annual WHO and United Nations International Children's Emergency Fund (UNICEF) coverage estimates. The empirical analysis consists of generalized estimating equation models to assess relationships between immunization rates and socioeconomic factors. Additionally, we follow the Barro and Sala-i-Martín approach to identify conditional convergence. Our findings show the strongest positive statistically significant association between immunization rates and GDP per capita, as well as births attended by skilled health staff. Moreover, our research demonstrates conditional convergence, indicating that countries converge towards different steady states. The present study brings new insights to investigating the determinants of childhood vaccination coverage and provides significant implications for health policies.