Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter

The Relationship Between News Coverage of COVID-19 Misinformation and Online Search Behavior

The spread of health misinformation poses a threat to public health as it can influence individuals' health beliefs and, potentially, behaviors, and their support for public health policies. The mainstream news media have the potential to inadvertently increase the salience of misinformation through their reporting. This study explores the agenda-setting effects of mainstream news media coverage on public salience of public health misinformation during the COVID-19 pandemic. We analyzed the association between news media coverage and public salience - as measured by Google Trends relative search volume - of three different pieces of COVID-19 misinformation: (1) hydroxychloroquine is a safe and effective treatment for COVID-19; (2) the COVID-19 vaccines cause infertility; and (3) ivermectin is a safe and effective treatment for COVID-19. We plotted news coverage of each piece of misinformation against Google Trends relative search volume over time. Autoregressive integrated moving average (ARIMA) models were used to account for autocorrelation and analyze the relationship between the two time series. News media coverage volume was a significant predictor of same-day relative search volume for hydroxychloroquine and ivermectin. The relationship between news media coverage and searches for COVID-19 vaccines and infertility was not significant. These findings indicate mainstream news media coverage may contribute to the public salience of misinformation. Mainstream media outlets should contextualize their reporting on misinformation with verification from scientific consensus.

Does Local Context Matter? - Content Analysis of COVID-19 Vaccine-Related Online Comments in Hungary

The COVID-19 situation brought novelties into discourses on anti-vaccination and vaccine hesitancy on social media-both in logic and concerning topics. The complexity of vaccine production and distribution parallel to constant political negotiations on a global level created an opaque and confusing system seedbed for misinformation, which decreased the trust in public management and authorities as the vaccination discussions became embedded in both local and global politics. In this study, we contrast the anti-vaxxers and the vaccine-hesitant people's attitudes toward the local aspects of vaccination. We compare these groups' main narratives in two key vaccine-related topics - locality and authority. Based on our analysis, anti-vaxxer comments are nonpolitical or differentiate national politics from global aspects of COVID-19 vaccination. On the contrary, vaccine-hesitant discourses are highly contextual and dependent on the continuous changing of the conditions. The east-west political narrative has severely impacted both non-anti-vaxxer and vaccine-hesitant groups and contributed to increased vaccination hesitancy in Hungary.

Cyber anti-intellectualism and science communication during the COVID-19 pandemic: a cross-sectional study

Background

During the COVID-19 pandemic, science communication played a crucial role in disseminating accurate information and promoting scientific literacy among the public. However, the rise of anti-intellectualism on social media platforms has posed significant challenges to science, scientists, and science communication, hindering effective public engagement with scientific affairs. This study aims to explore the mechanisms through which anti-intellectualism impacts science communication on social media platforms from the perspective of communication effect theory.

Method

This study employed a cross-sectional research design to conduct an online questionnaire survey of Chinese social media users from August to September 2021. The survey results were analyzed via descriptive statistics, t-tests, one-way ANOVA, and a chain mediation model with SPSS 26.0.

Results

There were significant differences in anti-intellectualism tendency among groups of different demographic characteristics. The majority of respondents placed greater emphasis on knowledge that has practical benefits in life. Respondents' trust in different groups of intellectuals showed significant inconsistencies, with economists and experts receiving the lowest levels of trust. Anti-intellectualism significantly and positively predicted the level of misconception of scientific and technological information, while significantly and negatively predicting individuals' attitudes toward science communication. It further influenced respondents' behavior in disseminating scientific and technological information through the chain mediation of scientific misconception and attitudes toward science communication.

Conclusion

This research enriches the conceptual framework of anti-intellectualism across various cultural contexts, as well as the theoretical framework concerning the interaction between anti-intellectualism and science communication. The findings provide suggestions for developing strategies to enhance the effectiveness of science communication and risk communication during public emergencies.

Trust Associated with South Korean Sojourners' Chinese COVID-19 Vaccination Intent and Concerns: A Qualitative Study

People's willingness to get vaccinated determines whether the campaigns against the COVID-19 pandemic can be successful in part. Considering the fact that both foreigners and its nationals are exposed to the risk of infection in China, the Chinese government has taken measures favorable to foreigners in terms of the vaccination, yet South Korean sojourners were reluctant to get China-developed COVID-19 vaccines. This study employed the trust in institutions and trust in media as a theoretical framework and seeks to analyze how these two affect South Korean sojourners' intention to get Chinese COVID-19 vaccines. 25 South Korean sojourners living in Beijing participated in semi-structured interviews. The results showed that the mistrust South Korean sojourners have in China's institutions and media, both traditional and social media, led to their reluctance to get Chinese COVID-19 vaccines. In addition, South Korean sojourners' higher interpersonal trust in their peers also influenced their willingness to get vaccines. This study further interpreted such results from the perspective of cultural traits and national properties.

Dynamic role of personality in explaining COVID-19 vaccine hesitancy and refusal

Vaccine hesitancy and refusal are threats to sufficient response to the COVID-19 pandemic and public health efforts more broadly. We focus on personal characteristics, specifically personality, to explain what types of people are resistant to COVID-19 vaccination and how the influence of these traits changed as circumstances surrounding the COVID-19 pandemic evolved. We use a large survey of over 40,000 Canadians between November 2020 and July 2021 to examine the relationship between personality and vaccine hesitancy and refusal. We find that all five facets of the Big-5 (openness to experience, conscientiousness, extraversion, agreeableness, and negative emotionality) are associated with COVID-19 vaccine refusal. Three facets (agreeableness, conscientiousness, and openness) tended to decline in importance as the vaccination rate and COVID-19 cases grew. Two facets (extraversion and negative emotionality) maintained or increased in their importance as pandemic circumstances changed. This study highlights the influence of personal characteristics on vaccine hesitancy and refusal and the need for additional study on foundational explanations of these behaviors. It calls for additional research on the dynamics of personal characteristics in explaining vaccine hesitancy and refusal. The influence of personality may not be immutable.

Explaining Health Misinformation Belief through News, Social, and Alternative Health Media Use: The Moderating Roles of Need for Cognition and Faith in Intuition

Explaining the spread and impact of health misinformation has garnered considerable attention with the uptake of social media and group messaging applications. This study contributes to that line of work by investigating how reliance on multiple digital media may help support or suppress misinformation belief, and how individual differences in misinformation susceptibility condition this process. Alternative health outlets (AH media), advocating home/homeopathic remedies over conventional medicine can be important sources of misinformation, yet are largely ignored previously. In this study, we first test how reliance on different platforms predicts health misinformation belief. Drawing from the elaboration likelihood model, we further investigate how need for cognition (NFC) and faith in intuition (FI) moderate the relationship between news reliance and susceptibility to misinformation. We conducted a survey in Singapore, Turkey, and the U.S (N = 3,664) to measure how these proposed relationships explain misinformed beliefs about vaccines, genetically modified foods and alternative medicine. We found reliance on online legacy news was negatively associated with the likelihood of believing health misinformation, while the reverse was true for social media and AH media. Additionally, those with both greater NFC and FI were more susceptible to health misinformation when they relied on social media and AH media more. In contrast, neither NFC nor FI moderated the relationship between reliance on online legacy news and health misinformation belief. These findings, mostly consistent across countries, also show that extensive reliance on social media and AH media for news mostly overwhelms the individual differences in predicting misinformation belief.

Fostering mask-wearing with virality metrics and social media literacy: evidence from the U.S. and Korea

Although social media can pose threats to the public health by spreading misinformation and causing confusion, they can also provide wider access to health information and opportunities for health surveillance. The current study investigates the ways in which preventive health behaviors and norms can be promoted on social media by analyzing data from surveys and experiments conducted in the U.S. and South Korea. Survey results suggest that the pathway from social media use for COVID-19 information to mask-wearing behavior through mask-wearing norms emerges only among individuals with strong perceived social media literacy in the U.S. Experimental findings show that wear-a-mask campaign posts on social media foster mask-wearing norms and behavioral intention when they come with large (vs. small) virality metrics (e.g., Likes, shares) in both the U.S. and South Korea. Additionally, American users are more willing to engage with posts that come with supportive (vs. mixed) comments by Liking, sharing and commenting. The results highlight the need to cultivate social media literacy and opportunities for exploiting social media virality metrics for promoting public health norms and behaviors.

Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England

Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.

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

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

The impact of COVID-19 misinformation and trust in institutions on preventive behaviors

Misinformation related to coronavirus disease 2019 (COVID-19) has the potential to suppress preventive behaviors that mitigate the spread of COVID-19. Early research on the behavioral consequences of COVID-19 misinformation is mixed, and most rely on cross-sectional data. We examined whether believing in COVID-19 misinformation at one time point influences engaging in preventive behaviors later. In addition, we investigated the role of trust in institutions. We conducted a two-wave survey in South Korea and examined the association between belief in COVID-19 misinformation at Wave 1 and preventive behaviors at Wave 2 controlling for preventive behaviors at Wave 1. We also analyzed whether there is an interaction between belief in COVID-19 misinformation and trust in institutions. Belief in COVID-19 misinformation at Wave 1 significantly increased avoidance of preventive behaviors at Wave 2, but after accounting for trust in institutions, this effect disappeared. Rather, trust in institutions significantly decreased avoidance of preventive behaviors. In addition, misinformation increased avoidance of preventive behaviors among those who trusted institutions the most. Results suggest that building trust in institutions is essential in promoting COVID-19 preventive behaviors. Belief in COVID-19 misinformation may have harmful effects, but these effects were pronounced for those who highly trust institutions.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

What College Biology Students Know about How Vaccines Work

Vaccines are an important and societally relevant biology topic, but it is unclear how much college biology students know about how vaccines work and what inaccurate ideas they have about that process. Therefore, we asked more than 600 college students taking biology courses at various levels to explain, "How does a vaccine work?" in a free-response format. Based on authoritative sources and responses from immunology and other biology faculty, we created a rubric to gauge the basic knowledge and accuracy present in student responses. Basic knowledge was defined as knowing that vaccines mimic the pathogen, elicit an active immune response, and provide protection against future infection. Accuracy was defined as the absence of scientifically inaccurate ideas. We found that advanced biology majors score significantly higher in basic knowledge and accuracy when compared with all other student groups, but there were no differences between entering biology majors, pre-health majors, and non-pre-health majors. We also uncovered a variety of inaccurate ideas, with the most common being that vaccines contain the original, unmodified pathogen. These results provide a new way to gauge college student understanding of how a vaccine works and enrich our understanding of what college students know about this process.

Conspiratorial thinking as a precursor to opposition to COVID-19 vaccination in the US: a multi-year study from 2018 to 2021

Despite widespread availability of safe and effective COVID-19 vaccines in the US, only about 66% of the eligible US population had taken the recommended initial doses of the COVID-19 vaccines as of April 2022. Explanations for this hesitancy have focused on misinformation about the vaccines, lack of trust in health authorities, and acceptance of conspiracy theories about the pandemic. Here we test whether those with a conspiratorial mindset, which distrusts a wide range of institutions, were poised to reject COVID vaccines before the pandemic even began. To answer that question, we reinterviewed members of a national US panel that we had previously surveyed beginning in 2018. As hypothesized, having a conspiratorial mindset in 2019 predicted COVID-vaccination hesitancy in 2021 better than prior trust in health authorities or acceptance of vaccine misinformation. Those with the mindset were also more likely to consume media that bolstered belief in pandemic conspiracies. Research is needed on the determinants of conspiratorial mindset and ways to minimize the likelihood that consequential health decisions will be influenced by it.

Impact of COVID-19 Vaccine Misinformation on Social Media Virality: Content Analysis of Message Themes and Writing Strategies

BACKGROUND

Vaccines serve an integral role in containing pandemics, yet vaccine hesitancy is prevalent globally. One key reason for this hesitancy is the pervasiveness of misinformation on social media. Although considerable research attention has been drawn to how exposure to misinformation is closely associated with vaccine hesitancy, little scholarly attention has been given to the investigation or robust theorizing of the various content themes pertaining to antivaccine misinformation about COVID-19 and the writing strategies in which these content themes are manifested. Virality of such content on social media exhibited in the form of comments, shares, and reactions has practical implications for COVID-19 vaccine hesitancy.

OBJECTIVE

We investigated whether there were differences in the content themes and writing strategies used to disseminate antivaccine misinformation about COVID-19 and their impact on virality on social media.

METHODS

We constructed an antivaccine misinformation database from major social media platforms during September 2019-August 2021 to examine how misinformation exhibited in the form of content themes and how these themes manifested in writing were associated with virality in terms of likes, comments, and shares. Antivaccine misinformation was retrieved from two globally leading and widely cited fake news databases, COVID Global Misinformation Dashboard and International Fact-Checking Network Corona Virus Facts Alliance Database, which aim to track and debunk COVID-19 misinformation. We primarily focused on 140 Facebook posts, since most antivaccine misinformation posts on COVID-19 were found on Facebook. We then employed quantitative content analysis to examine the content themes (ie, safety concerns, conspiracy theories, efficacy concerns) and manifestation strategies of misinformation (ie, mimicking of news and scientific reports in terms of the format and language features, use of a conversational style, use of amplification) in these posts and their association with virality of misinformation in the form of likes, comments, and shares.

RESULTS

Our study revealed that safety concern was the most prominent content theme and a negative predictor of likes and shares. Regarding the writing strategies manifested in content themes, a conversational style and mimicking of news and scientific reports via the format and language features were frequently employed in COVID-19 antivaccine misinformation, with the latter being a positive predictor of likes.

CONCLUSIONS

This study contributes to a richer research-informed understanding of which concerns about content theme and manifestation strategy need to be countered on antivaccine misinformation circulating on social media so that accurate information on COVID-19 vaccines can be disseminated to the public, ultimately reducing vaccine hesitancy. The liking of COVID-19 antivaccine posts that employ language features to mimic news or scientific reports is perturbing since a large audience can be reached on social media, potentially exacerbating the spread of misinformation and hampering global efforts to combat the virus.

Vaccines and the social amplification of risk

In 2019, the World Health Organization (WHO) named "Vaccine Hesitancy" one of the top 10 threats to global health. Shortly afterward, the COVID-19 pandemic emerged as the world's predominant health concern. COVID-19 vaccines of several types have been developed, tested, and partially deployed with remarkable speed; vaccines are now the primary control measure and hope for a return to normalcy. However, hesitancy concerning these vaccines, along with resistance to masking and other control measures, remains a substantial obstacle. The previous waves of vaccine hesitancy that led to the WHO threat designation, together with recent COVID-19 experience, provide a window for viewing new forms of social amplification of risk (SAR). Not surprisingly, vaccines provide fertile ground for questions, anxieties, concerns, and rumors. These appear in new globalized hyperconnected communications landscapes and in the context of complex human (social, economic, and political) systems that exhibit evolving concerns about vaccines and authorities. We look at drivers, impacts, and implications for vaccine initiatives in several recent historical examples and in the current efforts with COVID-19 vaccination. Findings and insights were drawn from the Vaccine Confidence Project's decade long monitoring of media and social media and its related research efforts. The trends in vaccine confidence and resistance have implications for updating the social amplification of risk framework (SARF); in turn, SARF has practical implications for guiding efforts to alleviate vaccine hesitancy and to mitigate harms from intentional and unintentional vaccine scares.

Trust in physicians and trust in government predict COVID-19 vaccine uptake

OBJECTIVE

We consider how trust in government, trust in physicians, and interpersonal trust affect the likelihood of COVID-19 vaccine uptake.

METHODS

A survey of 3057 registered South Dakota voters was fielded in April 2021 that measured COVID-19 vaccine uptake, three aspects of trust, and several other factors related to vaccine hesitancy. Logistic regression was utilized to analyze the responses.

RESULTS

We found positive, statistically significant, and substantively impactful effects for trust in government and trust in physicians on the likelihood of COVID-19 vaccine uptake, and null results for interpersonal trust.

CONCLUSIONS

Our findings provide a more nuanced understanding of the relationship between trust and COVID-19 vaccine uptake, and suggest that public health official as well as physicians should strive to increase the public's trust in the medical community.

Intención de vacunarse contra COVID-19 en la población de 40 años en adelante en México

Objetivo Evaluar el efecto de las fuentes de información sobre COVID-19, los beneficios y las barreras percibidas de la vacunación, y la actitud hacia la vacunación sobre la intención de vacunarse contra COVID-19 en la población de 40 años en adelante en México. Métodos Se desarrolló una investigación cuantitativa, transversal y explicativa. Se aplicó una encuesta electrónica a 703 personas de 40 años en adelante que residen en México. El análisis de resultados se realizó a través de la técnica de ecuaciones estructurales por medio del método de mínimos cuadrados parciales. Resultados Las fuentes de información sobre COVID-19 influyen positivamente sobre los beneficios percibidos de la vacuna y disminuyen las barreras percibidas. Además, los beneficios percibidos influyen positivamente sobre la actitud hacia la vacunación de COVID-19; sin embargo, las barreras no afectan la actitud. Adicionalmente, esta última influye en la intención a vacunarse contra COVID-19 e indirectamente las fuentes de información y los beneficios percibidos influyen sobre la intención a vacunarse mediados por la actitud.  

Rural Identity as a Contributing Factor to Anti-Intellectualism in the U.S

Anti-intellectualism-a distrust of intellectuals and experts-has had a significant political presence in the U.S. and globally, especially in recent years. Anti-intellectualism drives support for phenomena such as populism, a rejection of scientific consensus, and health and science misinformation endorsement. Therefore, discovering what drives someone to be more anti-intellectual is highly important in understanding contemporary public opinion and political behavior. Here, I argue that a significant and overlooked factor contributing to anti-intellectualism is rural social identification-a psychological attachment to being from a rural area or small town-because rural identity in particular views experts and intellectuals as an out-group. Using 2019 ANES pilot data (N = 3000), original survey data (N = 811) and a separate original survey experiment, I find that rural social identification significantly predicts greater anti-intellectualism. Conversely, anti-intellectualism is not significantly associated with rural residency alone, as theoretically speaking, simply living in a rural area does not capture the affective dimension of rural psychological attachment. These findings have implications for health and science attitudes, populist support, and other relevant political matters. They also have implications for what it means to hold a rural identity beyond anti-urban sentiment, and for understanding the urban-rural divide.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11109-022-09770-w.

The correlates and dynamics of COVID-19 vaccine-specific hesitancy

Most work on COVID-19 vaccine hesitancy has focused on its attitudinal and demographic correlates among individuals, but the characteristics of vaccines themselves also appear to be important. People are more willing to take vaccines with higher reported levels of efficacy and safety. Has this dynamic sparked comparative hesitancy towards specific COVID-19 vaccines? We conduct a series of cross-sectional survey experiments to test for brand-based differences in perceived effectiveness, perceived safety, and vaccination intention. Examining more than 6,200 individuals in a series of cross-sectional surveys, we find considerably more reluctance to take the AstraZeneca and Johnson & Johnson vaccines compared to those from Pfizer and Moderna if offered, despite all vaccines being approved and deemed safe and effective by a federal regulator. Comparative hesitancy towards these vaccines grew over the course of fielding as controversy arose over their link to extremely rare, but serious side effects. Comparative vaccine-specific hesitancy is strongest among people who are usually most open to mass vaccination efforts. Its effects are substantial: most respondents reported a willingness to wait months for their preferred vaccine rather than receive either the AstraZeneca or Johnson & Johnson vaccine immediately. Our findings call for additional research on the determinants and consequences of COVID-19 vaccine-specific hesitancy and communication strategies to minimize this challenge.

Predictors of vaccine hesitancy during the COVID-19 pandemic in Austria : A population-based cross-sectional study

BACKGROUND

Unwillingness to get vaccinated against the coronavirus disease 2019 (COVID-19) is a major barrier in managing the pandemic. Previous studies have explored predictors of hesitancy to be vaccinated against COVID-19, but evidence on these predictors was partly mixed, and the number of assessed predictors was often limited. This study aimed to explore a wide range of potential predictors of vaccine hesitancy in a population-based cross-sectional study.

METHODS

We assessed associations of vaccine hesitancy with individuals' fears about the future, social media use, and sociodemographics in a hierarchical multiple regression analysis. Data were collected via online questionnaires in a population-based cross-sectional study with 4018 respondents representative of the Austrian adult population between October and December 2020.

RESULTS

Vaccine hesitancy was predicted by freedom-related fears (i.e., fears regarding the political situation, particularly loss of personal freedoms), but were negatively associated with health-related fears (i.e., fears about physical or mental health) and society-related fears (i.e., fears regarding societal issues such as solidarity, distance learning, and isolation). Social media use as well as female gender, younger age, lower education, lower income, and living in rural regions were further predictors of vaccine hesitancy.

CONCLUSION

The study confirms that public health efforts targeting unvaccinated persons need to address freedom-related fears and social media discourse in order to improve vaccine uptake in the population. Particularly individuals in socially and economically disadvantaged groups and social media users need to be targeted to reduce vaccine hesitancy.

The role of non-COVID-specific and COVID-specific factors in predicting a shift in willingness to vaccinate: A panel study

In communities that remain below the immunity threshold needed to blunt COVID-19’s spread, SARS-CoV-2 has a greater chance of mutating to evade vaccines. This study underscores the central role of trust and knowledge in increasing the likelihood of vaccinating. Trust in scientific institutions and spokespersons anchors time 1 vaccination intentions and knowledge affects them at both times 1 and 2. These background (non–COVID-specific) factors as well as flu vaccination history and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than did COVID-specific ones. The study underscores the need for ongoing community engagement and trust building, proactive communication about vaccination, motivating vaccination against seasonal flu, and deploying science-consistent, provaccination voices across media.

Although declines in intent to vaccinate had been identified in international surveys conducted between June and October 2020, including in the United States, some individuals in the United States who previously expressed reluctance said, in spring 2021, that they were willing to vaccinate. That change raised the following questions: What factors predicted an increased willingness to inoculate against COVID-19? And, to what extent was the change driven by COVID-specific factors, such as personal worry about the disease and COVID-specific misinformation, and to what extent by background (non–COVID-specific) factors, such as trust in medical authorities, accurate/inaccurate information about vaccination, vaccination history, and patterns of media reliance? This panel study of more than 8,000 individuals found that trust in health authorities anchored acceptance of vaccination and that knowledge about vaccination, flu vaccination history, and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than COVID-specific factors. COVID-specific conspiracy beliefs did play a role, although a lesser one. These findings underscore the need to reinforce trust in health experts, facilitate community engagement with them, and preemptively communicate the benefits and safety record of authorized vaccines. The findings suggest, as well, the need to identify and deploy messaging able to undercut health-related conspiracy beliefs when they begin circulating.

Predictors of parents' infant vaccination decisions: A concept derivation

The myths surrounding coronavirus disease 2019 (COVID-19) vaccines have prompted scientists to refocus their attention on vaccine hesitancy, which is fuelled by the spread of misinformation. The scientific investigation of behavioural concepts relating to vaccine hesitancy can be enhanced by the examination of behavioural concepts from the field of consumer sciences. South African consumer scientists study personal decisions that contribute to individuals' well-being, including the decisions to prevent ill health. Current data on the predictors of vaccination decisions do not incorporate consumer science constructs imperative in decision-making, which could provide fresh insights in addressing vaccine hesitancy. This study aimed to investigate and illustrate the analogy between concepts of the Health Belief Model (HBM) as parent model, and consumer behaviour that could affect parents' infant vaccination decisions, by applying a concept derivation approach. The HBM was analysed within the context of public health, including literature from consumers' vaccination decisions, medical decisions, paediatrics, vaccinology, virology and nursing. Through a qualitative, theory derivation strategy, six main concepts of the HBM were redefined to consumer sciences, using four iterative concept derivation steps. Concept derivation resulted in consumer behaviour concepts that could be possible predictors of parents' infant vaccination decisions, including consumers' values; risk perception; consideration of immediate and future consequences; self-efficacy; cues to action; demographics; personal information and knowledge. These predictors could be a starting point for a context- and product-specific consumer primary preventive healthcare decisions model. Our findings highlight the opportunities for interdisciplinary collaboration in investigating consumer primary healthcare-related behaviour.

CONTRIBUTION

This study introduced interfaces between consumer science and health science literature. Through interdisciplinary collaboration, a better understanding of influences to promote primary preventive healthcare can be achieved.

A Study on the Relationship between Banyuwangi Government Policy Mall Orang Sehat Mall of Health People with the Acceptance of the Coronavirus Disease 2019 Vaccine in Indonesian – Implications for Vaccination Implementation Policies

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has caused more than 13 million cases. Until now, there is no very efficient treatment for COVID-19. There needs to be government support in socializing the COVID vaccine, one of which is the Mall Orang Sehat (MOS) innovation for healthy people, which aims to make people believe in vaccines. AIM: The purpose of this study was to determine the relationship between policy innovations in the MOS area of healthy people and the willingness of the community to be vaccinated. METHODS: The research method in this study uses a cross-sectional study design, with a sample of 200 using a stratified random sampling technique, with validated question instruments regarding the statement of respondents being willing to be vaccinated or not, the analysis in this study using Chi-square. RESULTS: The results of this study indicate that there is a relationship between MOS policy innovation and patient’s willingness to be vaccinated, as evidenced by the results of SPSS p 0.000 < 0.05 which means that there is a relationship between variable 1 and variable 2. CONCLUSIONS: The COVID-19 vaccine is the government’s effort in tackling the COVID-19 pandemic. With this health education based (Healthy People Mall) it has been proven to be able to influence the public in knowing the effects and impacts of COVID-19 so that people are willing to be vaccinated.

Assessment of Communication Strategies for Mitigating COVID-19 Vaccine-Specific Hesitancy in Canada

IMPORTANCE

Ensuring widespread uptake of available COVID-19 vaccinations, each with different safety and efficacy profiles, is essential to combating the unfolding pandemic.

OBJECTIVE

To test communication interventions that may encourage the uptake of less-preferred vaccines.

DESIGN, SETTING, AND PARTICIPANTS

This online survey was conducted from March 24 to 30, 2021, using a nonprobability convenience sample of Canadian citizens aged 18 years or older, with quota sampling to match 2016 Canadian Census benchmarks on age, gender, region, and language. Respondents completed a 2-by-2-by-2 factorial experiment with random assignment of brand (AstraZeneca or Johnson & Johnson), information about the vaccine's effectiveness against symptomatic infection (yes or no), and information about the vaccine's effectiveness at preventing death from COVID-19 (yes or no) before being asked about their willingness to receive their assigned vaccine and their beliefs about its effectiveness.

EXPOSURES

Respondents were randomly assigned a vaccine brand (AstraZeneca or Johnson & Johnson) and information about the vaccine's effectiveness against symptomatic COVID-19 infection (yes or no) and at preventing death from COVID-19 (yes or no).

MAIN OUTCOMES AND MEASURES

Respondents' self-reported likelihood of taking their assigned vaccine if offered (response categories: very likely, somewhat likely, not very likely, or not at all likely, scaled 0-1) and their beliefs about their assigned vaccine's effectiveness (response categories: very effective, somewhat effective, not very effective, or not at all effective, scaled 0-1) were measured.

RESULTS

A total of 2556 Canadian adults responded to the survey (median [IQR] age, 50 [34-63] years; 1339 women [52%]). The self-reported likelihood of taking an assigned AstraZeneca or Johnson & Johnson vaccine was higher for respondents given information about their assigned vaccine's effectiveness at preventing death from COVID-19 (b, 0.04; 95% CI, 0.01 to 0.06) and lower among those given information about its overall effectiveness at preventing symptomatic transmission (b, -0.03; 95% CI, -0.05 to 0.00), compared with those who were not given the information. Perceived effectiveness was also higher among those given information about their assigned vaccine's effectiveness at preventing death from COVID-19 (b, 0.03; 95% CI, 0.01 to 0.05) and lower among those given information about their assigned vaccine's overall efficacy at preventing symptomatic infection (b, -0.05; 95% CI, -0.08 to -0.03), compared with those who were not given this information. The interaction between these treatments was neither substantively nor statistically significant.

CONCLUSIONS AND RELEVANCE

These findings suggest that providing information on the effectiveness of less-preferred vaccines at preventing death from COVID-19 is associated with more confidence in their effectiveness and less vaccine-specific hesitancy. These results can inform public health communication strategies to reduce hesitancy toward specific COVID-19 vaccines.

Anti-intellectualism and the mass public's response to the COVID-19 pandemic

Anti-intellectualism (the generalized distrust of experts and intellectuals) is an important concept in explaining the public's engagement with advice from scientists and experts. We ask whether it has shaped the mass public's response to coronavirus disease 2019 (COVID-19). We provide evidence of a consistent connection between anti-intellectualism and COVID-19 risk perceptions, social distancing, mask usage, misperceptions and information acquisition using a representative survey of 27,615 Canadians conducted from March to July 2020. We exploit a panel component of our design (N = 4,910) to strongly link anti-intellectualism and within-respondent change in mask usage. Finally, we provide experimental evidence of anti-intellectualism's importance in information search behaviour with two conjoint studies (N ~ 2,500) that show that preferences for COVID-19 news and COVID-19 information from experts dissipate among respondents with higher levels of anti-intellectual sentiment. Anti-intellectualism poses a fundamental challenge in maintaining and increasing public compliance with expert-guided COVID-19 health directives.

Development of a Scale to Measure Trust in Public Health Authorities: Prevalence of Trust and Association with Vaccination

Infectious disease outbreaks highlight the importance of trust in public health authorities to avoid fear and improve adherence to recommendations. There is currently no established and validated measure for trust in public health authorities. We aimed to develop and validate an instrument that measures trust in public health authorities and to assess the association between trust in public health authorities and vaccine attitudes. We developed 20 items to measure trust in public health authorities. After implementing a survey in January 2020, we investigated relationships between the items, reduced the number of items, and identified latent constructs of the scale. We assessed variability in trust and how trust was associated with vaccine attitudes, beliefs, and self-reported vaccine acceptance. The pool was reduced to a 14-item trust in public health authorities scale and we found that this trust model was strongly associated with acceptance of vaccines. Our scale can be used to examine the relationship between trust in public health authorities and adherence to public health recommendations. The measure needs to be validated in other settings to determine whether they are associated with other areas where the public question public health authority recommendations.

COVID-19 Discourse on Twitter in Four Asian Countries: Case Study of Risk Communication

BACKGROUND

COVID-19, caused by SARS-CoV-2, has led to a global pandemic. The World Health Organization has also declared an infodemic (ie, a plethora of information regarding COVID-19 containing both false and accurate information circulated on the internet). Hence, it has become critical to test the veracity of information shared online and analyze the evolution of discussed topics among citizens related to the pandemic.

OBJECTIVE

This research analyzes the public discourse on COVID-19. It characterizes risk communication patterns in four Asian countries with outbreaks at varying degrees of severity: South Korea, Iran, Vietnam, and India.

METHODS

We collected tweets on COVID-19 from four Asian countries in the early phase of the disease outbreak from January to March 2020. The data set was collected by relevant keywords in each language, as suggested by locals. We present a method to automatically extract a time-topic cohesive relationship in an unsupervised fashion based on natural language processing. The extracted topics were evaluated qualitatively based on their semantic meanings.

RESULTS

This research found that each government's official phases of the epidemic were not well aligned with the degree of public attention represented by the daily tweet counts. Inspired by the issue-attention cycle theory, the presented natural language processing model can identify meaningful transition phases in the discussed topics among citizens. The analysis revealed an inverse relationship between the tweet count and topic diversity.

CONCLUSIONS

This paper compares similarities and differences of pandemic-related social media discourse in Asian countries. We observed multiple prominent peaks in the daily tweet counts across all countries, indicating multiple issue-attention cycles. Our analysis identified which topics the public concentrated on; some of these topics were related to misinformation and hate speech. These findings and the ability to quickly identify key topics can empower global efforts to fight against an infodemic during a pandemic.

Parental vaccine attitudes, beliefs, and practices: initial evidence in California after a vaccine policy change

Senate Bill 277 (SB277) eliminated nonmedical exemptions for school-entry vaccines in California, but the impact of parental vaccine knowledge, attitudes, and beliefs on vaccine decision-making has not been extensively examined within the post-SB277 context. This study generates preliminary understanding and discussion of the vaccination knowledge, attitudes, and beliefs among a pilot population of parents of kindergarten students in California after the implementation of SB277. School officials administered a cross-sectional survey to parents of kindergarten children in California from April to July 2019. Parents reported their perceptions of diseases and vaccines, key immunization beliefs, and confidence in different sources of vaccine information. Most parents (92%) had fully vaccinated their children post-SB277 and generally perceived vaccines to be safe and effective, but about 44% reported they were hesitant about childhood vaccines. The majority of parents (87%) rated vaccine information from their doctor as highly credible. This pilot group of kindergarten parents was generally supportive of vaccination and had fully vaccinated their children, but most parents still harbored concerns and misconceptions about vaccines and about public health authorities. This indicates a disconnect between parental vaccine compliance and confidence, and suggests that educational interventions could impact parental vaccine behavior and decision-making.

Association between Exposure to Influenza Vaccination and COVID-19 Diagnosis and Outcomes

We explored whether influenza vaccination (IV) affects susceptibility to SARS-CoV-2 infection and clinical outcomes in COVID-19 patients in 17,608 residents of the Italian province of Reggio Emilia undergoing a SARS-CoV-2 test. Exposure to IV was ascertained and the strength of the association with SARS-CoV-2 positivity expressed with odds ratios (OR). Rates of hospitalisations and death in those found positive were assessed and hazard ratios (HR) were estimated. The prevalence of IV was 34.3% in the 4885 SARS-CoV-2 positive and 29.5% in the 12,723 negative subjects, but the adjusted OR indicated that vaccinated individuals had a lower probability of testing positive (OR = 0.89; 95% CI 0.80-0.99). Among the 4885 positive individuals, 1676 had received IV. After adjusting for confounding factors, there was no association between IV and hospitalisation (1.00; 95% CI 0.84-1.29) or death (HR = 1.14; 95% CI 0.95-1.37). However, for patients age ≥65 vaccinated close to the SARS-CoV-2 outbreak, HRs were 0.66 (95% CI: 0.44-0.98) and 0.70 (95% CI 0.50-1.00), for hospitalisation and death, respectively. In this study, IV was associated with a lower probability of COVID-19 diagnosis. In COVID-19 patients, overall, IV did not affect outcomes, although a protective effect was observed for the elderly receiving IV almost in parallel with the SARS-CoV-2 outbreak. These findings provide reassurance in planning IV campaigns and underscore the need for exploring further their impact on COVID-19.

An Investigation of Low COVID-19 Vaccination Intentions among Black Americans: The Role of Behavioral Beliefs and Trust in COVID-19 Information Sources

Developing a COVID-19 vaccine is a critical strategy for combatting the pandemic. However, for vaccination efforts to succeed, there must be widespread willingness to vaccinate. Prior research has found that Black Americans, who are disproportionately impacted by COVID-19, report lower intentions to get a vaccine than do other populations. We investigate two potential contributors to this disparity: COVID-19 vaccine-related behavioral beliefs and trust in four COVID-19 information sources (mainstream media, social media, President Trump, and public health officials and agencies). Using a nationally-representative survey (n= 889), we demonstrate that differences in vaccination beliefs explain the lower vaccination intentions reported by Black participants, compared to non-Black participants. However, while trust in information sources is associated with vaccination beliefs, differences in trust do not account for the observed differences in vaccination beliefs by race. Furthermore, we find that race moderates the relationships between trust in two sources (Trump and public health officials and agencies) and vaccination beliefs. The effects of trusting these sources on COVID-19 vaccine-related beliefs are smaller among Black participants; thus trust in these sources is less consequential to their pro-vaccination beliefs. Our results suggest that trust in information sources alone does not explain the observed relationship between race and vaccination beliefs.

Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter

In February 2020, the World Health Organization announced an 'infodemic' -- a deluge of both accurate and inaccurate health information -- that accompanied the global pandemic of COVID-19 as a major challenge to effective health communication. We assessed content from the most active vaccine accounts on Twitter to understand how existing online communities contributed to the 'infodemic' during the early stages of the pandemic. While we expected vaccine opponents to share misleading information about COVID-19, we also found vaccine proponents were not immune to spreading less reliable claims. In both groups, the single largest topic of discussion consisted of narratives comparing COVID-19 to other diseases like seasonal influenza, often downplaying the severity of the novel coronavirus. When considering the scope of the 'infodemic,' researchers and health communicators must move beyond focusing on known bad actors and the most egregious types of misinformation to scrutinize the full spectrum of information -- from both reliable and unreliable sources -- that the public is likely to encounter online.