Exploring factors improving support for vaccinations among Polish primary care physicians

Impact of the COVID-19 pandemic on behavioral changes in healthcare workers in Italy

Introduction

During the COVID-19 pandemic, adherence to wearing face mask and washing hands procedures and achieving high COVID-19 vaccine coverage among healthcare workers (HCWs) were essential to minimize morbidity and possible death and limit the transmission of the virus. The objectives of the cross-sectional survey were to explore the influence of COVID-19 on the use of preventive measures and vaccination willingness among HCWs in the southern part of Italy and the associated factors.

Methods

The survey was carried out from 15 June 2023 to 15 July 2023 among 521 HCWs who worked in three randomly selected public hospitals. All data were collected through a self-administered questionnaire.

Results

HCWs had a positive change in the use of preventive measures if they did not often/always use them before the pandemic, but they are using in the current epidemiologic context and they were willing to use in a future epidemic situation. A positive change in the adherence to face mask-wearing (24.6%) was more likely among those with at least 5 years of university degree, nurses/midwives, and who had worked in COVID-19 wards. A positive change in alcohol-based hand rubbing (3.1%) was more likely in HCWs in Emergency/Critical/Infectious Diseases wards compared with medical wards. HCWs who were more likely to believe that the COVID-19 vaccine should be mandatory for them (58.1%) had at least 5 years of university degree, in Emergency/Critical/Infectious Diseases wards compared with surgical and medical wards, had received more than three doses of this vaccine, were more concerned to get infected during their activity, and had received information from scientific journals. HCWs more willing to receive the COVID-19 vaccine every year (39.8%) were males, physicians, those in Emergency/Critical/Infectious Diseases wards compared with medical wards, who had received more than three doses of this vaccine, who believed that this vaccine should be mandatory for HCWs, and who needed additional information.

Discussion

The survey showed that the COVID-19 pandemic had an impact on the use of preventive measures among HCWs, not necessarily for the improvement or increase. Educational messages on the importance of these measures regarding the promotion and recommendation of the vaccine need to be investigated and applied among HCWs in order to reduce vaccination gaps and the spread of the infection.

Vaccine Hesitancy among Healthcare Workers in Europe: A Systematic Review

This study analyzes vaccine hesitancy (VH) among healthcare workers (HCWs) in 15 European countries. We have undertaken a systematic review by synthesizing data from 46 articles (between 2015 and 2022) encompassing 55,612 subjects. Despite the heterogeneity of the methods in the various studies, we found that physicians had consistently higher vaccination rates than nurses across different countries and different vaccines. Physicians' average vaccination rate was 79% across a selection of vaccines, while that of nurses was 62%. Concerns regarding vaccine safety, information gaps, and the responsibility of healthcare authorities in managing VH are highlighted by qualitative insights. This research contributes to our comprehension of the ways in which VH among HCWs is impacted by healthcare roles, vaccine types, and regional disparities. The insights gleaned from this analysis can serve as a guide for targeted interventions aimed at increasing vaccine acceptance and coverage in Europe, ultimately strengthening public health.

Trust in Physicians in the Context of HPV Vaccination of Children from the Perspective of Social Exchange Theory: A Representative Study of Polish Parents

The vaccination of children against human papillomavirus (HPV) effectively prevents HPV infection and HPV-related cancers in women and men. However, HPV vaccination programs are met with vaccine hesitancy, which varies between countries. The coverage in Poland is low, although introducing nationally funded HPV vaccination for girls aged 12-13 in mid-2023 may increase it. The uptake of the HPV vaccine in adolescents is highly affected by parental decisions, which in turn can be influenced by interactions with the physician. The present representative study aimed to analyze the acceptance of the HPV vaccine among Polish parents (n = 360) and the level of trust in HPV vaccination in the pediatrician/general practitioner who takes care of their children aged 9-15 years. The data were gathered in September 2022 using computer-assisted telephone interviews. Most surveyed parents reported trusting their child's physician regarding vaccine recommendations (89.2%) and vaccinated their child with all or most of the vaccines recommended by a national vaccination guideline (94.7%). However, 13.3% declared themselves as moderate or strong vaccine opponents, a group characterized by high (83.4%) distrust in physicians. There was no difference in the awareness of HPV in groups varying in trusting the physicians, but parents who trusted them were more frequently aware of the HPV vaccine. Parental willingness to vaccinate their child against HPV was highly differentiated by the level of trust in the child's physician. The results highlight that trust in physicians is a critical factor shaping decisions for children's vaccination, stressing a continuous need to improve strategies to communicate with patients.

Analysis of Parents' Attitudes and Knowledge toward Immunization and How These Factors Influence Their Decisions to Vaccinate Their Children against Human Papilloma Virus (HPV)

Background and objectives: Vaccination hesitancy is a growing problem associated with decreasing chances for the elimination of vaccine-preventable diseases through immunization. This research was conducted to learn about parents' attitudes toward vaccination, particularly against HPV, in the context of their beliefs and fears regarding immunization and the impact of these views on their children's vaccination decisions. An additional goal was to determine what views or convictions most often lead to the phenomenon of delaying or refusing vaccinations, especially HPV vaccines, in the surveyed community. Materials and Methods: An online questionnaire was conducted in which parents marked how they vaccinated their children with mandatory vaccinations and whether they took the opportunity to protect their children with additional vaccinations, including HPV and COVID-19. Respondents also marked the extent to which they agreed with the statements, regarding the safety of vaccinations, doubts about them, as well as popular anti-vaccine myths. Results: A total of 250 questionnaires were collected with data on the immunization of 425 children. Associations between specific beliefs and vaccine abstention were established. The most motivating factor for vaccination against HPV was the parent's awareness that the virus HP is the cause of cancer. The most inhibiting factor was respondent's compliance with the opinion that HPV vaccines can affect the child's sexual activity. Conclusions: The results indicate that information campaigns are needed, especially focusing on vaccine safety and the regularity and transparency of monitoring adverse effects. The obtained results will be used to create educational interventions against vaccination hesitancy more adapted to local conditions.

The Influence of Recommendation of Medical and Non-Medical Authorities on the Decision to Vaccinate against Influenza from a Social Vaccinology Perspective: Cross-Sectional, Representative Study of Polish Society

Vaccination against seasonal flu is crucial to prevention of illness in modern societies. The level of influenza vaccination in Poland is low and, for many years, has hovered around a few percent of the general population. For this reason, it is crucial to understand the reasons for such a low level of vaccination and to assess the influence of medical and social authorities on the decision to vaccinate against influenza from the perspective of social vaccinology. For this purpose, a representative survey was conducted in 2022 among adult Poles (N = 805), orchestrated with the CAWI technique based on the author's questionnaire. The most significant authority in the context of influenza vaccination is held by physicians, especially among the oldest part of the population, over 65 years of age-in this group, 50.4% of respondents declare a very high level of respect for physicians on the issue of recommended influenza vaccination (p < 0.001), and the second-highest authority group for which seniors have respect in the aspect of influenza vaccination is pharmacists (p = 0.011). It was also shown that pharmacists have more authority on the issue of influenza vaccination than nurses, especially in the group that declared themselves opponents of vaccination (p < 0.001). The survey indicates the need to strengthen the authority of physicians and pharmacists regarding influenza vaccination, and, in the case of pharmacists, the need for changing the law to allow them to qualify for influenza vaccination.

Determinants of the decision to be vaccinated against COVID-19 as exemplified by employees of a long-term health care centre

INTRODUCTION

Health care professionals cover the front line in the battle against infectious diseases. Vaccination of healthcare workers represents a vital element of the strategy for enhancing epidemic safety and improving the quality of health care, inter alia, by limiting microorganism transmission, and reducing patient morbidity and mortality.

METHOD

The study group consisted of all employees of the long-term health care centre in Lublin, Poland. Participants were requested to complete a questionnaire prepared for the purpose of the study, along with a mandatory COVID-19 vaccination interview questionnaire.

RESULTS

The vaccination coverage rate for the group of medical workers was 77.3% and of non-medical 86%. The most frequently indicated sources of information on vaccination were the mass media. Males more often than females used the press as a source of information on vaccination. Scientific articles were the most common source of information for both people with higher education and medical professionals. The most common motive for vaccination for females is concern for the health of one's family, and for HCWs and people with at least secondary education-concern for the health of patients.

CONCLUSION

At least one assessed factor influences the decision to be vaccinated. The mass media are of the greatest importance in obtaining information about vaccination.

Knowledge and attitudes of health care workers about monkeypox virus infection in Southern Italy

Background

This present survey sought to investigate the level of knowledge and the attitudes pertaining the monkeypox (mpox) virus infection among a sample of health care workers (HCWs) in Italy, as well as the possible role of different factors on these outcomes.

Methods

The cross-sectional survey was performed from July through October, 2022 at four randomly selected hospitals located in Southern Italy.

Results

The questionnaire was completed by 421 HCWs, for an overall 59% response rate. Less than two-thirds were able to define the disease and the correct answer of the transmission mechanisms ranged from 22.8% for contact with contaminated objects to 75.8% through close contact with body fluids. Only 4% and 12.8% indicated HCWs and elderly/frail/people with underlying immune deficiencies as risk groups. The mean overall score of the knowledge assessment on mpox was 3.4 (0-9). The multivariate logistic regression analysis showed that HCWs with a lower number of years of working experience and those who had acquired information about mpox from scientific journals were more likely to have a higher level of knowledge. The average score of the perception of the severity of the disease was 6.3. A similar score with a value of 6.1 has been observed for the statement that mpox is a serious problem for the population. Regarding the level of concern about contracting mpox, the mean score was 5.1. Only 10.5% reported that they feel that this disease can be prevented, with an overall mean score of 6.5. Almost all HCWs reported that they are still living as usual, with no modification of their behavior for fear of contracting the mpox. The results of the multivariate logistic regression model showed that women, HCWs with a higher level of knowledge about mpox, and those who needed additional information about mpox were more likely to have a higher level of perception of the severity of the disease.

Conclusion

This survey has demonstrated that HCWs had an unsatisfactory level of knowledge toward mpox and only nearly half showed positive attitudes. Strategic health training programs should be made so that knowledge can be acquired.

Parental Acceptance of COVID-19 Vaccination for Children and Its Association With Information Sufficiency and Credibility in South Korea

IMPORTANCE

Vaccination against COVID-19 is an effective method for individuals to reduce negative health outcomes. However, widespread COVID-19 vaccination among children has been challenging owing to parental hesitancy.

OBJECTIVE

To examine parental decision-making in favor of the COVID-19 vaccine for their children and its association with the sufficiency and credibility of the information about the vaccine.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey study was conducted in South Korea from February 7 to 10, 2022, 7 weeks before initiation of the COVID-19 vaccine for children aged 5 to 11 years. Parents were included if they spoke Korean and had at least 1 child in elementary school (grades 1-6). Parents and children were included in a 1:1 ratio; a total of 113 450 parents and 113 450 children were included in the analysis. Statistical analysis was performed between March and April 2022.

MAIN OUTCOMES AND MEASURES

The main outcomes of interest were (1) parental acceptance of COVID-19 vaccination for their children and (2) its association with self-reported sufficiency and credibility of information about the vaccine. A multivariable logistic regression was used to evaluate factors associated with parental decision-making in favor of COVID-19 vaccination; path analysis was used to examine indirect effects of information sufficiency and credibility.

RESULTS

Of the 113 450 children, 58 342 (51.4%) were boys, and the mean (SD) age was 10.1 (1.5) years. Of the 113 450 parents who responded, 7379 (6.5%) were accepting vaccination for their children; 15 731 (13.9%) reported the vaccine-related information they received was sufficient, and 23 021 (20.3%) reported the information was credible. Parents who reported that the information was sufficient were 3.08 times (95% CI, 2.85-3.33; P < .001) more likely to report being willing to vaccinate their children than those who believed the information was insufficient, and those who reported that the information was credible were 7.55 times (95% CI, 6.46-8.87; P < .001) more likely to report being willing to vaccinate their children than those who believed the information was not credible. Higher levels of information sufficiency and credibility were associated with perceptions of increased vaccine safety (sufficiency: β = 0.08; P < .001; credibility: β = 0.59; P < .001) and effectiveness (sufficiency: β = 0.05; P < .001; credibility: β = 0.60; P < .001).

CONCLUSIONS AND RELEVANCE

In this study, a significant association was found between self-reported sufficiency and credibility of vaccine-related information and parental decision-making regarding COVID-19 vaccination for their children, suggesting that communications and policies that provide sound information are essential to improve vaccination rates.

Behavioural and Cognitive Attitudes of Paediatricians towards Influenza Self-Vaccination-Partial Mediation Model

(1) Background: This study aims to analyse the attitudinal components influencing paediatricians’ self-vaccination. (2) Methods: The national-cross survey was conducted among paediatricians involved in childhood vaccination within the immunisation program. (3) Results: A hypothetical model indicating the influence of cognitive and behavioural factors on influenza vaccination among paediatricians was verified based on a survey of Polish paediatricians. A simple mediation model, based on Triandis’ Theory of Interpersonal Behaviour, reflects a relationship in which knowledge and beliefs about outcomes contribute to whether paediatricians vaccinate against influenza. (4) Conclusions: The presented research shows that the pro-vaccination behaviours of paediatricians are not only influenced by cognitive factors but also the behavioural components of attitudes, which are equally important. The conclusions point to the pivotal role of shaping both knowledge and understanding of the effectiveness of immunisation programmes in building the pro-vaccination attitudes of paediatricians. (5) Practical Implications: This is the first representative study of Polish paediatricians to demonstrate how their attitudes and behaviour are related to self-vaccination. Its conclusions allow policymakers to develop programmes to support effective measures against the spread of infectious diseases through the self-vaccination of medical professionals.

Do Pediatricians and Nurses Recommend Vaccines for Preterm Infants? A Survey in Italy

OBJECTIVE

To assess the level of knowledge, attitudes, and behaviors regarding vaccination in preterm infants among primary care pediatricians (PCPs) and health care workers (HCWs) in neonatal intensive care units (NICUs).

STUDY DESIGN

Data were collected from PCPs through a confidential questionnaire distributed by email, whereas the research team distributed a self-administered anonymous questionnaire to all HCWs working in the selected NICUs.

RESULTS

Overall, 64.1% of HCWs consider vaccines in preterm infants to be very safe. The majority of HCWs (69.8%) stated that they always recommend that preterm infants' parents vaccinate their children following the same schedule as for term infants. This behavior was significantly more likely among those who know that the vaccination schedule for preterm infants is the same as for term infants, who consider vaccines in preterm infants very effective, and who strongly agree that preterm infants should be vaccinated on the same schedule as term infants. Moreover, PCPs were more likely than NICU pediatricians to always recommend that preterm infants' parents vaccinate their children following the immunization schedule of term infants, whereas this behavior was significantly less frequent among NICU nurses.

CONCLUSIONS

There is a need for physicians and nurses in the NICU and in the community to counteract missed or delayed immunizations. Engagement of HCWs in healthcare quality improvement initiatives focused on the promotion of timely vaccinations in preterm infants should be encouraged.

Vaccine hesitancy in health-care providers in Western countries: a narrative review

INTRODUCTION

Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant.

AREAS COVERED

This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience.

EXPERT OPINION

Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.

Influenza Vaccination Coverage, Motivators for, and Barriers to Influenza Vaccination among Healthcare Workers in Wroclaw, Poland

Background: Influenza vaccination, as a key element of control activities intended to prevent nosocomial influenza transmission, is recommended each year for all healthcare workers (HCWs). The objectives were to determine the rate of influenza vaccination and to identify reasons for receiving or declining the influenza vaccine among HCWs in the 2018/19 and 2019/20 influenza seasons. Methods: This study is a cross-sectional observational study carried out between January and March 2020, in 2 hospitals and 15 primary health-care settings (PHCS) in Wroclaw (Poland). Results: A total of 165 questionnaires were completed. The majority of participating HCWs were female—137 (83.0%), and, by profession, the majority were physicians 92 (55.8%). Influenza vaccination coverage was 61.2% in 2019/20, and 47.9% in the 2018/19 season for all participants. Participants who were male, physicians and personnel from PHCS were more frequently vaccinated in both seasons. According to the statistical analysis, physicians were more likely to receive vaccinations than nurses (p < 0.01), as were HCWs who had been vaccinated in the previous season (p < 0.001). Conclusion: The identified barriers were mainly caused by misconceptions (fear of vaccine adverse effects and perception of not being at risk/no need to get vaccinated) and an organizational barriers (lack of time). These findings may prove useful for designing immunization campaigns to tailor strategies to reach specific groups.

What Influences Health Professionals' Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals' Perspectives in Three Provinces of China

Recommendations by health professionals are important for vaccines that are not included in national schedules. This study explored health professionals’ perspectives on recommending non-scheduled (user-fee) childhood vaccinations in China, identifying key influences on professionals’ interactions with caregivers. We conducted individual semi-structured interviews with 20 health professionals from three provinces in China and analyzed data thematically using deductive and inductive coding. Health professionals from all three provinces were uncomfortable about being perceived to encourage parents to accept vaccines that incurred a fee. They provided information about non-scheduled vaccines but emphasized parental autonomy in decision-making. Rural parents were less aware of unscheduled vaccines and health professionals were more likely to encourage parents living in more affluent areas to consider these vaccines; varicella vaccine was preferred by parents as a way of preventing school absence. Economic incentives for unscheduled vaccines were given to staff at most study sites, although the amount given varied widely. These variations meant that staff receiving lower incentives were not motivated to promote non-scheduled vaccines if their workload was high; on the contrary, those receiving higher incentives were more likely to promote these vaccines. Health professionals need more guidance on how to recommend unscheduled vaccines in an informative, positive and appropriate manner. It is evident that parents’ awareness of these vaccines, and their economic circumstances, influence vaccinators recommendation practice. Economic incentives prompted health professionals to recommend non-scheduled vaccines; however, the application of such staff incentives varied widely in China. To adopt appropriate economic incentives, professional organizations should develop protocols for the use of incentives that account for their influence on recommendation practices. Suitable recommendation policy needs to balance basic salaries with performance-based incentives, consider overall workload, and include monitoring and evaluation of economic incentives.

The influence of social network on COVID-19 vaccine hesitancy among healthcare workers: a cross-sectional survey in Chongqing, China

The factors that lead to coronavirus disease 2019 (COVID-19) vaccine hesitancy among health-care workers (HCWs) are unclear. We aimed to identify the factors that influence HCWs' hesitancy, especially the influence of their social network. Using an online platform, we surveyed HCWs in Chongqing, China, in January 2021 to understand the factors that influence the COVID-19 vaccine hesitancy among HCWs. Proportional allocation stratified sampling method was used to recruit respondents. Multivariable logistic regression and social network analysis (SNA) were used to analyze the influence factors. A total of 5247 HCWs were included and 23.3% of them were vaccine-hesitant. Participants were more hesitant if they had chronic diseases (OR = 1.411, 95% CI: 1.146-1.738), worked in tertiary hospitals (OR = 1.546, 95% CI: 1.231-1.942), and reported a history of vaccine hesitancy (OR = 1.637, 95% CI: 1.395-1.920) and refusal toward other vaccines (OR = 2.433, 95% CI: 2.067-2.863). The participants with a social network to communicate COVID-19 immunization were less hesitant (OR = 0.850, 95% CI: 0.728-0.993). Several influential members with social networks were found in SNA. Most of these influential members in the networks were department leaders who were willing to get COVID-19 vaccines (P < .05). Hesitant subgroups among Chinese HCWs were linked to the lack of a social network to communicate COVID-19 immunization. Our findings may lead to tailored interventions to enhance COVID-19 vaccine uptake among HCWs by targeting key members in social network.

Changes in Behaviors and Attitudes in Response to COVID-19 Pandemic and Vaccination in Healthcare Workers and University Students in Italy

The objectives of the cross-sectional study were to measure how behaviors and attitudes about preventive measures toward COVID-19 changed over time among Italian vaccinated healthcare workers and university students, and the associated characteristics. The study was carried out between February and March 2021 in the city of Naples, Campania region, Southern Italy. The perceived personal risk of being infected by SARS-CoV-2 after the vaccination was significantly higher among males, in those having a higher perceived personal risk of being infected by SARS-CoV-2 before the vaccination, and in those who were more concerned about the efficacy of the vaccination. The fear of getting the disease as reason to have the COVID-19 vaccination was reported more frequently in younger participants, in those with at least one chronic medical condition, in those with a higher concern about the severity of COVID-19, in those with a higher level of trust in the information received, and in those who acquired information from scientific journals. Overall, 21.3% were willing to engage the three main public health measures (wearing a mask, careful hand washing, physical distancing) after receiving the second dose of the vaccination compared to the behavior before the pandemic began. This willingness was predicted by a higher level of trust in the information received and by a lower self-rated health status. Only 0.1% of participants were willing to engage all three measures after receiving the second dose of the vaccination compared to the behavior before receiving the first dose. These findings are useful in order to develop information strategies regarding vaccine safety and efficacy and the importance of public health measures against COVID-19.

Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.

HPV Vaccination Attitudes and Behaviors among General Practitioners in Italy

This cross-sectional electronic online or telephone survey assessed the attitudes and behaviors regarding human papillomavirus (HPV) vaccination and the effect of different factors among a nationally representative random sample of 349 general practitioners (GPs) in Italy. A semi-structured interview was performed between September 2018 and October 2020. Almost all respondents considered the HPV vaccine safe with an overall mean value of 8.8, on a scale ranging from 1 to 10, and 59.9% and 32.6% believed that the vaccination was very effective in preventing the related diseases among 12–26 years’ girls and boys. Multivariate logistic regression analysis showed that GPs who had received information about HPV vaccination from scientific journals were more likely to have positive attitude towards the effectiveness of the vaccine in preventing HPV-related diseases in girls between 12–26 years. A large majority (81.5%) of GPs who provided assistance to girls’ patients aged 11–12 years often or always recommend the HPV vaccine to them, and this behavior was more likely to occur in those who believed that the vaccine was very effective in preventing HPV-related diseases in girls between 12–26 years. GPs were more likely to often or always recommend the HPV vaccine to boys aged 11–12 years if they often or always recommended the vaccine to girls aged 11–12 years, if they believed that the vaccine was very effective in preventing HPV-related diseases in boys between 12–26 years, and if they considered the HPV vaccine very safe. GPs should receive information about the HPV immunization to ensure that they routinely communicate with their patient population in order to achieve better coverage rates.

WITHDRAWN: Vaccine hesitancy in Maltese family physicians and their trainees vis-à-vis influenza and novel COVID-19 vaccination

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Who or What Influences the Individuals' Decision-Making Process Regarding Vaccinations?

Thanks to vaccines, many people are not exposed to the risks associated with vaccine-preventable diseases (VPDs). This, however, results in growing popularity of antivaccine movements and affects global and local epidemiological situation. Vaccine hesitancy has become a significant problem not only for epidemiologists but also for practitioners. Fortunately, the hesitant group seems to be vulnerable to intervention, and studies indicate that these patients can be persuaded to undergo vaccinations. The aim of the present study was to determine the factors most strongly affecting vaccination-related attitudes and decisions. An anonymous, self-administered survey consisting of demographic data and single select multiple-choice questions regarding vaccination was conducted. The voluntary study included secondary school pupils, medical and nonmedical students, healthcare professionals, hospital and clinic patients as well as parents. A total of 7950 survey forms were distributed between January 2018 and June 2019 in south-eastern Poland. A total of 6432 respondents (80.2%) completed a questionnaire that was eligible for analysis. The positive attitude toward vaccination was significantly affected by older age, by the fact of obtaining information on vaccinations from a physician, this information's higher quality (assessed in school grade scale), higher level of knowledge on vaccines and by the fact of denying the association between vaccination and autism in children (p < 0.001). The probability of supporting vaccinations was almost eight-fold lower among respondents believing the vaccine-autism relationship. Chance of supporting vaccination doubled in the group with a higher knowledge level. The individuals not provided with expert information on vaccination were twice as often unconvinced. Age, education and having children significantly affected the attitude toward influenza immunization (p < 0.001). Older, better educated respondents and those having children were more positive about vaccinations. The medical community still exert decisive effects on attitudes toward vaccinations. High-quality information provided by them is of great importance. Skillful and competent provision of evidence-based information disproving the myth about vaccine-autism connection and proper education of medical staff is essential in molding positive attitudes toward vaccinations.